The Role of

the Media in 

Promoting and 

Reducing

Tobacco Use

NCI TOBACCO CONTROL MONOGRAPH SERIES

U.S. DEPARTMENT 

OF HEALTH AND 

HUMAN SERVICES

National Institutes 

of Health

National Cancer Institute

Edited by

Ronald M. Davis, M.D.

Elizabeth A. Gilpin, M.S.

Barbara Loken, Ph.D.

K. Viswanath, Ph.D.

Melanie A. Wakefi eld, Ph.D.

19
Other NCI Tobacco Control Monographs

Strategies to Control Tobacco Use in the United States: A Blueprint for Public Health Action in the 

1990’s. Smoking and Tobacco Control Monograph No. 1. NIH Pub. No. 92-3316, December 1991.

Smokeless Tobacco or Health: An International Perspective. Smoking and Tobacco Control 

Monograph No. 2. NIH Pub. No. 92-3461, September 1992.

Major Local Tobacco Control Ordinances in the United States. Smoking and Tobacco Control 

Monograph No. 3. NIH Pub. No. 93-3532, May 1993.

Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. Smoking and 

Tobacco Control Monograph No. 4. NIH Pub. No. 93-3605, August 1993.

Tobacco and the Clinician: Interventions for Medical and Dental Practice. Smoking and Tobacco 

Control Monograph No. 5. NIH Pub. No. 94-3693, January 1994.

Community-based Interventions for Smokers: The COMMIT Field Experience. Smoking and 

Tobacco Control Monograph No. 6. NIH Pub. No. 95-4028, August 1995.

The FTC Cigarette Test Method for Determining Tar, Nicotine, and Carbon Monoxide Yields of 

U.S. Cigarettes. Report of the NCI Expert Committee. Smoking and Tobacco Control Monograph 

No. 7. NIH Pub. No. 96-4028, August 1996.

Changes in Cigarette-Related Disease Risks and Their Implications for Prevention and Control.

Smoking and Tobacco Control Monograph No. 8. NIH Pub. No. 97-4213, February 1997.

Cigars: Health Effects and Trends. Smoking and Tobacco Control Monograph No. 9. NIH Pub. No. 

98-4302, February 1998.

Health Effects of Exposure to Environmental Tobacco Smoke. Smoking and Tobacco Control 

Monograph No. 10. NIH Pub. No. 99-4645, August 1999.

State and Local Legislative Action to Reduce Tobacco Use. Smoking and Tobacco Control 

Monograph No. 11. NIH Pub. No. 00-4804, August 2000.

Population Based Smoking Cessation. Smoking and Tobacco Control Monograph No. 12. NIH Pub. 

No. 00-4892, November 2000.

Risks Associated with Smoking Cigarettes with Low Machine-Measured Yields of Tar and Nicotine.

Smoking and Tobacco Control Monograph No. 13. NIH Pub. No. 02-5047, October 2001.

Changing Adolescent Smoking Prevalence. Smoking and Tobacco Control Monograph No. 14. 

NIH Pub. No. 02-5086, November 2001.

Those Who Continue to Smoke. Smoking and Tobacco Control Monograph No. 15. NIH Pub. No. 

03-5370, September 2003.

ASSIST: Shaping the Future of Tobacco Prevention and Control. Tobacco Control Monograph 

No. 16. NIH Pub. No. 05-5645, May 2005.

Evaluating ASSIST: A Blueprint for Understanding State-level Tobacco Control. Tobacco Control 

Monograph No. 17. NIH Pub. No. 06-6058, October 2006.

Greater than the Sum: Systems Thinking in Tobacco Control. Tobacco Control Monograph No. 18. 

NIH Pub. No. 06-6085, April 2007.

Note, when citing this monograph in other works, please use the following format:

National Cancer Institute. The Role of the Media in Promoting and Reducing Tobacco Use. Tobacco 

Control Monograph No. 19. Bethesda, MD: U.S. Department of Health and Human Services, National 

Institutes of Health, National Cancer Institute. NIH Pub. No. 07-6242, June 2008.
We dedicate this monograph

to our cherished colleague and friend,

Ronald M. Davis, M.D.

We have considered it a privilege to work with Ron Davis as the lead Senior Scientifi c Editor 

of this monograph. Ron is known to many as a passionate advocate for tobacco control, 

who has used his fi nely honed skills as a translator of complex scientifi c concepts to facilitate 

progress in public health policy. Ron guided the development of this monograph from its 

conception to completion with outstanding leadership qualities and an unfl inching pursuit 

of excellence. The extraordinary breadth and depth of his knowledge and experience in this 

fi eld, combined with his scientifi c rigor and precision, made his contributions invaluable. 

Despite being diagnosed with pancreatic cancer in early 2008, Ron continued to work 

tirelessly on this monograph, employing his characteristic patience, good humor, and focused 

determination. His contributions will help ensure that this volume will serve as a defi nitive 

resource to guide the tobacco control community for many years to come.

Both we and the tobacco control community are indebted to Ron for his work on this 

monograph and for his remarkable and inspiring leadership in the cause of public health. 

The Editorial Team of Monograph 19

M.W., E.G., B.L., K.V., S.M., and M.R.

v

Contents

Figures and Tables ....................................................................................................................... ix

Foreword .................................................................................................................................... xiii

Message from the Series Editor ..................................................................................................xv

Preface ...................................................................................................................................... xvii

Acknowledgments ......................................................................................................................xix

Acronyms and Abbreviations ..................................................................................................xxvii

Part 1—Introduction ..................................................................................................1

Chapter 1—Overview and Conclusions ..................................................................................................3

Introduction ................................................................................................................................. 4

Tobacco and the Media: A Multilevel Perspective ....................................................................... 5

Studying the Media and Tobacco ................................................................................................. 8

Preparation of this Monograph ...................................................................................................10

Monograph Organization ............................................................................................................10

Major Conclusions .......................................................................................................................11

Chapter Summaries and Conclusions ....................................................................................... 12

References ................................................................................................................................... 23

Chapter 2—Theoretical Underpinnings of Media Research in Tobacco Control and

Tobacco Promotion ....................................................................................................................................25

Introduction ............................................................................................................................... 26

History of Media-Effects Research ............................................................................................. 27

Levels of Theory and Analysis .................................................................................................... 28

Summary .................................................................................................................................... 44

References ................................................................................................................................... 45

Part 2—Tobacco Marketing...................................................................................51

Chapter 3—Key Principles of Tobacco Promotion and Rationales for Regulation .....................53

Introduction ............................................................................................................................... 54

Key Principles of Tobacco Advertising and Promotion............................................................. 54

A Rationale for Regulating Tobacco Promotion .........................................................................74

Summary .................................................................................................................................... 86

Conclusions ................................................................................................................................ 86

References ................................................................................................................................... 88

Chapter 4—Types and Extent of Tobacco Advertising and Promotion .........................................99

Introduction ..............................................................................................................................100

Sources of Data ..........................................................................................................................101

Types of Tobacco Advertising and Promotion ..........................................................................102

Extent of Tobacco Advertising and Promotion ........................................................................118
vi

Summary .................................................................................................................................. 132

Conclusions .............................................................................................................................. 132

References ................................................................................................................................. 134

Chapter 5—Themes and Targets of Tobacco Advertising and Promotion ...................................141

Introduction ..............................................................................................................................142

Segmentation, Tailoring, and Targeting ..................................................................................143

Dominant Themes .....................................................................................................................145

Targeting of Population Subgroups ......................................................................................... 150

Summary ...................................................................................................................................170

Conclusions ...............................................................................................................................170

References ..................................................................................................................................172

Chapter 6—Tobacco Companies’ Public Relations Efforts: Corporate Sponsorship

and Advertising .........................................................................................................................................179

Introduction ..............................................................................................................................180

Public-Image Problems of the Tobacco Companies.................................................................182

Corporate Sponsorship ............................................................................................................ 184

Corporate Advertising ...............................................................................................................189

PM21: An Integrated Public Relations Campaign ....................................................................198

Summary .................................................................................................................................. 202

Conclusions .............................................................................................................................. 204

References ................................................................................................................................ 205

Chapter 7—Infl uence of Tobacco Marketing on Smoking Behavior ............................................211

Introduction ..............................................................................................................................212

Adolescents’ Psychological Needs and the Infl uence of Cigarette Marketing ........................213

Role of Image Enhancement from Cigarette Marketing ........................................................ 227

Evidence of Effects of Exposure to Cigarette Marketing on Adolescent Smoking ................ 238

Effects of Tobacco Advertising on Tobacco Consumption ...................................................... 268

Summary .................................................................................................................................. 278

Conclusions .............................................................................................................................. 280

References ................................................................................................................................. 282

Chapter 8—Legal and Constitutional Perspectives on Tobacco Marketing

Restrictions ............................................................................................................................................... 293

Introduction ............................................................................................................................. 294

Constitutional, Statutory, and Regulatory Perspectives......................................................... 294

Summary ...................................................................................................................................316

Conclusions ...............................................................................................................................316

Notes ..........................................................................................................................................317

References ................................................................................................................................. 320

Part 3—Tobacco in News and Entertainment Media ....................................327

Chapter 9—How the News Media Infl uence Tobacco Use ........................................................... 329

Introduction ............................................................................................................................. 330

Perspectives on News Story Selection and Content .................................................................331

Contents
vii

Monograph 19. The Role of the Media

Media Advocacy for Tobacco Control ....................................................................................... 335

Descriptive Studies of News Coverage of Tobacco Use ........................................................... 336

Relating News Coverage of Tobacco to Individual Attitudes, Behaviors, and

Policy Outcomes .................................................................................................................... 341

Tobacco Industry Infl uence on News Reporting ..................................................................... 345

Future Directions ..................................................................................................................... 348

Summary .................................................................................................................................. 350

Conclusions .............................................................................................................................. 350

References ................................................................................................................................. 352

Chapter 10—Role of Entertainment Media in Promoting or Discouraging Tobacco Use ...........357

Introduction ............................................................................................................................. 358

Historical Perspective: Movies ................................................................................................. 360

Movie Content .......................................................................................................................... 364

Effects on Attitudes, Beliefs, and Behavior: Movies .................................................................376

Tobacco Content in Other Media ............................................................................................. 392

Efforts to Reduce Exposure ..................................................................................................... 399

Efforts to Modify Response to Exposure ................................................................................. 409

Summary ...................................................................................................................................411

Conclusions ...............................................................................................................................412

Appendix 10A. Statement by Attorney General Curran of Maryland on Role of the

State Attorneys General ..........................................................................................................414

Appendix 10B. Letter from 28 State Attorneys General to Jack Valenti and Response ..........418

Appendix 10C. Letter from Lorillard to California Assistant Attorney General

Dennis Eckhart Regarding Brand Appearance of Newport in the Movie 

City by the Sea ....................................................................................................................... 422

References ................................................................................................................................. 423

Part 4—Tobacco Control Media Interventions ...............................................429

Chapter 11—An Overview of Media Interventions in Tobacco Control: Strategies

and Themes ................................................................................................................................................431

Introduction ............................................................................................................................. 432

Nontelevised Mass Media Antitobacco Interventions ............................................................. 434

Televised Antitobacco Advertisements .................................................................................... 445

Relative Performance of Televised Antitobacco Advertising Approaches ............................... 449

New-Media Interactive Health Communications for Smoking Cessation ............................. 463

Summary .................................................................................................................................. 468

Conclusions .............................................................................................................................. 469

References ..................................................................................................................................470

Chapter 12—Assessing the Effectiveness of the Mass Media in Discouraging

Smoking Behavior ....................................................................................................................................479

Introduction ............................................................................................................................. 480

Controlled Field Experiments .................................................................................................. 482

Population-Based Studies ........................................................................................................ 509

Summary .................................................................................................................................. 535
viii

Conclusions .............................................................................................................................. 536

References ................................................................................................................................. 538

Part 5—Media, Tobacco Control Interventions, and Tobacco Industry 

Mitigation Efforts ...................................................................................................547

Chapter 13—Tobacco Industry Efforts to Infl uence Tobacco Control Media

Interventions ............................................................................................................................................. 549

Introduction ............................................................................................................................. 550

Fairness Doctrine ..................................................................................................................... 550

Minnesota ..................................................................................................................................551

California .................................................................................................................................. 556

Arizona ...................................................................................................................................... 562

Florida ....................................................................................................................................... 565

American Legacy Foundation .................................................................................................. 567

Summary ...................................................................................................................................571

Conclusions ...............................................................................................................................571

References .................................................................................................................................572

Chapter 14—Tobacco Industry Media Efforts to Defeat State Tobacco Control

Ballot Initiatives and Referenda ...........................................................................................................577

Introduction ..............................................................................................................................578

Criticisms of State Initiatives and Referenda ...........................................................................579

General Role of Media in State Initiatives and Referenda....................................................... 583

Methods .................................................................................................................................... 584

State Tobacco Control Initiatives and Referenda .................................................................... 585

Tobacco Industry Opposition to State Tobacco Tax Initiatives and Referenda...................... 585

Results ...................................................................................................................................... 589

Summary ...................................................................................................................................591

Conclusions .............................................................................................................................. 592

References ................................................................................................................................. 593

Part 6—Future Directions ....................................................................................595

Chapter 15—Future Directions..............................................................................................................597

Introduction ............................................................................................................................. 598

Future Directions to Address Tobacco Promotion .................................................................. 598

Future Directions for Media Strategies in Tobacco Control ................................................... 604

Conclusions ...............................................................................................................................612

References ..................................................................................................................................614

Appendix—Michigan’s Proposal A ............................................................................................619

Index ......................................................................................................................................... 627

Contents
ix

Figures and Tables

Figures

Figure 1.1 The Nested Relationships among Advertising, Marketing

Communications, Consumer Marketing, and Stakeholder Marketing

in Tobacco Promotion .......................................................................................... 6

Figure 2.1 Institutional Conception of Media Organization .............................................. 37

Figure 4.1 Cigarette Advertising and Promotional Expenditures in the

United States, 1970–2005 ................................................................................. 120

Figure 4.2 Share of Market for Light Cigarettes and Percentage of Marketing

Expenditures Devoted to Light Cigarettes, 1967–1998 ................................... 128

Figure 6.1 Public Opinion of Tobacco Companies: Roper Poll of 2,078 Adults,

September 1999 ................................................................................................ 183

Figure 6.2 Philip Morris’s Annual Advertising Expenditures for its Corporate and

Marlboro Brands ................................................................................................. 194

Figure 6.3 Overview of PM21 Advertising Campaign ....................................................... 199

Figure 7.1 Relationship between Levels of Advertising and Consumption

Aggregated at the National Level ......................................................................270

Figure 7.2 Relationship between Levels of Advertising and Consumption

Aggregated at the Market Level ....................................................................... 271

Figure 10.1 Smoking Initiation Rates Among U.S. Males and Females Ages 14–17

Years, by Year .....................................................................................................361

Figure 10.2 Lowess Smoothed Curve Showing Cross-Sectional Relationship

between Exposure to Movie Smoking Depictions and Adolescent

Smoking Initiation in a Study of Northern New England Adolescents ......... 382

Figure 10.3 Lowess Smoothed Curve Showing the Longitudinal Relationship

between Exposure to Movie Smoking Depictions and Adolescent

Smoking Initiation in a Study of Northern New England Adolescents ......... 384

Figure 13.1 Adult Per Capita Cigarette Consumption and Major Smoking-andHealth Events ....................................................................................................551

Figure 13.2 Total Number and Type of Advertisements for the California Tobacco

Control Media Campaign, 1990 –2006 ............................................................. 560

Figure 13.3 Budget Allocations for the California Tobacco Control Media Program,

1989–2003 ......................................................................................................... 562

Tables

Table 4.1 Chronology of Tobacco Industry Activities Related to Smoking in

Motion Pictures, 1972–2001 .............................................................................115

Table 4.2 Cigarette Advertising and Promotional Expenditures in the

United States, 1970–2005 ..................................................................................119
x

Table 4.3 Cigarette Advertising and Promotional Expenditures in the

United States, 2005 ............................................................................................121

Table 4.4 Cigarette Advertising and Promotional Expenditures in the

United States, 1995–2005 ................................................................................ 122

Table 4.5 Cigarette Advertising and Promotional Expenditures in the

United States, 1970–2005, with Relative Emphasis on Advertising 

Versus Promotion ............................................................................................. 122

Table 4.6 Advertising-to-Sales Ratios for Selected Product Categories,

1975–2006 ......................................................................................................... 123

Table 4.7 Cigarette Company Advertising Expenditures, 1945–1980 ............................ 124

Table 4.8 Cigarette Company Advertising Expenditures for Selected Brands in

Selected Years between 1972 and 2000 ........................................................... 125

Table 4.9 Global Brand Equity for Leading Brands, 2006 .............................................. 126

Table 4.10 Percentage of Total Advertising Expenditures in Selected Media

Devoted to Cigarette Advertising, United States, 1984–1988 ......................... 127

Table 4.11 Cigar Advertising and Promotional Expenditures for Years 1996

and 1997 ............................................................................................................ 129

Table 4.12 Smokeless Tobacco Advertising and Promotional Expenditures by

Category for 2005 ............................................................................................. 130

Table 7.1 Studies of the Relationships among Self-Image, Smoker Image, and

Adolescent Smoking ......................................................................................... 228

Table 7.2 Studies Involving Randomized Experimental Manipulation of

Exposure to Cigarette Marketing ..................................................................... 235

Table 7.3 Cross-Sectional Studies of the Association of Tobacco Marketing

with Adolescent Smoking ................................................................................. 242

Table 7.4 Longitudinal Studies Predicting Later Smoking Behavior from

Measures of Exposure to Tobacco Marketing at Baseline ............................... 259

Table 7.5 Econometric Studies of Tobacco Advertising and Consumption ................... 273

Table 9.1 News Media Papers Presented at World Conferences on Tobacco OR

Health, 1983–2003 ....................................................................................................332

Table 10.1 Summary of Methods for Content Analysis Studies: Tobacco

in Movies ........................................................................................................... 367

Table 10.2 Brand Cigarette Use Depicted in Contemporary Movies ................................. 375

Table 10.3 Summary of Results of Cross-Sectional and Longitudinal Studies:

Smoking and Movies..........................................................................................378

Table 10.4 Validity of Adolescents’ Recognition of Movie Titles ........................................381

Table 10.5 Summary of the Methods and Results of Experimental Studies

Assessing Responses to On-Screen Tobacco Use ............................................. 386

Table 10.6 Number of Smoking Acts per Hour of Television Drama for Different

Content Analysis Studies Conducted in the United States ............................ 393

Table 11.1 Mean Monthly Exposures per Year to Tobacco-Related Television

Advertising for Television Households and Adolescents Aged 12–17

Years, Based on the Top 75 Designated Market Areas in the

United States ..................................................................................................... 435

Figures and Tables
xi

Monograph 19. The Role of the Media

Table 11.2 States Ranked for Mean Monthly Exposures to State Antitobacco

Television Advertising (Households, Gross Rating Points) ............................. 436

Table 11.3 States Ranked for Mean Monthly Exposures to State Antitobacco

Television Advertising (Adolescents Aged 12–17 Years, Target

Rating Points) ................................................................................................... 437

Table 11.4 Mass Media Antitobacco Campaigns in the United States, 1990–2004 ......... 438

Table 11.5 Characterizations of Antitobacco Advertisements’ Content and Style ........... 450

Table 11.6 Studies Examining the Relative Performance of Different Advertising

Messages .............................................................................................................451

Table 12.1 Summary of Reviewed Controlled Field Experiments: Youth ........................ 486

Table 12.2 Summary of Reviewed Controlled Field Experiments: Adults ........................ 494

Table 14.1 U.S. States in 2005 with Statewide Initiatives and Referenda .........................579

Table 14.2 U.S. States in 2005 by Type of Initiative Allowed ............................................ 580

Table 14.3 Tobacco Control State Initiatives and Referenda from 1988 to 2006 ..............581

Table 14.4 1988 Tobacco Industry Advertisements Opposing California’s

Proposition 99 ................................................................................................... 586

Table 14.5 1992 Tobacco Industry Advertisements Opposing Massachusetts’s

Question 1 ......................................................................................................... 587

Table 14.6 2004 Tobacco Industry Advertisements Opposing Oklahoma’s State

Question 713 ..................................................................................................... 587

Table 14.7 2004 Tobacco Industry Advertisements Opposing Montana’s

Initiative 149 ..................................................................................................... 589

Table 14.8 2004 Tobacco Industry Advertisements Opposing Colorado’s

Amendment 35 .................................................................................................. 589

Table 14.9 2006 Tobacco Industry Advertisements Opposing California’s

Proposition 86 ................................................................................................... 590

Table 14.10 2006 Tobacco Industry Advertisements Opposing Missouri’s

Amendment 3 .................................................................................................... 590

Table 14.11 Number of Times Tobacco Industry Advertising Themes Were Used

to Oppose California and Massachusetts Tobacco Tax Initiatives in

1988 and 1992 ................................................................................................... 590

Table 14.12 Number of Times Tobacco Industry Advertising Themes Were Used

to Oppose 2004 Colorado, Montana, and Oklahoma Initiatives and

Referenda and 2006 California and Missouri Initiatives ..................................591

xiii

Foreword

When I fi rst started TV work with the ABC affi liate in Boston in 1972, broadcast television 

was king, with a realm dominated by only ABC, CBS, and NBC. Even though I got into the 

business by accident and had no formal training in media, I quickly understood the power 

of the airwaves to infl uence the minds and hearts of viewers. I also became very conscious of 

the attendant responsibility to be accurate and understandable, remembering Mark Twain’s 

admonition (loosely phrased) to beware of reading health books because mistakes can kill you.

Perusing the information in this enormously informative volume, I was once again reminded 

of those elemental emotions: exhilaration about the opportunities offered by media and 

anxiety about the potential for misuse. Any phrase or sound bite can affect millions of 

people. In dealing with tobacco, I think the power of this potential must never be forgotten. 

Tobacco captivates people when they cannot rationally resist its siren call and can unleash 

a slow, deadly disease that can kill them even as they try to escape the tenacious trap of 

addiction. So those of us given the privilege of access to media should be aware of our own 

responsibilities in the fi ght against tobacco use—including the need to choose words and 

images to counter misinformation and temptation aimed at the young entrusted to our care. 

I have come to believe that unless we think and feel that we are fi ghting a lethal battle against 

tobacco use, we will not succeed in stemming the forces that would promote it. This volume 

contains a wealth of information about how tobacco companies use media to their benefi t. 

I predict that, like me, even though you have seen them in action, you will be amazed by 

the tactics used to promote tobacco. Tobacco use is a social phenomenon largely propelled 

by mass media over the past century, led by tobacco industry professionals who constantly 

change strategies to reach their goals. They combine the resourcefulness of a profi t-making 

industry with a changing media and regulatory landscape to sell a product that remains our 

greatest public health challenge. We will not remove tobacco from our society unless we are 

willing to understand the industry’s constantly changing tactics.

But this volume provides encouragement—information about successful efforts to fi ght back. 

Again I was surprised by what can work and stimulated to think about new ways to take a 

stand and make a difference.

I invite you to consider this volume a valuable reference for understanding how media can 

be used in the war against tobacco. Keep it handy for wise counsel, strategic encouragement, 

and a partner in a noble cause.

Tim Johnson, M.D., M.P.H.

Medical Editor, ABC News

June 2008

xv

Message from the Series Editor

This volume is the 19th of the Tobacco Control Monograph series of the National Cancer 

Institute (NCI). This series began in 1991 with a visionary blueprint for public health action 

on tobacco prevention and control. In the years since, it has disseminated important crosscutting research in areas such as the effectiveness of community-based and population-level 

interventions, the impact of tobacco control policies, the risks associated with smoking 

cigars and low-tar cigarettes, and systems approaches to tobacco control.

The subject matter of this monograph stands at the confl uence of three major trends of the 

past century: the growth of mass media, the concomitant rise in cigarette smoking as a social 

phenomenon, and more recently, research to understand and to decrease the disease burden 

caused by tobacco use. Cigarettes are a product of the mass media era; the art and science of 

mass communications and mass marketing were critical to the growth of tobacco use in the 

past century. At the same time, however, the media have contributed signifi cantly to the roughly 

50% decline in smoking prevalence that took place over the past four decades, by increasing 

public knowledge of the health hazards of cigarette smoking, helping to change social norms 

about cigarette smoking, and increasing public acceptance of tobacco control policies.

This monograph summarizes what we have learned about the ability of the media to encourage 

and discourage tobacco use. There has been much interest in and study of media, and several 

government publications document the impact of advertising on tobacco use. This publication 

provides the most comprehensive and critical review and synthesis of the current evidence base 

in this area, drawing on work from many disciplines and research traditions. There is growing 

interest in applying what we have learned in tobacco prevention and control to other public 

health areas (such as dietary behavior). This monograph has important messages for public 

health researchers, practitioners, and policymakers as well as those in the communication 

science and media studies communities.

This monograph provides a comprehensive assessment of the literature on developing 

effective pro-health media messages and on policies to control tobacco marketing, both in 

the United States and abroad. This information is critical to support efforts to reduce the use 

of tobacco and the morbidity and mortality associated with its use. The evidence presented 

in this volume also underscores the need to continue to study and understand the ability of 

protobacco forces to change media strategies to adapt to a changing tobacco control policy 

environment. 

We are pleased that Dr. Timothy Johnson, Medical Editor for ABC News, has provided the 

Foreword to this volume. As a physician who began working in television in 1972, he has 

a long-standing record of communicating the harmful effects of smoking to the public. 

His background and commitment provide invaluable perspectives about the power of the 

media and why this monograph is so important for tobacco prevention and control.

Stephen E. Marcus, Ph.D.

Monograph Series Editor

June 2008

xvii

Preface

The work presented in the National Cancer Institute’s Tobacco Control Monograph 19, 

The Role of the Media in Promoting and Reducing Tobacco Use, is the most current and 

comprehensive distillation of the scientifi c literature on media communications in tobacco 

promotion and tobacco control. This ambitious effort to synthesize the science bridged 

the disciplines of marketing, psychology, communications, statistics, epidemiology, and 

public health and represents the combined efforts of fi ve scientifi c editors, 23 authors, 

and 62 external peer reviewers.

The six main parts of this monograph deal with aspects of media communications relevant 

to tobacco promotion and tobacco control. Part 1, an overview, frames the rationale for 

the monograph’s organization and presents the key issues and conclusions of the research 

as a whole and of the individual chapters. This section describes media research theories 

that guided this assessment of the relationship between media and tobacco use, which can 

be viewed as a multilevel issue ranging from consumer-level advertising and promotion to 

stakeholder-level marketing aimed toward retailers, policymakers, and others.

Part 2 further explores tobacco marketing—the range of media interventions used by 

the tobacco industry to promote its products, such as brand advertising and promotion, 

as well as corporate sponsorship and advertising. This section also evaluates the evidence 

for the infl uence of tobacco marketing on smoking behavior and discusses regulatory and 

constitutional issues related to marketing restrictions.

Part 3 explores how both the tobacco control community and the tobacco industry have 

used news and entertainment media to advocate their positions and how such coverage 

relates to tobacco use and tobacco policy change. The section also appraises evidence of the 

infl uence of tobacco use in movies on youth smoking initiation. Part 4 focuses on tobacco 

control media interventions and the strategies, themes, and communication designs 

intended to prevent tobacco use or encourage cessation, including opportunities for new 

media interventions. This section also synthesizes evidence on the effectiveness of mass 

media campaigns in reducing smoking. Part 5 discusses tobacco industry efforts to diminish 

media interventions by the tobacco control community and to use the media to oppose state 

tobacco control ballot initiatives and referenda. Finally, Part 6 examines possible future 

directions in the use of media to promote or to control tobacco use and summarizes research 

needs and opportunities.

Key lessons from this volume can inform policymakers as well as scientists and practitioners. 

Most critical from a policy standpoint is the conclusion, supported by strong evidence, that 

both exposure to tobacco marketing and depictions of tobacco in movies promote smoking 

initiation. A fundamental theme throughout this monograph is the dynamic interplay 

between tobacco promotion and tobacco control, whereby action in one area produces change 

in the other. For example, when limits have been placed on tobacco promotion, the tobacco 

industry typically has resisted, evolving alternative strategies to effectively reach current and 

potential smokers with media messages that promote its products.
xviii

Preface

In the United States in 2005—the same year in which 2.7 million American adolescents 

aged 12 to 17 used cigarettes in the past month1

 and 438,000 Americans died prematurely 

from diseases caused by tobacco use or secondhand smoke exposure2—the tobacco industry 

spent $13.5 billion (in 2006 dollars) on cigarette advertising and promotion,3

 an average 

of $37 million per day. The tobacco industry continues to succeed in overcoming partial 

restrictions on tobacco marketing in the United States, and tobacco marketing remains 

pervasive and effective in promoting tobacco use. Efforts to curb the depiction of tobacco 

use in movies have increased in recent years, and the evidence reviewed here indicates 

that progress in this area could be expected to translate into lower rates of youth smoking 

initiation in the future.

Strong evidence indicates that media campaigns can reduce tobacco use. This underscores 

the importance of adequately funding mass media campaigns and of protecting them from the 

tobacco industry’s efforts to impede them. The monograph provides guidance about the types 

of media campaign messages that are most and least likely to perform well.

This volume highlights the complexities of assessing the media’s infl uence on tobacco-related 

attitudes and behavior. The ubiquity of the media means that randomized controlled trial 

designs are typically not feasible, so other study approaches must be used to assess causality 

of associations between exposures and outcomes. Accordingly, a vast range of research—

from experimental forced-exposure studies in the laboratory to survey and cohort studies of 

populations—is reviewed.

The monograph editors hope that the evidence gathered and synthesized in this volume 

will facilitate progress in tobacco control in the United States and throughout the world. 

This review should be a valuable resource for those seeking to understand the effects of 

tobacco promotion and tobacco control media campaigns in their own jurisdictions as well as 

those charged with implementing aspects of the Framework Convention on Tobacco Control. 

Finally, this monograph contributes to a broader understanding of the media’s past and 

potential roles to exacerbate or ameliorate other major public health problems of our time.

The Scientifi c Editors of Monograph 19

R.D., E.G., B.L., K.V., and M.W.

References

1. Substance Abuse and Mental Health Services Administration. 2005. Results from the 2005 National 

Survey on Drug Use and Health. Offi ce of Applied Studies, NSDUH Series H-27, DHHS Publication 

no. SMA 05–4061. Rockville, MD. http://oas.samhsa.gov/nsduh/2k5nsduh/2k5results.pdf.

2. Centers for Disease Control and Prevention. 2006. Smoking and tobacco use fact sheet: Tobaccorelated mortality (updated September 2006). http//www.cdc.gov/tobacco/data_statistics/Factsheets/

tobacco_related_mortality.htm.

3. Federal Trade Commission. 2007. Federal Trade Commission cigarette report for 2004 and 2005. 

http://www.ftc.gov/reports/tobacco/2007cigarette2004-2005.pdf.
xix

Monograph Series Editor

Stephen E. Marcus, Ph.D.

Epidemiologist

Tobacco Control Research Branch

Behavioral Research Program

Division of Cancer Control and Population 

Sciences

National Cancer Institute

Bethesda, MD 

Scientifi c Editors

Ronald M. Davis, M.D.

Senior Scientifi c Editor

Director

Center for Health Promotion & Disease 

Prevention

Henry Ford Health System

Detroit, MI 

Elizabeth A. Gilpin, M.S.

Clinical Professor of Biostatistics

Cancer Prevention & Control Program

University of California, San Diego

Moores Cancer Center

La Jolla, CA 

Barbara Loken, Ph.D.

Professor

Department of Marketing

Carlson School of Management

University of Minnesota

Minneapolis, MN

K. Viswanath, Ph.D.

Associate Professor

Department of Society, Human Development 

& Health

Harvard School of Public Health

Department of Medical Oncology

Dana Farber Cancer Institute

Boston, MA 

Melanie A. Wakefi eld, Ph.D.

Senior Scientifi c Editor

Director and NHMRC Principal Research 

Fellow

Centre for Behavioural Research in Cancer

Cancer Control Research Institute

The Cancer Council Victoria

Victoria, Australia

Contributing Authors

Lois Biener, Ph.D.

Senior Research Fellow

Center for Survey Research

University of Massachusetts, Boston

Boston, MA 

Anthony Biglan, Ph.D.

Senior Scientist

Oregon Research Institute

Eugene, OR

Simon Chapman, Ph.D.

Professor

School of Public Health

University of Sydney

New South Wales, Australia

This monograph was developed by the National Cancer Institute under the general direction 

of Stephen E. Marcus, Monograph Series Editor. The Scientifi c Editors Ronald M. Davis,

Elizabeth A. Gilpin, Barbara Loken, K. Viswanath, and Melanie A. Wakefi eld were responsible 

for the editorial content of the monograph. The editors also drafted original chapters or 

sections of chapters for this monograph. Contributing authors drafted chapters or sections of 

chapters. Reviewers with relevant expertise provided critical reviews of the content by section, 

chapter, and/or volume. 

Acknowledgments
xx

Christine Cody

Oregon Research Institute

Eugene, OR

Erik C. Crankshaw, M.P.H.

Public Health Research Associate, 

Community Health Promotion Research

Public Health and Environment Division

RTI International

Research Triangle Park, NC 

Tess Boley Cruz, Ph.D., M.P.H.

Assistant Professor of Research

Institute for Prevention Research

Keck School of Medicine

University of Southern California

Alhambra, CA

Kevin C. Davis

Research Economist

RTI International

Research Triangle Park, NC 

Timothy Dewhirst, Ph.D.

Assistant Professor

Department of Marketing and Consumer 

Studies

College of Management and Economics

University of Guelph

Guelph, Ontario, Canada 

Helen Dixon, Ph.D.

Senior Research Fellow

Centre for Behavioural Research in Cancer

Cancer Control Research Institute

The Cancer Council Victoria

Victoria, Australia

Matthew C. Farrelly, Ph.D.

Senior Program Director

Public Health Policy Research

Public Health & Environment Division

RTI International

Research Triangle Park, NC

John R. Finnegan Jr., Ph.D.

Professor & Dean

School of Public Health

University of Minnesota

Minneapolis, MN 55455

Michael Givel, Ph.D.

Associate Professor

Department of Political Science

University of Oklahoma

Norman, OK

Stanton A. Glantz, Ph.D.

Professor of Medicine

Department of Medicine 

Division of Cardiology

University of California, San Francisco

San Francisco, CA

Marvin E. Goldberg, Ph.D.

Irving and Irene Bard Professor of Marketing

Smeal College of Business

Pennsylvania State University 

University Park, PA

Lawrence Gostin, J.D.

Associate Dean 

Research and Academic Programs

Georgetown University

Washington, DC 

Gerard Hastings, Ph.D.

Director of the Institute for Social 

Marketing and the Centre for Tobacco 

Control Research

University of Stirling and the Open University

Stirling, Scotland

Lisa Henriksen, Ph.D.

Senior Research Scientist

Stanford Prevention Research Center

Stanford University School of Medicine

Stanford, CA

Jennifer K. Ibrahim, Ph.D., M.P.H., M.A.

Assistant Professor

Department of Public Health

Temple University

Philadelphia, PA 

Gail H. Javitt, J.D., M.P.H.

Law and Policy Director

Genetics & Public Policy Center 

Phoebe R. Berman Bioethics Institute 

The Johns Hopkins University

Washington, DC

Acknowledgments
xxi

Monograph 19. The Role of the Media

Pamela Ling, M.D, M.P.H.

Assistant Professor in Residence

Department of Medicine, General Internal 

Medicine

University of California San Francisco

San Francisco, CA

Henry Saffer, Ph.D.

Research Associate

National Bureau of Economic Research

New York, NY

James D. Sargent, M.D.

Professor of Pediatrics 

Director, Cancer Control Research Program

Norris Cotton Cancer Center

Dartmouth Medical School

Lebanon, NH

Katherine Clegg Smith, Ph.D.

Assistant Professor

Bloomberg School of Public Health

Department of Health, Behavior, and Society

The Johns Hopkins University

Baltimore, MD 

Victor J. Strecher, Ph.D., M.P.H.

Professor and Director

Health Media Research Laboratory

Department of Health Behavior & 

Health Education

University of Michigan School of 

Public Health

Associate Director, Cancer Prevention 

and Control

University of Michigan Comprehensive 

Cancer Center

Ann Arbor, MI

Reviewers

Edith Balbach, Ph.D.

Senior Lecturer

Community Health Program

Tufts University

Medford, MA

Ursula E. Bauer, Ph.D., M.P.H.

Director

Bureau of Tobacco Use Prevention and 

Control

New York State Department of Health

Albany, NY

Michael E. Begay, Ph.D.

Department of Community Health Studies

School of Public Health & Health Science

University of Massachusetts, Amherst

Amherst, MA 

Stella Aguinaga Bialous, RN, Dr.P.H., FAAN 

President

Tobacco Policy International

San Francisco, CA

Paul N. Bloom, Ph.D. 

Senior Research Scholar of Social 

Entrepreneurship & Marketing

Center for the Advancement of Social 

Entrepreneurship

The Fuqua School of Business

Duke University

Durham, NC

Alan Blum, M.D. 

Center for the Study of Tobacco & Society

The University of Alabama

Tuscaloosa, AL 

Ron Borland, Ph.D.

Nigel Gray Distinguished Research Fellow 

in Cancer Prevention

The Cancer Council Victoria

Carlton South, Victoria, Australia

William J. Bukoski, Ph.D.

Senior Scientist 

Division of Epidemiology, Services and 

Prevention Research

National Institute on Drug Abuse

Rockville, MD

Joseph N. Cappella, Ph.D.

Annenberg School for Communication

University of Pennsylvania

Philadelphia, PA
xxii

Simon Chapman, Ph.D.

Professor

School of Public Health

University of Sydney

New South Wales, Australia

Joel B. Cohen, Ph.D.

Director

Center for Consumer Research

University of Florida 

Gainesville, FL

K. Michael Cummings, Ph.D, M.P.H.

Chair, Department of Health Behavior

Division of Cancer Prevention & 

Population Sciences

Roswell Park Cancer Institute

Buffalo, NY

Prabu David, Ph.D. 

Associate Professor

School of Communication

The Ohio State University

Columbus, OH 

Richard A. Daynard, J.D., Ph.D.

Professor of Law

Northeastern University School of Law

Boston, MA 

Robert Donovan, Ph.D.

Professor of Behavioral Research

Division of Health Sciences

Curtin University

Bentley WA, Australia

Sherry L. Emery, Ph.D., M.B.A.

Senior Research Scientist

Institute for Health Research and Policy

University of Illinois at Chicago

Chicago, IL

Michael P. Eriksen, Sc.D.

Professor and Director

Institute of Public Health

Georgia State University

Atlanta, GA

James S. Ettema, Ph.D. 

Department of Communications Studies

Northwestern University

Evanston, IL 

Jean L. Forster, Ph.D., M.P.H.

Division of Epidemiology and Community 

Health

University of Minnesota, Twin Cities

Minneapolis, MN

Brion Fox, S.M., J.D.

Associate Scientist

University of Wisconsin Paul P. Carborne 

Comprehensive Cancer Center

Madison, WI

Stanton A. Glantz, Ph.D. 

Professor of Medicine

Department of Medicine

Division of Cardiology 

University of California, San Francisco

San Francisco, CA

Marvin E. Goldberg, Ph.D.

Professor of Marketing

Smeal College of Business 

Pennsylvania State University 

University Park, PA 

Gerard Hastings, Ph.D.

Director of the Institute for Social 

Marketing and the Centre for Tobacco 

Control Research

University of Stirling and the Open University

Stirling, Scotland

Cheryl Healton, Ph.D.

President and CEO

American Legacy Foundation

Washington, DC 

Anthony J. Hedley 

Department of Community Medicine 

University of Hong Kong 

Hong Kong, China

Norbert Hirschhorn, M.D.

Retired

London, England

Acknowledgments
xxiii

Monograph 19. The Role of the Media

Thomas P. Houston, M.D. 

Director

Ohio Health Nicotine Dependence Program

McConnell Heart Health Center

Clinical Professor

Family Medicine and Health

The Ohio State University

Columbus, OH 

Corinne G. Husten, M.D., M.P.H.

Medical Offi cer

Offi ce of Smoking and Health

Centers for Disease Control and Prevention

Atlanta, GA

Gerald Kosicki, Ph.D.

Associate Professor

School of Journalism and Communication

Director of the Center for Survey Research

The Ohio State University

Columbus, OH

Matthew Kreuter, Ph.D., M.P.H.

Associate Professor and Director

Health Communication Research Laboratory

St. Louis University

St. Louis, MO

Anne Landman 

Tobacco Document Research & Consulting

Glade Park, CO 

Scott J. Leischow, Ph.D. 

Professor, Family and Community Medicine 

and Public Health

Deputy Director for Strategic Partnerships 

and Policy

Arizona Cancer Center 

The University of Arizona 

Tucson, AZ 

Ruth E. Malone, RN, Ph.D., FAAN

Professor and Vice Chair

Department of Social and Behavioral 

Sciences

School of Nursing

University of California

San Francisco, CA 

Alan B. Morrison, J.D. 

Director, Public Citizen Litigation Group

Washington, DC 

Monique E. Muggli, M.P.H. 

Tobacco Document Consultancy

St. Paul, MN

Rebecca Murphy-Hoefer

Health Communications Specialist

National Center for Chronic Disease 

Prevention & Health Promotion

Centers for Disease Control and Prevention

Atlanta, GA

David E. Nelson, M.D., M.P.H.

Senior Scientifi c Advisor, Alcohol Team

Centers for Disease Control and Prevention

Atlanta, GA

Cornelia Pechmann, Ph.D.

Graduate School of Management

Transdisciplinary Tobacco Use Research 

Center

University of California, Irvine

Irvine, CA

Cheryl L. Perry, Ph.D.

Rockwell Chair in Society and Health

Professor and Regional Dean

Austin Regional Campus

University of Texas

Austin, Texas

John P. Pierce, Ph.D., M.Sc., M.A.

Sam M. Walton Professor for Cancer Research

Associate Director for Population Sciences

University of California, San Diego

Moores Cancer Center

La Jolla, CA

Richard W. Pollay, Ph.D.

Professor, Sauder School of Business

Vancouver, British Columbia, Canada

Ronald E. Rice, Ph.D.

Arthur N. Rupe Professor in Social Effects

University of California, Santa Barbara

Santa Barbara, CA

Charles T. Salmon, Ph.D.

Dean

College of Communication Arts and Sciences

Michigan State University

East Lansing, MI
xxiv

James E. Shanahan, Ph.D.

Associate Professor 

Department of Communications

Cornell University

Ithaca, NY 

Michael Siegel, M.D., M.P.H.

Professor

Social and Behavioral Sciences Department

Boston University School of Public Health

Boston, MA 

David Simpson, OBE

International Agency on Tobacco & Health

London, England

Michael D. Slater, Ph.D.

Distinguished Professor

School of Communication 

College of Social and Behavioral Sciences 

The Ohio State University

Columbus, OH

Linda Squiers, Ph.D. 

Project Offi cer for Research

National Cancer Institute, Cancer 

Information Service

Rockville, MD

Colleen Stevens, M.S.W.

Tobacco Control Section

Department of Health Services

Sacramento, CA

Sharyn Sutton, Ph.D.

Managing Director

Communication & Social Marketing Group

Health Program

American Institutes for Research

Silver Spring, MD 

Esther Thorson, Ph.D.

Acting Dean of Graduate Studies

Missouri School of Journalism

Columbia, MO 

Thomas W. Valente, Ph.D.

Director, Master of Public Health Program

Institute for Prevention Research

University of Southern California

Alhambra, CA

Lawrence M. Wallack, Dr.P.H.

Dean 

College of Urban and Public Affairs

Portland State University

Portland, OR 

D. Charles Whitney, Ph.D. 

Department of Creative Writing

University of California, Riverside

Riverside, CA 

Phillip Wilbur

Director, Tobacco Control and Health 

Programs

Danya International, Inc.

Silver Spring, MD

John K. Worden, Ph.D.

Research Professor Emeritus

University of Vermont

Offi ce of Health Promotion Research

University of Vermont

Burlington, VT

Other Contributors

Amanda Amos, Ph.D., M.Sc.

Professor of Health Promotion

Public Health Sciences

Medical School

University of Edinburgh

Edinburgh, Scotland

Thomas W. Valente, Ph.D.

Director, Master of Public Health Program

Department of Preventive Medicine

University of Southern California

Alhambra, CA

Gemma P. Vestal, J.D., M.P.H., M.B.A., R.N.

Legal Offi cer/Scientist 

Tobacco Free Initiative 

World Health Organization 

Geneva, Switzerland

Acknowledgments
xxv

Monograph 19. The Role of the Media

The editors would like to acknowledge the 

publication support services provided for 

this monograph:

American Institutes for Research

Margot Raphael, Project Director and 

Managing Editor

Elizabeth Bruce, Monograph Editor

Bethany Meissner, Project Assistant

Matthew Mowczko, Publication Production

Cygnus Corporation

Jennifer Bishop, Publications Manager

Ruth Christie and Patricia Spellman, 

Copyeditors

Mary Bedford, Proofreader

R.S. Gallagher and Associates

Richard S. Gallagher, Technical Editor

xxvii

Acronyms and Abbreviations

AB Assembly Bill

ACS American Cancer Society

AFSCME American Federation of State, County, and Municipal Employees

AHA American Heart Association

ALA American Lung Association

ALF American Legacy Foundation

ASH Action on Smoking and Health

ASSIST American Stop Smoking Intervention Study for Cancer Prevention

AzTEPP Arizona Tobacco Education and Prevention Program

BUGA-UP Billboard Utilising Graffi tists Against Unhealthy Promotions

CBOs community-based organizations

CBPR community-based participatory research

CD compact disc

CDC Centers for Disease Control and Prevention

CI confi dence interval

COMMIT Community Intervention Trial for Smoking Cessation

DFL Democratic Farm Labor Party

DHHS Department of Health and Human Services

DMAs designated market areas

DOC Doctors Ought to Care

DV dependent variable

DVD digital versatile disc

ESPN [a multimedia sports entertainment company]

FCC Federal Communications Commission

FDA Food and Drug Administration

FTC Federal Trade Commission

FTCP Florida Tobacco Control Program

FY fi scal year

HB House Bill

HIS Health Interview Survey 

HYD “Helping Youth Decide” [an education campaign]

IAA International Advertising Association

IHC interactive health communications

IMPACT Initiatives to Mobilize for the Prevention and Control of Tobacco Use

IV independent variable

LGIs large group interventions

LISREL [software for structural equation modeling]

MBH Maine Bureau of Health

MCRC Media Campaign Resource Center

MDPHHS Montana Department of Public Health and Human Services

MEA Michigan Education Association

MSA Master Settlement Agreement

MSAs metropolitan statistical areas
xxviii

MSDH Mississippi State Department of Health

MTV Music Television

NA not applicable

NAAG National Association of Attorneys General

NASBE National Association of State Boards of Education

NCSH National Clearinghouse for Smoking and Health

NRT nicotine replacement therapy

NTC National Tobacco Campaign

OECD Organisation for Economic Co-operation and Development

OR odds ratio

OSH Offi ce on Smoking and Health

PM21 Philip Morris in the 21st century [an advertising campaign]

PREP potential reduced exposure product

PSA public service announcement

ROM read only memory

SWAT Students Working Against Tobacco

TACNH Technical Advisory Committee on Nonsmoking and Health

TUPAC Tobacco Use Prevention Advisory Committee

UK United Kingdom

WHO World Health Organization

Acronyms and Abbreviations
1

Introduction

Part

1

The growth of mass media has been critical to the rapid expansion of tobacco use in the 

20th century and the subsequent evolution of effective tobacco control interventions 

into the early 21st century. The public health field’s understanding of this relationship 

has paralleled the growth of tobacco control efforts, even as smoking levels in the 

United States declined by approximately half since their peak in the 1960s. Today, 

innovative research frameworks advance the study of tobacco use and the media at 

individual, organizational, and societal levels, and the knowledge and evidence base in 

this area continues to expand.

This introductory part highlights the key issues and conclusions of this monograph 

and describes the theoretical frameworks for media research that shaped the individual 

chapters. The relationship between media and tobacco use is explored as a multilevel 

issue, ranging from consumer-oriented advertising and promotion to stakeholder-level 

marketing aimed toward retailers and policymakers among others. This systemic view of 

tobacco use and media is reflected in the structure of the monograph as it explores the 

impact of these issues on tobacco promotion and tobacco control.

3

1

Overview and Conclusions

This chapter introduces a monograph examining the relationship between tobacco 

and mass communications media. It summarizes the role of media as an agent for 

both tobacco promotion and tobacco control efforts, and the broader societal role that 

media plays within nested levels of advertising, marketing communications, consumer 

marketing, and stakeholder marketing.

This chapter introduces the methodological challenges inherent in studying the impact 

of media on tobacco and describes the organization of this monograph around topic 

areas including tobacco marketing, tobacco coverage in news and entertainment 

media, tobacco control media interventions, tobacco industry counter-efforts, and 

future directions. The closing sections of this chapter present the volume and chapter 

conclusions that spring from the work presented here.

Media communications play a key role in shaping attitudes toward tobacco, and current 

evidence shows that tobacco-related media exposure affects both tobacco use and 

prevention. Tobacco advertising and promotion in the United States totalled more than 

$13.5 billion in 2005 (in 2006 dollars), and media communications continue to play an 

important role in tobacco control efforts and policy interventions. Against this context, 

the intention of this volume is to stimulate dialogue on what remains an important issue 

in global public health.
4

1 . O v e r v i e w a n d C o n c l u s i o n s

Introduction

Tobacco use is the single largest cause of 

preventable death in the United States. 

According to the Centers for Disease Control 

and Prevention, cigarette smoking is 

responsible for more than 400,000 premature 

deaths per year and reduces the life 

expectancy of smokers by an average of 

14 years. This total exceeds the death toll of 

HIV/AIDS, substance abuse, motor-vehicle 

collisions, suicide, and homicide combined.1

In 1964, the first Surgeon General’s report 

on smoking and health raised the alarm 

about the dangers of cigarette smoking.2

Four decades later, despite a rapidly growing 

evidence base on the impact of tobacco use, 

1 in 5 American adults continue to smoke3

and more than 4,000 young people smoke 

their first cigarette each day.4 Illnesses 

caused by smoking cost the nation more 

than $160 billion per year in health care 

expenditures and lost productivity. While 

tobacco use continues, evidence implicating 

the number of illnesses caused by tobacco 

continues to mount. Smoking plays a key 

role in the causation of lung, oral, laryngeal, 

and pharyngeal cancers. It has also been 

implicated in other cancers, such as those 

of the cervix, pancreas, and kidney, and has 

a substantial impact on the prevalence of 

heart disease, emphysema, and pneumonia, 

among other health problems.5,6

Yet, the proportion of adults who are current 

smokers has declined from 42% in 1965 

to 21% in 2006,3 and the percentage of 

ever smokers (aged 18–35 years) who have 

quit was 34% in 2006.7 More important 

for the future, youth smoking prevalence 

has declined substantially; between 1976 

and 2006, the 30-day prevalence of current 

smoking (smoking on one or more occasions 

during the past 30 days) among high school 

students decreased from 39% to 22%.8 Given 

these promising trends, how does one explain 

the paradox of millions who successfully 

quit tobacco use while millions more initiate 

tobacco use and continue to smoke? 

The history of tobacco control efforts to date 

ranges from educational and communitybased efforts directed at smoking prevention 

and cessation to policy interventions such as 

tobacco tax increases, clean indoor air laws, 

and stricter enforcement of laws restricting 

youth access to tobacco products.9 Against 

this backdrop, this monograph focuses on 

what remains one of the most important 

phenomena in both tobacco promotion and 

tobacco control: mass communications. 

A uniquely twentieth-century development, 

mass communications are the product of 

enterprises that are explicitly organized 

to produce and distribute information 

products such as news, entertainment, and 

advertising to inform, amuse, and/or sell 

commodities to the public. Analogous to 

the agent-vector-host-environment model 

for transmission of infectious diseases, mass 

media became a powerful vector that carried 

tobacco—the agent—to a growing number 

of susceptible hosts throughout the country. 

Mass media have also changed the fabric 

of the environment in ways that facilitate 

the movement of that agent (for example, 

by influencing social norms surrounding 

tobacco). At the same time, media play a 

critical role in tobacco control, helping to 

counterbalance the protobacco cues in the 

environment.10

The influence of the media and their role in 

product marketing represent one of the key 

developments of modern society. Effective 

advertising and promotion through media 

channels have created entire categories of 

human product and service needs beyond 

basic survival, which, in turn, have fueled 

the economic growth of communication 

media that include newspapers, magazines, 

radio, and television. Today, these media 

have evolved to become part of a global 

virtual society linked by channels such as 

the Internet, text messaging, and interactive 

gaming. As mass communications have 
5

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

bridged societies around the world, they 

have also magnified the impact of media 

on global public health. Over 80% of the 

more than 1 billion smokers worldwide live 

in developing countries, and the impact of 

globalization has led to an increase of more 

than 250% in cigarette exports from the 

United States alone in the decade preceding 

2002.1,11 Moreover, smoking prevalence in 

the developing world is rising as prevalence 

among developed nations continues to 

decline, with the United Nations projecting 

a 1.7% net global annual increase between 

1998 and 2010. If current trends continue, 

more than one-half billion of the world’s 

current inhabitants are predicted to lose 

their lives to tobacco use,12,13 underscoring 

the urgency of examining the media’s role in 

global tobacco marketing. 

At the same time, the media have an equally 

powerful role in influencing individuals 

and policymakers and have made critical 

contributions to the cause of tobacco 

control. Media channels hold the power 

to frame conceptual models, influence the 

evolution of these models in the public’s 

perceptions, and ultimately guide these 

perceptions toward the implementation of 

policy.14 Tobacco control interventions have 

been inherently intertwined with the media, 

ranging from the antitobacco public service 

announcements broadcast on television 

under the Federal Communications 

Commission’s (FCC’s) Fairness Doctrine 

in the late 1960s15,16 to the advertising 

restrictions of the 1998 Master Settlement 

Agreement and the advertising restrictions 

contained in the World Health Organization’s 

(WHO’s) Framework Convention on 

Tobacco Control.17 Annual adult per capita 

cigarette consumption in the United States 

has declined from its peak level of 

4,345 cigarettes in 1963 to a preliminary 

estimate of 1,654 in 2006,18,19 a process that 

started with the media publicity surrounding 

the 1964 Surgeon General’s report and 

continues through today’s media advocacy 

efforts on behalf of tobacco control.

Despite these successes, tobacco use still 

accounts for nearly one-third of cancer 

deaths worldwide. As a result of growing 

international tobacco use, WHO predicts 

that deaths caused by tobacco will increase 

to 6.4 million per year by 2015, representing 

10% of all deaths worldwide.10,20 These 

trends, combined with the interrelationships 

between tobacco and media, mean that it 

is critical to understand how exposure to 

media influences tobacco use and to explore 

ways to effectively leverage the media to 

improve the overall state of public health.

This introductory chapter provides 

a framework for understanding the 

relationship between tobacco and the media, 

methodological issues in researching mediarelated issues in tobacco, and an overview 

and summary of the specific areas addressed 

in this monograph. Subsequent sections 

present the conclusions of individual 

chapters, followed by the major conclusions 

of the volume, as an executive summary of 

its overall findings.

Tobacco and the 

Media: A Multilevel 

Perspective

A complete and comprehensive 

understanding of the role of mass 

communications in tobacco control and 

tobacco promotion requires a multilevel 

approach. At the individual level, one 

must examine how individual-level factors 

such as knowledge, beliefs, and attitudes 

influence and are influenced by tobaccorelated media messages and the channels 

in which the messages occur. At the 

organizational level, attention needs to be 

focused on (1) how the structure of mass 

media organizations and the practices of 

media practitioners lead to the production of 

media messages in the form of advertising, 

news, and entertainment; (2) how advocates 

for both the tobacco industry and tobacco 
6

1 . O v e r v i e w a n d C o n c l u s i o n s

control attempt to influence the news and 

entertainment media; and (3) the role of 

regulation and public policy in influencing 

tobacco communications. Finally, at the 

population level, it is important to consider 

the larger cultural environment that is 

shaped by the interplay of the tobacco 

industry, mass media, tobacco control 

researchers, advocates, and policymakers.

The media also function at several levels, and 

the levels at which stakeholders on both sides 

of tobacco issues interact with media can 

be seen as a nested relationship, as shown 

in figure 1.1. Each level from 1 through 4 

represents a broader and more indirect level 

of marketing effort, and at the same time, 

a more powerful one. For example, although 

the ultimate impact of media efforts may be 

felt most clearly by direct consumer response 

to advertising or marketing communications, 

interventions at the stakeholder level often 

have broad-reaching effects on promotional 

efforts, social attitudes toward an issue or 

product, or even policies and regulation. 

This monograph attempts to examine 

the dynamics of tobacco-related media 

interventions at each of these levels, within 

a systemic framework.

The relationships among these levels and 

stakeholders on either side of the tobacco 

Figure 1.1 The Nested Relationships among Advertising, Marketing Communications, 

Consumer Marketing, and Stakeholder Marketing in Tobacco Promotion

Television

Billboards 

Radio

Cinema 

Press

Sponsorship 

Merchandising 

Point-of-sale

promotions

Internet Product

placement

Brand

stretching

Loyalty

schemes

Free samples 

Packaging 

Product

design 

Pricing 

Distribution 

Youth

prevention

Health

warnings

Corporate social

responsibility

Media

training

Relationship

building

Scientific

seminars

Other Marketing 2 Communications

Consumer 3 Marketing

Stakeholder 4 Marketing

Mass Media 1 Advertising
7

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

debate, and their relationships with chapters 

in this monograph, can be seen as follows:

Advertising. Cigarette advertising and 

promotion in the United States totaled 

more than $13.5 billion in 2005 (in 2006 

dollars),21 with effects that included 

recruiting new smokers, especially young 

smokers, as well as expanding the market for 

tobacco products by reinforcing smoking, 

discouraging quitting, and appealing 

to health concerns. Chapter 4 provides 

an overview of tobacco advertising and 

promotional efforts throughout modern 

history, while chapters 3 and 8 examine 

the rationales for and legal issues faced in 

regulating such efforts. Chapter 11 provides 

a detailed look at the strategies and themes 

of media efforts used by tobacco control 

advocates. Finally, chapter 14 explores how 

the tobacco industry uses media advertising 

and promotion to defeat state tobacco 

control referenda and ballot initiatives.

Marketing communications. Tobacco 

advertising forms part of an integrated 

marketing communications strategy 

combining sponsorship, brand 

merchandising, brand stretching, 

packaging, point-of-sale promotions, and 

product placement, across a broad range 

of channels ranging from event marketing 

to the Internet.22,23 Chapter 3 explores 

key aspects of the branding process, and 

(along with chapter 4) defines these terms 

and strategies as they relate to tobacco. 

Chapter 6 examines tobacco manufacturers’ 

corporate sponsorship efforts—i.e., those 

carried out in the name of the company 

but not connected to a specific tobacco 

product brand. Chapter 15, the monograph’s 

concluding chapter, examines future issues 

in tobacco promotion, including pointof-sale displays, discounting, and brand 

marketing, in the context of the current 

regulatory and social environment.

Consumer marketing. Consumer-product 

marketing efforts, including pricing, 

distribution, packaging, and product 

design, are aimed at the development of 

tobacco product brand identities that often 

are targeted toward specific demographic, 

psychographic, or ethnic markets.24,25

Chapter 3 examines key principles of 

targeted marketing and communicating 

brand image, while chapter 5 looks in 

detail at common marketing themes used 

by tobacco companies to reach their target 

audiences. An even more important issue 

is the effectiveness of such media efforts 

on targeted consumers. Chapters 7 and 12 

review the impact of media interventions 

by tobacco industry and tobacco control 

advocates, respectively, on smoking behavior, 

while chapters 9 and 10 explore the role 

of the news and entertainment media in 

influencing tobacco use among consumers.

Stakeholder marketing. Image- and 

relationship-building initiatives aimed 

at stakeholders, such as retailers, the 

hospitality industry, and policymakers, 

range from personal outreach to mass media 

organizations and public relations efforts 

around broad themes such as corporate social 

responsibility, youth smoking prevention, 

and providing information on health risks.26–

28 Chapters 6 and 9, discussed previously, 

explore corporate advertising and news media 

advocacy as tools to create an image among 

stakeholders, while chapter 13 addresses 

how the tobacco industry uses stakeholder 

marketing efforts in an attempt to mitigate 

the impact of tobacco control media 

interventions on tobacco product sales.

These integrated levels of marketing and 

promotion pose a challenge to the goals 

of tobacco control and public health and 

underscore the need to further examine 

appropriate policy interventions to address 

the role of media efforts by the tobacco 

industry. Moreover, as direct advertising 

channels have become increasingly 

restricted by policy interventions on both 

the domestic and global levels, promotional 

expenditures for tobacco continue to 
8

1 . O v e r v i e w a n d C o n c l u s i o n s

increase in areas such as point-of-purchase 

displays, promotional allowances, and 

viral, or “stealth,” marketing.21,24,25,29,30

Given these trends and the realities of a 

digitally interconnected age, public health 

stakeholders must continue to monitor the 

relationship between media and tobacco use 

as both evolve in the twenty-first century.

Studying the Media 

and Tobacco

As is the case with most social science 

research, assessing causality is a 

significant challenge—in this instance, 

in determining the relationship between 

mass communications and tobacco-related 

outcomes. Establishing causality is even 

more challenging in the case of mass 

communications, given their ubiquity, the 

complex nature of communication effects, 

and the limitations of research designs.31,32

Major challenges in assessing causality in 

media studies include the following:

n Media effects are complex and 

multidimensional:32 (1) media can have 

short-term effects such as the impact of 

a short burst of advertising on consumer 

attitudes and behaviors—for example, 

on sales of cigarettes—and long-term 

effects that are stable and sustained, 

such as on social norms and values; 

(2) media influence may be at the micro 

level, such as on individual cognitions, 

affect, and behavior, or at the macro 

level, influencing social policies, social 

movements, and social actors; (3) some 

effects may alter norms or opinions, such 

as changing norms regarding tobacco 

use, while others may stabilize and 

reinforce existing norms on smoking; 

(4) the effects of media can accumulate 

after sustained exposure to messages or 

be noncumulative; (5) media influence 

may range from effects on individual 

cognitions or attitudes to direct behavior; 

(6) some media effects are direct and 

others conditional; and (7) media effects 

can be as diffuse as general exposure to 

media or can be content specific. 

n It is difficult to establish control groups. 

In epidemiology, some consider the 

randomized clinical trial as a gold 

standard that can clearly establish 

the difference in “exposures” between 

control and treatment groups. The 

fundamental assumption behind the idea 

of a control group is that the members of 

this group are not exposed to “treatment,” 

in contrast to an intervention group 

that is exposed to treatment.5 In the case 

of media, it is often difficult to confine 

the spread of messages to specified 

geographic areas, control for prior 

exposure or “background” exposure to the 

messages, blunt the impact of competing 

messages, and achieve sufficient exposure 

to messages in the treatment group so 

that it can be distinguished from controlgroup exposure.

n As noted above, media effects, particularly 

in the complex domain of health, 

may take longer to establish, whereas 

most research designs may not have 

observations for a sufficiently long 

duration to document the effects.31

A research design with observations 

over a short duration may not be able to 

document media effects adequately. 

n Media effects can be selective for certain 

population subgroups; that is, not all 

groups are equally influenced by the 

media. For example, evidence shows that 

information campaigns or diffusion of 

information could potentially benefit 

some groups more than others.10,33

n Media effects are not always direct but 

instead may be diffused through others.31

For example, a campaign to promote a 

tobacco quitline may reach a smoker 

only through a family member or friend 

who is exposed to the campaign and 

shares messages with the smoker. If the 

observations are limited to those receiving 
9

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

quitline services, one might underestimate 

the effectiveness of the campaign.

n Last, the all-pervasive nature of the media 

environment includes both messages of 

interest as well as background “noise.”

Given these challenges, no single study 

method or design is likely to provide the 

weight of evidence necessary for causal 

inferences regarding the influence of 

mass communications on tobacco control 

or tobacco promotion. What is needed 

is a combination of methods, designs, 

interpretive techniques, and judgments 

that provides a body of evidence to enable 

an overall assessment of the relationship 

between media and outcomes pertaining 

to tobacco use.34 In assessing the impact of 

media, studies should examine how media 

messages are generated (e.g., interplay 

between journalistic practices and tobacco 

industry efforts to influence news coverage), 

the nature of the media environment (how 

news on tobacco use and its effects are 

covered or the depiction of tobacco use in 

entertainment media), and the impact of the 

media environment on a range of tobaccorelated outcomes. The phrase “range 

of tobacco-related outcomes” is worth 

underscoring here. Unlike epidemiological 

studies in many other fields of research—

in which exposure-outcome relationships 

are more straightforward—it is not always 

easy to establish a direct causal link 

between media messages and behavior. 

Often, as discussed above, media effects 

could be on antecedents to behavior such 

as beliefs, norms, and intentions. Focusing 

on behavior alone could lead one to falsely 

conclude that media effects are weak. 

This monograph reviews studies based on 

multiple research designs and methods 

including surveys, field and laboratory 

experiments, and analyses of media content 

and tobacco industry documents. Studies 

based on surveys of population groups or 

subgroups have the advantage of observing 

people in their natural environment, do 

not interrupt or disrupt their routines, 

and are generalizable. What is gained in 

external validity, however, is traded against 

internal validity in the form of controlling 

for extraneous factors. The choice of 

these control variables is often important. 

Surveys can be single or repeated crosssections, or they can be longitudinal (or 

panel) designs in which the same persons 

are interviewed at different points in time. 

The latter method can be quite effective in 

measuring change over time and can be an 

important contributor to providing evidence 

of causality.

Experiments, particularly laboratory-based 

experiments, provide the advantage of 

internal validity and are helpful in confirming 

causal relationships. These experiments, 

however, are often limited in terms of the 

rather forced nature of exposure, unnatural 

viewing situations, and the limitations of the 

experimental populations, which are often 

college students. Field experiments have the 

potential to increase external validity, while 

maintaining a degree of internal validity, but 

are subject to a number of sources of error, 

as discussed by Cook and Campbell in their 

classic work on quasi-experimental designs.35

Analyses of media content can be both 

quantitative and qualitative. The analysis 

of news content on tobacco for example, 

as reviewed in chapter 9, demonstrates how 

systematic analysis of news coverage can 

provide an understanding of the news to 

which consumers are likely to be exposed. 

This facilitates the interpretation of the 

impact of news content on audiences exposed 

to news. Systematic content analyses 

require that the criteria for classifying media 

content be explicit and formal and that the 

classification, or coding, be done by more 

than one coder. Documentary analysis 

(e.g., the analyses of tobacco industry efforts 

to influence media) may not be “systematic” 

but may rely more on expert judgment. This 

analysis can be considered valid as long as 
10

1 . O v e r v i e w a n d C o n c l u s i o n s

the criteria for interpretation are transparent 

and the inferences are plausible in light of 

the evidence from other methods.

In summary, this monograph relies on 

the totality of evidence from multiple 

studies using a variety of research designs 

and methods to understand the effects 

of media on tobacco promotion and 

tobacco control. The evidence is based on 

consistency, strength of associations, and 

theoretical plausibility.5,34

Preparation of this 

Monograph

The National Cancer Institute’s Tobacco 

Control Research Branch invited five 

experts representing the domains of 

medicine, public health, communications, 

marketing, epidemiology, and statistics 

to serve as editors of this monograph. 

This ambitious effort to synthesize the 

science included the contributions from 

23 authors selected for their individual 

expertise. The monograph was subjected 

to a rigorous review process, which began 

with a review of the monograph outline. 

As each chapter was drafted, the chapter 

was reviewed by multiple peer reviewers 

with expertise on the individual topic. 

When the entire volume was complete, 

the full draft was submitted to expert 

reviewers who evaluated the monograph 

as a whole, who related one chapter to 

another, and who ensured that the volume 

level conclusions were supported by the 

monograph’s content. The National Cancer 

Institute conducted the final review before 

the monograph was printed. Comments 

from 62 expert reviewers formed the basis 

of revisions the authors and volume editors 

made to the monograph. All of these efforts 

have culminated in a monograph that 

includes nearly 2,000 references, 44 tables, 

15 figures, and numerous illustrative 

examples used in the media to promote 

and to discourage tobacco use. 

This monograph is supported by its Web 

page, http://www.cancercontrol.cancer.gov/

tcrb/monographs/19/index.htm, where 

supplemental materials for this monograph 

(fact sheets and presentation slides) and 

links to additional resources on the media 

and tobacco are located. 

Monograph 

Organization

This monograph reflects a comprehensive 

examination of how mass media have been 

used in both tobacco promotion and tobacco 

control by various stakeholders and the 

consequences of such use. This examination 

included reviewing 

n different types of media, such as news, 

television, advertising, movies, and 

the Internet;

n strategies to influence the content of 

media products, such as public relations 

and strategic communications; and 

n the effects of media communications on 

tobacco initiation and use.

Part 1—Introduction, frames the discussion 

of media and tobacco use. This first chapter 

provides an overview of the topic of this 

monograph. It also includes volumelevel conclusions and chapter-by-chapter 

synopses and conclusions. The second 

chapter summarizes the theoretical 

underpinnings of media research that 

support the rationale and methodology 

for the subsequent examination of specific 

areas of interest surrounding tobacco 

and media.

Part 2—Tobacco Marketing, explores 

issues related to the media interventions 

used by the tobacco industry to promote 

its products. Its chapters focus on areas 

that include several aspects of tobacco 

advertising and promotion, the use of 

media by the tobacco industry for corporate 
11

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

sponsorship and advertising, the influence 

of tobacco marketing on smoking behavior, 

and the regulatory and constitutional issues 

surrounding policy interventions directed 

at tobacco marketing.

Part 3—Tobacco in News and Entertainment 

Media, looks at two media channels that 

go beyond traditional paid advertising and 

promotion to play a key role in shaping public 

opinion on smoking. Its chapters explore how 

news media coverage influences tobacco use 

and the role that entertainment media play in 

attitudes toward tobacco use.

Part 4—Tobacco Control Media 

Interventions, focuses on how media efforts 

are used in support of tobacco cessation and 

prevention, including an overview of the 

strategies and themes in tobacco control 

media interventions and efforts to assess the 

effectiveness of mass media campaigns in 

reducing smoking.

Part 5—Media, Tobacco Control 

Interventions, and Tobacco Industry 

Mitigation Efforts, discusses two separate 

aspects of tobacco industry counterefforts 

and the media: the industry’s efforts to 

weaken tobacco control media interventions 

and its use of the media in the political 

realm to attempt to defeat state tobacco 

control ballot initiatives and referenda.

Part 6—Future Directions, examines 

possible future trends in the use of media 

for both tobacco promotion and tobacco 

control, as a summary of the issues 

discussed throughout the previous sections.

Major Conclusions

These conclusions are based on the scientific 

evidence and evaluation provided in the 

monograph.

1. Media communications play a key 

role in shaping tobacco-related 

knowledge, opinions, attitudes, and 

behaviors among individuals and within 

communities. Media communications 

on tobacco include brand-specific 

advertising and promotion, news 

coverage, depictions of tobacco use 

and tobacco products in entertainment 

media, public relations, corporate 

sponsorship, corporate advertising, 

political advertising for ballot initiatives 

and referenda, and media campaigns 

for tobacco control.

2. Cigarettes are one of the most heavily 

marketed products in the United States. 

Between 1940 and 2005, U.S. cigarette 

manufacturers spent about $250 billion 

(in 2006 dollars) on cigarette advertising 

and promotion. In 2005, the industry 

spent $13.5 billion (in 2006 dollars) on 

cigarette advertising and promotion 

($37 million per day on average). 

Currently, most of the cigarette 

industry’s marketing budget is allocated 

to promotional activities, especially 

for price discounts. Price discounts 

accounted for 75% of total marketing 

expenditures in 2005 ($10.1 billion in 

2006 dollars). Less than 1% of cigarette 

marketing expenditures are now used for 

advertising in traditional print media.

3. Tobacco advertising has been dominated 

by three themes: providing satisfaction 

(taste, freshness, mildness, etc.), 

assuaging anxieties about the dangers 

of smoking, and creating associations 

between smoking and desirable 

outcomes (independence, social 

success, sexual attraction, thinness, 

etc.). Targeting various population 

groups—including men, women, youth 

and young adults, specific racial and 

ethnic populations, religious groups, 

the working class, and gay and lesbian 

populations—has been strategically 

important to the tobacco industry.

4. The total weight of evidence—from 

multiple types of studies, conducted by 
12

1 . O v e r v i e w a n d C o n c l u s i o n s

investigators from different disciplines, 

and using data from many countries—

demonstrates a causal relationship 

between tobacco advertising and 

promotion and increased tobacco use.

5. The depiction of cigarette smoking 

is pervasive in movies, occurring in 

three-quarters or more of contemporary 

box-office hits. Identifiable cigarette 

brands appear in about one-third of 

movies. The total weight of evidence 

from cross-sectional, longitudinal, 

and experimental studies indicates a 

causal relationship between exposure 

to depictions of smoking in movies and 

youth smoking initiation.

6. Evidence from controlled field 

experiments and population studies 

shows that mass media campaigns 

designed to discourage tobacco use 

can change youth attitudes about 

tobacco use, curb smoking initiation, 

and encourage adult cessation. The 

initiation effect appears greater in 

controlled field experiments when 

mass media campaigns are combined 

with school- and/or community-based 

programming. Many population studies 

document reductions in smoking 

prevalence when mass media campaigns 

are combined with other strategies 

in multicomponent tobacco control 

programs.

Chapter Summaries 

and Conclusions

Part 1—Introduction

Chapter 1. Overview and Conclusions

This chapter provides an introduction and 

framework for the monograph, describes 

how it is organized, and includes major 

volume conclusions and individual 

chapter conclusions. 

Chapter 2. Theoretical Underpinnings 

of Media Research in Tobacco Control 

and Tobacco Prevention

This chapter examines the history and 

theory of conceptual models currently 

used in media research. It looks at three 

broad levels of theories and analysis for 

media studies in tobacco—the individual, 

organizational, and societal levels—and how 

these levels affect the framing of research 

efforts and their findings. This chapter 

lays the groundwork for understanding 

some of the important theoretical and 

methodological differences underlying the 

media studies discussed in this monograph 

and their impact on tobacco control efforts.

Part 2—Tobacco Marketing

Chapter 3. Key Principles of Tobacco 

Promotion and Rationales for 

Regulation

This chapter explores the use of advertising 

and promotion by the tobacco industry 

to create demand for its products, 

including market segmentation to target 

consumers by demographic, geographic, 

behavioral, and psychographic factors, 

as well as branding strategies to create a 

consistent product identity and message.

Conclusions

1. The promotion of tobacco products 

involves sophisticated targeting and 

market segmentation of potential 

customers. Common market 

segmentation dimensions include 

demographics (e.g., age, gender, race/

ethnicity), geography (e.g., market 

density, regional differences within 

a domestic or international market), 

behavioral characteristics (e.g., occasions 

of cigarette use, extent of use, user’s 

smoking status), and psychographics 

(lifestyle analysis). 
13

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

2. Internal tobacco company documents 

reveal that two key typologies of 

cigarette consumers used by cigarette 

firms are “starters” (who frequently 

initiate smoking during adolescence) 

and “pre-quitters” (i.e., existing smokers 

who need reassurance).

3. The brand image of most tobacco 

products represents the end result of a 

multifaceted marketing effort involving 

brand identity, logos, taglines and slogans, 

pictorial elements, and the use of color. 

The development, enhancement, and 

reinforcement of this brand imagery are 

primary objectives of tobacco promotion. 

4. Tobacco companies have designed 

their communications of brand image 

to use principles relating to message 

repetition, consistency, and relevance to 

a contemporary audience. The brand’s 

image is built slowly and collectively by 

all of the accumulated associations and 

images of the communications strategy, 

such as social status, sophistication 

and social acceptance, athleticism and 

healthfulness, glamour and fashion, 

rewarded risk-taking and adventure, 

and masculinity or femininity. 

5. The key rationales cited for 

implementing a comprehensive ban 

on tobacco advertising and promotion 

include (1) the health consequences 

of tobacco use (including addiction); 

(2) the deceptive or misleading nature of 

several tobacco promotional campaigns; 

(3) the unavoidable exposure of youth to 

these campaigns; (4) the role of tobacco 

advertising and promotion in increasing 

tobacco use in the population, especially 

among youth; (5) the targeting of 

“at-risk” populations, including youth, 

women, and ethnic and racial minorities, 

through advertising and promotion; 

(6) the failure of the tobacco industry 

to effectively self-regulate its marketing 

practices; and (7) the ineffectiveness of 

partial advertising bans. 

6. Substantial evidence exists from the United 

States and several other countries that the 

tobacco industry does not effectively selfregulate its marketing practices.

7. Substantial evidence exists from the 

United States and several other countries 

that tobacco companies typically respond 

to partial advertising bans in ways that 

undermine the ban’s effectiveness. These 

responses include shifting promotional 

expenditures from “banned” media to 

“permitted” media (which may include 

emerging technologies and “new” 

media), changing the types and targets 

of advertising in permitted media, 

using tobacco-product brand names 

for nontobacco products and services, 

and availing themselves of imprecise 

clauses in the legislative text of the bans 

that allow them to continue to promote 

their products.

Chapter 4. Types and Extent of 

Tobacco Advertising and Promotion

This chapter examines the scope of 

tobacco advertising and promotion in the 

United States and its evolution over time. 

Areas discussed include a taxonomy of past 

and present channels used in advertising 

and promoting tobacco products; emerging 

promotional channels such as packaging, 

viral marketing, and the Internet; and 

recent trends in tobacco advertising and 

promotional expenditures, including the 

shift from traditional print advertising to 

promotional activities.

Conclusions

1. Cigarettes are one of the most heavily 

marketed products in the United States. 

Between 1940 and 2005, U.S. cigarette 

manufacturers spent about $250 billion 

(in 2006 dollars) on cigarette advertising 

and promotion. In 2005, the industry 

spent $13.5 billion (in 2006 dollars) on 

cigarette advertising and promotion 

($37 million per day on average).
14

1 . O v e r v i e w a n d C o n c l u s i o n s

2. Most of the cigarette industry’s 

marketing budget is allocated to 

promotional activities, especially for price 

discounts, which accounted for 75% 

($10.1 billion in 2006 dollars) of total 

marketing expenditures in 2005. From 

1970 to 2005, the pattern of marketing 

expenditures shifted dramatically; the 

proportion of expenditures allocated 

for advertising in “measured media” 

decreased from 82% in 1970 to almost 

none in 2005. Measured media include 

television, radio, newspapers, magazines, 

and billboards. Correspondingly, the 

proportion of marketing expenditures 

devoted to promotional activities 

increased from 18% to almost 100%.

3. During the past three decades, 

Philip Morris has consistently 

committed more than $100 million per 

year (in 2006 dollars) to advertising 

for Marlboro, the industry’s dominant 

brand, which currently has 40% of the 

U.S. market share. In 2006, the Marlboro 

brand was the 12th most highly valued 

brand worldwide, with an estimated 

$21.4 billion in brand equity.

4. Expenditures for smokeless tobacco 

advertising and promotion reached 

$259 million (in 2006 dollars) in 2005. 

The five largest categories of expenditure 

were price discounts (40%), coupons 

(11%), sampling (11%), point of sale 

(8%), and magazines (8%).

5. Cigarette advertising and promotion 

are heavy in volume and high in 

visibility at the point of sale, particularly 

in convenience stores. Cigarette 

marketing at the point of sale increased 

substantially after the 1998 Master 

Settlement Agreement, which included 

a ban on cigarette advertising on 

billboards. About 60% of all cigarettes 

sold in the United States are purchased 

in convenience stores, where cigarettes 

are the top in-store product category in 

terms of consumer sales.

6. As cigarette advertising is being curtailed 

in some traditional media, cigarette 

companies are exploring the use of new 

or nontraditional media for distributing 

protobacco messages and images, 

including the Internet and cigarette 

packages. In addition, cigarette firms 

(like other companies) are experimenting 

with viral (stealth) marketing to create a 

“buzz” about a product.

Chapter 5. Themes and Targets of 

Tobacco Advertising and Promotion

This chapter provides an overview of specific 

themes and population targets used in 

tobacco advertising and promotion on the 

basis of studies of marketing materials and 

tobacco industry documents. It examines 

key themes for tobacco marketing efforts 

such as taste and satisfaction, implied harm 

reduction, social affinity, brand loyalty, and 

“smokers’ rights.” It also discusses efforts 

to market tobacco products to specific 

populations—most of which are defined by 

age, gender, race or ethnicity, and sexual 

orientation—and the implications of these 

targets for marketing themes and brand 

identity.

Conclusions

1. Tobacco advertising has been dominated 

by three broad themes: providing 

satisfaction (taste, freshness, mildness, 

etc.), assuaging anxieties about the 

dangers of smoking, and creating 

associations between smoking and 

desirable outcomes (independence, social 

success, sexual attraction, thinness, etc.).

2. Targeting various population groups—

including men, women, youth and 

young adults, specific racial and ethnic 

populations, religious groups, the 

working class, and gay and lesbian 

populations—has been strategically 

important to the tobacco industry. 

3. The tobacco industry has become 

increasingly sophisticated in applying 
15

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

market research to population segments 

in order to design products, messages, 

communication channels, and 

promotions more aligned with the needs 

and susceptibilities of particular market 

segments. This research results in more 

efficiency, greater reach, and increased 

effectiveness for marketing activities 

aimed at targeted populations.

4. Little attention has been paid to 

understanding tobacco marketing 

aimed at American Indians and Alaska 

Natives, despite their high prevalence 

of tobacco use.

5. Targeted marketing of tobacco products 

to specific groups such as youth, women, 

and minorities has become a focus for 

monitoring and protest by antitobacco 

advocates and community groups.

Chapter 6. Tobacco Companies’ 

Public Relations Efforts: Corporate 

Sponsorship and Advertising

This chapter examines corporate public 

relations activities that can have an important 

impact on public perceptions of and attitudes 

toward individual tobacco companies. 

Such activities include corporate sponsorship 

activities targeting core customer groups, 

corporate advocacy advertising in areas such 

as youth smoking, and corporate image 

advertising designed to highlight charitable 

work or create a new corporate brand identity.

Conclusions

1. Corporate sponsorship of events and 

social causes represents a key public 

relations strategy for major tobacco 

companies, which spent more than 

$360 million on these efforts in 2003. 

Key targets included sporting events, 

antihunger organizations, and arts and 

minority organizations. These efforts 

have been used, in certain cases, to 

influence opinion leaders who benefit 

from such sponsorship. 

2. Corporate image campaigns by tobacco 

companies have highlighted their 

charitable work in the community and 

have promoted their youth smoking 

prevention programs; at times, corporate 

spending on these campaigns has vastly 

exceeded the amount actually given to 

the charities. These campaigns have 

reduced perceptions among adolescents 

and adults that tobacco companies are 

dishonest and culpable for adolescent 

smoking, and among adults, have 

increased perceptions of responsible 

marketing practices and favorable 

ratings for the individual companies.

3. Tobacco industry youth smoking 

prevention campaigns have been 

generally ineffective in reducing youth 

smoking. Moreover, they may even have 

increased smoking in some subgroups 

of youth. 

4. Tobacco industry public relations efforts 

such as corporate sponsorship and 

advertising may make audiences more 

resistant to criticism of the industry, 

may mitigate jurors’ negative views 

toward the industry, and may weaken 

public or legislative support for tobacco 

control policies. 

5. Systematic monitoring and descriptions 

of tobacco companies’ activities and 

expenditures for corporate sponsorship 

and advertising are needed to better 

understand the impact of these 

activities on the public image of tobacco 

companies, on consumers’ smoking 

intentions and behaviors, and on the 

image of sponsored events and causes. 

Chapter 7. Influence of Tobacco 

Marketing on Smoking Behavior

This chapter examines the evidence base 

for how tobacco marketing efforts affect 

tobacco use by adolescents as well as tobacco 

consumption across the general population 

by using results from numerous studies 
16

1 . O v e r v i e w a n d C o n c l u s i o n s

as well as findings from tobacco industry 

documents. Areas examined include the 

relationship between cigarette advertising 

and adolescent needs and self-image, the 

effects of marketing exposure on adolescent 

smoking, and the relationship between 

tobacco marketing expenditures and overall 

tobacco consumption.

Conclusions

1. Much tobacco advertising targets the 

psychological needs of adolescents, 

such as popularity, peer acceptance, 

and positive self-image. Advertising 

creates the perception that smoking 

will satisfy these needs.

2. Adolescents who believe that smoking 

can satisfy their psychological needs or 

whose desired image of themselves is 

similar to their image of smokers are 

more likely to smoke cigarettes.

3. Experimental studies show that even 

brief exposure to tobacco advertising 

influences adolescents’ attitudes and 

perceptions about smoking and smokers, 

and adolescents’ intentions to smoke.

4. The vast majority of cross-sectional 

studies find an association between 

exposure to cigarette advertising, 

measured in numerous ways, and 

adolescent smoking behavior, measured 

in numerous ways, indicating a robust 

association.

5. Strong and consistent evidence from 

longitudinal studies indicates that 

exposure to cigarette advertising 

influences nonsmoking adolescents to 

initiate smoking and to move toward 

regular smoking.

6. Many econometric studies have used 

national time-series data to examine the 

association between tobacco advertising 

expenditures and tobacco consumption. 

Some of these studies found a small 

positive effect of advertising on 

consumption. Other studies failed to find 

a positive effect, probably because the 

data used had little variance and were 

measured at a high level of advertising 

expenditure at which changes in the 

volume of advertising have little or no 

marginal effect.

7. The evidence from three cross-sectional 

econometric studies using disaggregated 

local-level data indicates a positive effect 

of advertising on tobacco consumption.

8. The studies of tobacco advertising 

bans in various countries show that 

comprehensive bans reduce tobacco 

consumption. Noncomprehensive 

restrictions generally induce an 

increase in expenditures for advertising 

in “nonbanned” media and for other 

marketing activities, which offset the 

effect of the partial ban so that any net 

change in consumption is minimal 

or undetectable. 

9. The total weight of evidence from 

multiple types of studies, conducted by 

investigators from different disciplines, 

using data from many countries, 

demonstrates a causal relationship 

between tobacco advertising and 

promotion and increased tobacco use, 

as manifested by increased smoking 

initiation and increased per capita 

tobacco consumption in the population.

Chapter 8. Legal and Constitutional 

Perspectives on Tobacco Marketing 

Restrictions

This chapter explores legal and 

constitutional issues surrounding regulation 

of tobacco promotion within the context 

of legislative efforts in the United States as 

well as WHO’s Framework Convention on 

Tobacco Control. 

Conclusions

1. The First Amendment to the U.S. 

Constitution, as the Supreme Court 

has interpreted it in recent years, 

grants broad protection for commercial 
17

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

speech, including speech about tobacco 

products. The Court has precluded 

regulation of tobacco products by the 

U.S. Food and Drug Administration 

(FDA) on the basis of the Court’s analysis 

of existing authorities under the FDA’s 

governing statute and the complex 

balance that Congress has struck 

between protecting and promoting 

trade in tobacco products and informing 

consumers of their dangers.

2. The Federal Trade Commission has 

authority to prevent “unfair or deceptive 

acts or practices in or affecting 

commerce.” However, the agency’s 

efforts to prevent tobacco advertisements 

that are false or misleading have been 

limited. 

3. Canada and the European Union 

have imposed limitations on tobacco 

advertising and promotion, but these 

policies were weakened as a result of 

legal challenges. Nevertheless, Canadian 

and European restrictions on tobacco 

marketing are stronger than those 

currently in place in the United States.

4. The Framework Convention on 

Tobacco Control (FCTC), the first treaty 

ever negotiated by the World Health 

Organization, calls on each party to the 

treaty to “undertake a comprehensive 

ban of all tobacco advertising, promotion 

and sponsorship ... in accordance with its 

constitution or constitutional principles.” 

As of April 2008, 154 countries were 

parties to the FCTC. The United States 

signed the treaty in May 2004 but has 

yet to ratify it. 

Part 3—Tobacco in News and 

Entertainment Media

Chapter 9. How the News Media 

Influence Tobacco Use

This chapter examines news media 

coverage of tobacco issues and its ultimate 

relationship with both individual tobacco 

use outcomes and policy interventions. 

It looks at the nature and volume of tobacco 

issue coverage and provides a content 

analysis of news media items referring to 

tobacco. It also examines common framing 

issues for tobacco-related news items as 

well as relationships with outcome measures 

and tobacco industry efforts to influence 

media coverage.

Conclusions

1. The news media represent a key source 

of health information for the general 

public. More important, they serve 

as a framing mechanism for issues 

surrounding tobacco control. As a 

result, news coverage is a frequent aim 

of stakeholder activity on both sides of 

tobacco-related issues. However, only 

a small proportion of tobacco control 

research has been devoted to news media 

issues to date.

2. News coverage that supports tobacco 

control has been shown to set the agenda 

for further change at the community, 

state, and national levels. Despite this, 

organized media advocacy efforts on 

behalf of tobacco control issues remain 

an underutilized area of activity within 

public health.

3. Key issues covered as news stories 

include secondhand smoke, tobacco 

policies, and the health effects of 

smoking. Studies of tobacco-related news 

coverage often show that the majority of 

stories favor tobacco control progress, 

including opinion pieces. Other studies 

have shown the tobacco industry to be 

successful in gaining consistent coverage 

for selected issues.

4. Content analyses of tobacco-related 

news articles have revealed some trends 

that remain favorable to protobacco 

interests. These trends include the 

underrepresentation of tobacco farming 

diversification in the farming press, 
18

1 . O v e r v i e w a n d C o n c l u s i o n s

a tendency of articles to challenge the 

science behind secondhand smoke 

issues, and positive coverage of the 

growth in cigar smoking.

5. Numerous factors can affect the 

volume and nature of tobacco 

news coverage. The American Stop 

Smoking Intervention Study found 

more support for tobacco control in 

letters to the editor in participating 

states, and editors largely support 

tobacco control efforts. However, news 

coverage often focuses on specific areas 

such as tobacco control policies, the 

outcomes of tobacco lawsuits, or the 

disbursement of Master Settlement 

Agreement funds.

6. Large-scale studies have yet to be 

undertaken investigating associations 

between tobacco-related news 

coverage and attitudes, behaviors, 

and outcomes related to tobacco 

use. These studies face challenges in 

separating the effects of news coverage 

from those of the interventions or 

policy changes they describe. Research 

shows potential evidence for such 

an impact, including a drop in per 

capita cigarette consumption after 

news coverage of the 1964 Surgeon 

General’s report on smoking and 

health, a relationship between 

tobacco-related news coverage and 

cessation, and a link between news 

coverage of specific tobacco control 

efforts and lower adolescent smoking 

prevalence and consumption.

7. Paid tobacco advertising tends to 

suppress or reduce news coverage of 

tobacco-related issues, particularly in 

magazines. However, bans on tobacco 

advertising that accompany ratification 

of the World Health Organization’s 

Framework Convention on Tobacco 

Control may impair the tobacco 

industry’s ability to exert editorial 

control over published content.

Chapter 10. Role of Entertainment 

Media in Promoting or Discouraging 

Tobacco Use 

This chapter looks at the impact of media 

channels for entertainment on attitudes 

and outcomes related to smoking in an 

environment in which American youth are 

exposed to more than five hours per day of 

media from television and other sources. 

It describes portrayals of tobacco products 

and tobacco use in the movies together 

with a discussion of other channels such 

as television, music, magazines, and the 

Internet. It also looks at the influence of 

such portrayals on social attitudes and 

behaviors related to smoking, as well as 

current strategies for reducing media 

exposure to tobacco products.

Conclusions

1. Children and adolescents in the 

United States have heavy exposure to 

entertainment media, with an average 

of 5.5 person-hours of media use per 

day. Tobacco use often is integrated into 

entertainment media programming, 

especially in movies.

2. Portrayals of tobacco in movies include 

images of tobacco use and images of 

tobacco product brand names and logos. 

Depictions of smoking are pervasive in 

movies, occurring in three-quarters or 

more of contemporary box-office hits. 

Cigar use also is commonly depicted in 

movies, but use of smokeless tobacco 

is not. Smoking is more common in 

movies rated for adults (i.e., R-rated), but 

depiction of smoking is not related to boxoffice success. Identifiable cigarette brands 

appeared in about one-third of movies 

released during the 1990s. In contrast to 

its frequent depiction in movies, tobacco 

use is found in about 20% of television 

shows and 25% of music videos.

3. Smoking prevalence among contemporary 

movie characters is approximately 25%, 
19

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

about twice what it was in the 1970s and 

1980s. In contrast, smoking in the general 

population has declined since the 1970s. 

Smokers in movies differ from smokers 

in the general population: the former 

are more likely to be affluent and white. 

The health consequences of smoking are 

rarely depicted in movies.

4. Cross-sectional studies show that, 

among adolescents, exposure to smoking 

in movies is associated with initiation of 

smoking, independent of several other 

factors such as smoking by friends and 

family. Cross-sectional studies also 

indicate that among adolescent never 

smokers, exposure to smoking in movies 

is associated with more positive attitudes 

toward smoking.

5. Two longitudinal studies demonstrate 

that adolescents with higher exposure to 

smoking in movies at baseline are 2.0 to 

2.7 times more likely to try cigarette 

smoking in the future. More studies are 

needed on the role exposure to smoking 

in movies plays in adolescents’ smoking 

beyond the initiation phase. 

6. Experimental studies show that 

images of cigarette smoking in film 

can influence adolescent and adult 

viewers’ beliefs about social norms for 

smoking, beliefs about the function 

and consequences of smoking, 

and their personal intentions to 

smoke. Protobacco movie content 

(e.g., stars smoking, absence of health 

consequences portrayed) appears 

to promote prosmoking beliefs and 

intentions. The effects observed for 

experimental studies of smoking in 

movies on viewers’ smoking-related 

beliefs are of a similar magnitude 

as those observed in experimental 

media research on other health topics 

(e.g., effects of media violence on 

viewers’ aggression).

7. Experimental studies indicate that 

antitobacco advertisements screened 

before films can partially counter the 

impact of tobacco portrayals in movies. 

8. The total weight of evidence from 

cross-sectional, longitudinal, and 

experimental studies, combined with the 

high theoretical plausibility from the 

perspective of social influences, indicates 

a causal relationship between exposure 

to movie smoking depictions and youth 

smoking initiation.

9. One longitudinal study indicates that 

parental steps to reduce the exposure 

of never smokers (aged 10–14 years) 

to R-rated movies, which have higher 

numbers of smoking events, produced 

a corresponding reduction in their 

smoking initiation. 

10. Efforts to reduce media exposure to 

tobacco include restrictions on tobacco 

advertising and product placements, 

advocacy targeted to entertainment 

providers, media literacy interventions 

aimed at the general public, continued 

dialogue with key stakeholders in the 

entertainment industry, and proposed 

self-regulation by the movie industry 

(e.g., tobacco-related ratings).

Part 4—Tobacco Control Media 

Interventions

Chapter 11. An Overview of Media 

Interventions in Tobacco Control: 

Strategies and Themes

This chapter examines current and future 

trends in media interventions for tobacco 

control, including the evolution of media 

efforts from their start under the FCC’s 

Fairness Doctrine for television advertising, 

to recent initiatives funded by state 

authorities and the 1998 Master Settlement 

Agreement. It also discusses examples of 

advertising themes used in tobacco control 

programs, research on factors in effective 

tobacco control advertising campaigns, 
20

1 . O v e r v i e w a n d C o n c l u s i o n s

and the potential for “new-media” channels 

such as interactive health communications 

using the Internet.

Conclusions

1. From their beginnings with the successful 

1967–70 application of the Fairness 

Doctrine to cigarette advertising in the 

broadcast media, media interventions for 

tobacco control have evolved to become a 

key component of tobacco control efforts. 

These interventions have been aided by 

funding from the 1998 Master Settlement 

Agreement.

2. Media channels commonly used for 

tobacco control advertising include 

television, radio, print, and billboards. 

Much research on tobacco control media 

interventions revolves around television, 

regarded as the most powerful medium.

3. Public-health-sponsored antitobacco 

advertising has included themes such 

as the health risks of smoking, exposure 

to secondhand smoke, questioning 

the accuracy of tobacco industry 

communications, and the declining 

social acceptability of smoking. Other 

forms of smoking-relevant advertising 

include advertisements for commercial 

smoking cessation products as well as 

the tobacco industry’s youth smoking 

prevention and adult cessation programs. 

4. Numerous studies have shown 

consistently that advertising carrying 

strong negative messages about health 

consequences performs better in 

affecting target audience appraisals and 

indicators of message processing (such as 

recall of the advertisement, thinking 

more about it, discussing it) compared 

with other forms of advertising, such 

as humorous or emotionally neutral 

advertisements. Some of these negative 

advertisements also portray deception 

on the part of the tobacco industry. 

Advertisements for smoking cessation 

products and tobacco-industry-sponsored 

smoking prevention advertising have 

been shown to elicit significantly 

poorer target audience appraisals than 

do advertisements based on negative 

health consequences.

5. Studies have shown that particular 

characteristics of advertisements 

(such as those eliciting negative 

emotion) are more important than 

demographic factors (such as race/

ethnicity, nationality, and age group) 

in driving immediate advertising-related 

appraisals and indicators of message 

processing.

6. Because many smokers search the 

Internet for help to quit, interactive 

Web-based health communications may 

have potential for assisting smoking 

cessation. However, these services need 

to be informed by smoking cessation 

theory and research and structured to 

expose users to appropriate information.

Chapter 12. Assessing the 

Effectiveness of the Mass Media in 

Discouraging Smoking Behavior

This chapter studies the use of mass media 

in tobacco control and health promotion, 

and examines research results relative to 

changing smoking behavior in light of 

their methodological challenges. Specific 

areas covered include (1) controlled field 

experiments involving antismoking mass 

media campaigns aimed at youth and adults, 

often only one part of multicomponent 

interventions; and (2) population-level 

studies, including both longitudinal 

and cross-sectional evaluation studies 

of national- and state-level tobacco 

control mass media campaigns conducted 

either alone or as one component of a 

multicomponent tobacco control program.

Conclusions

1. Several evaluations of the antismoking 

public service announcements required 
21

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

under the Fairness Doctrine between 

1967 and 1970, the first large-scale 

U.S. national mass media campaign, 

indicate that there were discernible 

reductions in tobacco consumption, 

smoking prevalence, and smoking 

initiation. This natural experiment 

spurred research into the use of media 

to influence health behaviors.

2. Evidence from controlled field 

experiments suggests that antitobacco 

mass media campaigns conducted in 

conjunction with school- or communitybased programming can be effective in 

curbing smoking initiation in youth and 

promoting smoking cessation in adults. 

This evidence has provided the impetus 

for antitobacco mass media campaigns 

to become important components of 

tobacco control programs.

3. The few population-based studies of 

antitobacco mass media campaigns, 

in which the media campaign was the 

only antitobacco program, demonstrate 

that the media campaigns were effective 

in reducing smoking in the youth and 

adult target populations.

4. Population-based studies of antitobacco 

mass media campaigns that were only 

one component of multicomponent 

tobacco control programs provide 

considerable evidence for reduced use 

of tobacco by youth and adults. The 

antitobacco mass media campaign and 

the other program components together 

may have reduced smoking more 

than did any single component alone. 

The relative contributions of various 

components to program effectiveness 

are difficult to determine, but some of 

the controlled field experiments showed 

a dose-response relationship between 

reduced smoking and an increased 

number of program components.

5. Evidence from controlled field 

experiments and population studies 

conducted by many investigators in many 

countries shows that antitobacco mass 

media campaigns can reduce tobacco use.

Part 5—Media, Tobacco Control 

Interventions, and Tobacco 

Industry Mitigation Efforts 

Chapter 13. Tobacco Industry Efforts 

to Influence Tobacco Control Media 

Interventions

This chapter examines how tobacco 

interests and their allies work to impede 

antitobacco media efforts by using 

techniques such as diverting funding to 

other causes, lobbying elected officials, 

restricting antitobacco media content 

through negotiated settlements, and filing 

legal challenges. Examples are given from 

state-level media campaigns in Minnesota, 

California, Arizona, and Florida.

Conclusions

1. Tobacco industry efforts to impede 

tobacco control media campaigns 

include attempts to prevent or reduce 

their funding. Examples include 

opposition to a tobacco tax increase 

intended to fund media campaigns in 

California and claims that a “budget 

crisis” precluded spending on tobacco 

control media campaigns in Minnesota. 

2. Efforts to weaken the messages or 

reduce the size of the target audience 

in tobacco control media campaigns 

include restricting the scope of 

Arizona’s Proposition 200 initiative to 

address specific topics such as nicotine 

addiction and to target only children and 

pregnant women and, in the American 

Legacy Foundation’s “truth” campaign, 

disallowing public policy advocacy and 

vilification of the tobacco industry. 

3. The tobacco industry has cited its own 

media campaigns—such as “Helping 

Youth Decide,” “Think. Don’t Smoke,” 
22

1 . O v e r v i e w a n d C o n c l u s i o n s

and “Tobacco Is Whacko if You’re a 

Teen”—to argue that government-funded 

campaigns duplicate these efforts and 

waste taxpayer dollars. This strategy was 

seen first in Minnesota and leading up 

to and following the 1998 signing of the 

Master Settlement Agreement.

4. Increasing consumer awareness of 

tobacco industry activities to counteract 

public-health-sponsored campaigns 

designed to reduce tobacco use can be 

an important component of effective 

media interventions. 

Chapter 14. Tobacco Industry Media 

Efforts to Defeat State Tobacco Control 

Ballot Initiatives and Referenda

This chapter examines tobacco industry 

efforts to use media to counter ballot 

initiatives and referenda for a sample of 

the 42 state-level tobacco control measures 

put before voters between 1988 and 2006. 

This chapter discusses media campaigns 

in several states, together with primary 

themes used by the tobacco industry in 

these efforts, such as unfair taxation, 

diversion of funds, personal choice, and 

wasteful government spending.

Conclusions

1. Within those states that allow these 

processes, ballot initiatives and referenda 

have served as an effective tool for 

enacting tobacco control legislation by 

direct vote. Tobacco industry interests 

frequently have used media channels 

(such as radio, television, print media, 

and direct mail) to defeat these ballot 

measures.

2. Despite the tobacco industry’s media 

efforts, it has generally not prevailed, 

losing in 32 (76%) of 42 state initiatives 

and referenda from 1988 to 2006. 

Given the industry’s lack of success in 

defeating tobacco control state initiatives 

and referenda at the state level, holding 

tobacco control initiatives or referenda is 

an important, though expensive, option 

if a state legislature has blocked tobacco 

control legislation.

3. The tobacco industry consistently has 

used several primary themes to defeat 

state tobacco tax increase initiatives. 

These include suggestions that the 

measures would impose unfair taxes 

and that tax revenues would not be 

spent on health care or tobacco control 

programs as intended. Secondary themes 

used consistently over an 18-year time 

span include that the measures would 

increase “big government” and wasteful 

spending, discriminate against smokers, 

and increase crime and smuggling. 

Other, less frequent themes were that the 

measures would be a tax cut for the rich, 

impede economic growth, fail to solve 

state budget problems, restrict personal 

choice, and violate antitrust laws.

Part 6—Future Directions

Chapter 15. Future Directions

This chapter examines the future of media 

as they relate to both tobacco promotion and 

tobacco control. Issues discussed relative 

to tobacco promotion include point-ofpurchase marketing, packaging, the use of 

entertainment media, and public relations. 

Tobacco control media issues include news 

and media advocacy, measurement of news 

media effectiveness, media interventions, 

and the potential for newer alternate 

media channels.
23

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

References

1. Centers for Disease Control and Prevention. 

2006. Smoking and tobacco use fact 

sheet: Tobacco-related mortality (updated 

September 2006). http//www.cdc.gov/

tobacco/data_statistics/Factsheets/tobacco

_related_mortality.htm.

2. U.S. Department of Health, Education, and 

Welfare. 1964. Smoking and health: Report 

of the Advisory Committee to the Surgeon 

General of the Public Health Service

(PHS publication no. 1103). Washington, 

DC: U.S. Department of Health, Education, 

and Welfare, Public Health Service, Center 

for Disease Control.

3. Centers for Disease Control and Prevention. 

2007. Cigarette smoking among adults—

United States, 2006. Morbidity and 

Mortality Weekly Report 56 (44): 1157–61. 

4. Substance Abuse and Mental Health 

Services Administration. 2006. Results 

from the 2005 National Survey on Drug 

Use and Health: National findings (DHHS 

publication no. SMA 06-4194). NSDUH 

Series H-30. Rockville, MD: U.S. Department 

of Health and Human Services, Substance 

Abuse and Mental Health Services 

Administration, Office of Applied Studies. 

http://www.samhsa.gov or http://www.oas

.samhsa.gov.

5. U.S. Department of Health and Human 

Services. 2004. The health consequences 

of smoking: A report of the Surgeon 

General. Atlanta: U.S. Department of 

Health and Human Services, Centers for 

Disease Control and Prevention, National 

Center for Chronic Disease Prevention 

and Health Promotion, Office on Smoking 

and Health.

6. Parkin, D. M., F. Bray, J. Ferlay, and 

P. Pisani. 2005. Global cancer statistics, 

2002. CA: A Cancer Journal for Clinicians

55 (2): 74–108. 

7. Centers for Disease Control and Prevention. 

2007. State-specific prevalence of cigarette 

smoking among adults and quitting among 

persons aged 18–35 years—United States, 

2006. Morbidity and Mortality Weekly 

Report 56 (38): 993–96.

8. Johnston, L. D., P. M. O’Malley, 

J. G. Bachman, and J. E. Schulenberg. 2007. 

Monitoring the Future: National results 

on adolescent drug use—Overview of key 

findings, 2006. (NIH publication no. 07-6202). 

Bethesda, MD: National Institute on Drug 

Abuse. http://www.monitoringthefuture.org/

pubs/monographs/overview2006.pdf

9. National Cancer Institute. 2006. Evaluating 

ASSIST: A blueprint for understanding 

state-level tobacco control (Tobacco control 

monograph no. 17, NIH publication no. 

06-6058). Bethesda, MD: National Cancer 

Institute. http://cancercontrol.cancer.gov/

tcrb/monographs/17/index.html.

10. Viswanath, K. 2005. Science and society: 

The communications revolution and cancer 

control. Nature Reviews Cancer 5 (10): 

828–35. 

11. World Health Organization. 2007. Q&A: 

Tobacco. World Health Organization. 

http://www.who.int/topics/tobacco/qa/en/

index.html (accessed July 30, 2007).

12. Peto, R., A. D. Lopez, J. Boreham, M. Thun, 

and C. Heath Jr. 1994. Mortality from 

smoking in developed countries, 1950–2000: 

Indirect estimates from national vital 

statistics. Oxford: Oxford Univ. Press.

13. United Nations. 2005. Tunis agenda for 

the information society. Tunis, Tunisia: 

http://www.itu.int/wsis/docs2/tunis/off/

6rev1.html.

14. World Health Organization. 2004. Basic 

principles of media advocacy. World Health 

Organization. http://www.who.int/tobacco/

policy/media/en/.

15. Federal Communications Commission. 

1967. Applicability of the Fairness 

Doctrine to cigarette advertising. http://

tobaccodocuments.org/rjr/501881916-1928

.html.

16. National Association of Attorneys General. 

1998. Master Settlement Agreement 

and amendments. Washington, DC: 

National Association of Attorneys General. 

http://www.naag.org/backpages/naag/

tobacco/msa (accessed June 1, 2007).

17. World Health Organization. 2003. Framework 

Convention on Tobacco Control: Resolutions. 

http://www.who.int/gb/ebwha/pdf_files/

WHA56/ea56R1.pdf.

18. Giovino, G. A., M. W. Schooley, B. P. Zhu, 

J. H. Chrismon, S. L. Tomar, J. P. Peddicord, 

R. K. Merritt, C. G. Husten, and M. P. Eriksen. 

1994. Surveillance for selected tobaccouse behaviors—United States, 1900–1994. 

Morbidity and Mortality Weekly Report 

Surveillance Summaries 43 (3): 1–43. 

19. U.S. Department of Agriculture. 2007. 

Tobacco: Data tables. http://www.ers.usda
24

1 . O v e r v i e w a n d C o n c l u s i o n s

.gov/Briefing/Tobacco/tables.htm (accessed 

November 25, 2007).

20. Mathers, C. D., and D. Loncar. 2006. 

Projections of global mortality and burden 

of disease from 2002 to 2030. PLoS Medicine

3 (11): e442. 

21. Federal Trade Commission. 2005. Federal 

Trade Commission cigarette report for 2003. 

http://www.ftc.gov/reports/cigarette05/

050809cigrpt.pdf.

22. Ling, P. M., and S. A. Glantz. 2002. Why and 

how the tobacco industry sells cigarettes 

to young adults: Evidence from industry 

documents. American Journal of Public 

Health 92 (6): 908–16. 

23. MacFadyen, L., G. Hastings, and 

A. M. MacKintosh. 2001. Cross-sectional 

study of young people’s awareness of and 

involvement with tobacco marketing. 

British Medical Journal 322 (7285): 513–17. 

24. Chaloupka, F. J., K. M. Cummings, 

C. P. Morley, and J. K. Horan. 2002. Tax, 

price and cigarette smoking: Evidence from 

the tobacco documents and implications 

for tobacco company marketing strategies. 

Tobacco Control 11 Suppl. 1: i62–i72. 

25. Hastings, G., and L. MacFadyen. 2000. A day 

in the life of an advertising man: Review of 

internal documents from the UK tobacco 

industry’s principal advertising agencies. 

British Medical Journal 321 (7257): 366–71. 

26. Bero, L. 2003. Implications of the tobacco 

industry documents for public health and 

policy. Annual Review of Public Health

24:267–88. 

27. Bialous, S. A., and S. A. Glantz. 2002. 

ASHRAE Standard 62: Tobacco industry’s 

influence over national ventilation 

standards. Tobacco Control 11 (4): 315–28. 

28. Hastings, G., and K. Angus. 2004. The 

influence of the tobacco industry on 

European tobacco-control policy. In Tobacco 

or health in the European Union: Past, 

present and future, 195–225. Luxemburg: 

Office for Official Publications of the 

European Communities.

29. Khermouch, G., and J. Green. 2001. Buzz 

marketing: Suddenly this stealth strategy is 

hot—but it’s still fraught with risk. Business 

Week, July 30. http://www.businessweek.com/

magazine/content/01_31/b3743001.htm.

30. Wakefield, M. A., Y. M. Terry-McElrath, 

F. J. Chaloupka, D. C. Barker, S. J. Slater, 

P. I. Clark, and G. A. Giovino. 2002. Tobacco 

industry marketing at point of purchase 

after the 1998 MSA billboard advertising 

ban. American Journal of Public Health

92 (6): 937–40. 

31. Hornik, R. C. 2002. Introduction. Public 

health communication: Making sense of 

contradictory evidence. In Public Health 

Communication: Evidence for Behavior 

Change, ed. R. C. Hornik, 1–20. Mahwah, 

NJ: Lawrence Erlbaum.

32. McLeod, J., G. Kosicki, and Z. Pan. 1991. 

On understanding and misunderstanding 

media effects. In Mass media and society,

ed. J. Curran and M. Gurevitch, 235–66. 

London: Edward Arnold.

33. Biener, L., R. L. Reimer, M. Wakefield, 

G. Szczypka, N. A. Rigotti, and G. Connolly. 

2006. Impact of smoking cessation aids 

and mass media among recent quitters. 

American Journal of Preventive Medicine

30 (3): 217–24.

34. Weed, D. L. 2005. Weight of evidence: 

A review of concept and methods. Risk 

Analysis 25 (6): 1545–557. 

35. Cook, T. D., and D. T. Campbell. 1979. 

Quasi-experimentation: Design and 

analysis issues for field settings. Boston: 

Houghton Mifflin.
25

2

Theoretical Underpinnings of 

Media Research in Tobacco 

Control and Tobacco Promotion

The media have played a key role in historical trends in tobacco use and its impact on 

human health and are involved in subsequent efforts to promote health and control tobacco 

use. This chapter examines the theoretical base for media studies (both protobacco and 

antitobacco) within the context of three research frameworks.

n	 Individual-level framework. This includes the effects of media and mass 

communications on individuals, including expectancy-value theories of behavior 

change based on attitudes and beliefs, social cognitive theory and its related 

construct of modeling beliefs and behavior, and information-processing models.

n	 Social network/organizational-level framework. A higher system-level 

approach in which groups of actors, including the media, advertisers, and other 

stakeholders, interact with the defined and targeted characteristics of an audience, 

driven by feedback such as readership or ratings. Such models break down further 

into areas such as specific organizational roles within the media, the overall flow 

of information, and the larger political, economic, and cultural contexts.

n	 Societal-level framework. This approach envisions the media as a product of 

forces in society, serving in turn as agents for social conflict and social change or 

as advocates of emerging social movements. Concepts such as media advocacy, 

framing, and communications inequality all have their roots in this societal view 

of the role of the media.

Each of these three frameworks provides a backdrop to the theoretical assumptions 

informing the work reviewed throughout this monograph to study the media and tobacco, 

ranging from studies of individual message recall or attitude change, to the effect of 

protobacco and antitobacco media messages on tobacco use, to the social or political 

impact of media interventions. Each of these efforts, in turn, contributes to a broader 

and continually evolving understanding of the impact of media on smoking behavior 

and public health.
26

2 . T h e o r e t i c a l U n d e r p i n n i n g s o f M e d i a R e s e a r c h

Introduction

This chapter presents an overview of the 

history of media-effects research, abiding 

issues and concerns that have driven the 

research, and three broad frameworks (levels 

of analysis) that inform communications 

science, discussed here in the context of their 

relevance to tobacco use and tobacco control.

Mass media are among the most powerful 

socializing agents of our time. The media 

influence how we think and what we think 

about. They daily shape our collective 

perceptions of “normative” and “normal,” of 

“important” and “insignificant,” of “good” and 

“bad,” of “success” and “failure,” of “cool” and 

“uncool,” and much more. The importance 

of media communications is woven deeply 

into the fabric of postindustrial societies such 

as the United States and, increasingly, the 

industrial and developing world. The media’s 

roles and functions have grown complex 

over time, reflecting the postindustrial 

world’s own growth and complexity as well 

as its paradoxes and contradictions. This is 

nowhere more evident than in the media’s 

variable impact on human health.1

Although tobacco has been commercially 

exploited since the sixteenth century,2 the 

convergence of historical forces that created 

the Industrial Revolution set the stage for 

tobacco’s global diffusion and its devastation 

of human health. The 20/20 hindsight of 

this century makes it possible to see that 

energy-harnessing technologies made mass 

production of tobacco and other products 

possible but also transformed economic 

models. Technology sped up production, 

reduced per unit production costs, and 

permitted the manufacture of mass supplies 

of products. While there must have been 

some demand for tobacco to start with, mass 

supply required mass demand, sales, and 

consumption to complete the equation. How 

did manufacturers drive demand leading to 

mass sales and consumption of tobacco?

The Industrial Revolution also provided a 

unique part of the answer: modern means of 

media communications. The combination of 

mass production and mass communications 

(e.g., advertising), in essence, created 

the modern market economy.3 In the 

case of tobacco and the instruments of 

communications, conditions converged, 

beginning in the nineteenth century, to 

create the “perfect storm” that has been 

affecting human health ever since.

Key to understanding the interaction of 

media communications and tobacco is the 

recognition that both are industries—that 

is, formal organizations with rationalized 

goals and objectives, differentiated 

functions, and established routines to 

accomplish their work. Arguably, the media 

are the more complex of the two, if only 

because they are not composed of a single 

industry with a single goal, but many 

industries with many goals. They also play 

multiple roles and functions in society that 

are frequently contradictory.

For example, while modern advertising, 

marketing, and communications are used 

every day to propel sales and consumption 

of tobacco and other products, the same 

strategies are used to promote health 

and prevention. While entertainment 

media intentionally or unwittingly shape 

youthful perceptions of smoking as cool 

and sexy, leading to increased initiation 

of teen smoking, the same media may 

be used to promote pro-health changes 

through powerful drama and narratives.4

Advocates of both tobacco control and the 

tobacco industry have dueled in the arena 

of the news media, attempting to interpret 

tobacco’s role in causing cancer and 

other illnesses.

These contradictions, coupled with the 

perceived power of the media, have endowed 

the study of media in tobacco promotion 

and tobacco control with the substantive 

interest of scholars, policymakers, tobacco 
27

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

control advocates, and the tobacco industry. 

The controversy associated with mass 

media’s role in tobacco has garnered funding 

to study media effects on tobacco use, with 

equally substantive interest in shaping the 

debate on media effects themselves. This 

voluminous body of work, while providing 

deep insights into the role of the media, 

has also created a fog of misunderstanding 

through both over- and underestimation of 

media effects.

The arrival of the digital information 

epoch, characterized by profound 

transformation in communications and 

biomedical innovation,1 is a good time 

to take stock of the literature on the role 

of mass media in tobacco promotion and 

tobacco control, especially to define media 

impact with greater precision. A systematic 

and intensive examination, informed by 

research frameworks at multiple levels, 

may serve several functions for the future 

of tobacco control: identify lessons learned, 

discern gaps in research, call attention to 

implications for public communications, 

and highlight pointers for public health 

and communication policies. Finally, this 

examination may better prepare us to study 

and understand how new media technologies 

may be harnessed for tobacco control and 

the general improvement of public health.

History of MediaEffects Research

The history of communications research 

is rich in multiple perspectives and can 

be traced back at least 100 years to near 

the turn of the twentieth century. While 

space limitations prevent doing justice to 

this rich history, many erudite accounts 

of its development exist.5–9 Briefly, 

however, communications research has 

developed along five distinct dimensions:7

the study of communications in politics, 

political process, and institutions; 

communications in social life; psychology 

and social psychology of communications; 

communications in education; and 

sponsored communications research.

A narrow reading of the history of mass 

communications research could convey the 

mistaken impression that it has emphasized 

media effects on individuals primarily to 

cater to the interests of the industry, such 

as audience research, and to the interests of 

the government for propaganda. Yet, earlier 

accounts7–9 have pointed out that mass 

communications research has been driven 

quite extensively by public concerns about 

media’s power to promote certain ideas and 

world views and their impact on the social 

order, particularly on more vulnerable 

audiences such as children.9 Conventionally, 

such research has focused on three broad 

areas, though not necessarily with the 

same degree of emphasis: (1) media effects 

on public opinion, public attitudes, beliefs, 

knowledge, and behavior; (2) the roles of 

the press in society, including immigrant 

socialization and community integration; 

and (3) media production processes, 

including organizational determinants 

and professional practices of reporters 

and producers.

The research literature on mass media 

and children, including effects of mass 

communications (e.g., advertising and 

television among others), may also be 

applicable to adults. The literature suggests 

the following:9

n The appearance of each new mass 

medium triggered similar research 

questions on media effects.

n The primary interest has been the effects 

of media on the moral development and 

behavior of children.

n The research questions were shaped by 

public controversies and debates about 

the new media.

n Most research programs, in general, 

concluded that the effects of media are 
28

2 . T h e o r e t i c a l U n d e r p i n n i n g s o f M e d i a R e s e a r c h

subject to the influence of a number 

of conditions, including interpersonal 

influences, and are mediated by a set 

of individual, situational, parental, 

and societal factors.

n Earlier programs of research have set 

the agenda for subsequent programs of 

research on media effects.

n Some of the media research, especially 

on youth, was influenced by the social 

reform movements of the twentieth 

century, such as women’s rights, civil 

rights, and the peace movements, 

among others.

The relevance of this history for the 

study of media effects in tobacco-related 

communications is important given the 

driving concern about the impact of tobaccorelated content in media. This history 

includes media such as advertising and 

movies; the impact on the public in general 

and children in particular; and the use of 

mass media to reduce, if not eliminate, 

tobacco use among the American public 

through education and policy advocacy 

campaigns. The extensive body of work in 

tobacco-related communications research 

spans the spectrum of tobacco industry 

and tobacco control advocates’ influence 

on the production of media messages in 

advertising, news, and entertainment and 

the effects of such messages on individuals, 

groups, institutions, and policymakers.

The context of tobacco-related 

communications research is critical to 

understanding this work. Typical of earlier 

stages in the history of communications 

research, both the tobacco industry and 

the government took an abiding interest in 

examining the impact of communications 

on tobacco use, though for different 

reasons. Each new finding was subject to 

different interpretation—social action and 

policymaking thus generating fodder for 

continuing controversy. This charged context 

provides the backdrop for this monograph, 

which examines the theory, evidence, and 

significance of communications research 

for tobacco use and control.

Levels of Theory and 

Analysis

Media studies in tobacco may be organized 

along three broad levels of analysis: 

individual, social network/organizational, 

and societal.10

This framework is not intended to be fully 

comprehensive of media studies; it is a way 

of organizing the vast body of research 

that is relevant to tobacco use and tobacco 

control. At the same time, this framework 

is not without consequences. A researcher’s 

selection of a unit and level of analysis 

conveys the importance of understanding 

a problem at that particular level. More 

critically, perhaps, the level of analysis is 

consequential to how findings are used 

to shape social action for prevention and 

control or, for that matter, how best to 

market tobacco and smoking to particular 

audiences. Invariably, the level of analysis 

in all research determines the framing and 

importance of the problem of interest, in 

this case, tobacco.

Some research cuts across levels of analysis. 

For example, a particular study may focus 

on how mass communication campaigns 

change social norms associated with 

secondhand smoke among individuals. 

The study may discover subsequent 

changes, not only in social norms among 

individuals, but also in social policies, such 

as restriction of smoking in public places 

(e.g., in bars and restaurants). In other 

words, communications focused on changes 

in social norms around tobacco among 

individuals may either directly or indirectly 

contribute to social policies on restricting 

tobacco use in public places. From this 

example, it could be argued that organizing 

tobacco-related communications research 
29

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

along levels of analysis could provide a 

more holistic understanding of the impact 

of communications on tobacco use and 

control for individuals, groups, institutions, 

and the broader society. Similarly, tobacco 

companies may promote the idea that 

any restrictions on smoking in public are 

an infringement on individual rights and 

potentially reduce support for public policies 

to regulate smoking. In the interpretation of 

research, findings seldom divide neatly and 

exclusively along discrete levels.

In the sections that follow, research in 

media studies is discussed along the three 

levels of analysis/frameworks: individual, 

social network/organizational,* and societal. 

Examples are drawn from tobacco-related 

research.

Individual-Level Analyses 

and Tobacco-Related 

Communications

Understanding the effects of communications 

on individuals has been the most common 

and dominant level of analysis in media 

studies. Analysis at this level has been 

dominant because two of the earliest 

and longest-sustained contributions to 

communications research emerged from 

(1) work on the study of the negative 

effects of propaganda during World War II 

and subsequent work carried out at Yale 

University in the 1950s that led to a focus 

on the study of a persuasion approach in 

communication studies8,11 and (2) work on 

the negative effects of communications on 

children.9 Both approaches have influenced 

subsequent work in tobacco-related 

communications.

This work had considerable influence on 

understanding the mechanisms that could 

explain the effects of media in promoting 

or preventing tobacco use through 

commercial advertising or public health 

communication campaigns or tobaccorelated content in mass media. For example, 

tobacco advertising and the presence of 

tobacco in movies may frame the use 

of tobacco as “cool” and “liberating,” and 

tobacco use as “satisfying,” thus focusing 

on the individual’s affect (see part 2, 

especially chapters 3–5). Similarly, most 

mass media interventions in tobacco control 

also focused on changing the cognitions, 

affect, and behaviors of individuals 

(chapters 11 and 12). Media interventions 

can promote smoking cessation by either 

increasing smokers’ motivation to quit or 

increasing their chance of success on any 

given attempt.12,13 Media interventions can 

also promote adoption of policies such 

as clean air legislation that reduces both 

the population’s exposure to secondhand 

smoke and the visibility of smokers.14

Media campaigns can reduce smoking 

initiation among youth by deglamorizing 

smoking and framing it as a deviant and 

undesirable behavior.15 Specifying the 

psychological mechanisms by which mass 

media can contribute to tobacco promotion 

or tobacco control depends on the theory 

of attitude and behavior change as well as 

on how media messages are processed and 

retained in the minds of the audience.

Early persuasion models that focused 

on individual effects suggested that 

advertisements brought about behavior 

changes through a hierarchy or chain 

of contingent conditions.16 For example, 

McGuire17 suggests that to be influenced by 

a message, an audience must be exposed to 

it, pay attention to and understand it, and 

develop a cognitive or affective response. 

These models assume that a break in the 

chain of contingency or a reduced outcome 

at any of the steps will lead to little or 

no response to the advertising. Many of 

*

Another approach is to examine the social-network and organizational levels separately. They are 

combined here for the sake of simplicity.
30

2 . T h e o r e t i c a l U n d e r p i n n i n g s o f M e d i a R e s e a r c h

these models also assume that attitudes 

and behaviors in response to persuasive 

messages are developed consciously and 

rationally,18 though it is equally conceivable 

that the processes that McGuire and others 

postulate operate at an automatic or 

unconscious level.

Expectancy-Value Theories of Attitude 

and Behavior Change

Like these early models, expectancy-value 

models implicitly assume that individuals 

have control over their choices and that they 

base their choices on information available 

to them. The expectancy-value models 

include two components as predictors of 

attitudes, or in the case of decision models, 

behavioral choice. The two components 

are an expectancy—the likelihood that 

the decision is associated with a particular 

outcome—and a value, that is, the positive 

or negative valence associated with that 

outcome. Introduced in various forms but 

dating back to early psychological research 

(e.g., behavioral decision theory19 and 

subjective probability theory 20), the core 

assumption of expectancy-value models is 

that people strive to maximize the perceived 

benefits and minimize the perceived costs 

associated with performing a behavior. 

In health behavior research, a number 

of these expectancy-value models (and 

variants) have been popular.

One of the more influential models in 

the health area is the Health Belief Model 

(HBM), which proposes that the cognitive 

activities in response to messages pertain 

to formulating beliefs about health risks 

and the health-protective qualities of 

certain behaviors. To preserve one’s 

health, modification of behavior may take 

place.21,22 The HBM assumes that selfdestructive behavior, such as smoking, 

occurs when individuals (1) do not have 

adequate information about the health 

risks posed by their behavior, (2) fail to 

understand their vulnerability to the 

consequences of their behavior, (3) fail 

to understand that avoiding the behavior 

will reduce health risks, or (4) encounter 

other informational barriers to behavior 

change. To promote smoking cessation, for 

example, the HBM, and expectancy-value 

models in general, suggest strengthening 

the individual’s perception of the risk and 

severity of the consequences of smoking 

and of their physical vulnerability to 

those consequences. At the same time, a 

persuasive message should try to reduce the 

perceived benefits of continued smoking 

as well as the barriers to changing the 

behavior, perhaps by increasing necessary 

skills to quit or perceived self-efficacy that 

quitting is possible and beneficial.

Like the HBM, the theory of reasoned action 

(TRA)23,24 and the theory of planned behavior 

(TPB)25 both argue that health behavior 

choices are reasoned and are based on the 

information available to the individual who 

is making the behavioral choice. According 

to these theories, an individual’s intention 

to act is the single best predictor of behavior 

(TRA), as long as the individual perceives 

that he or she has volitional control over 

the behavior (TPB). This intention to act 

is, in turn, influenced by one or both of 

two components: (1) attitudes toward 

performing the behavior, or one’s overall 

feeling of favorability toward performing 

the behavior, and/or (2) subjective norms, 

or the degree to which salient important 

referents are perceived to endorse (or not 

endorse) the behavior. Attitudes and norms 

are, in turn, influenced by underlying 

beliefs driving those attitudes and norms. 

For different groups of people, different 

consequences of performing the behavior 

may be salient and may be held with 

different belief strengths. As a result, the 

consequences driving the behavior for one 

group (e.g., teens) may differ considerably 

for another group (e.g., adults). Similarly, 

health communications may increase 

the salience and the strength of a belief 
31

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

that drives behavior. An assessment of the 

American Legacy Foundation’s “truth” 

campaign found that exposure to antiindustry messaging resulted in negative 

beliefs about industry practices and, 

accordingly, negative attitudes toward the 

tobacco industry. The increase in negative 

attitudes is linked to decreased progression 

toward intention to smoke and actual 

smoking behavior.15

Fishbein and colleagues26,27 extended the 

TRA and TPB by bringing together a number 

of different theoretical perspectives. They 

proposed the Integrative Model of Behavior 

(Integrative Model), arguing that there are 

only a finite number of determinants that 

lead to behavior change. The Integrative 

Model incorporates the construct of selfefficacy, originally proposed by Bandura in 

his social cognitive theory.28 Self-efficacy 

is the feeling of confidence one has in 

performing a recommended action. In the 

Integrative Model, the role of environmental 

factors, as well as skills and abilities of 

the individual to perform the behavior, 

are described as influencing the extent 

to which an individual’s intentions to 

perform the behavior will predict behavior. 

Intentions, in turn, are determined by 

attitudes toward the behavior, the perceived 

norms concerning the behavior, and 

self-efficacy in performing the behavior. 

Attitudes, perceived norms, and selfefficacy are functions of underlying beliefs 

associated with each of them. According 

to the Integrative Model, media messages 

should primarily target those beliefs that 

are associated strongly with behavioral 

intentions and determined by formative 

research. For example, an adolescent’s 

perceived norms toward smoking 

(e.g., whether friends or family think he 

or she should smoke) may influence the 

intention to smoke, in which case campaign 

messages may aim to change those norms. 

On the other hand, a smoker could have 

intentions to quit smoking but may lack 

the self-efficacy that would enable such 

behavior. Campaigns, in turn, may target 

self-efficacy.

Another theory that focuses on the 

individual’s perceptions of health 

consequences and self-efficacy is the 

protection motivation theory.22 This model 

emphasizes that whether one will change 

a health-damaging behavior such as 

smoking depends on the perceived severity 

of a threatened event (e.g., heart disease, 

lung cancer, emphysema), the perceived 

probability of the event, the efficacy of 

the recommended preventive behavior 

(the perceived response efficacy), and the 

perceived self-efficacy (i.e., the level of 

confidence in one’s ability to undertake the 

recommended preventive behavior). A 2006 

study29 based on this theory found that 

adolescents’ intention to smoke decreased 

more as a result of advertising that showed 

the disease and suffering of tobacco users 

than by anti-industry advertising. The key 

finding was that evoking empathy for those 

suffering from health problems caused by 

tobacco was an effective driver of reduced 

intention to smoke.29

Programs and strategies that encourage 

and support people to quit or not to 

initiate smoking, including antitobacco 

advertising, reflect many aspects of 

these expectancy-value models of health 

behavior change. For example, advertising 

may seek to highlight the increased risks 

posed by smoking, to stress the severity 

of conditions caused by tobacco or the 

personal probability of being affected, to 

communicate the health and other benefits 

of quitting smoking, to alert smokers of 

smoking cessation services that may help 

them quit, or to build smokers’ confidence 

to make quit attempts and keep trying 

to quit (trial behavior). According to 

the Integrative Model, provision of new 

message information can increase the 

salience of a new belief underlying attitudes, 

thereby affecting attitude change. Also, 

if intentions are determined by subjective 
32

2 . T h e o r e t i c a l U n d e r p i n n i n g s o f M e d i a R e s e a r c h

norms, then making salient key referents 

would be useful.

Another important theoretical framework 

for understanding individual behavior 

change, particularly regarding tobacco, 

is the Transtheoretical Model (TTM).30

As the name suggests, this model is the 

result of a review and synthesis of leading 

behavior change theories and focuses on 

the idea that behavior change is a process 

that occurs in stages. The concept of 

stages of change (individuals need different 

information and face different barriers while 

in different stages) is extremely popular 

and is often used for matching participants 

to intervention components. The TTM was 

developed with a focus on understanding 

smoking cessation patterns and has been 

used often in this context. A 2002 review of 

148 studies revealed that the evidence for 

use of the TTM with smoking was growing 

but not conclusive.31

Social Cognitive Theory

Social cognitive theory28 provides a dynamic 

model of learning in which people are 

viewed as engaging in proactive and selfregulating processes that enable them to 

adapt and change to their environment. 

Human behavior is viewed as a dynamic 

interplay among personal factors, behavioral 

factors, and environmental influences. 

One of the core methods for acquiring 

knowledge and skills, according to this 

theory, is by learning through observation 

and imitation of others. Learning is 

facilitated when individuals observe the 

behavior of others who are similar along 

key dimensions. Particularly relevant to the 

area of health communications is the role of 

symbolic modeling, in which the medium 

of observation is through mass media (such 

as television or movies) rather than face-toface observation (such as parent and child). 

In fact, symbolic modeling has potential for 

magnified impact because of the number of 

people that it can reach in diverse regions 

and because the attributes of certain role 

models (e.g., celebrities) may render them 

especially persuasive.

While social cognitive theory accords an 

influential role for mass media, audiences 

are conceived of as complex and active 

agents in the person-media relationship. 

People will not automatically mimic 

whatever is modeled. The prevalence, 

salience, accessibility, and functional 

value of modeled behavior are predicted 

to influence the audience’s attention. 

Model characteristics such as prestige or 

similarity to the audience member may also 

attract attention. The audience members 

may then retain knowledge and thoughts 

about the modeled behavior, or they may 

forget them. They may then go on to carry 

out modeled behaviors, or they may not. 

Motivational processes may play a role 

in reinforcing or averting the behavior. 

If the person receives material, social, or 

self-evaluative incentives for the behavior, 

or observes others benefiting from the 

behavior, he or she may be motivated to 

engage in similar conduct in the future. 

If negative consequences are observed to 

occur in response to modeled behaviors, 

the observer will be reluctant to follow suit. 

Learning is also a function of whether the 

individual feels capable of performing a 

behavior (self-efficacy).

A review of how social cognitive theory 

may help explain the impact of depiction 

of smoking in movies on adolescent 

experimentation is discussed in chapter 10. 

Dual Process Models of Attitude 

and Persuasion

Increasingly, researchers have recognized 

that in making health choices, consumers 

do not always conduct a systematic review 

of relevant information. Psychological 

models of persuasion called dual process 

models argue that one route to persuasion 

is effortful, systematic, and focused on 
33

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

persuasive arguments, but that a different 

route to persuasion is not effortful, and 

instead, is based on heuristics, peripheral 

cues, and experiential or affective 

processing. Early dual process models, and 

the ones most influential in psychology, 

marketing, and health communications 

during the past 20 years, include the 

Elaboration Likelihood Model (ELM) and 

the Heuristic-Systematic Model (HSM).32,33

The ELM suggests that attitude change 

can occur via a central route (based on 

purposeful information-processing activity 

aimed at uncovering the central merits of 

an issue) or via a peripheral route (based on 

low-effort attitude change). The route used 

depends on level of motivation and ability 

to assess the central merits of a message. 

Thus, when motivation or ability to process 

a message is low, attitudes are more likely to 

be changed by relatively simple associations, 

such as classical conditioning or heuristics 

retrieved from memory. Attitudes formed 

by this route are hypothesized to be less 

enduring and less likely to lead to longterm behavior change. As shown by Petty 

and Cacioppo,33 people exposed under 

low-motivation conditions agree with a 

message more if there are more arguments, 

whereas people under high-motivation 

conditions agree with a message more if the 

arguments are more compelling. Thus, at 

the low-motivation end of the elaboration 

continuum, it is the quantity and/or type of 

cues that affects the degree of persuasion; at 

the high motivation end of the continuum, 

it is the quality of the message arguments 

and the relevance of other cues to the 

message that affect persuasion.

Other dual process models focus more 

explicitly on affective, sensory cues (such as 

visual imagery) and/or experiential processes 

as the alternative to the systematic, 

effortful route to persuasion. These cues are 

relevant in the present context, as tobacco 

promotions often use symbolic imagery 

that could be highly persuasive under lowmotivation conditions (chapters 3 and 4). 

For example, in observing how individuals 

respond to advertising messages and 

other information in the environment, 

Hibbard and Peters34 describe two modes 

of thinking that can determine judgments 

and decision making: one is analytic 

and logical; the other is emotional and 

intuitive. The former, termed rational, is 

a conscious mode that takes a relatively 

longer time to occur and, the authors 

argue, has developed rather late in human 

evolutionary development. The latter mode, 

termed experiential, is less than conscious, 

occurs rapidly, and is hardwired because 

of its survival value. The role of emotion, 

mood, and other affective and experiential 

responses in decision making has increased 

in research importance over the past decade. 

Emotional states guide both decisions and 

perception of information35 and can function 

as information in and of themselves (i.e., if it 

feels good, it is probably good for me; if it 

feels bad, I should stay away).

Using multiple pathways to changing 

attitudes was also emphasized in research 

in social and consumer psychology36

published in 2006. While the traditional 

view of attitudes is that an attitude is 

an enduring evaluative summary that 

guides behavioral choices (an assumption 

underlying many expectancy-value models), 

later evidence suggests that attitudes are 

less stable across time, situations, and 

environmental contexts than previously 

thought.37 The enduring nature of attitudes 

may depend on whether they have been 

formed as a result of “central” or peripheral 

reasoning. Attitudes may be constructed 

on the spot on the basis of the information 

available in the context in which the attitude 

is reported.37 Furthermore, researchers have 

argued that individuals may have two types 

of attitudes: an explicit attitude based on 

reported cognitions and an implicit attitude 

based on more automatic stored affective 

responses.38–40 An individual may also 

experience ambivalent attitudes,41 such that, 

for example, a teenager’s former (implicit) 
34

2 . T h e o r e t i c a l U n d e r p i n n i n g s o f M e d i a R e s e a r c h

attitude toward smoking may have been 

positive, but with increasing antismoking 

messages received, two types of attitudes 

(one positive implicit attitude and one 

negative explicit attitude) may form. Over 

time, if the positive (but not the negative) 

associations with smoking are rejected, the 

formerly positive implicit attitude may be 

replaced with a negative implicit attitude.

Media, Message Structure, and 

Information Processing

Studies in the psychology of communication 

may draw on physiological and biological 

processes that mediate audience reactions to 

mass media communications.42–45 According 

to this approach, people’s reactions to media 

messages, a form of environmental stimuli, 

are subject to both their capacity and their 

motivation to process the information. 

For example, the Limited Capacity Model 

of Motivated Mediated Message Processing 

argues that people have a limited capacity to 

process information and allocate cognitive 

resources selectively to encode, store, 

and retrieve information.45 Drawing on 

an evolutionary approach, these studies 

suggest that the mechanisms for encoding, 

storage, and retrieval of information 

depend on motivation for either survival or 

avoiding danger. In fact, the relationship 

between mass mediated messages and 

underlying cognitive and motivational 

systems is dynamic and interactive and is 

subject to the nature of the medium and 

the structure of the message. This means 

that some media and certain messages elicit 

different responses in different individuals, 

phenomena that must be taken into account 

in designing persuasive communications. 

Messages can be designed so they are novel 

(sensation seeking),46 indicate importance, 

or are motivationally salient, and to reassure 

the audience in its motivation for survival 

or to avoid danger. These theories have been 

applied to examine campaign effects on 

stemming illicit drug use and smoking.

Media-Message Effects, Information 

Processing, and Behavior Change

The effects of mass media on health 

outcomes such as tobacco use are influenced 

by both the channels in which the media 

messages are placed, as well as the 

construction of the message, including its 

format and content. The theories discussed 

so far address (1) the routes to behavior 

change by identifying determinants of 

behavioral intentions or behaviors by 

focusing on beliefs, affect, and/or experiential 

processes that need to be targeted to promote 

change and (2) information processing 

theories that examine the psychological 

processes that influence exposure, attention, 

encoding, and acceptance of messages.47

Work on message-effects theories adds to 

the understanding of the impact of mass 

mediated messages on health outcomes 

by addressing more explicitly executional 

elements of a message. Message-effects 

theories explain which features of the 

messages are likely to lead to certain 

health outcomes, and in combination 

with information processing and behavior 

change theories, connect media messages 

with behavioral outcomes.47 Message-effects 

theories provide a way to understand how 

mass media messages could break through 

the clutter of the information environment 

to reach and influence the target audience.48

Researchers have identified numerous 

message features and executional approaches 

that may be important in advertising and 

persuasive communications: emotional 

appeals,49 tailoring,50 narratives,51 frames,52

and exemplars,53 to name just a few. Like 

dual process models,33 these characteristics 

of messages are postulated to work through 

the motivation and ability of the intended 

audience; affect their exposure, attention, 

and recall; and finally, determine if the 

audience member has accepted the message 

or not. As Viswanath and Emmons48 point 

out, these individual-level cognitive and 
35

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

affective factors that mediate message effects 

with behavior change are also influenced by 

social determinants such as culture, class, 

race, and ethnicity.

Media Messages and Neural 

Marketing 

An emerging practice of using brain imaging 

through functional magnetic resonance 

imaging or positron emission tomography 

scanning to understand people’s responses 

to external stimuli such as advertising 

messages has begun to attract the attention 

of advertisers and marketers, bioethicists, 

and consumer advocates. This practice, 

sometimes called neural marketing, draws 

from the latest developments in cognitive 

neuroscience54 and the growing availability of 

neural imaging facilities. Neural marketing 

claims that a person’s response to favorite 

commercial brands or images and responses 

to stimuli such as advertising messages can 

be mapped through brain imaging.55

Advertisers and marketers are reported to 

have spent an estimated $6.8 billion in 2002 

on such market research tools as focus 

groups and surveys to understand audience 

perceptions of and reactions to product 

promotions.55 Brain imaging technology 

offers yet another tool, with a scientific 

imprimatur, to understand how audiences 

react to marketing communications. Despite 

debate over its utility in communications 

practice, proponents of this approach 

argue that imaging of neural activity in the 

brain reveals unconscious preferences or 

underlying predilections of the audience 

when exposed to stimuli.56

For example, when subjects in an 

experiment viewed their favorite brands, 

the parts of the brain associated with 

rewards were activated compared with 

portions of the brain that deal with 

reasoning.57 In other words, seeing favorite 

brands may reduce more-conscious 

reasoning, a possible effect of exposure to 

years of advertising. Schaefer and Rotte58

speculate that such unconscious associations 

could potentially influence behavior by 

biasing product choice based on brands. 

The reliance on neurocognitive science is a 

response, in part, to the dual process theories 

discussed earlier. For example, research has 

shown that attitude change as a result of 

messages that engender central or systematic 

processing is effective when consumers’ 

attitudes are strong and enduring, relative 

to messages that rely on more superficial 

or peripheral cues.32,33 Work is now under 

way to understand if these different routes 

of persuasion could lead to neural activities 

in different parts of the brain. In addition 

to understanding persuasion to promote 

product use, work in neurocognitive science 

may also be helpful in understanding how 

different messages and images could lead 

to more systematic processing by observing 

neural activities in the brain. The field of 

neural marketing is just beginning to attract 

attention by scholars and practitioners alike 

and bears watching.

Mass Media and Addiction 

While the literature suggests that media have 

a strong role to play in tobacco prevention, 

the role of media in cessation is also critical 

(chapters 11 and 12). Highly arousing media 

messages could result in central processing 

and lead to quitting smoking as Biener and 

colleagues report in their study.59 More 

research is needed to determine how the 

impact of media on tobacco prevention 

and cessation may vary among persons at 

different levels of tobacco dependence.

Mass Media Messages and 

Interpersonal Communication 

Most media-effects theories focus on 

psychological or intra-individual factors 

associated with message or campaign 
36

2 . T h e o r e t i c a l U n d e r p i n n i n g s o f M e d i a R e s e a r c h

effectiveness. In contrast, diffusion of 

innovations theory60 has also incorporated 

interpersonal and sociological factors such 

as cultural compatibility, interpersonal 

persuasion, and social networks. Few 

researchers have attempted to combine 

studies of media influence with studies 

of interpersonal influence on behavior. 

The lack of research on this topic stems 

from a long-standing divide in the field of 

communications between interpersonal 

communication scholars, typically located 

in departments of speech communication, 

and those interested in media effects, 

who are typically trained in many other 

disciplines (e.g., psychology, sociology, 

political science) but housed in departments 

of communications and/or journalism.61,62

Yet, mass media and campaign influences 

do not happen in a vacuum; they are 

filtered by peer networks, peer groups, 

and cultural attitudes.

The one model developed from 

communication studies that combined 

media and peer influence is the twostep flow hypothesis. This hypothesis of 

communication effects proposes that the 

media influence opinion leaders, and these 

leaders in turn influence others in their 

community or social networks.63,64 To be 

effective, the media need influence only 

leaders, who are expected to spread the 

media’s messages to other members of 

the community. Research on the two-step 

flow hypothesis has been scant in the past 

few decades. This is partly because few 

scholars study both mass and interpersonal 

sources of influence on behavior and partly 

because sophisticated tools for the study 

of social network analysis have been slow 

in developing. There is some evidence to 

support the two-step flow model,65 and 

researchers have proposed variants and 

extensions that broaden its theoretical 

contribution.66

While this review of individual-level 

processes is necessarily brief and cannot 

capture all of the numerous theories of 

health cognition, affect, and behavior, 

it shows the range of psychological processes 

that have been studied to understand the 

effects of mass media on an individual’s 

health choices. They also provide an 

idea on how to understand the effects of 

media on tobacco control and tobacco 

promotion. The next section discusses the 

structure of communication organizations 

and how organizational processes and 

the occupational practices of professional 

communicators influence both the 

production of media products and the effects 

of media on different target audiences. 

Organization-Level Analyses 

and Tobacco-Related 

Communications

Ettema and Whitney67 argue for an 

institutional conception of mass media in 

contrast to earlier approaches that focused 

on direct transfer of messages between the 

sender and the receiver. In this conception, 

the media, including the people who 

work within them, are a part of the larger 

industrial and cultural systems wherein 

audiences are one element of many agencies, 

groups, companies, and professionals who 

interact with each other.

For example, a market research agency 

may collect data on the readership of a 

local newspaper, including the consumer 

products that readers use. Tobacco products 

could be an example: data may be gathered 

on use patterns or the potential for 

tobacco use among newspaper readers, 

and those data may, in turn, be shared 

with advertisers (tobacco companies) 

and advertising agencies for the tobacco 

companies. Agencies may then construct and 

disseminate messages promoting tobacco 

use targeted at readers of the newspaper.

In this conception, the clients (advertisers), 

the advertising agency, and the media 
37

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

“constitute” the audience in that they 

have economic or some other meaning 

to the industry, a process that Ettema 

and Whitney67 term audience-making.

In this process, audience tastes, interests, 

user styles, and preferences are tracked, 

measured, packaged, and used to offer 

services and products. In short, the media 

production process occurs within the 

context of complex organizations set 

in larger social, cultural, and economic 

milieus. The advantage of such a conception 

of media organizations is that the focus 

goes beyond the exchange of messages 

between the sender and the receiver to a 

view of components of a broader ecology of 

media: producers, advertisers, agencies, and 

sources of news, among others (figure 2.1). 

Such a conception may also influence 

how an audience is viewed.67 The tobacco 

companies may visualize the audience for its 

advertising and promotions as “consumers,” 

whereas tobacco control advocates may 

see the audience in this case as “victims.” 

While the audience may try to influence the 

medium through subscription or viewership, 

there is, in general, asymmetry in power 

between the medium and audience, given 

the complex media ecology. More specifically, 

an action such as the cancellation of a 

subscription by an individual audience 

member is unlikely to have an influence on a 

medium that is in complex relationship with 

other media organizations such as public 

relations and advertising agencies.

The structure and organization of the 

media industry, therefore, are critical 

to understanding the functions of mass 

media and their products. The products 

that emanate from mass media—news, 

advertising, and entertainment—are very 

much influenced by how the media industry 

is structured, the competing sources of 

influence, and the nature of subsidy that 

sustains media organizations. Mass media 

institutions are bureaucracies in which 

organizational functions, hierarchy, roles, 

and culture are well defined (figure 2.1).

Given this description, even though there 

are differences among media industries on 

how message and media production are 

organized, there are several commonalities 

that characterize the contemporary media 

industry. These may be discussed along 

the following lines: (1) specialization 

of structure, functions, and content; 

(2) a methodical approach to occupational 

practices; (3) a demand for information and 

a reliance on information subsidies; and 

(4) reliance on social science.

Figure 2.1 Institutional Conception of Media Organization

Feedback loop: circulations, readership, ratings, and box-office receipts

Sources of

Influence

News sources

Markets (audience)

Advertising

Advertisers 

Media

Organizations

Employees

Routines

Culture

Hierarchy

Subsidies

Financial

Informational

Exemplar

Products

News

Entertainment

TV shows

Movies

Video games

Advertising

Web sites

Constituted

Audience

Readers

Viewers

Consumers
38

2 . T h e o r e t i c a l U n d e r p i n n i n g s o f M e d i a R e s e a r c h

Specialization of Structure, Function, 

and Content

As proposed earlier, media organizations 

are typical of many complex organizations. 

Even though the nature of a product—

advertisement, news story, movie, television 

show, or music—may involve creativity and 

symbol manipulation, media institutions 

are structured and organized to generate 

their products efficiently, predictably, and 

routinely. The degree of specialization 

depends on the size of the organization, 

but there are similarities in organizational 

structures of the media.

Newspapers, for example, are organized 

along editorial and business lines with 

separation of functions and reporting 

authority. The news side, for example, is 

usually protected from the advertising 

side to foster a sense of independence 

and objectivity, though there are always 

tensions between the two.68–70

Television separates its entertainment, 

news, and business functions. Strategic 

communications agencies such as public 

relations and advertising have departments 

that oversee client services, media planning, 

and message development.

This separation of functions and structure 

does not mean that there are not occasional 

breaches or, in some cases, greater 

interaction among different departments. 

The degree of separation varies by medium, 

with the editorial side of a news medium 

enjoying greater autonomy compared with 

departments in a typical advertising or 

public relations agency.

Systematic Approach to Occupational 

Practices

The media production process is 

systematic and organized even though it 

may appear random to an untrained eye. 

The occupational practices of professional 

communicators are structured to generate 

the product efficiently and expeditiously.

Journalism, for example, is divided along 

two broad lines: editorial and reporting. 

The editorial side usually oversees the 

selection, presentation, and placement of 

news stories. The editorial side may also 

present different positions on a subject to 

reflect broader opinion among significant 

publics. Thus, the editorial/opinion side 

of the newspaper may present contrasting 

positions on regulating secondhand smoke 

in public places and may even take a 

formal position on supporting or opposing 

such regulations.

Reporters follow a well-designed set of 

informal rules, occupational practices, 

and news values in selecting and reporting 

stories. For example, to structure the world 

to make news gathering efficient, media 

organizations often organize news gathering 

into “beats.”71,72 Beats may be organized 

along geopolitical lines such as the activities 

of various governmental bodies; along 

topics or subjects such as business, health, 

entertainment, or the environment; or along 

a combination of both geopolitical and 

topical lines such as Wall Street. Reporters 

and editors also follow a set of well-defined 

news values73 in selecting, developing, and 

writing stories. News sources—human 

contacts such as legislators, policymakers, 

spokespersons, public relations personnel, 

and activists, among others—often influence 

reporters and editors in this enterprise.

Tobacco companies and tobacco control 

advocates, respectively, have been able to 

use this knowledge to aggressively promote 

tobacco use or frame news to communicate 

the risk associated with tobacco use 

(chapters 4 and 9). 

A similar systematic approach is also 

practiced in other media industries, such 

as public relations and advertising, as has 
39

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

been well investigated in the case of tobacco 

(see chapters 4 and 6).

A Demand for Information and 

Reliance on Information Subsidies

It is trite but true that professional 

communicators are in the business of 

information. They gather, process, and 

disseminate information to different 

audiences. Public relations practitioners 

and spokespeople for agencies gather 

information from their “clients” either 

within their organization or outside the 

organization, massage it to make it suitable 

for presentation in the form of either a 

news release or a story idea, and pitch it to 

reporters or other stakeholders (see detailed 

discussion of the tobacco industry’s public 

relations efforts in chapter 6). Advertisers 

draw extensively on market and consumer 

research to produce messages. Journalists 

rely on their sources, such as press 

spokespersons, the person on the street, 

or anonymous sources, or on nonhuman 

sources such as press releases,73 databases, 

or Web sites to develop their stories. 

Such mutual reliance spawns a symbiotic 

relationship, particularly between the 

press and public relations, despite tensions 

between the two. The “information subsidy” 

provided by the sources can influence 

whether a story will be covered and, 

potentially, how it will be covered.71,74 While 

reporters may rely on sources, particularly 

for story ideas and in developing stories, 

they also have some autonomy in selecting 

the sources and framing the stories.75,76

Social Science and Professional 

Communications

The evolution of the social sciences, 

particularly in the area of measurement, 

has had considerable influence on 

the development of professional 

communications.8 Sophisticated audience 

measurement techniques, such as Nielsen’s 

people’s meters, allow for segmentation 

of the audience and specialization of 

media content that can be more effectively 

used by advertisers to sell their wares 

and by programmers to offer programs.77

Market research has enabled advertisers 

to identify, assess, target, and even create 

markets for various products. Audience 

and media-effects research has enabled 

strategic communicators to promote causes, 

ideas, and services for both public good 

and ill. Reporters rely on such strategies 

as “objectivity” to distance themselves, 

and they communicate that distance to 

the audience. While objectivity is not a 

strict social science technique, the idea of 

presenting different sides to verify a story 

uses social science principles to achieve 

objectivity. Public opinion data, for example, 

are routinely used in news stories.

Organization-Level Analyses: Summary

Although the early history of media studies, 

particularly the sociology of journalism, 

focused on studying communications with a 

narrow emphasis on senders and receivers, 

some later research took a more institutional 

approach in examining the media industry 

within a larger political, economic, and 

cultural context.67 Such an institutional 

approach does not ignore or deny lessons 

learned from earlier approaches but broadens 

our understanding of how media work. This 

approach provides a useful framework for

n Examining not only the contemporary 

structure of media industries but also 

tracking their future trajectory as media 

industries evolve.

n Providing a wider lens within which 

to examine media effects without 

limiting them to one genre or 

medium. For example, when tobacco 

advertisements were banned from 

U.S. television and radio in 1971, the 

tobacco industry successfully shifted its 

tactics to billboards, product placements, 
40

2 . T h e o r e t i c a l U n d e r p i n n i n g s o f M e d i a R e s e a r c h

and sponsorship. Billboards seen on 

sports telecasts, for example, allowed the 

industry to overcome the ban and still 

display protobacco messages and images 

in broadcast media.

n Exhibiting more clearly the asymmetry 

in power between the audience and the 

media industry.

n Identifying clearly the nexus of 

interdependence as well as conflict 

among different segments of the industry, 

providing a more dynamic view of that 

relationship.

n Providing a means to follow the trajectory 

of the evolving media industry and 

business models that shape the creation 

of demand and markets for products 

and behaviors.

Societal-Level Theories 

in Tobacco-Related 

Communications

Although the individual has been the most 

visible and dominant unit of analysis in 

media studies, social and societal-level 

concerns over the role of the media have 

been a subject of abiding interest among 

scholars. As Hardt and Carey78 write, 

the sociological conceptions of mass 

communications emerged out of scholars’ 

need to explain emerging social changes 

and growing inequalities. Social theorists 

including Marx, Weber, Robert Park, and 

others, Hardt and Carey elaborate, focused 

attention on the “social production of 

consciousness”—that is, communications or 

agencies that produced the consciousness. 

Mass communication was the essence of 

modern social organization and integration, 

Hardt and Carey opine, as the circulation 

and exchange of ideas were made possible 

by modern means of communications—

books, pamphlets, and newspapers. 

Subsequently, the “Chicago school” of 

sociology, represented primarily in the work 

of Robert Park and his students, examined 

the role of community and immigrant 

presses in social and community integration.

This early commitment to social theories of 

communications became less visible because 

a concern stemming from resistance to 

World War II propaganda shifted attention to 

the study of attitude formation and change. 

This research was pursued more vigorously 

at Yale University after World War II.

Work at the societal level of analysis, 

however, was continued by such scholars 

as Janowitz.79 Two developments in the 

1960s and 1970s are germane to tracking 

the evolution of societal-level analysis and 

to tobacco control: (1) the evolution of 

the structural model with its focus on the 

community press, social conflict, and social 

change and (2) the cognitive revolution.

Social Conflict, Social Change, and 

the Media

The 1970s and 1980s saw the emergence 

of a vigorous body of work that examined 

(1) the role of the media as agents of social 

control60,80–82 and agents of social change83

and (2) the media’s role in social movements 

and social conflicts.84,85 This body of work 

offered considerable insight into how 

different institutions in the larger society 

interact with the mass media industry, 

leading to certain kinds of media content, 

and hence, media effects.

While individual programs of research and 

scholars working at this level may differ 

in details, in general a structural approach 

proposes the following:81

n Mass media, more often than not, are 

responsive to the more powerful forces 

in the system; that is, in general, the 

interests of the elite may take precedence 

over the interests of the less powerful. 

In fact, media and other powerful groups 

are interdependent. For example, news 

media may rely on advertising as a 
41

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

source of revenue and are organized to 

meet those interests. The division of a 

newspaper into sections such as metro, 

sports, and business is a way to provide 

advertisers with segmented audience 

subgroups who have common interests, 

while maintaining and satisfying the 

interests of the readers.

n Media messages reinforce dominant 

values and support existing social 

arrangements, that is, social control. 

The social norm regarding smoking 

is a reflection of this principle in 

practice. Smoking has evolved from 

a widely accepted and even highly 

encouraged phenomenon to the norm 

that it is unacceptable to smoke given 

its deleterious consequences for smokers 

and those exposed to secondhand smoke.

n Though they are highly responsive 

to the common power arrangements, 

the media are neither “lapdogs” nor 

completely independent “attack dogs.” 

They play more of a “guard dog” function 

wherein they may protect the system 

though punish individual actors who 

abuse or threaten it.86

n Media may also advance the interests 

of social movements such as women’s 

rights or civil rights,82 challenging the 

status quo under the right conditions. 

The success of the tobacco control 

movement that led to its evolution 

from margins to mainstream is a good 

exemplar of how media can amplify the 

voices of those who challenge the status 

quo under the right conditions,87 often 

using a “media advocacy” approach.88

The tobacco control movement has used 

media advocacy quite effectively in a number 

of situations. One effect was seen when 

the impact of the American Stop Smoking 

Intervention Study (ASSIST) project was 

assessed. Major goals of ASSIST were to 

use media advocacy techniques to increase 

media coverage of tobacco control activities 

and encourage comprehensive tobacco 

control as well as increase public discussion 

and debate regarding tobacco control. 

Program affiliates interacted with newspaper 

editorial boards to encourage pro-health 

messages; they developed relationships with 

community members and key reporters, 

used paid advertising and unpaid public 

service announcements, and relied on their 

knowledge of media outlets to increase the 

presence of pro-health messages. When 

researchers assessed the impact of the 

ASSIST program, they found that compared 

with states without the program, the states 

with the ASSIST program had significantly 

more local newspaper articles that supported 

tobacco control as well as pro-health letters 

to the editor.89

An effective and inexpensive media advocacy 

strategy used in Australia was to issue 

media releases about newsworthy research 

regarding debates on tobacco control so 

that newspapers would increase tobacco 

control coverage. In one metropolitan area, 

six media releases were linked to 58 of 283 

(20.5%) news reports on tobacco control 

during the study period.90

Media Effects at the Societal Level

Some have argued that the 1960s also 

saw a shift in communications research, 

from focusing on media effects on attitude 

change or reinforcement to a focus on 

cognitions: knowledge, public opinion, 

and social reality. In communications 

research, this has been called the cognitive 

revolution. Several major hypotheses 

predicting media effects were formalized 

during this era, including the knowledgegap hypothesis,91 the agenda-setting 

hypothesis,92 the spiral of silence,93 and the 

cultivation hypothesis.94

The knowledge-gap hypothesis proposes 

that the flow of information on a topic 

will be taken advantage of more quickly by 

people from higher socioeconomic status 
42

2 . T h e o r e t i c a l U n d e r p i n n i n g s o f M e d i a R e s e a r c h

(SES) compared with people from lower 

SES, thereby widening the knowledge gaps 

between them.91,95 For example, despite 

four decades of sustained attention in 

media, health, and policy circles, those with 

higher education and income were much 

more likely to know that tobacco use could 

lead to lung cancer compared to those 

with less education and lower income.96

The agenda-setting hypothesis posits that the 

news media, through selective coverage and 

amplification of certain topics, govern the 

importance the public assigns to those topics 

as opposed to issues that do not receive any, 

or minimal, coverage. In fact, some have 

suggested that media effects exceed setting 

priorities to include shaping audience 

perceptions though “framing,”75,97–99 thereby 

communicating the impression that one 

view is more acceptable than others. Over 

time, this may lead to silencing alternative 

viewpoints—a spiral of silence—even though 

a majority may share them.93,100

An example of agenda setting can be 

found in terms of framing the debate over 

tobacco. A content analysis of newspaper 

coverage during the U.S. tobacco settlement 

deliberations in 1997–98 demonstrated 

that tobacco was portrayed as an issue of 

adolescent smoking rather than as a deadly 

behavior and public health hazard. Similarly, 

revenue generation and advertising 

restrictions, rather than the health 

consequences of smoking, were major 

themes of discussion. The key conclusion 

from the study was that public health 

professionals must take better advantage of 

these opportunities to frame the discussion 

in a manner favorable to public health.101

Similarly, an analysis of U.S. newspaper 

articles that focused on adolescents suggests 

that the articles framed the concept that 

tobacco issues should be resolved via 

individual-level education as opposed to 

structural or policy changes.102

The cultivation hypothesis suggests that 

persistent and sustained exposure to media 

content cultivates a stilted worldview that is 

congruent with the media content to which 

the audience is exposed.94,103 Exposure to 

smoking in movies and other media, for 

example, can lead viewers to a perception 

that smoking is common and normative 

even if this is not so in the real world.104

In fact, the role of entertainment media 

in shaping popular conceptions of social 

mores and lifestyles—including knowledge, 

beliefs, and behaviors in health—has been 

a subject of intense interest and debate 

throughout the history of communications 

research as discussed earlier in this chapter. 

The influence of entertainment media, 

particularly movies, on tobacco use is well 

documented (see chapter 10). The power 

of the narratives stems from a process 

in which the viewer becomes immersed 

in, or “transported” by, the story and, 

consequently, is less likely to argue against 

the message. The narratives provide role 

models for behaviors, create attitudes and 

beliefs consistent with the message, and 

generate empathy.51 Not surprisingly, movies 

have been found to have a powerful influence 

on adolescent smoking (see chapter 10). 

Evidence (and the conditions under which 

the hypotheses hold true) varies, but 

macrolevel theories of media effects have 

been successful in spawning systematic 

programs of research and shifting attention 

to effects of media on large populations, 

social classes, social organizations, social 

movements, and institutions.

Communication Inequalities

U.S. smoking rates have steadily declined 

since the publication of Surgeon General 

Luther Terry’s 1964 report on the harmful 

effects of smoking, aided by scientists, 

grass-roots social movements advocating 

policies to stem tobacco use, and the 

reactions and response of policymakers. 

Yet the decline in smoking has not been 

uniform across social groups. Research has 

extensively documented that smoking is 
43

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

higher among those with less education, low 

income, or blue-collar jobs; among those 

without jobs; and among people of specific 

ethnic and racial backgrounds.105 Morbidity 

and mortality caused by smoking also 

disproportionately affect lower SES groups. 

These disparities in smoking prevalence and 

tobacco-attributable disease are similar to 

the disproportionate burden faced by lower 

SES and certain ethnic and racial minority 

groups for chronic diseases such as cancer, 

cardiovascular disease, diabetes, high blood 

pressure, and asthma.

Reasons for these disparities are many: lack 

of access to health services or a usual source 

of care, lack of insurance, living in poor 

neighborhoods with limited amenities and 

an unhealthy environment, and racism and 

racist social policies, among others.106–109

In addition, studies have suggested that 

inequalities in communications contribute 

to health disparities. Communications 

inequality may be defined as differences 

among social classes in the generation, 

manipulation, and distribution of 

information at the group level and differences 

in access to and ability to take advantage of 

information at the individual level.1,96

Disparities in tobacco-use prevalence and 

disease outcomes can partially be explained 

by communication inequalities. Tobacco 

companies have been powerful social 

actors with resources and institutional 

structures to generate and distribute 

information favorable to their point of view, 

as is documented in several chapters in 

this monograph. The sophisticated public 

relations and strategic communication 

operations, either within the company or 

through outside agencies, have facilitated 

the dissemination of information counter 

to tobacco control. Scientists, think tanks, 

and editorialists sponsored by the tobacco 

industry have worked strenuously to cast 

doubts on the links between smoking 

and disease and on the health effects of 

secondhand smoke and have argued that 

tobacco control poses a threat to the 

personal liberty of smokers. Analysis of 

internal tobacco company documents 

demonstrates the extent to which tobacco 

companies were able to influence journalists’ 

reports regarding scientific findings on 

tobacco and undermine the credibility of 

the Environmental Protection Agency.110,111

The federal government, supported by 

tobacco control organizations and scientists, 

has attempted (with some success) to 

counter the tobacco industry’s efforts.

Inequalities in communications have also 

been demonstrated at the individual level. 

Studies have documented knowledge gaps 

between social groups on the harmful 

effects of smoking96,112 and the effects of 

secondhand smoke.113 Knowledge gaps have 

also been found in framing tobacco control 

policies as curbs on individual liberties. 

Persistent advocacy in the media through 

news and advertising casting doubts on the 

evidence of injurious effects of smoking may 

also deter information processing among 

those from lower SES groups.

Attempts to explain disparities in outcomes 

caused by tobacco have proceeded slowly. 

The contribution of communication 

inequalities to these disparities is ripe for 

further research.

Societal-Level Theories: Summary

The macrolevel approach in media studies 

has provided insights into how the media 

act and interact with other major social 

institutions, thus shifting the attention of 

scholars and policymakers to the population 

level of the impact of mass media. This shift 

from the individual to society has laid bare 

the asymmetric power structure between 

the audience and the media, the difficulties 

individuals may face in bringing about 

change in media practices, and the conditions 

and strategies with which the media can 

promote social change against established 
44

2 . T h e o r e t i c a l U n d e r p i n n i n g s o f M e d i a R e s e a r c h

interests. With tobacco being consumed all 

over the world, this approach is particularly 

useful to tobacco control proponents, given 

the global scale, reach, and organization of 

the tobacco industry and the global burden 

resulting from tobacco use.

Summary

The study of media in tobacco use can be 

seen not only as a multilevel process but as 

an evolutionary one as well, which in fact 

parallels the path of tobacco control itself 

over time. In the early days surrounding the 

release of the 1964 Surgeon General’s report 

on smoking and health, tobacco control 

was often seen as an issue of educating 

individuals, leading to media interventions 

such as antismoking television advertising 

under the Federal Communications 

Commission’s Fairness Doctrine in the 

1960s.114,115 Over time, both tobacco 

control and its concomitant media efforts 

evolved to a much broader social context of 

community-level interventions such as the 

Community Intervention Trial for Smoking 

Cessation. Eventually, these efforts extended 

to broader policy interventions, such as 

today’s clean indoor air laws, tobacco taxes, 

and industry agreements such as the 1998 

Master Settlement Agreement, and included 

global efforts such as the World Health 

Organization’s Framework Convention on 

Tobacco Control.116–118 The evolution across 

individual, organizational, and societal levels 

of media research reflects how we have come 

to view not only tobacco control efforts 

but also larger issues of public health and 

social change.

Today, we realize that the media, tobacco 

use, and tobacco control efforts all interact 

at multiple levels of a system, each of 

which may affect stakeholders ranging 

from individuals to society itself. In the 

process, fields ranging from public health 

to cognitive psychology have become 

essential parts in a growing transdisciplinary 

science of smoking and health, supported 

by research frameworks such as the ones 

outlined here. We have already seen the 

fruits of many of these efforts in the form of 

reducing per capita cigarette consumption 

rates by approximately one-half in the 

United States since their peak in the 1960s119

along with more fundamental changes in 

social attitudes toward tobacco use. These 

changes give hope that today’s media, whose 

history is intertwined with the widespread 

emergence of tobacco use over the past 

century, can continue to serve as a critical 

tool in addressing what remains as the 

nation’s leading cause of preventable death.
45

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

References

1. Viswanath, K. 2005. Science and society: 

The communications revolution and cancer 

control. Nature Reviews Cancer 5 (10): 

828–35. 

2. Borio, G. 2007. The tobacco timeline. 

http://www.tobacco.org/History/

Tobacco_History.html.

3. Ewen, S. 1976. Captains of consciousness: 

Advertising and the social roots of the 

consumer culture. New York: McGraw-Hill.

4. Maxfield, A. 2004. Information and 

communication technologies for the 

developing world. Health Communication 

Insights. http://comminit.com/en/node/

212794.

5. Chaffee, S. H., and J. L. Hochheimer. 1985. 

The beginnings of political communication 

research in the United States: Origins of 

the ‘limited effects’ model. In The media 

revolution in America and western Europe,

ed. E. M. Rogers and F. Balle, 267–96. 

Norwood, NJ: Ablex Publishing.

6. Czitrom, D. J. 1982. Media and the American 

mind: From Morse to McLuhan. Chapel Hill, 

NC: Univ. of North Carolina Press.

7. Delia, J. G. 1987. Communication research: 

A history. In Handbook of communication 

science, ed. C. R. Berger and S. H. Chaffee, 

20–98. Newbury Park, CA: Sage.

8. Rowland Jr., W. D. 1983. The politics of 

TV violence: Policy uses of communication 

research. Beverly Hills, CA: Sage.

9. Wartella, E., and B. Reeves. 1985. 

Historical trends in research on children 

and the media: 1900–1960. Journal of 

Communication 35 (2): 118–33. 

10. Chaffee, S. H., and C. R. Berger. 1987. What 

communication scientists do. In Handbook 

of communication science, ed. C. R. Berger 

and S. H. Chaffee, 99–122. Newbury Park, 

CA: Sage.

11. Sherif, M., and C. I. Hovland. 1961. Social 

judgment: assimilation and contrast effects 

in communication and attitude change.

Yale Studies in Attitude and Communication, 

vol. IV. New Haven, CT: Yale Univ. Press.

12. McAlister, A., T. C. Morrison, S. Hu, 

A. F. Meshack, A. Ramirez, K. Gallion, 

V. Rabius, and P. Huang. 2004. Media and 

community campaign effects on adult 

tobacco use in Texas. Journal of Health 

Communication 9 (2): 95–109. 

13. McVey, D., and J. Stapleton. 2000. Can 

anti-smoking television advertising affect 

smoking behaviour? Controlled trial of the 

Health Education Authority for England’s 

anti-smoking TV campaign. Tobacco Control

9 (3): 273–82. 

14. Evans, W. D., E. Crankshaw, C. Nimsch, 

A. Morgan-Lopez, M. C. Farrelly, and 

J. Allen. 2006. Media and secondhand smoke 

exposure: results from a national survey. 

American Journal of Health Behavior 30 

(1): 62–71. 

15. Hersey, J. C., J. Niederdeppe, W. D. Evans, 

J. Nonnemaker, S. Blahut, D. Holden, 

P. Messeri, and M. L. Haviland. 2005. The 

theory of “truth”: How counterindustry 

campaigns affect smoking behavior among 

teens. Health Psychology 24 (1): 22–31. 

16. Lavidge, R. J., and G. A. Steiner. 1961. 

A model for predictive measurements 

of advertising effectiveness. Journal of 

Marketing 25 (6): 59–62. 

17. McGuire, W. 1989. Theoretical foundations 

of campaigns. In Public communication 

campaigns, 2nd ed., ed. R. E. Rice and 

C. K. Atkin, 43–65. Newbury Park, CA: Sage.

18. Thorson, E. 1996. Advertising. In An 

integrated approach to communication 

theory and research, ed. M. B. Salwen 

and D. W. Stacks, 211–30. Mahwah, NJ: 

Lawrence Erlbaum.

19. Edwards, W. 1961. Behavioral decision theory. 

Annual Review of Psychology 12:473–98. 

20. Lewin, K. 1936. Principles of topological 

psychology. New York: McGraw-Hill.

21. Becker, M. H. 1974. The health belief model 

and personal health behavior. Health 

Education Monographs 2:324–473. 

22. Rogers, R. W. 1975. A protection motivation 

theory of fear appeals and attitude change. 

Journal of Psychology 91:93–114. 

23. Ajzen, I., and M. Fishbein. 1980. 

Understanding attitudes and predicting 

social behavior. Englewood Cliffs, NJ: 

Prentice Hall.

24. Fishbein, M., and I. Azjen. 1975. Belief, 

attitude, intention and behavior: An 

introduction to theory and research.

Reading, MA: Addison-Wesley.

25. Ajzen, I. 1991. The theory of planned 

behavior. Organizational Behavior and 

Human Decision Processes 50 (2): 179–211. 

26. Fishbein, M. 2000. The role of theory in HIV 

prevention. AIDS Care 12 (3): 273–78. 
46

2 . T h e o r e t i c a l U n d e r p i n n i n g s o f M e d i a R e s e a r c h

27. Fishbein, M., and J. N. Cappella. 2006. 

The role of theory in developing effective 

health communications. Journal of 

Communication 56 Suppl. 1: S1–S17. 

28. Bandura, A. 1994. Social cognitive theory 

of mass communication. In Media effects: 

Advances in theory and research, ed. 

J. Bryant and D. Zillmann, 61–90. Hillsdale, 

NJ: Lawrence Erlbaum.

29. Pechmann, C., and E. T. Reibling. 2006. 

Antismoking advertisements for youths: An 

independent evaluation of health, counterindustry, and industry approaches. American 

Journal of Public Health 96 (5): 906–13. 

30. Prochaska, J. O., C. A. Redding, and 

K. Evers. 2002. The transtheoretical model 

and stages of change. In Health behavior 

and health education: Theory, research, and 

practice, 3rd ed., ed. K. Glanz, B. K. Rimer, 

and F. M. Lewis, 99–120. San Francisco: 

Jossey-Bass.

31. Spencer, L., F. Pagell, M. E. Hallion, 

and T. B. Adams. 2002. Applying the 

transtheoretical model to tobacco cessation 

and prevention: A review of literature. 

American Journal of Health Promotion

17 (1): 7–71. 

32. Chaiken, S. 1980. Heuristic versus 

systematic information processing and 

the use of source versus message cues in 

persuasion. Journal of Personality and 

Social Psychology 39 (5): 752–66. 

33. Petty, R. E., and J. T. Cacioppo. 1996. 

Attitudes and persuasion: Classic and 

contemporary approaches. Boulder, CO: 

Westview Press.

34. Hibbard, J. H., and E. Peters. 2003. 

Supporting informed consumer health care 

decisions: Data presentation approaches that 

facilitate the use of information in choice. 

Annual Review of Public Health 24:413–33. 

35. Peters, E., and P. Slovic. 2000. The springs of 

action: Affective and analytical information 

processing in choice. Personality and Social 

Psychology Bulletin 26 (12): 1465–75. 

36. Cohen, J. B., and A. Reed II. 2006. A 

multiple pathway anchoring and adjustment 

(MPAA) model of attitude generation and 

recruitment. Journal of Consumer Research

33 (1): 28–30. 

37. Schwarz, N., and G. Bohner. 2001. The 

construction of attitudes. In Blackwell 

handbook of social psychology: 

Intraindividual processes, vol. 1, ed. A. Tesser 

and N. Schwarz, 436–57. Oxford: Blackwell.

38. Greenwald, A. G., and M. R. Banaji. 1995. 

Implicit social cognition: Attitudes, selfesteem, and stereotypes. Psychological 

Review 102 (1): 4–27. 

39. Wilson, T. D., S. Lindsey, and T. Y. Schooler. 

2000. A model of dual attitudes. 

Psychological Review 107 (1): 101–26. 

40. Bargh, J. A., S. Chaiken, R. Govender, 

and F. Pratto. 1992. The generality of the 

automatic attitude activation effect. Journal 

of Personality and Social Psychology 62 (6): 

893–912. 

41. Petty, R. E. 2006. A metacognitive model of 

attitudes. Journal of Consumer Research

33 (1): 22–24. 

42. Basil, M. D. 1994. Multiple resource theory I. 

Communication Research 21 (2): 177–207. 

43. Cappella, J. N. 1996. Why biological 

explanation? Journal of Communication

46 (3): 4–7. 

44. Detenber, B. H., and B. Reeves. 1996. A bioinformational theory of emotion: Motion 

and image size effects on viewers. Journal of 

Communication 46 (3): 66–84. 

45. Lang, A. 2006. Using the limited capacity 

model of motivated mediated message 

processing to design effective cancer 

communication messages. Journal of 

Communication 56 Suppl. 1: S57–S80. 

46. Donohew, L., P. Palmgreen, E. P. Lorch, 

R. Zimmerman, and N. G. Harrington. 

2002. Attention, persuasive communication, 

and prevention. In Mass media and drug 

prevention: Classic and contemporary 

theories and research, ed. W. Crano 

and M. Burgoon, 119–43. Hillsdale, NJ: 

Lawrence Erlbaum.

47. Cappella, J. N. 2006. Integrating message 

effects and behavior change theories: 

Organizing comments and unanswered 

questions. Journal of Communication 56 

Suppl. 1: S265–S279. 

48. Viswanath, K., and K. M. Emmons. 2006. 

Message effects and social determinants of 

health: Its application to cancer disparities. 

Journal of Communication 56 Suppl. 1: 

S238–S264. 

49. Dillard, J. P., and Nabi R. L. 2006. The 

persuasive influence of emotion in cancer 

prevention and detection messages. 

Journal of Communication 56 Suppl. 1: 

S123–S139. 

50. Rimer, B. K., and M. W. Kreuter. 2006. 

Advancing tailored health communication: 

A persuasion and message effects perspective. 
47

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Journal of Communication 56 Suppl. 1: 

S184–S201. 

51. Green, M. C. 2006. Narratives and cancer 

communication. Journal of Communication

56 Suppl. 1: S163–S183. 

52. Rothman, A. J., R. D. Bartels, J. Wlaschin, 

and P. Salovey. 2006. The strategic use of 

gain- and loss-framed messages to promote 

healthy behavior: How theory can inform 

practice. Journal of Communication 56 

Suppl. 1: S202–S220. 

53. Zillmann, D. 2006. Exemplification effects in 

the promotion of safety and health. Journal 

of Communication 56 Suppl. 1: S221–S237. 

54. Lieberman, M. D. 2007. Social cognitive 

neuroscience: A review of core processes. 

Annual Review of Psychology 58:259–89. 

55. Allen, C. 2004. Media watch. Lancet 3 (2): 129. 

56. Singer, E. 2004. They know what you 

want—if neuromarketers can find the key 

to our consumer desires, will they be able to 

manipulate what we buy. New Science 183 

(2458): 36–37. 

57. Deppe, M., W. Schwindt, H. Kugel, 

H. Plassmann, and P. Kenning. 2005. 

Nonlinear responses within the medial 

prefrontal cortex reveal when specific 

implicit information influences economic 

decision making. Journal of Neuroimaging

15 (2): 171–82. 

58. Schaefer, M., and M. Rotte. 2007. Favorite 

brands as cultural objects modulate reward 

circuit. Neuroreport 18 (2): 141–45. 

59. Biener, L., R. L. Reimer, M. Wakefield, 

G. Szczypka, N. A. Rigotti, and G. Connolly. 

2006. Impact of smoking cessation aids 

and mass media among recent quitters. 

American Journal of Preventive Medicine

30 (3): 217–24. 

60. Rogers, E. M. 2003. Diffusion of innovations.

5th ed. New York: Free Press.

61. Barnett, G. A., and J. A. Danowski. 

1992. The structure of communication: 

A network analysis of the International 

Communication Association. Human 

Communication Research 19 (2): 264–85. 

62. Reardon, K. K., and E. M. Rogers. 1988. 

Interpersonal versus mass communication: 

A false dichotomy. Human Communication 

Research 15 (2): 284–303. 

63. Katz, E., and P. Lazarsfeld. 1955. Personal 

influence: The part played by people in the 

flow of mass communications. New York: 

Free Press.

64. Katz, E. 1957. The two-step flow of 

communication: An up-to-date report on 

a hypothesis. Public Opinion Quarterly

21 (1): 61–78. 

65. Valente, T. W., and W. P. Saba. 1998. Mass 

media and interpersonal influence in 

a reproductive health communication 

campaign in Bolivia. Communication 

Research 25 (1): 96–124. 

66. Valente, T. W., and R. Fosados. 2006. 

Diffusion of innovations and network 

segmentation: The part played by people 

in promoting health. Journal of Sexually 

Transmitted Diseases 33 Suppl. 7: S23–S31. 

67. Ettema, J. S., and D. C. Whitney. 1994. 

Audiencemaking: How the media create the 

audience. Thousand Oaks, CA: Sage.

68. Demers, D. P. 1991. Corporate structure and 

emphasis on profits and product quality at 

U.S. daily newspapers. Journalism Quarterly

68 (1–2): 15–26. 

69. Demers, D. P. 1993. Effect of corporate 

structure on autonomy of top editors at 

U.S. dailies. Journalism Quarterly 70 (3): 

499–508. 

70. Soley, L. C., and R. L. Craig. 1992. 

Advertising pressures on newspapers: 

A survey. Journal of Advertising 21 (4): 1–9. 

71. Fishman, M. 1980. Manufacturing the news.

Austin, TX: Univ. of Texas Press.

72. Tuchman, G. 1978. Making news: A study 

in the construction of reality. New York: 

Free Press.

73. Stryker, J. E. 2002. Reporting medical 

information: Effects of press releases and 

newsworthiness on medical journal articles’ 

visibility in the news media. Preventive 

Medicine 35 (5): 519–30. 

74. Gandy, O. H. 1982. Beyond agenda setting: 

Information subsidies and public policy.

Norwood, NJ: Ablex Publishing.

75. Pan, Z., and G. M. Kosicki. 2001. Framing 

as a strategic action in public deliberation. 

In Framing public life: Perspectives on 

media and our understanding of the world,

ed. S. D. Reese, O. Gandy Jr., and A. Grant, 

35–66. Mahwah, NJ: Lawrence Erlbaum.

76. Reese, S. D., A. E. Grant, and O. H. Gandy, 

eds. 2001. Framing public life: Perspectives 

on media and our understanding of the social 

world. Mahwah, NJ: Lawrence Erlbaum.

77. Barnes, B. E., and L. M. Thomson. 1994. 

Power to the people (meter): Audience 

measurement technology and media 
48

2 . T h e o r e t i c a l U n d e r p i n n i n g s o f M e d i a R e s e a r c h

specialization. In Audiencemaking: How the 

media create the audience, ed. J. S. Ettema 

and D. C. Whitney, 75–94. Thousand Oaks, 

CA: Sage.

78. Hardt, H., and J. W. Carey. 2001. Social 

theories of the press: Constituents of 

communication research, 1840s to 1920s.

2nd ed. Lanham, MD: Rowman & Littlefield.

79. Janowitz, M. 1967. The community press 

in an urban setting: The social elements of 

urbanism. Chicago: Univ. of Chicago Press.

80. Tichenor, P. J., G. A. Donohue, and 

C. N. Olien. 1980. Community conflict and 

the press. Beverly Hills, CA: Sage.

81. Viswanath, K., and D. P. Demers. 1999. 

Mass media from a macrosocial perspective. 

In Mass media, social control, and social 

change: A macrosocial perspective, ed. 

D. P. Demers and K. Viswanath, 3–28. Ames, 

IA: Iowa State Univ. Press.

82. Demers, D. P. 1995. The menace of the 

corporate newspaper: Fact or fiction?

Ames, IA: Iowa State Univ. Press.

83. Shah, H. 1994. News and the self-production 

of society: Times of India coverage of caste 

conflict and job reservations in India. 

Journalism Monographs 144:1–31.

84. Gitlin, T. 2003. The whole world is watching: 

Mass media in the making and unmaking of 

the new left, with a new preface. Berkeley, 

CA: Univ. of California Press.

85. Hallin, D. C. 1986. The uncensored war: 

The media and Vietnam. New York: Oxford 

University Press, USA.

86. Donohue, G. A., P. J. Tichenor, and 

C. N. Olien. 1995. A guard dog perspective 

on the role of media. Journal of 

Communication 45 (2): 115–32. 

87. Wolfson, M. 2001. The fight against big 

tobacco: The movement, the state, and the 

public’s health. New York: Aldine Transaction.

88. Wallack, L., L. Dorfman, D. Jernigan, and 

M. Themba-Nixon. 1993. Media advocacy 

and public health: Power for prevention.

Thousand Oaks, CA: Sage.

89. Stillman, F. A., K. A. Cronin, W. D. Evans, 

and A. Ulasevich. 2001. Can media 

advocacy influence newspaper coverage 

of tobacco: Measuring the effectiveness of 

the American Stop Smoking Intervention 

Study’s (ASSIST) media advocacy strategies. 

Tobacco Control 10 (2): 137–44. 

90. Chapman, S., and A. Dominello. 2001. A 

strategy for increasing news media coverage 

of tobacco and health in Australia. Health 

Promotion International 16 (2): 137–43. 

91. Tichenor, P. J., G. A. Donohue, and 

C. N. Olien. 1970. Mass media flow and 

differential growth in knowledge. Public 

Opinion Quarterly 34 (2): 159–70. 

92. McCombs, M. 2004. Setting the agenda: The 

mass media and public opinion. Cambridge, 

UK: Polity Press.

93. Noelle-Neumann, E. 1984. Spiral of silence.

Chicago: Univ. of Chicago Press.

94. Gerbner, G., L. Gross, M. Morgan, and 

N. Signorielli. 1994. Growing up with 

television: The cultivation perspective. 

In Media effects: Advances in theory and 

research, ed. J. Bryant and D. Zillmann, 

17–42. Hillsdale, NJ: Lawrence Erlbaum.

95. Viswanath, K., and J. R. Finnegan. 1996. 

The knowledge gap hypothesis: Twenty five 

years later. In Communication yearbook 19,

ed. B. Burleson, 187–227. Thousand Oaks, 

CA: Sage.

96. Viswanath, K., N. Breen, H. Meissner, 

R. P. Moser, B. Hesse, W. R. Steele, and 

W. Rakowski. 2006. Cancer knowledge and 

disparities in the information age. Journal 

of Health Communication 11 Suppl. 1: 

S1–S17. 

97. Entman, R. M. 1993. Framing: Toward 

clarification of a fractured paradigm. 

Journal of Communication 43 (4): 51–58. 

98. Gamson, W. A. 2003. Foreword. In Framing 

public life: Perspectives on media and 

our understanding of the social world,

ed. S. D. Reese, O. H. Gandy, A. E. Grant, 

and O. H. Gandy Jr., ix–xi. Mahwah, NJ: 

Lawrence Erlbaum.

99. Iyengar, S., and D. R. Kinder. 1987. News 

that matters: Television and American 

opinion. Chicago: Univ. of Chicago Press.

100. Salmon, C. T., and F. G. Kline. 1985. 

The spiral of silence ten years later: An 

examination and evaluation. In Political 

communication yearbook 1984, ed. 

K. R. Sanders, L. L. Kaid, and D. Nimmo, 

3–30. Carbondale, IL: Southern Illinois 

Univ. Press.

101. Lima, J. C., and M. Siegel. 1999. The tobacco 

settlement: An analysis of newspaper 

coverage of a national policy debate, 

1997–98. Tobacco Control 8 (3): 247–53. 

102. Clegg Smith, K., and M. Wakefield. 2006. 

Newspaper coverage of youth and tobacco: 

Implications for public health. Health 

Communication 19 (1): 19–28. 
49

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

103. Shanahan, J., and V. Jones. 1999. Cultivation 

and social control. In Mass media, social 

control, and social change: A macrosocial 

perspective, eds. D. Demers and K. Viswanath, 

31–50. Ames, IA: Iowa State Press.

104. Dalton, M. A., J. D. Sargent, M. L. Beach, 

L. Titus-Ernstoff, J. J. Gibson, M. B. Ahrens, 

J. J. Tickle, and T. F. Heatherton. 2003. 

Effect of viewing smoking in movies on 

adolescent smoking initiation: A cohort 

study. Lancet 362 (9380): 281–85. 

105. Centers for Disease Control and Prevention. 

2006. Adult cigarette smoking in the 

United States: Current estimates (updated 

November 2006). http://www.cdc.gov/

tobacco/data_statistics/Factsheets/

adult_cig_smoking.htm.

106. Institute of Medicine. 2003. Unequal 

treatment: Confronting racial and ethnic 

disparities in health care. Washington, DC: 

National Academies Press.

107. Kawachi, I., and C. Kroenke. 2006. 

Socioeconomic disparities in cancer 

incidence and mortality. In Cancer 

epidemiology and prevention, 3rd ed., ed. 

D. Schottenfeld and J. F. Fraumeni, 174–88. 

New York: Oxford University Press.

108. Story, M., M. Evans, R. R. Fabsitz, T. E. Clay, 

B. Holy Rock, and B. Broussard. 1999. 

The epidemic of obesity in American Indian 

communities and the need for childhood 

obesity-prevention programs. American 

Journal of Clinical Nutrition 69 Suppl. 4: 

747S–754S. 

109. Centers for Disease Control and 

Prevention. 2004. The burden of chronic 

diseases and their risk factors: National 

and state perspectives. Atlanta, GA: 

U.S. Department of Health and Human 

Services, Centers for Disease Control and 

Prevention. http://www.cdc.gov/nccdphp/

burdenbook2004/index.htm.

110. Muggli, M. E., R. D. Hurt, and L. B. Becker. 

2004. Turning free speech into corporate 

speech: Philip Morris’ efforts to influence 

U.S. and European journalists regarding 

the U.S. EPA report on secondhand smoke. 

Preventive Medicine 39 (3): 568–80. 

111. United States v. Philip Morris USA, Civil 

Action No. 99-CV-02496GK (D.C.C.) 

(United States’ final proposed finding of fact, 

incorporating errata of August 16, 2005). 

http://www.usdoj.gov/civil/cases/tobacco2/

US%20Executive%20Summary%20Redacted

%2020050815.pdf 

112. Siahpush, M., A. McNeill, D. Hammond, 

and G. T. Fong. 2006. Socioeconomic 

and country variations in knowledge of 

health risks of tobacco smoking and toxic 

constituents of smoke: Results from the 

2002 International Tobacco Control (ITC) 

Four Country Survey. Tobacco Control 15 

Suppl. 3: iii65–iii70. 

113. Kurtz, M. E., J. C. Kurtz, D. Contreras, and 

C. Booth. 2003. Knowledge and attitudes 

of economically disadvantaged women 

regarding exposure to environmental 

tobacco smoke: A Michigan, USA study. 

European Journal of Public Health 13 (2): 

171–76. 

114. U.S. Department of Health, Education, and 

Welfare. 1964. Smoking and health: Report 

of the Advisory Committee to the Surgeon 

General of the Public Health Service

(PHS publication no. 1103). Washington, 

DC: U.S. Department of Health, Education, 

and Welfare, Public Health Service, Center 

for Disease Control.

115. Federal Communications Commission. 

1967. Applicability of the Fairness 

Doctrine to cigarette advertising. http://

tobaccodocuments.org/rjr/501881916-

1928.html.

116. National Cancer Institute. 1995. 

Community-based interventions for 

smokers: The COMMIT field experience

(Smoking and tobacco control monograph 

no. 6, NIH publication no. 95-4028). 

Bethesda, MD: National Cancer Institute. 

http://cancercontrol.cancer.gov/tcrb/

monographs/6/index.html.

117. National Association of Attorneys General. 

1998. Multistate settlement with the tobacco 

industry. http://library.ucsf.edu/tobacco/

litigation/msa.pdf.

118. World Health Organization. 2003. 

World Health Assembly Resolution 56.1. 

http://www.who.int/tobacco/framework/

final_text/en.

119. Capehart, T. 2003. Tobacco acreage in 

2003 to decline 3 percent. In Tobacco 

Outlook, TBS 254. http://usda.mannlib

.cornell.edu/usda/ers/TBS//2000s/2003/

TBS-04-16-2003_Summary.txt.

51

Tobacco Marketing

Part

2

As with any consumer product in modern history, mass media have proven to be 

highly effective tools for marketing tobacco products, while global tobacco control 

efforts increasingly seek to restrict such marketing channels. The landscape of tobacco 

promotion has changed substantially, with increasing legislative and policy constraints 

on traditional media promotion for tobacco and a concomitant shift in marketing toward 

areas ranging from point-of-sale displays to modern viral marketing techniques.

This part examines the advertising and promotion of tobacco through the media 

and the legislative and policy issues surrounding limits on such marketing. Basic 

principles of market segmentation and the creation of brand identities for tobacco 

products are explored, along with their evolution in an increasingly restrictive direct 

marketing environment. As new communications channels emerge, ranging from the 

Internet to stealth marketing, trends in promotional expenditures for tobacco change. 

These developments are discussed along with indirect promotional activities such as 

corporate image advertising.

A subsequent chapter examines current research findings linking tobacco promotion to 

actual smoking behavior, focusing on the relationship between advertising exposure and 

adolescent smoking initiation, and the relationship between industry expenditures for 

tobacco advertising and promotions and tobacco use. This part closes with a discussion of 

the regulatory and constitutional issues involved in limiting tobacco marketing.

53

3

Key Principles of 

Tobacco Promotion and 

Rationales for Regulation

The promotion of tobacco products represents an important part of tobacco industry 

efforts to create demand for its products. Tobacco advertising campaigns are often held 

up as leading examples of product marketing. This chapter explores the key principles 

of tobacco advertising and promotion and reviews important developments in regulating 

this promotion. Specific areas discussed here include

n	 Use of market segmentation by tobacco firms to target consumers by 

demographics, geographic region, behavioral factors, and the psychographics 

of specific population groups

n	 Tools and strategies used by tobacco firms in communicating a consistent brand 

image, including brand logos, taglines, pictorial elements, and color, as well as 

the development and repetition of a consistent brand message

n	 Arguments for the regulation of tobacco promotion, including the health 

consequences of tobacco use, the use of deceptive or misleading promotional 

tactics, the failure of tobacco industry efforts to self-regulate, and the 

ineffectiveness of partial restrictions on tobacco advertising and promotion
54

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

Introduction

This chapter examines the promotion of 

tobacco products from two perspectives: 

its economic importance to the tobacco 

industry and the growing argument for its 

regulation as part of global tobacco control 

efforts. First, the chapter gives an overview 

of tobacco company efforts to build strong 

brands with an identity, a market position, 

and an execution aimed consistently over 

time at well-defined target audiences. 

The second part of the chapter describes 

the fundamental determinants that led 

the World Health Organization (WHO) to 

make a case for a comprehensive ban on 

all forms of tobacco promotion as part of 

the Framework Convention on Tobacco 

Control (FCTC).

Tobacco advertising and promotion efforts 

have been remarkably effective in the eyes 

of both consumers and the advertising 

industry, as evidenced by the consistent 

high rankings of cigarette advertising 

campaigns among lists of leading 

twentieth-century advertising campaigns 

reported by advertising and marketing 

trade publications. For Advertising Age,

the Marlboro Man was the top advertising 

icon of the century, reflecting that this 

image had the most powerful resonance 

in the marketplace with respect to 

effectiveness, longevity, recognition, and 

cultural impact. Furthermore, Marlboro 

was ranked as the third-best advertising 

campaign of the century, surpassed only 

by Volkswagen and Coca-Cola. Advertising 

campaigns for Benson & Hedges, Winston, 

Camel, and Lucky Strike were also on the 

Advertising Age top 100 list.1 During 2003, 

Business Week regarded Marlboro as the 

world’s ninth most valuable global brand.2,3

These honors speak to the pervasiveness of 

tobacco advertising as well as the strength of 

cigarette brand imagery. The value of these 

tobacco trademarks has been quite durable, 

persisting despite growing awareness 

of the health consequences of cigarette 

use, an increasingly stringent regulatory 

environment, and ongoing litigation against 

the industry.

In response to the global health impact 

of these promotional efforts, combined 

with the failure of industry self-regulation 

and the ineffectiveness of partial bans on 

marketing—discussed in detail later in 

this chapter in the section, “A Rationale for 

Regulating Tobacco Promotion”—the WHO 

FCTC has called for countries to undertake 

a comprehensive ban of all tobacco 

promotion directed toward consumers 

(see chapter 8). As a global public health 

issue that is now being addressed through 

international law and treaty, important 

developments and illustrative examples 

from outside the United States are reviewed 

to lay out the broader context in which 

tobacco marketing—and efforts to restrict 

this marketing—are occurring. However, 

the focus of this chapter, like that of the 

monograph as a whole, is on the promotion 

of tobacco products in the United States, 

within the context of its corresponding 

legal environment.

Key Principles of 

Tobacco Advertising 

and Promotion

The development of a marketing strategy

involves specifying a target market and 

establishing a related marketing mix, 

which is commonly broken down into four 

classes known as the 4Ps—product, price, 

place (i.e., distribution), and promotion. 

The fourth P, promotion, pertains to the 

seller communicating information and 

lifestyle dimensions to a potential buyer, 

in an attempt to influence the buyer’s 

attitudes and behavior. 

The primary purposes of promotion are to 

inform, persuade, and remind. Informing is 
55

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

considered particularly essential for newly 

developed or “introduced” products, and 

related communications efforts are meant 

to tell potential customers something about 

the product. Promotions with an aim of 

persuading often focus on the reasons that 

one brand is better than competing brands. 

The promoter seeks to develop a favorable 

set of brand beliefs and attitudes among 

customers so that they will buy and keep 

buying the product4 (see chapter 2 for a 

discussion of persuasion-based processes and 

expectancy-value models of attitude change). 

In addition to focusing on brand beliefs and 

attitudes, persuasion-based promotions 

also commonly link products with desirable 

images (such as lifestyle imagery) and 

identities (such as slogans, jingles, or 

brand symbols). The aim is for consumers 

to associate the brand or product use with 

either positive emotions or the reduction 

of negative emotions. Persuasion strategies 

that focus on desirable image and identity 

characteristics are particularly important 

for product categories such as cigarettes, 

because differences among various brands 

are often very subtle or intangible. Finally, 

promotions with the goal of reminding are 

typically directed toward buyers who already 

have positive, well-established attitudes 

about a product, including its price, features, 

availability, or image.4

Defining the Target Market: 

Market Segmentation

Promotion planning starts with a clear 

target market. The audience may consist 

of potential buyers, current users, those 

who make the buying decision, or those 

who influence it. Segmentation is a 

commonly used approach for defining 

the target market, in which specific 

audiences are identified for a product by 

dividing a mass market into subsets on the 

basis of variables such as demographics, 

geography, preference for product benefits, 

consumption patterns, and psychographics. 

Few products are promoted in an 

undifferentiated manner, with the total 

potential market treated as a whole. Rather, 

promotions tend to be directed toward 

well-defined consumer groups according to 

dimensions such as age, gender, ethnicity, 

income, occupation, religion, family 

life cycle, place of residence, lifestyles, 

interests, and values. Chapter 5 discusses 

several population groups defined by these 

dimensions that have been targeted by 

tobacco companies.

The message in a segmented marketing 

campaign typically has reasonably broad 

appeal (i.e., referring to popular culture) 

yet at the same time will be most salient 

and resonant to a specific cluster or 

segment. The target audience will heavily 

affect communication decisions regarding 

what will be said, how it will be said, when

it will be said, where it will be said, and 

who will say it.4 The objective is to meet 

the needs typified by a specific group of 

consumers in an efficient manner, whereby 

the product’s characteristics and promoted 

attributes can clearly match what is desired 

by the user(s).5,6

Demographic Segmentation

Positioning is defined as the place a product, 

brand, or group of products occupies in 

consumers’ minds (with respect to brand 

identity and value) relative to competing 

offerings.4,7 The positioning of various 

cigarette brands to appeal to a specific group 

of consumers, on the basis of demographics, 

is easily illustrated with concrete examples 

from the advertising world.

Gender

Tobacco marketing aimed at women dates 

back to the 1920s, when American Tobacco 

urged women to “Reach for a Lucky 

instead of a sweet,” playing directly to 

concerns about body weight8,9 (chapter 5). 

In more recent times, Virginia Slims and 

Eve exemplify U.S. cigarette brands that 
56

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

are promoted as “feminine” and explicitly 

targeted toward women (chapter 5 also 

includes discussion about cigarette 

brands targeted toward men). During the 

late 1960s, initial advertising campaigns 

for Virginia Slims included the claims, 

“Now there’s even a cigarette for women 

only,” and, “This is the slim cigarette made 

just for women.... Tailored slimmer than 

the fat cigarettes men smoke.” John Landry, 

vice president of tobacco products marketing 

at Philip Morris USA, indicated in 1969 that 

early ideas of a thin-circumference cigarette 

did not gain a positive response among 

market research respondents, but “it worked 

beautifully when we added the idea of female 

orientation.”10(p.76) The Virginia Slims tagline, 

“You’ve come a long way, baby,” implied 

that women had become liberated.11 In an 

analysis of competition in female-oriented 

cigarette advertising during the early 1970s 

that included Virginia Slims, the Lorillard 

Tobacco Company stated, “The campaign 

line ‘You’ve come a long way, baby’ hit the 

cigarette market in 1968, just as women’s 

lib was entering the national consciousness. 

The cigarette is positioned specifically for 

today’s liberated woman with a unique, 

swinging image.”12(Bates no. 03375510) Reflecting 

the specified target audience, Virginia Slims’ 

advertising was circulated in magazines 

such as Cosmopolitan, New Woman, 

Vanity Fair, Harper’s Bazaar, Woman’s Day, 

Ladies’ Home Journal, and Vogue.

Liggett & Myers’s Eve serves as a second 

example of a cigarette brand that is explicitly 

targeted to women. Eve, featuring a feminine 

floral design on the filter, was introduced 

to the U.S. marketplace in 1971.13 Early 

advertising for Eve included the following 

advertising copy: “The lady has taste. Farewell 

to the ugly cigarette. Smoke pretty. Eve.” 

Wernick, who provides a semiotic analysis of 

advertising for Eve cigarettes, states, “Eves 

are shown as the embodiment of a certain—

mid-1970s, socially independent but safely 

fashionable and ideologically compromising—

conception of femininity.”14(p.29) Other 

U.S. cigarette brands with ultrafeminine 

positioning include Lorillard’s Satin and 

Brown & Williamson’s Capri and Misty. 

Brands explicitly targeted at women account 

for roughly 5%–10% of the U.S. cigarette 

market.13 In contrast, Marlboro and Winston 

exemplify brands with rugged and masculine 

brand images, yet these brands have proven 

popular among both men and women.

Race/Ethnicity

Roughly three-fourths of African-American 

smokers consume mentholated cigarettes, 

with Newport, Kool, and Salem representing 

the most popular brands.15 Mentholated 

Gender and Cigarette Branding

Features of tobacco products and their promoted images largely determine the masculinefeminine dichotomy of U.S. cigarette brands. For example,

n Brands offering relatively high tar content and strong flavors are promoted as 

“masculine,” often corresponding with appeals that have an action, excitement, 

and adventure orientation.

n Conversely, low tar, mild taste, longer length, and slimness of cigarettes are considered 

“feminine” product characteristics, which often carry image platforms related to 

relaxation, stress relief, self-indulgence, and women’s independence.

Gender positioning takes place within a broader context of market segmentation and targeting, 

such as the tendency to promote mentholated cigarette brands to African-American audiences. 

Brands with cross-gender positioning often use promotional appeals designed to attract both 

sexes, such as messages about upward status and being upscale.
57

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

brands are commonly depicted in cigarette 

advertising that is targeted toward African 

Americans. As documented by Balbach 

and colleagues,16 internal tobacco industry 

documents show that advertising for menthol 

brands was designed around lifestyle appeals 

relating to “fantasy and escapism,” “expensive 

objects,” and “nightlife, entertainment, and 

music” themes. Appeals designed around 

concepts of “youthfulness, silliness, and fun” 

were also aimed at African Americans, as well 

as messages conveying the refreshing and 

medicinal aspects of menthol.17,18 Advertising 

campaigns meant to reach African Americans 

are likely to feature models or celebrities 

who are African American.19 During the 

mid-1980s, for example, marketing research 

for Kool stipulated, “Generic media will 

contain only White models and Black media, 

Black models.... An exception can be mixed 

groups.”20(Bates no. 670249931) Similarly, the 1984 

Kool Operational Plan stated, “One campaign 

should be continued for all ethnic groups 

with Black musicians only in Black media 

and White musicians only in generic 

media.”20(Bates no. 670249938) Targeted advertising 

in black media would be placed in magazines 

such as Ebony, Essence, and Vibe, as well 

as weekly newspapers that circulate where 

the largest African-American populations 

are located (i.e., New York, Los Angeles, 

Chicago, Houston, and Philadelphia). 

Detroit, Baltimore, Washington, Memphis, 

Birmingham, Jackson, and New Orleans 

are other U.S. cities that have populations 

with a notably high percentage of 

African Americans.21

Age

The tobacco industry’s use of age 

segmentation has been well documented. 

Reviews of internal tobacco industry 

documents reveal that cigarette trademarks 

are successfully marketed to youth, including 

consumers who are classified as “starters” 

or “new smokers” (chapters 5 and 7). The 

rationale for directing promotions toward 

youth is that the pivotal period for smoking 

initiation in the United States is early 

adolescence. Smokers are also known to be 

extremely brand loyal, so the brand choice 

of consumers during the early stages of their 

smoking “careers” becomes crucial. In the 

United States, less than 10% of smokers 

switch brands annually, with less than 8% 

switching companies.22

Tobacco industry representatives have 

publicly denied that they market their 

products to youth, but internal documents 

indicate otherwise. Several investigators 

have examined U.S. tobacco industry 

documents that were obtained through 

whistleblowers and tobacco litigation and 

found that youth are a target of tobacco 

marketing activities23–27 (also see below 

and chapter 5). Researchers who examined 

tobacco industry documents that are 

accessible primarily as a result of two sets 

of court proceedings in Canada—the 1989 

federal trial to decide the constitutionality 

of the Tobacco Products Control Act and 

the 2002 Quebec Superior Court trial 

to determine the constitutionality of 

the Tobacco Act—have reached similar 

conclusions.28–35 Furthermore, internal 

documents from both the British and 

Australian tobacco industries and their 

leading advertising agencies reveal that 

youth constitute a key group for marketing 

purposes.36,37 Below are some specific 

examples from the U.S. tobacco industry.

Philip Morris’s Myron Johnston explained 

in 1981, “It is important to know as 

much as possible about teenage smoking 

patterns and attitudes. Today’s teenager 

is tomorrow’s potential regular customer, 

and the overwhelming majority of 

smokers first begin to smoke while still 

in their teens.... The smoking patterns 

of teenagers are particularly important to 

Philip Morris.”38(Bates no. 1000390808) The Philip 

Morris report monitored smokers as 

young as 12 years old. Market research for 

Lorillard Tobacco revealed, “The success 

of Newport has been fantastic during the 

past few years. Our profile taken locally 
58

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

shows this brand being purchased by black 

people (all ages), young adults (usually 

college age), but the base of our business 

is the high school student.”39(Bates no. 03537131)

Regarding Kool, a menthol brand directly 

competing with Newport, Brown & 

Williamson’s market research stated that 

the “Kool media target audience principle 

remains the same. Most valuable prospect 

is young adult male and female new smoker

and switcher.... Promotion philosophy of 

trial generation and meeting competition 

approved”20(Bates no. 670249932) (italics added). 

According to an advertising agency 

advising the R.J. Reynolds marketing 

department, “Many manufacturers have 

‘studied’ the 14–20 market in hopes of 

uncovering the ‘secret’ of the instant 

popularity some brands enjoy to the 

almost complete exclusion of others.... 

Creating a ‘fad’ in this market can be a 

great bonanza.”40(Bates no. 501167050)

Although it has been demonstrated that 

the tobacco industry has an interest in the 

attitudes and behaviors of preteens and 

adolescents, researchers have also called 

attention to the importance of young 

adults as a target of tobacco industry 

marketing strategies.41–44 The importance 

of this segment reflects its relatively high 

prevalence of smoking—23.9% of 18- to 

24-year-olds in 2003.45 Although adolescents 

are the main group that initiates smoking, 

it is during the period of young adulthood 

that more established and committed 

cigarette use begins to take place. Cigarette 

advertising that is targeted at 18- to 24-

year-olds often can appeal simultaneously 

to young adults and adolescents because 

many teenagers start smoking as a way 

to propel themselves into maturity 

(i.e., smoking serves as a tool for attempts 

to look older).34 Furthermore, as advertising 

restrictions become increasingly stringent, 

licensed (age of majority) venues become a 

key setting for tobacco promotion.46–50

Geographic Segmentation

Geographic segmentation, which 

involves accounting for market density, 

Joe Camel—When a Cartoon Character Becomes a Brand Identity

During the late 1980s and much of the 1990s, R J. Reynolds underwent particular scrutiny 

for its Camel advertising campaign, in which a cartoon camel (Old Joe) was the central figure, 

with the theme “smooth character.” Many company documents about the origins and aims of 

the “Joe Camel” campaign and its effects on youth were disclosed publicly as a result of the 

Mangini v. R.J. Reynolds Tobacco Company lawsuit.a

 The “Joe Camel” advertising campaign, 

which is discussed in further detail in chapters 5 and 7, was later the subject of a 1997 Federal 

Trade Commission complaintb,c,d that was an important antecedent for the curbs imposed on 

youth-oriented advertising through the Master Settlement Agreement between the attorneys 

general of 46 states and the major tobacco companies.

a

Coughlin, P. J., and F. Janacek, Jr. 1998. A review of R.J. Reynolds’ internal documents produced in 

Mangini vs. R.J. Reynolds Tobacco Company, Civil Number 939359: The case that rid California and the 

American landscape of “Joe Camel.” http://legacy.library.ucsf.edu/mangini_report.html.

b

Federal Trade Commission. 1997. In the matter of R.J. Reynolds Tobacco Company. www.ftc.gov/os/199705/

d9285cmp.pdf.

c

Cohen, J. B. 2000. Playing to win: Marketing and public policy at odds over Joe Camel. Journal of Public 

Policy and Marketing 19 (2): 155–67.

d

Etzioni, A. 2004. Symposium: Do children have the same First Amendment rights as adults? On protecting 

children from speech. Chicago-Kent Law Review 79:3, 23.
59

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

regional differences within a domestic 

or international market, and climate, 

may also play a role in the development of 

promotional strategies for various brands. 

For example, during the early 1980s, market 

research for Philip Morris distinguished 

smoking trends among four U.S. regions: 

Northeast, North Central/Midwest, South, 

and West.38 It was observed that teenage 

smoking was most pronounced in the 

Northeast and smoking prevalence was 

lowest in the West (this pattern was 

described by the Philip Morris researcher 

as consistent with data collected from 1968 

through 1980). More recent marketing 

efforts for new “niche” cigarette brands, 

such as Camel’s special “exotic” blends or 

Moonlight Tobacco, have largely focused on 

urban centers. Within this strategy, there 

is an apparent selectivity for cosmopolitan 

cities. It is not clear whether such a 

distribution indicates a long-term strategy 

or whether these cities are meant to act 

as test markets. New cigarette products, 

including line extensions, are commonly 

test-marketed on a geographically limited 

basis. In 2004, Phoenix served as the test 

market for Brown & Williamson’s Advance 

cigarette brand. Advance is targeted at 

“health conscious” smokers with a campaign 

that includes the following advertising copy: 

“Great taste—less toxins,” “Advance the way 

you smoke,” and “Everyone knows quitting 

is the best thing. But for those who continue 

to smoke, now there’s Advance.”51

Ethnic targeting of Asian Americans, 

Hispanics, or African Americans ultimately 

generates media plans and distribution 

patterns that are regionally focused on 

locations where the ethnic populations 

are most densely situated. U.S. census 

data pertaining to the geographic 

distribution of the Asian population reveal 

that more than one-half (51%) reside in 

just three states: California, New York, 

and Hawaii.52 The Hispanic population 

is most concentrated in the western 

(44%) and southern (33%) regions of the 

United States, with California and Texas 

representing the top two states. Notably, 

more than 4 million Hispanics reside in 

Los Angeles County, California.53 When 

cigarette billboard advertising was still 

permitted, before the 1998 U.S. Master 

Settlement Agreement (MSA) stipulations 

took effect, a disproportionate number of 

tobacco promotions in San Francisco and 

Chicago were found in neighborhoods that 

were predominantly African American.54,55

When media buys increased for local 

markets, this was traditionally done by using 

billboard or newspaper advertising.

Although geographic segmentation plays 

a role in the development of advertising 

strategies and media buys, for the most 

part it is national brands that dominate the 

U.S. marketplace. These brands are sold on 

a national basis by using national media. 

Regional variations in cigarette brand 

success do not seem nearly as pronounced 

in the United States relative to other 

markets such as Canada and Australia. 

Marketing research for Imperial Tobacco Ltd., 

Canada’s largest tobacco manufacturer, 

has identified that “Quebec and the Atlantic 

continue to be full-flavoured markets; 

British Columbia and Ontario tend to be 

milder markets,”56(p.47) indicating which 

line extensions are most favorably received 

in various regions of Canada. A review of 

internal tobacco industry documents reveals 

that the Australian cigarette market is also 

decidedly regionalized. Escort is a popular 

brand in South Australia, while Winfield has 

been a brand leader in Western Australia, 

New South Wales, and Victoria. During the 

mid-1980s, Sydney, the most populated 

city in Australia, was identified as a largely 

image-based market, while consumers in 

Melbourne, Australia’s second most populated 

city, were recognized as considerably more 

responsive to discounting. Melbourne was 

thus classified as a value-based market.57

Climate—in relation to seasonal variation 

and geographic or regional setting—can 
60

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

play a role in the development of product 

and related promotional strategies. Camel 

Exotic Blends includes flavors such as 

Kauai Kolada and Twista Lime, which 

are identified as “summer” blends.58,59

The Kauai Kolada and Twista Lime line 

extensions, with hints of coconut, pineapple, 

and citrus, are limited-edition offerings.58

In addition, promotions circulating 

during the summer months are expected 

to commonly depict summer settings 

(e.g., beaches, baseball games); those during 

the winter months more often portray 

activities such as skiing and skating.60

Behavioral Segmentation

Behavioral segmentation involves dividing 

consumers into groups according to 

occasions of use, usage situation, extent 

of use, user status, and benefits sought.61

Some cigarette promotions are designed to 

link cigarette brands or smoking with specific 

occasions such as Christmas, Halloween, 

or Independence Day. Philip Morris’s market 

research reveals that during the 1970s and 

1980s, the Marlboro Resort Program included 

promotional activities during the Christmas 

holiday period at vacation settings such as 

Daytona Beach and Fort Lauderdale, Florida.26

In the early 1990s, Kool ads featuring the 

“Willy the Penguin” cartoon character had 

themes associated with Thanksgiving and 

Christmas.62 Camel’s more recent “Pleasure 

to Burn” advertising campaign featured 

occasion-themed pictorials.

With respect to occasions of use as a 

segmentation variable, marketers assess 

whether consumers are likely to use a 

product primarily on special occasions 

or more regularly. Product consumption 

patterns often fluctuate from month to 

month (described in management and 

marketing as “the rhythm of the business”), 

and cigarettes are no exception. In the 

United States, cigarette sales peak during 

the summer months, June through 

August.63 Moreover, this summer period 

represents the time when youth smoking 

onset is most likely to happen.64,65 A higher 

instance of cigarette consumption during 

the summer months may reflect that 

time is less structured for adults and 

youth alike. The warmer weather during 

the summer months may also prompt 

smokers to more frequently go outside to 

smoke in locales where indoor smoking 

laws have been enacted. The seasonal 

smoking rates also correspond with alcohol 

consumption patterns. 

The situation in which products are used 

can be considered as a market segmentation 

variable.66 Tobacco firms recognize which 

products are often used concurrently with 

cigarettes. Smoking is frequently done 

in conjunction with the consumption of 

alcohol or coffee, and cigarette promotions 

may include pictorials that encourage the 

co-use of these products. The statement 

“Complements Your Cocktail” is found 

on the packaging of Camel Izmir Stinger, 

which is one of the Exotic Blends line 

extensions. Reflecting the synergy between 

smoking and drinking alcohol, as well 

as a similar target consumer, several 

examples of industry efforts co-promote 

cigarette brands with particular liquor 

and beer brands whose cultural identity 

Camel’s “Pleasure to Burn” occasionthemed advertisement
61

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

and status are complementary.34,67 Kool 

and Jim Beam, for example, were both 

sponsors of a Champ Car auto racing team, 

whereas in 2003, Molson Canadian “bubbas” 

(i.e., minikegs) depicted the Player’s 

Champ Car racing uniforms. Player’s Light 

and Molson Canadian are leading brands 

in Canada in cigarettes and beer product 

categories, respectively.

In terms of the usage situation, from a 

marketer’s perspective, products such 

as alcohol and cigarettes should be 

complementary on the basis of function 

(i.e., the products are often used 

together), symbolic imagery, and quality. 

As cultural anthropologist Grant McCracken 

explains, “The meaning of a good is best 

(and sometimes only) communicated 

when this good is surrounded by a 

complement of goods that carry the same 

significance. Within this complement, 

there is sufficient redundancy to allow the 

observer to identify the meaning of the 

good.”68(p.121) Thus, it might be expected 

that an upscale cigarette brand such as 

Dunhill would be depicted with a martini, 

whereas Marlboro and Budweiser are 

likely to be seen by marketers as more 

suitable product complements. Conversely, 

Winston cigarettes combined with a bottle 

of fine wine would seem inappropriate.

When segmenting a market, marketers 

also account for user status, which may 

involve classifying groups of consumers 

into nonusers, ex-users, potential users, 

first-time users, sporadic users, and heavy 

users of a product.61 Thus, some smokers 

might be best described as “social smokers” 

or “chippers,” whereas others would be 

clustered as “committed smokers.” On the 

basis of a review of internal tobacco industry 

documents, Pollay33 concludes that two 

key typologies of cigarette consumers 

used by cigarette firms are “new users” 

(young starters) and “latent quitters” 

(concerned smokers who need reassurance). 

An appearance of healthfulness and 

reassurance is particularly likely to be seen 

in the advertising of cigarette brands such 

as Carlton and Merit Ultra Lights, which 

are promoted with messages about their 

low-tar yields.69 Despite the demonstrated 

seasonality of cigarette sales, it is during 

the first few months of the year that the 

frequency of cigarette advertising tends to 

be higher. These advertisements may be 

more likely to target “health-concerned” 

smokers and to counter the common 

New Year’s resolution to quit smoking.60,70

It is also common for marketers to cluster 

a market according to the various benefits 

that consumers seek from a product. Basic, 

GPC, and Doral exemplify “value” brands and 

are positioned to appeal to consumers who 

are looking for discount prices or getting a 

“bang for their buck.” Doral advertising that 

circulated in 1998 included the following 

advertising copy: “Doral combines the taste, 

quality, and extras of higher-priced brands 

with a price that’s always fair. We think 

that’s the kind of honest value you deserve. 

Discover the Doral difference.” During 1999, 

the tagline “Imagine Getting More” was 

used for Doral with the implication that the 

tobacco was “slow burning” relative to other 

brands. Meanwhile, cigarette brands such 

as Marlboro and Camel are both classified 

“Value” brand advertisement for Doral 

cigarettes
62

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

and promoted as “premium” brands. The 

“premium” moniker conveys that the 

product is of high quality and a market 

leader, suggesting status redemption for 

its user.

Tobacco advertisements are also used 

to link smoking with a variety of other 

supposed benefits such as affording 

pleasure, improving social confidence, 

advancing relaxation, reducing stress, 

aiding concentration, and helping in weight 

reduction71 (chapter 5). According to 

internal documentation of R.J. Reynolds that 

detailed an assessment of various product 

designs, consumer benefits can include 

“prestige,” “cost,” “time management,” 

“social interaction,” “mood enhancement,” 

“health,” “implied health,” and “taste 

burnout.”72(Bates no. 504663481/3484) Tobacco industry 

documents also reveal that many consumers 

seek a cigarette brand that will deliver 

reduced irritation to their throats, although 

it has been documented that several 

supposedly harm-reduced products that 

were launched in the marketplace did not in 

fact meet this desired consumer benefit.73

Psychographic Segmentation

Psychographics, also referred to as 

lifestyle analysis, is another commonly 

used segmentation approach in which 

the personality, activities, interests, 

and opinions of the target market are 

considered. According to Kapferer,74(p.23)

one primary consumer benefit served by 

brands is “to have confirmation of your 

self-image or the image that you present 

to others.” Brands can help provide an 

identity for consumers, making them feel as 

though they belong to a special group.75–77

When selecting a particular brand of 

cigarettes, consumers engage in an act of 

distinction (i.e., the brand says something 

about them, much like the clothes they are 

wearing, the music they listen to, or the 

car they drive). Several content analysis 

studies reveal that health and vitality, 

risk and adventure, independence, status 

redemption, romance, recreation, and 

relaxation are common themes associated 

with cigarette products in advertising78,79

(chapter 5 presents an overview of the 

content analysis literature that pertains to 

cigarette advertising).

Tobacco companies, and the market 

research firms that do contract work for 

them, extensively study the personality 

characteristics of smokers. Personality 

characteristics identified by Lorillard 

during the mid-1980s included the rugged 

man, pleasure seekers, unsettled dreamers, 

outdoor individualists, refined ladies, 

satisfied secures, and social strivers.71

Labels used by Philip Morris during the 

early 1990s to describe the psychographics 

of men included macho hedonists, 

‘50s throwbacks, enlightened go-getters, 

and new age men, whereas women were 

classified as ‘90s traditionalists, uptown 

girls, mavericks, and wallflowers.80

Importance of Communicating 

Brand Image

Promotional planning, therefore, involves 

establishing advertising objectives and 

determining the target audience. As discussed 

in chapter 4, there are several ways to 

communicate with consumers, including 

advertising, event sponsorship, celebrity 

endorsements, packaging, coupons, personal 

selling, sampling, contests, publicity, 

product placement, and public relations. 

For conventional advertising, the copy 

platform entails the formation of creative 

promises (i.e., communicating what benefits 

the product will provide or, alternatively, 

what problems the product will solve), 

supported by reasons why the customer 

should buy the product rather than a 

competing offering (i.e., focus is often placed 

on one or two key points of differentiation).

Communicating brand image is considered 

particularly crucial for product categories 
63

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

such as cigarettes and beer; several brands 

possess minimal product differentiation, 

yet have a high degree of social visibility. 

Such characteristics are the basis for these 

goods sometimes being coined badge 

products. Particular brands are depicted 

as expressions of success, sophistication, 

femininity, rebellion, and so on.7 Marlboro, 

for example, represents masculine, rugged, 

tough, and no-nonsense qualities, while 

Virginia Slims typifies feminine, sexy, 

and glamorous.

Cornerstones for Effectively 

Communicating Brand Image

Brand equity is defined as “a set of assets 

(and liabilities) linked to a brand’s name and 

symbol that adds to (or subtracts from) the 

value provided by a product or service to a 

firm and/or that firm’s customers.”7(pp.7–8)

These assets include brand loyalty, brand 

name awareness, perceived quality, and 

brand associations. A cigarette brand’s 

identity or image is collectively constructed 

through the use of brand names, logos, 

taglines, typography, pictorials, and primary 

and secondary colors.81 Several principles 

are considered as cornerstones for effectively 

communicating brand identity or image. 

Effective media messages are typically 

repetitive, consistent across various media 

contexts and across brand elements over 

time, and relevant to a contemporary 

market of consumers.

Branding

The use of a name, term, symbol, or 

design to identify a product is known as 

branding.7 Effective brand names are often 

short and simple; easy to spell, read, and 

pronounce; distinctive and memorable 

(easy to recognize and remember); pleasant 

sounding (not offensive, obscene, or 

negative); applicable for multinational use; 

timely (unlikely to become out-of-date); 

and legally available for use (not in use by 

another firm).82 Moreover, a good brand 

name commonly suggests something 

about the product’s benefits, is adaptable 

to packaging and labeling needs, and is 

appropriate to new products that may be 

added as line extensions at a later date.83

The logo, meanwhile, is the visual element 

used to define a firm or brand.82 Common 

objectives when designing logos are 

(1) having a style that is highly memorable 

(e.g., a logo with a totally unique shape); 

(2) helping identify the company’s product; 

and (3) being bold, simple, and easily 

readable.83 Lucky Strike’s target motif, 

Tobacco Branding: What’s in a Name?

Tobacco product brand names spring from a wide range of sources, from product-positioning 

factors to company history. Virginia Slims, for example, is a brand name that is rich in meaning 

for U.S. consumers. Virginia conveys a woman’s name as well as the name of a U.S. state well 

known for tobacco farming and production. Slims, meanwhile, refers to a reduced-circumference 

cigarette; this product feature was innovative when the brand was launched in 1968.a Slims may 

also be intended to refer implicitly to the weight-controlling effects of smoking.

The Winston and Salem cigarette brand names reflect that the head office of producer R.J. Reynolds 

is based in Winston-Salem, North Carolina; Kent, launched in 1952 by Lorillard, was named after 

the company’s president, Herbert A. Kent.b

a

Kluger, R. 1997. Ashes to ashes: America’s hundred-year cigarette war, the public health, and the unabashed 

triumph of Philip Morris. New York: Vintage Books.

b

White, L. C. 1988. Merchants of death: The American tobacco industry. New York: Beech Tree Books, 

William Morrow and Company.
64

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

for example, is legendary. Raymond Loewy, 

widely considered to be the father of 

industrial design and well known for 

designing several celebrated brand 

icons, including the Exxon and Shell Oil 

logos and the U.S. Postal Service seal, 

produced the modern package design of 

Lucky Strike in 1941. He was paid $50,000 

for the design, in which he replaced the 

green background with white (the brand’s 

advertising campaigns, meanwhile, included 

the advertising copy “Lucky Strike Green 

has gone to war! So here’s the smart new 

uniform for fine tobacco”), sharpened the 

typography, and made both sides of the 

package identical by depicting the circular 

motif or “target” on the front and back.84

Loewy’s design remains largely unchanged 

more than 60 years later.

Taglines and Slogans

Taglines (or slogans) are another integral 

part of a promotional campaign and are 

commonly developed with the objective of 

being understandable and memorable as 

well as linking benefits or positive images 

to a brand.82 According to Andrew Stodart, 

president of the Toronto-based consulting 

company Brand Builders, “A slogan that 

works can offer constant reinforcement 

for a product. It can be money well spent 

if it is created in a way that consumers 

identify with it immediately.... A tag line 

becomes shorthand for your company’s 

message.”85(p.B11) Enduring cigarette 

advertising taglines include “I’d walk a 

mile for a Camel” and “Come to Marlboro 

Country”; Virginia Slims’ “You’ve come 

a long way, baby”; Benson & Hedges’s 

“The length you go to for pleasure”; and 

Newport’s “Alive with Pleasure!” The slogan, 

“Winston tastes good like a cigarette 

should,” was named as one of the top 

10 jingles of the twentieth century in 

Advertising Age.1

Pictorials

In pursuit of effective communication, 

advertisers attempt to create a message 

that is simple, familiar, easily recognized, 

comprehensible, and distinctive. 

Acknowledging that many advertisements 

attract limited and indirect attention 

from the viewer amid all of the “clutter,” 

advertisers often design messages that 

draw attention or stand out but do not 

require large amounts of time and effort 

to understand. This is facilitated through 

the visual imagery predominating in many 

advertisements, with its function illustrated 

by the aphorisms, “A picture is worth a 

thousand words,” and “Seeing is believing.” 

Market research is typically conducted 

that both informs (i.e., pretesting) and 

validates (i.e., posttesting) promotional 

planning efforts.

Brand imagery is further reinforced or 

enhanced in advertising visuals through 

the use of lifestyle portrayals, which do 

not necessarily require depictions of 

people. Cobranding, event sponsorship, 

and endorsements exemplify three ways 

of enriching the symbolic value of brands 

or trademarks.82 Distinct trademark 

meanings (and implied product users) 

will be communicated if one advertisement 

features tickets for an opera performance 

on the dashboard of a Mercedes while 

another depicts tickets for a stock car race 

on the dashboard of a Chevy pickup truck. 

Product endorsement from an Olympic 

gold medalist would potentially associate 

a trademark with qualities of nationalism, 

leadership, and high performance. 

The personality of the particular athlete 

might also be transferred to the endorsed 

brand. Clearly, associating a brand or 

trademark with other objects, settings, 

and people that are rich in meaning can 

effectively convey lifestyle imagery and 

brand personality.86–88

Use of Color

Tobacco promotions are commonly 

dominated by visual imagery, with color 

playing an important role in distinguishing 

trademarks and communicating both 
65

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

imagery and product characteristics.89

Generally, red evokes strong feelings 

related to passion, danger, anger, love, sex, 

strength, and power, whereas gold is the 

conventional color of money and can bring 

to mind feelings of security, wealth, and 

abundance. Blue is frequently associated 

with calmness, coolness, introspection, 

wisdom, and solitude, and green suggests 

nature, renewal, new beginnings, healing, 

health, and harmony.90 Some brands have 

used colors as main features of marketing 

campaigns, such as the “What can brown 

do for you?” advertising campaign for 

the UPS package delivery company,91 and 

the promotions for the Orange Savings 

Account marketed by the Internet bank 

ING Direct.92,93

With respect to the marketing of cigarettes, 

red normally communicates strong flavor, 

blue commonly symbolizes a “mild” brand 

extension, and green usually conveys that a 

brand is mentholated.94 Moreover, industry 

documents and trade sources indicate that 

the color and imagery used in advertising 

executions and packaging are meant to 

imply product “lightness.”69(pp.217–219),94(pp.i76–i77)

Promotions for brands with supposedly 

low-tar yields often use lighter color shades 

or white-on-white executions, which 

may signify cleanliness or a less harmful 

product and dissociate cigarettes from 

unpleasant aromas. According to British 

American Tobacco, “ ‘light-lighter-lightest’ 

were achieved by insistance [sic] on lighter 

presentations - product story imagery 

- white packs - pale colours - mildness 

dominated copy.”95(p.14) Colors have also 

been associated with specific cigarette 

brands, such as red for Marlboro and 

purple for Silk Cut, as described below in 

the section on surreal advertising in the 

United Kingdom.

Repetition, Consistency, and Relevance

Repetition of a promotional message or 

brand identity, over time, across multiple 

media, and across advertising executions 

leads to familiarity and increased advertising 

effectiveness.96–99 A dense environment of 

cigarette promotion and imagery gives 

the impression that tobacco use is socially 

acceptable, desirable, and prevalent.100

The large promotional budgets that are 

apparent for leading cigarette brands 

reinforce and elevate consumer perceptions 

about the popularity of those brands, and 

popularity is considered to be a crucial 

factor in brand desirability among youth.101

The persistence and pervasiveness of 

tobacco promotion are notable. The major 

cigarette manufacturers in the United States 

spent $13.1 billion in 2005 on advertising 

and promoting cigarettes102 (chapter 4). 

Repeating a basic promotional message 

with a variety of advertising executions 

requires a considerable advertising budget. 

Firms often spend a large proportion 

of advertising expenditures on one or 

two leading brands (i.e., those that have 

demonstrated popularity). 

It is considered important among 

marketers to have promotional messages 

that are consistent with the overall image 

and characteristics of the brand.7,75,82,103

Companies are diligent about protecting 

their brands from negative effects related 

to inconsistent brand associations.104,105

According to Wells and colleagues, 

Because the effects of image advertising 

build up over time, consistency is 

critical to the process. You can’t say one 

thing today and something different 

tomorrow ... every ad contributes to the 

image. The message must focus on what 

the image is supposed to be, and should be 

consistent over a long time.106(p.207)

When a promotional message is consistently 

portrayed across different media contexts 

(i.e., accounting for the setting of media 

consumption, such as New York City’s 

Times Square compared to the living room 

of one’s home) and across different elements 

of the brand (e.g., logos, slogans, product 
66

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

package, product message, characters, 

brand community events), it is generally 

more effective.76,107–110

Marlboro serves as a good example of 

a brand or trademark that has been 

successfully linked to consistent imagery 

over a long time. Wernick explains that

the meaning of any single message is 

modified by, and depends on, the ones 

that came before. The same is true for 

sub-campaigns, where even the launching 

of a new product may build on meanings 

previously achieved. During the 1980s, 

for example, ads for Marlboro Lights 

projected a soft focus version of the 

leathered cowboy which had already 

become ultra-familiar in previous 

advertising for its parent brand.14(p.92)

Yet, while the image(s) communicated 

may remain the same, different symbols 

can be used to help the brand remain 

relevant, contemporary, and appealing 

to an ever-changing audience.75,82

Marketing practitioners are mindful 

that the target market is likely to evolve; 

that is, even though the target age group 

(e.g., 18–24 years) may remain unchanged, 

the individuals receiving the message will 

vary over several years. For promotional 

campaigns to remain effective over time, 

practitioners need to maintain message 

salience for a contemporary audience, 

including those not yet affected by a 

particular campaign, and account for a 

cohort effect (i.e. with an age segment of 

18–24 years, for example, a set of people 

will move in and out of the target market 

each year). 

Ellen Merlo, Philip Morris’s vice president 

of marketing services, makes clear why the 

company makes such a heavy investment in 

Marlboro’s being an auto-racing sponsor: 

Everything we do at Philip Morris is an 

extension of our overall brand positioning 

and brand imagery. We perceive Formula 

One and Indy car racing as adding, if 

you will, a modern-day dimension to the 

Marlboro Man. The image of Marlboro is 

very rugged, individualistic, heroic. And so 

is this style of auto racing. From an image 

standpoint, the fit is good.111

Thus, the Marlboro brand image of rugged 

masculinity has been communicated 

consistently over a considerable period of 

time, yet modified over the years. Thus, ways 

of communicating rugged masculinity may 

be adjusted over time, including activities 

and celebrities depicted. 

Integrated Marketing Communications: 

Marlboro as a Case Study

The importance of the cornerstones for 

effectively communicating brand image, 

such as repetition, consistency, and 

relevance to a contemporary or modern 

audience, are well illustrated in a case 

study of Marlboro and Philip Morris’s use 

of integrated marketing communications 

(IMC). A brief case study of Marlboro and 

IMC is presented below.

IMC involves “the intentional coordination 

of every communication from a firm to 

a target customer to convey a consistent 

and complete message.”4(p.433) The market 

dominance of Marlboro, for example, is 

in part explained by Philip Morris’s wellintegrated marketing communication efforts 

(relative to competitors’ trademarks) and the 

firm’s ability to appeal to the all-important 

youth market (for examples of IMC efforts 

that are substantiated by Philip Morris’s 

internal documentation, see the written 

direct testimony of Krugman.112 Dewhirst 

and Davis113 provide a case study of brand 

strategy and IMC for Player’s, which is a 

leading cigarette brand in Canada with a 

positioning similar to Marlboro’s).

Philip Morris has communicated a 

consistent, complementary message to the 
67

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

target consumer over time and through 

different elements of the promotional 

mix. “Marlboro Country” conjures up 

visual images of the American West, 

including cowboys on horseback, 

the herding of beef cattle, and vistas of 

mountains, tree-lined streams, high 

rock faces, and canyons. A cowboy 

has been used as a Marlboro symbol 

since 1954. Earlier, Marlboro had been 

targeted to women “as the essence of 

femininity,”8 with advertising slogans 

such as “Mild as May.”13(p.493) However, 

the Marlboro brand was reissued and 

repositioned in 1954 and featured, 

in addition to the cowboy character, 

other rugged, ultramasculine figures, 

typically with tattoos. By 1964, Marlboro 

had become linked nearly exclusively with 

a cowboy, considered an ideal symbol of 

rugged masculinity, freedom, escapism, 

adventure, independence, simple 

pleasures, and heroism.31,114 Legendary 

ad maker Leo Burnett conceived the 

initial idea of using a cowboy.115 To this 

day, the Leo Burnett advertising agency, 

which is based in Chicago, handles the 

Marlboro account.

Marlboro’s brand image is also consistently 

conveyed through various elements 

of the communications mix. Marlboro 

cigarettes are offered in a flip-top 

package, which is publicized as solid 

and “crush-proof.”114 Philip Morris has 

launched a lifestyle magazine titled 

Unlimited, which is distributed by direct 

mail to those in the firm’s database. The 

magazine content—hailed as “Action, 

Adventure, and Good Times”—closely 

matches the psychographics of the target 

market for the Marlboro brand. Labels 

for the Marlboro Classics clothing line 

point to the garments’ combination of 

“strength” and “endurance,” implying that 

the garments can endure harsh outdoor 

activities like those expected of a cowboy. 

Marlboro Unlimited Gear, which includes 

branded items such as trail watches, 

transportable gas grills, and gear bags, 

is promoted as durable, “without limits,” 

and “built for adventure.” During the late 

1990s, promotional initiatives dubbed 

“Party at the Marlboro Ranch” provided 

sweepstakes winners with vacation 

opportunities to ranches located in 

Montana and Arizona. These advertising 

campaigns were preceded by “Marlboro 

Adventure Team” holiday promotions, 

which stipulated that 

a hand-picked team of ten will meet 

in Grand Junction, Colorado, to take a 

journey down white water and rock walls, 

across deserts and over trails that lead 

to places that aren’t even considered 

places yet. Hell Canyon, Lizard Rock, 

Marlboro advertisements featuring a cowboy character

Advertisement for the “Marlboro 

Adventure Team”
68

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

Thunder Pass. This is the West—where 

you find your adventure, you don’t wait for 

it to find you ... for eleven days, experience 

Marlboro’s unforgettable world of freedom 

and adventure.116(p.43)

During the 11-day vacation, contest winners 

were engaged in activities such as whitewater rafting, dirt biking, 4 × 4 automobile 

driving, and horseback riding.

The key sponsorship properties of 

Marlboro are automobile racing and 

motorcycle racing. During the early 

2000s, Philip Morris, in its Formula One 

partnership with Ferrari, spent roughly 

$23 million each year toward race-car driver 

Michael Schumacher’s salary and about 

$65 million each year to have Marlboro 

placed in multiple locations on the race 

car, helmet, and overalls of Schumacher 

and his teammate Rubens Barrichello.117,118

Schumacher’s performance has been 

unprecedented; he holds numerous 

Formula One records such as most wins 

in a single season, winner of the longest 

string of races within a season, and seven 

overall drivers’ titles.119 With Schumacher 

often a race leader, Marlboro received 

considerable television coverage during 

Formula One events, compounded by the 

fact that the winning driver often appears 

in magazines, newspapers, and television 

newscasts worldwide. It is estimated that 

300 million people watch each Formula One 

race on television.120 Similarly, during a 

94-minute broadcast of the 1989 Marlboro 

Grand Prix, the Marlboro brand name was 

shown or mentioned 5,933 times, and the 

name was seen for a total of 46.2 minutes, 

or about one-half of the total broadcast 

time.121 For viewers, it was easy to make the 

link between Schumacher as a leader in the 

auto-racing field and the Marlboro brand as 

the market leader in the cigarette product 

category. In addition, it is easy to see that 

the various Marlboro promotional efforts 

collectively communicate a cohesive and 

powerful message.

Nowak and Phelps122 note a trend in greater 

usage of databases and new expectations 

from marketing communication suppliers 

such as sponsorships (e.g., staging contests 

at event sites that require contestants 

to submit their demographic profiles 

and correspondence details) to assist 

in database development. Duncan has 

defined IMC as “a cross-functional process 

for creating and nourishing profitable 

relationships with customers and other 

stakeholders by strategically controlling 

or influencing all messages sent to these 

groups and encouraging data-driven, 

purposeful dialogue with them.”123(p.8)

Several tobacco firms, such as Philip Morris, 

have demonstrated their strong commitment 

to IMC, moving away from traditional 

mass media promotion to integrated forms 

of communications such as sponsorship, 

public relations, direct marketing, and sales 

promotion. For tobacco companies such 

as Philip Morris, regulated restrictions on 

access to different media further compelled 

seeking a variety of nontraditional media 

(making use of emerging technologies and 

new media). A greater use of databases 

and new expectations from marketing 

communication suppliers to provide 

database-building capabilities indicate an 

IMC approach. A highly targeted customerfocused strategy and a strategically consistent 

brand positioning, which are key tenets of an 

IMC mindset, have contributed to Marlboro 

becoming the best-selling and dominant 

brand in the U.S. market.

“Surreal Advertising” in the United 

Kingdom as a Case Study

“Surreal advertising” for cigarettes in 

the United Kingdom provides another 

powerful illustration of the cornerstones 

for effectively communicating brand 

image that are discussed above—especially 

branding, pictorials, use of color, and 

repetition. A case study of this advertising 

genre is presented below. 
69

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

The Tobacco Advertising and Promotion 

Act in the United Kingdom prohibits 

tobacco advertising in the print media 

and on billboards as well as by direct mail 

and other promotions, effective in 2003. 

The act also banned tobacco sponsorship of 

sporting events (other than international 

events) in July of that year, and tobacco 

sponsorship of Formula One motor racing 

ended in July 2005. Regulations on indirect 

advertising (i.e., the use of tobacco product 

brand names on nontobacco products and 

services) and point-of-sale advertising were 

issued in 2003.124

Before passage of this act, tobacco 

advertising in the print media and 

tobacco sponsorship of sporting events 

in the United Kingdom were governed by 

two voluntary agreements periodically 

negotiated between the tobacco industry 

and the government.124 One of these 

agreements required, among other things, 

adherence to the Cigarette Code.125

The code, which was developed jointly by 

the U.K. Department of Health, cigarette 

manufacturers and importers, and the 

Advertising Standards Authority (ASA), 

promulgated rules on the content of tobacco 

advertising. The ASA, which was responsible 

for certifying advertisements as acceptable 

before they were published, described the 

rules as follows:

The essence of the Code was that 

advertisements were not to encourage 

people to start smoking nor were they 

to entice smokers to smoke more or 

to excess.

As with every other part of the Codes, the 

Cigarette Code’s rules were applied in the 

spirit as well as the letter. Broadly, they 

included the following requirements:

Youth: Advertisements were not to be 

designed or presented in a way which had 

a greater appeal to those under 18 than 

to the general public. Anyone shown 

smoking was required to be clearly over 

the age of twenty-five. Advertisements were 

not to play on the susceptibilities of the 

immature or vulnerable nor were they to 

feature heroic, cult or fashionable figures 

in a way that might appeal to the young. 

In the 1995 edition of the Codes, the rules 

were tightened to prohibit humour being 

used to attract young people.

Health, context and environment: 

Advertisements were not to suggest 

that smoking was safe, popular, natural, 

healthy or necessary for relaxation and 

concentration. Cigarettes were not to be 

shown in the mouth and smoking was not 

to be associated with healthy eating or a 

wholesome life-style.

Social success: Advertisements were not 

to link smoking with people who were 

evidently wealthy, successful or fashionable 

or who possessed other qualities that 

might command admiration or encourage 

emulation. They were not to claim or imply 

that smoking was a sign of masculinity or 

that it enhanced feminine charm. Nor were 

they to imply a link between smoking 

and social, sexual, romantic or business 

success. The attractions of smoking were 

not to be exaggerated.

Promotions: Advertisements for coupon 

brands were not to feature products unless 

those products could be obtained through 

the redemption of coupons collected 

over a reasonable period of average 

consumption.126

Advertising for several cigarette brands 

appeared in British media, demonstrating 

creative and often bizarre uses of color, 

symbols, and imagery that were still 

permitted under the code. Silk Cut and 

Benson & Hedges (sold in the United 

Kingdom by Gallaher Group Plc), as well 

as Marlboro, were the most notable brands 

employing surreal advertising. In most of 

these advertisements, the only indication 
70

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

that cigarettes were being promoted was 

the government-mandated health warning 

shown at the bottom of the ad.

According to the Wall Street Journal,127

Benson & Hedges (B&H) “pioneered the 

genre” of surreal advertising with a series 

of ads showing the brand’s gold box in 

strange ways:

One [ad in 1977] showed the box in front 

of a mouse hole—likening it to a trap. 

Another [ad in 1980] showed it being 

carried away by ants as if it were something 

dead. A recent ad shows someone being 

hypnotized by a gold watch.

Other advertisements showed the B&H box 

floating on blue water, looking like a can 

of sardines, partially opened to reveal 

the cigarettes; a pack of B&H in a bird 

cage; a giant B&H box floating on a pond, 

next to a flock of ducks being fed by an 

elderly woman; a large B&H box on top 

of which rested a curling iron, with many 

curled cigarettes strewn about; and yet 

another oversized box buried on a rocky 

beach, reminiscent of the image of the 

Statue of Liberty buried in the sand at the 

end of the original Planet of the Apes movie. 

A B&H ad in the 1990s showed “a dentist 

with a perverse grin who has just pulled a 

gold tooth.”128 A cinema commercial 

showed a giant B&H packet swinging from 

a helicopter above the Arizona desert, 

watched by bug-eyed iguanas and then 

dropped into a swimming pool.... It was, 

they said, the most expensive cinema 

commercial ever produced. And almost 

certainly the best-remembered.129

The advertising campaign for Silk Cut, 

which was launched in 1983, used a series 

of images showing purple silk that had 

been cut, or purple silk with something 

sharp (the brand’s package is purple and 

white). The first advertisement in this series 

“showed a pool of silk gathered in a dreamy 

haphazard way—and cut with a significant 

slit.”129 A similar ad showed the silk with a 

bandage on it, presumably covering a tear. 

Other ads in the campaign were described in 

the Wall Street Journal as follows:

One award-winning ad shows a row of 

scissors dancing the cancan in purple silk 

skirts. Another shows a rhinoceros whose 

horn protrudes through a purple silk cap. 

In an obscure twist on the theme, one ad 

simply showed a purple shower curtain. 

The implication was that the silk curtain 

would be slashed as in Alfred Hitchcock’s 

“Psycho.”127

Many Silk Cut advertisements included 

images of scissors, knives, and other 

cutting instruments. One showed strips of 

purple silk falling from the holes of giant, 

building-like cheese graters, resembling a 

ticker-tape parade. Another featured a purple 

brassiere, cupping two round and spiny cacti.

Surreal advertisements for Benson & Hedges showing 

cigarettes curled by a curling iron (above) and an 

oversized cigarette box buried on a rocky beach (right)
71

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Surreal advertisements for Marlboro 

cigarettes also appeared in the United 

Kingdom, typically showing one prominent 

item in red within an otherwise black-andwhite scene that one might expect to find 

in “Marlboro Country” (i.e., the American 

West). As in the case of many of the surreal 

ads for Silk Cut and B&H, many of these 

Marlboro ads did not show cigarettes or 

depict smoking. Although some of the 

ads proclaimed “Welcome to Marlboro 

Country,”127 other ads had no obvious 

connection to cigarettes, except for the health 

warning at the bottom of the ads. The red 

color—the only feature identifying the brand 

being advertised—was a link to the color of 

the well-known Marlboro chevron used in 

the brand’s logo and on its packaging. One 

surreal Marlboro ad, for example, showed 

a red river flowing through the valley of a 

broad and desolate canyon. Another showed 

a bright red motorcycle alongside a bleak 

and deserted country road. McIntosh128 has 

described other ads in this campaign.

What are these surreal advertisements 

attempting to accomplish? They may have 

been designed to achieve one or more of the 

following goals: (1) to get noticed in a “noisy” 

marketing environment; (2) to engage the 

viewer in attempting to discern the meaning 

of the ad; (3) to affirm the intelligence of 

the viewer who solves the riddle of the ad; 

(4) to evoke humor; (5) to elicit feelings 

of eroticism, violence, or death; and (6) to 

influence smoking behavior and attitudes 

toward smoking while navigating through or 

around the provisions of the Cigarette Code. 

These purposes are addressed below in 

greater detail.

To be successful, an advertisement must 

break through the cluttered sensory 

environment in modern society to get 

noticed. The average consumer is exposed 

to about 2 million brand messages each 

year across all media channels.130 No matter 

how well an advertisement is constructed, 

it will be ineffective if it is not noticed. 

Unusual or bizarre images in advertising are 

more likely than is traditional imagery to 

capture the attention of a reader perusing a 

magazine or a person walking or driving by a 

billboard. A related objective is that atypical 

advertising is more likely to garner publicity 

or “buzz” (see chapter 4 for a discussion of 

“viral” marketing).

Another likely purpose of surreal 

advertisements is to engage the viewer 

in attempting to discern their meaning. 

Academic research finds that such 

advertisements not only attract attention 

Surreal advertisements for Silk Cut cigarettes (above 

and right)

Surreal advertisement to link the color red with the red 

Marlboro chevron
72

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

but also engage consumers in more 

thought.107 According to Goldman,131(p.171)

ads which are unpredictable and 

whose meanings are opaque, if not 

impenetrable ... arrest the attention of 

the viewers.... If viewers spend more 

time pondering the meaning of an advert, 

if they make more of an investment in 

interpreting it,... then perhaps they will be 

more likely to recall the product name.

Product name recognition is another key 

element of effective marketing campaigns.

A third purpose of these advertisements may 

be to have viewers feel good about themselves 

for having figured out the meaning of an 

advertisement or an advertising campaign. 

Viewers who experience a sense of 

accomplishment after solving the riddle of an 

ad132 are likely to have more favorable views 

toward the product being advertised (and 

toward the manufacturer of the product). 

In reference to the Silk Cut “shower curtain 

ad” mentioned above, a creative executive at 

M&C Saatchi (the ad agency that produced 

many of the Silk Cut ads) said,

People recognize the connection between 

the advertisement and Psycho, the thriller, 

so people think they’re quite clever. It’s 

smart arse. It affirms their intelligence 

and their wittiness. It strikes a chord 

with them.128

Many of the surreal ads attempt to evoke 

humor. The M&C Saatchi creative executive 

asserted that,

The primary motivating factor in my 

culture, in my advertising culture, is 

an attempt to get humour into the 

advertisement.... [They] work if it’s funny, 

if people find it engaging.”128

As noted above, the Cigarette Code was 

tightened in 1995 to prohibit the use of 

humor in advertising as a means to attract 

young people. The driving force for this 

modification of the code was not the 

surreal ads, but evidence that a baldheaded 

man named Reg, used in an advertising 

campaign for Imperial Tobacco’s Embassy 

Regal brand, appealed to youth, partly 

through humor.133,134

These last two aims may overlap when a 

viewer is challenged to understand the 

humor in an advertisement. As York explains, 

both campaigns [Benson & Hedges 

and Silk Cut] confirmed the audience’s 

cleverness and visual literacy in 

recognizing the elegance of the jokes. 

Clever advertising driven by puns on 

intrinsic properties—the box, the brand 

name—made for clever, memorable 

brands; brands with an assurance that 

made the older cigarette advertising 

approaches look decidedly klutzy.129

An example is an ad showing a short branch 

with two purple, silken leaves; the pun is 

that the plant is a cutting.135

In an essay titled “From Eros to 

Thanatos,”128 McIntosh argues that several 

of the Silk Cut advertisements have 

imagery suggestive of sexual organs, sexual 

violence, and death. During a discussion 

of the semiotics of a Silk Cut ad in the 

novel Nice Work,136 the female protagonist 

maintained that the ad “appeals to both 

sensual and sadistic impulses....” Sexual 

symbolism—whether subliminal or 

perceptible—is not confined to surreal 

cigarette ads. Pollay has identified many 

examples in conventional cigarette ads.137

Suggestions of sexual violence and death are 

in some Silk Cut advertisements. Many of 

the Silk Cut advertisements, as noted above, 

feature scissors, knives, and other cutting 

instruments, including saws, axes, and meat 

cleavers. Gallaher’s last U.K. campaign for 

Silk Cut cigarettes included two ads showing 

a woman holding a cutting instrument in 
73

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

a scene with an undercurrent of violence. 

In one, a woman is holding garden shears, 

seemingly upset that her husband is talking 

with the buxom woman next door (who is 

hanging her purple undergarments on a 

clothes line). In the other, a man is working 

on a newspaper crossword puzzle and 

ignoring his food at the dinner table, while 

his wife is gripping a knife in a menacing 

way. McIntosh argues that the imagery 

suggesting sexual violence and death 

is tapping into “rape fantasy” and what 

Sigmund Freud called the “death instinct.”128

Finally, the potent imagery in surreal 

advertisements can be seen as a strategy to 

affect smoking behavior while circumventing 

the provisions of the Cigarette Code. The 

general manager of corporate affairs for 

Gallaher seemed to acknowledge as much 

when he said, “One of the reasons we have 

the most creative advertising in the world 

is because we’ve had the toughest rules for 

so long.127 Others have recognized the same 

connection. Langan135 commented as follows:

Silk Cut has managed to allude to sensual 

and sexual desire, thus demonstrating one 

way in which [an] advertiser can attempt 

to covertly allude to qualities, or suggest 

reasons for buying their product which, 

because of the strict laws in the case of 

cigarette advertisements, they are not able 

to do overtly.

Similarly, Lindstrom has noted, 

The Silk Cut campaign was wordlessly 

articulate and negotiated the newly 

introduced, mid-’80s bans on cigarette 

advertising with such elegance, the brand’s 

image and message remained intact without 

the slightest reference to the product.

You don’t need too much creativity to 

imagine how a range of beautiful, silk-filled 

wallpaper could work for Silk Cut. Instead 

of advertising, a branding tool stands as 

a work of art. Any brand communication 

that achieves this level of sophistication is 

a brand-building victory. Such a campaign 

could integrate its message across 

channels, even conquering those channels 

in which advertising is restricted, as is the 

case with tobacco and other products.130

Lindstrom’s allusion to “silk-filled wallpaper” 

as an extension of Silk Cut’s advertising is not 

necessarily far-fetched. As Langan explains, 

Sexual imagery used in surreal advertisements for 

Silk Cut cigarettes (above and right)

Silk Cut cigarette advertisements suggesting violence
74

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

The repetition of this metaphor [cut silk] 

for the brand Silk Cut has produced an 

important effect. The signifier, the purple 

colour, has become just as important as 

the brand name. It now works to anchor 

the picture, ... [in ads] where the silken 

sheet is absent (i.e., through recognition 

of the colour the viewers are steered 

towards the correct interpretation of the 

advertisements). It is mainly the colour 

which has become the symbolic tool 

with which the viewer can approach and 

“correctly” discover the preferred reading 

of the adverts. This becomes important 

in later advertisements where the silken 

object and the cut are even less apparent.135

Once a color has become strongly associated 

with a brand (e.g., purple for Silk Cut, red 

for Marlboro, gold for Benson & Hedges), 

it is possible that the color by itself may 

serve to promote the associated product. 

This raises the question of whether cigarette 

companies strive to develop strong color 

associations for their leading brands to 

allow the companies to continue color-based 

brand promotions under severe marketing 

rules anticipated to exist in the future. 

Indeed, in Papua New Guinea, “the entire 

exteriors of shopping centres and small 

trading posts are not uncommonly painted 

in the colours of a major cigarette brand ...

and sporting a large number of posters 

and point-of-sale displays for cigarettes.”138

If legislation were to ban the posters and 

point-of-sale displays, the cigarette colors 

on the store exteriors might remain, along 

with their attendant associations with 

specific cigarette brands.

A Rationale for 

Regulating Tobacco 

Promotion

Regulation, according to C. Lloyd BrownJohn, is defined as “any constraint imposed 

upon the normal freedom of individuals by 

the legitimate activity of government.”139(p.7)

Because regulation involves government 

activities that limit the choices available 

to individuals, it is often controversial.140

The regulation of tobacco promotion is no 

exception. To what extent can and should 

the government intervene in the lives of 

citizens? Moreover, which government 

activities should be regarded as legitimate? 

The key rationales for implementing a 

comprehensive ban on tobacco advertising 

and promotion include (1) the health 

consequences of tobacco use (including 

addiction); (2) the deceptive or misleading 

nature of several tobacco promotional 

campaigns; (3) the unavoidable exposure 

of youth to these campaigns; (4) the role 

of tobacco advertising and promotion in 

increasing tobacco use in the population, 

especially among youth; (5) the targeting of 

“at-risk” populations through advertising and 

promotion, including youth, women, and 

ethnic and racial minorities; (6) the failure 

of the tobacco industry to effectively selfregulate; and (7) the ineffectiveness of partial 

advertising bans. The third, fourth, and fifth 

rationales are reviewed in detail in chapters 

4, 5, and 7; the others are discussed below. 

The call, by the WHO FCTC and others, for a 

comprehensive ban on tobacco advertising 

and promotion requires discussion of 

whether this policy would violate federal 

statute or the First Amendment to the 

U.S. Constitution (see chapter 8).

Health Consequences of 

Tobacco Use

A government regulatory role in the 

creation of tobacco control policies is 

largely justified because cigarette smoking 

represents the single most important cause 

of preventable illness and premature death in 

the United States. Smoking has been linked 

to a number of health problems, including 

chronic bronchitis and emphysema; strokes 

and heart disease; and cancer of the lung, 

lip, oral cavity, pharynx, larynx, esophagus, 
75

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

pancreas, bladder, and kidney. It is 

estimated that roughly 440,000 Americans 

die prematurely each year as a result of 

smoking. Tobacco use is responsible for a 

greater number of deaths among Americans 

than the total number of deaths caused by 

motor-vehicle crashes, suicides, murders, 

AIDS, and illicit drug use combined.141

An important element in the harm caused by 

tobacco is the addictiveness of smoking and 

other forms of tobacco use.142 Because most 

tobacco users develop dependence during 

childhood and adolescence,78 many tobacco 

control programs and policies (including 

bans on advertising and promotion) are 

intended to prevent the initiation of tobacco 

use among youth.

The health effects of smoking extend 

beyond the smoker. Secondhand smoke 

is the combination of smoke produced 

by the burning of tobacco (sidestream 

smoke) and the exhaled smoke from a 

smoker. Secondhand smoke consists of 

gases and particles that contain more 

than 4,000 chemicals, more than 50 of 

which are cancer-causing agents.143

An estimated 50,000 deaths per year in 

the United States—from lung cancer, 

ischemic heart disease, and sudden infant 

death syndrome—have been attributed to 

exposure to secondhand smoke.144

The health consequences of smoking may 

act as an important factor in government 

deliberations about the role that health care 

costs can and will play in the reduction of 

the federal deficit. A reduction in overall 

tobacco consumption levels is regarded 

as a valuable objective toward health care 

reform efforts and offsetting ever-increasing 

health care costs. The social and economic 

costs of tobacco are noteworthy. Costbenefit analyses (see the 2004 Surgeon 

General’s report on smoking and health for a 

thorough literature review) reveal that while 

government tax revenues from tobacco sales 

are substantial, they are largely outweighed 

by the costs attributable to smoking. In the 

United States, it is estimated that the 

economic costs attributable to smoking 

are $157 billion each year, including 

$75.5 billion spent on direct medical care 

among adults, $81.9 billion attributed to lost 

productivity, and $366 million for neonatal 

care. During 2001, the states alone spent 

roughly $12 billion toward the treatment of 

smoking-attributable diseases.141

Deceptive or Misleading 

Promotion

Deceptive advertising has been described 

as marketing communications that likely 

result in consumers having information 

or beliefs that are incorrect or cannot be 

substantiated.145 The Lanham Act, which 

contains the federal statutes governing 

trademark law in the United States, defines 

false advertising as “any advertising 

or promotion that misrepresents the 

nature, characteristics, qualities or 

geographic origin of ... goods, services, 

or commercial activities.”146 In addition to 

misrepresentation (e.g., a company makes 

a claim that has no validity), deceptive 

advertising may occur as a result of 

omitted information.145,147

In a 1,742-page decision issued on 

August 17, 2006, U.S. District Judge 

Gladys Kessler ruled that the major 

U.S. cigarette manufacturers violated 

civil (i.e., noncriminal) provisions of 

the Racketeer Influenced and Corrupt 

Organizations (RICO) Act. She wrote,

For several decades, Defendants have 

marketed and promoted their low tar 

brands as being less harmful than 

conventional cigarettes. That claim is false, 

as these Findings of Fact demonstrate. 

By making these false claims, Defendants 

have given smokers an acceptable 

alternative to quitting smoking, as well 

as an excuse for not quitting.148(p.740)
76

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

As demonstrated by Kessler’s judgment, 

tobacco firms have undergone particular 

scrutiny for the marketing of filtered and 

low-tar cigarette brands, in which product 

descriptors, such as mild, light, ultra low tar, 

slim, smooth, and natural, have commonly 

been used. More than 30 countries have 

now banned the use of “light” and “mild” 

as cigarette product descriptors.149(p.4)

During the 1930s, Camel promotions 

claimed, “More doctors smoke Camels than 

any other cigarette,” and the tagline for 

Old Gold was, “Not a cough in a carload.” 

During the early 1950s, however, articles 

in scientific and lay publications reported 

research findings about the link between 

smoking and lung cancer, leading smokers 

to become increasingly concerned about 

the dangers of smoking, and initiating 

what the tobacco industry referred to as 

a “health scare.” The American Cancer 

Society, for example, released a major study 

linking smoking with lung cancer in 1950, 

and Reader’s Digest articles in 1952 and 

1953 discussed the relationship between 

smoking and cancer.150 Tobacco firms became 

increasingly concerned about the negative 

publicity, which prompted the industry to 

hire Hill and Knowlton, a renowned public 

relations firm, in 1953. Recommendations 

by Hill and Knowlton led to the formation 

of the New York-based Tobacco Industry 

Research Committee (TIRC) in 1954. 

On January 4, 1954, a full-page advocacy 

advertisement, using the headline “A Frank 

Statement to Cigarette Smokers,” circulated 

in 448 newspapers in 258 U.S. cities, reaching 

an estimated readership of more than 

43 million. The advertisement announced 

that the TIRC was being established with 

a mandate to support scientific research 

on the health effects of tobacco use.23,151

The promotion cast doubt on unfavorable 

research findings and included the 

statements: “We [the tobacco industry] 

accept an interest in people’s health as a basic 

responsibility, paramount to every other 

consideration in our business. We believe 

the products we make are not injurious 

to health. We always have and always will 

cooperate closely with those whose task it is 

to safeguard the public health.”

Filtered cigarettes became prominent in 

the U.S. market during the 1950s; in 1950, 

the market share of filtered cigarettes was 

negligible, yet by the end of the decade, 

the majority of cigarette sales were for brands 

with filters.152 Filtered cigarettes offered 

reassurance to consumers about the “safety” 

of smoking (many promotions portrayed 

filters as the technological fix to health 

concerns); they were also more profitable 

because they contained roughly one-third 

less tobacco than did nonfiltered brands as 

a consequence of a shorter column, a new 

freeze-dry “puffing” process, and greater use 

of reconstituted tobacco sheet.69,153 Cigarette 

promotions commonly featured taglines that 

implied health, such as Viceroy’s “DoubleBarreled Health Protection,” Pall Mall’s 

“Guard Against Throat-Scratch,” and L&M’s 

“Just What the Dr. Ordered.”

In 1964, the first Surgeon General’s report 

on smoking and health was released, 

and tobacco manufacturers recognized 

the competitive value of introducing 

brands that offered further reassurance 

to consumers concerned about the health 

risks of smoking. The 1970s marked the 

launch of several cigarette brands that were 

promoted with lower (machine measured) 

tar deliveries. Some of the product launches 

were line extensions of familiar trademarks 

(e.g., Marlboro Lights was introduced by 

Philip Morris in 1971); others were new, 

stand-alone trademarks (e.g., Merit was 

introduced by Philip Morris in 1976). Several 

virtuous-sounding brand names such as 

Merit, Fact, True, and Life are inherently 

misleading for a product such as cigarettes. 

According to Pollay and Dewhirst, 

the product development process for Merit®

was as much focused on consumer and 

market testing as on product technologies, 
77

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

per se. The final market launch strategies 

used in 1976 gave particular emphasis to 

the choice of the name Merit,® obviously 

communicating apparent virtue, and used 

an advertising style that made this product 

development seem eminently scientific and 

newsworthy and less like an ad.69(p.213)

Consumers likely assumed that 

governmental agencies would not permit 

the use of deceptive health claims, yet 

U.S. tobacco manufacturers used Federal 

Trade Commission (FTC) test results 

for tar and nicotine yields in advertising 

copy in attempts to gain a competitive 

advantage. For example, during the mid1980s, when tobacco industry promotional 

spending was overrepresented among 

brands with supposedly low-tar yields, 

Brown & Williamson advertisements 

asserted that among all cigarettes, 

“Carlton is lowest” by referring to the 

U.S. Government laboratory test current 

at that time.69,154 Consumers were likely 

to perceive the FTC-attributed tar and 

nicotine ratings as precise even though 

tobacco manufacturers acknowledged 

within internal corporate documents 

that the FTC testing procedures were 

inaccurate.148(p.571),155,156 Cigarette papers and 

filters were developed that enabled smoke 

to be “air-conditioned” and the smoke 

column to be diluted through the entry 

of sidestream air. These vents were placed 

in locations of the cigarette commonly 

obstructed by a person’s fingers or lips 

while the cigarette was being smoked.157

Thus, tar and nicotine yields generated 

for cigarettes smoked by machines during 

FTC testing were appreciably lower than 

yields delivered by cigarettes smoked by 

actual people.158–160 FTC test results were 

inconsistent with actual tar and nicotine 

yields because the machines did not initially 

account for the compensatory behavior 

demonstrated by people. To satisfy their 

addiction, smokers often compensate when 

smoking lower-yield cigarettes.142,160,161

Compensatory behavior includes smoking 

the cigarette closer to the butt, taking 

deeper puffs, increasing the number of puffs, 

and smoking more cigarettes per day.

Internal British American Tobacco 

documentation claimed, “opportunities 

exist for filter and cigarette designs 

which offer the image of ‘health 

re-assurance’.”162(Bates no. 110069979) Moreover, 

a Lorillard document assessed whether 

consumers perceived their Kent brand to 

have the best filter, stating that, “‘best filter’ 

is undoubtedly considered in terms of many 

different benefits including the taste the 

filter delivers, ease of drawing, mild taste, 

as well as health.”163(Bates no. 01140947) Another 

document, expressing the thoughts of 

cigarette-company research directors at a 

Hilton Head meeting on February 14–16, 

1968, stated, “the increasing popularity 

of filters and acceptability of low delivery 

brands indicate people are worrying about 

the problem [the health implications of 

smoking].”164(Bates no. 1005106316) Under the 

subtitle Attitudes Toward the Effects of 

Smoking on Health, a Brown & Williamson 

document acknowledged that “in discussing 

how a smoker can limit the risks of serious 

disease without actually giving up smoking, 

the respondents clearly recognized the role 

of high filtration cigarettes.”165(Bates no. 680109289)

Similarly, trade sources and internal 

tobacco industry documents acknowledge 

that mildness claims communicate 

health-related messages to consumers. 

For example, a marketing consultancy firm, 

the Institute for Analytical Research Inc., 

in its submission of motivation research 

findings to Imperial Tobacco Ltd. (Canada’s 

largest tobacco manufacturer), stated that 

“the majority of respondents indicate that 

they see ‘mildness’ as synonymous with a 

‘safer’ product and reveal that mildness is 

a criterion for brand selection which takes 

on additional significance in the present 

smoking climate.”166(p.104) According to a 

1977 British American Tobacco document, 

communication strategies 
78

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

should be directed towards providing 

consumer reassurance about cigarettes 

and the smoking habit. This can be 

provided in different ways, e.g. by claimed 

low deliveries, by the perception of 

low deliveries and by the perception of 

“mildness.” Furthermore, advertising for 

low delivery or traditional brands should 

be constructed in ways so as not to provoke 

anxiety about health, but to alleviate it, 

and enable the smoker to feel assured about 

the habit and confident in maintaining it 

over time 167(p.3) (emphasis in original)

Meanwhile, market research prepared for 

Philip Morris revealed that “smoking an 

ultra low tar cigarette seems to relieve 

some of the guilt of smoking and provide 

an excuse not to quit.”168(p.11, Bates no. 2040066754)

Similarly, internal documentation from 

British American Tobacco95 shows that “it is 

useful to consider lights more as a third 

alternative to quitting and cutting down—

a branded hybrid of smokers’ unsuccessful 

attempts to modify their habit on their 

own.”95(Bates no. 400459922) These industry views 

are consistent with research by Tindle and 

colleagues,169 who found that smokers using 

“light” cigarettes had lower odds of smoking 

cessation; these investigators concluded 

that smokers may still be using “light” 

cigarettes as an alternative to quitting.

For many consumers, cigarettes with 

the “slim” product descriptor may imply 

that the product is “risk reduced.” When 

Philip Morris conducted market research 

of a competitor’s ultraslim brand, it found 

that several consumers consider reducedcircumference cigarettes to be a safer 

alternative relative to those brands with 

traditional physical dimensions. Under the 

subtitle “Health Implications,” interoffice 

correspondence included a summary of 

findings gleaned from consumer testing:

Overriding the perception of its stylishness 

is an impression that this cigarette has 

potential health advantages because there 

is so much less tobacco being consumed. 

For many of the women, the idea that 

they would be “getting less” was a huge 

advantage.... This is an illusion, in a 

sense, for it is the actual tar and nicotine 

delivery which is the main factor of a 

health attribute, but most people ignored 

this. What they wanted and liked was a 

visible cue that they were smoking less.... 

Perception is more important than reality, 

and in this case the perception is of reduced 

tobacco consumption. It would be easy to 

substantiate such a claim.170(Bates no. 2057762567)

Meanwhile, executive testimony and 

internal Imperial Tobacco Ltd. documents, 

which were released during Canadian 

court proceedings, revealed that the 

“smooth” product descriptor is meant to 

convey reduced irritation to the smoker’s 

throat or lungs.73

Failure of Self-Regulation

Another rationale for regulating tobacco 

promotion is the demonstrated inability 

of the tobacco industry to self-regulate 

effectively. Self-regulation should 

ensure that advertisements are not false, 

misleading, in poor taste, unfair, or socially 

irresponsible. It is a process by which 

there is “voluntary control of business 

conduct and performance by business itself. 

It is control exercised by an advertiser’s 

peers, including those in the agencies 

and media used.”171(p.5) Media, advertising, 

and trade organizations are common 

proponents of self-regulation, including 

the International Advertising Association, 

American Advertising Federation, American 

Association of Advertising Agencies, 

Association of National Advertisers, 

Outdoor Advertising Association of America, 

Motion Picture Association of America, 

National Association of Broadcasters, 

Direct Selling Association, Direct Marketing 

Association, Council of Better Business 

Bureaus, and International Chamber of 

Commerce.
79

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Self-regulation is often viewed as a means 

for the industry in question to avoid 

government regulation and an attempt 

at restoring the public’s faith in business 

practices.171 Boddewyn,172 an advocate of 

self-regulation and a paid consultant for 

the tobacco industry, presents several 

advantages and disadvantages of selfregulation. First, self-regulation can assist 

and complement statutory regulation 

given that the codes and guidelines of 

self-regulation are often more stringent 

than those imposed by law. Second, when 

advertising practices are questioned, 

there is typically less animosity because of 

self-regulation by the industry. Statutory 

regulation, on the other hand, relies heavily 

on the judicial system for enforcement. 

Third, self-regulation is typically seen 

as a more efficient and less expensive 

mechanism for handling complaints 

compared with government regulation. 

Industry representatives, it is argued, 

are more knowledgeable about their field 

than are government officials. Finally, 

when justifiable complaints surface, 

the noncomplier is likely to adhere to the 

resulting decisions because the standards 

that were breached had previously been 

accepted voluntarily.

Self-regulation has several disadvantages, 

however, that lead many to consider it 

improbable that private interests can selfregulate in the public interest. Even if it 

is demonstrated that self-regulation can 

produce responsible advertisements, 

the voluntary standards of self-regulation 

may be purposely loose to ensure greater 

participation of the industry members. 

What Is a “Natural” Cigarette?

During the late 1990s, Winston’s “No Additives, 

100% Tobacco, True Taste” campaign underwent 

considerable scrutiny for the apparent 

deceptiveness of the claim, whereby the FTC 

required R.J. Reynolds to include the disclaimer, 

“No additives in our tobacco does NOT mean 

a safer cigarette.” The Winston campaign ran 

for nearly two years before the disclaimer was 

mandated, however, and the brand experienced 

market share growth in the interim.a,b,c During 

2004, promotions for Natural American Spirit 

cigarettes asserted that the product consists of 

“100% additive-free natural tobacco” and that it is “the only brand that offers products made with 

both natural and 100% certified organic tobacco.” The promotions do not specify, however, that 

the American Spirit offerings have higher nicotine levels and tar deliveries than do conventional 

cigarettes. “Natural,” synonymous with untreated and unprocessed, is seemingly ambiguous for 

the American Spirit mentholated line extensions or for the “Pow Wow Blend,” which combines 

tobacco with herbs such as red willow bark and sage.d

a

Shatenstein, S. 1998. Thank you for not smoking additives. Tobacco Control 7 (2): 187–88.

b

Arnett, J. J. 1999. Winston’s “no additives” campaign: “Straight up”? “No bull”? Public Health Reports

114 (6): 522–27.

c

Schwartz, J. 1999. FTC has a beef with ‘no bull’ ads: Cigarette maker to add health disclaimer for ‘no additives’ 

Winstons. The Washington Post, March 4.

d

Kezwer, G. 1998. Organic cigarettes new fad for “health-conscious” smokers. Canadian Medical Association 

Journal 158 (1): 13.
80

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

Furthermore, enforcement of and 

compliance with voluntary codes may be 

deficient, and participation in the selfregulation of the industry may not be 

compulsory. This has serious implications 

in a free-market economy. What does the 

tobacco industry do, for example, with those 

competitors that refuse to comply with 

the self-regulatory standards? Consumers 

may also be unaware of self-regulatory 

mechanisms, how to submit a complaint, 

or to whom the complaint should be 

submitted. The activities of self-regulation 

primarily involve industry-selected 

representatives, whereas the general public 

may be considered “token” outsiders.

An examination of the history of regulation 

of tobacco advertising makes it apparent 

that the tobacco industry does not 

effectively self-regulate. Pollay,173 for 

example, assessed the efficacy of the 

U.S. cigarette industry’s self-regulation of 

1963 broadcast advertising, in which each 

of the major firms (with the exception of 

Brown & Williamson) agreed to Tobacco 

Institute guidelines that specify that 

programs directed at youthful audiences 

should not be sponsored. Despite the 

tobacco industry’s voluntary course of 

action, American Research Bureau data 

(accessible from an FTC report on 

cigarette advertising) combined with 

census information and trade data on spot 

television advertising revealed that children 

and adolescents still represented 26% 

of the audiences for purchased network 

television programming. Winston, for 

example, was the sponsor of The Beverly 

Hillbillies and The Flintstones programs 

on television.

In 1964, American tobacco manufacturers 

voluntarily adopted the Cigarette Advertising 

Code, yet it was allowable for individual 

cigarette firms to withdraw from the code 

and then later rejoin at their own volition. 

By 1967, American Tobacco and Lorillard 

had both withdrawn; thus, advertising for 

the product launches of both Carlton and 

True was no longer required to adhere to the 

regulations of the advertising code that had 

been established.174–176 Moreover, Richards 

and colleagues176 demonstrate that the key 

tenets of the code were not respected by 

those remaining as participants. The code, 

for example, stipulated that cigarette 

advertising should not depict smoking as 

essential to social prominence, distinction, 

success, or sexual attraction, even though 

Vantage advertisements using the tagline 

“The Taste of Success” (typified by pictorials 

of a couple with their classic automobile) 

were permitted to circulate.177 Similarly, 

Barbeau and colleagues 178 found that 

cigarette print advertising for Camel, 

Marlboro, Newport, and Virginia Slims 

violated the fundamental tenets of the 

code. Their study revealed that a sizable 

percentage of U.S. students, 10 to 15 years 

old, perceived dimensions related to social 

prominence, distinction, success, or sexual 

attraction to be apparent in the cigarette 

advertising shown. A majority of students 

believed that cigarette advertising linked 

product use with popularity (ranging from 

50% for Marlboro to 80% for Virginia Slims) 

and appearing to be “cool” (ranging from 

72% for Marlboro to 84% for Camel). 

While the code also stated that cigarette 

advertising should not depict smokers 

who had obviously just participated in 

a physical activity requiring stamina or 

athletic conditioning beyond that of normal 

recreation, 78% of the students indicated 

that Marlboro advertising did so.

Another provision of the code reads, 

Natural persons depicted as smokers 

in cigarette advertising shall be at least 

twenty-five years of age and shall not be 

dressed or otherwise made to appear to be 

less than twenty-five years of age.179

Mazis and colleagues180 examined how 

more than 500 respondents perceived the 

ages of models in a sample of cigarette 
81

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

advertisements. The percentage of 

respondents who perceived the models to 

be younger than 25 years old reached as 

high as 76% for a Kool Milds model, 89% 

for a Lucky Strike Lights model, 79% for 

a Virginia Slims Ultra Lights model, and 

91% for a Winston Lights model. 

The code prohibited advertising 

“in school, college, or university media 

(including athletic, theatrical and other 

programs)” and the distribution of 

sample cigarettes to persons under the 

age of 21 years. In addition, it stated that 

“no sample cigarettes shall be distributed 

or promotional efforts conducted on school, 

college, or university campuses, or in 

their facilities, or in fraternity or sorority 

houses.”179 Nevertheless, in a survey of 

10,904 students enrolled in 119 nationally 

representative four-year colleges and 

universities during the 2000–2001 school 

year, Rigotti and colleagues50 found that 

8.5% of respondents had attended a bar, 

nightclub, or campus social event where 

free cigarettes were distributed. 

Additional examples of violations of these 

provisions of the code are cited in chapter 5. 

The introduction to that chapter mentions 

that these provisions of the code were 

highlighted in congressional testimony in 

1969 by Joseph F. Cullman III, president of 

Philip Morris and chairman of the Tobacco 

Institute, who promised that cigarette 

manufacturers would comply with the 

provisions after cigarette advertising was 

banned from the broadcast media. 

The practice of product placement, which 

involves contractual agreements that 

stipulate on-screen exposures of brandname goods and services in exchange for 

fees or services being provided181 (chapters 4 

and 10), serves as another example of the 

failure of self-regulation. U.S. tobacco 

manufacturers amended the Cigarette 

Advertising Code in 1990 (renamed as 

Cigarette Advertising and Promotion Code) 

and agreed to no longer “place” their 

products in movies. A review of internal 

tobacco industry documents by Mekemson 

and Glantz,182 however, revealed that 

product placement initiatives remained 

active at least three years after the code 

was amended.

Another flaw in tobacco industry selfregulation is the inconsistency in policy 

and behavior between the cigarette 

and smokeless tobacco manufacturers. 

For example, the cigarette companies 

had a voluntary code on the distribution 

of cigarette samples that prohibited 

distribution of free samples to persons 

under the age of 21. The smokeless tobacco 

industry had a similar voluntary code, 

but it banned distribution of smokeless 

tobacco samples to persons under the age 

of 18.183 This younger age cutoff allowed 

smokeless tobacco manufacturers to 

conduct aggressive promotional campaigns, 

including free sampling, on college 

campuses and at vacation venues attended 

by large numbers of college students.184

In addition, the cigarette industry code 

prohibited the use of testimonials by 

athletes and other celebrities perceived 

to appeal to the young, but smokeless 

tobacco advertising has prominently 

featured well-known sports figures such as 

Walt Garrison (football/Dallas Cowboys), 

Terry Bradshaw (football/Pittsburgh 

Steelers), George Brett (baseball/Kansas 

City Royals), Sparky Lyle (baseball/Texas 

Rangers), and Tom Seaver (baseball/

Cincinnati Reds), and other celebrities 

such as musician Charlie Daniels.185

Another inconsistency in tobacco industry 

self-regulation is that advertising and 

promotions for American brand-name 

products in foreign countries may not 

always comply with the industry’s code. 

For example, despite the code’s ban on the 

use of celebrities in cigarette advertising, 

actor James Coburn appeared in a youthoriented Japanese television commercial for 
82

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

Lark cigarettes.185 In some cases, American 

brand-name cigarettes are distributed in 

foreign countries by foreign corporations; 

however, the sales and licensing agreements 

that allow such arrangements could require 

compliance with the American company’s 

advertising code.

The 1998 MSA between 46 attorneys general 

and the major cigarette firms imposed bans 

on product placement, cigarette billboard 

advertising, the use of cartoon characters, 

merchandise displaying brand logos, and 

any promotions that target youth. One can 

view this agreement as occupying a middle 

ground between purely voluntary selfregulation and regulation or legislation. 

Yet even with its added “teeth” (compared 

with purely voluntary codes), the MSA has 

suffered violations. As noted by Goldberg 

and colleagues,27 the California attorney 

general has had four successful prosecutions 

of R.J. Reynolds (RJR) for violations of 

the MSA and state legislation on the 

sale and marketing of tobacco products. 

A San Diego court ruled in June 2002 

that RJR unlawfully placed cigarette 

advertisements in magazines with a large 

percentage of readers aged 12–17 years.186

In his ruling, the judge ordered the 

company to pay $20 million in fines and 

commented as follows:

The evidence reveals that after it entered 

into the MSA, RJR made absolutely no 

changes to its advertising campaigns, 

failed to include the goal of reducing 

Youth exposure to tobacco advertising 

in its marketing plans and failed to take 

any actions to track whether or not it was 

meeting its professed goal of reducing 

Youth smoking.... [S]ince the MSA was 

signed, RJR has exposed Youth to its 

tobacco advertising at levels very similar to 

those of targeted groups of adult smokers.187

The U.S. experience with tobacco 

industry self-regulation is not unique. 

Cunningham30 and Dewhirst,35 for 

example, discuss breaches of voluntary 

advertising codes that occurred in Canada. 

At least four studies125,188–190 assess the 

U.K. experience, which is also addressed 

above in the section on surreal advertising 

in the United Kingdom. Chapman191 and 

Winstanley and colleagues192 provide an 

Australian perspective. There are numerous 

examples from multiple jurisdictions 

in which tobacco companies have not 

abided by the principles of self-regulatory 

advertising codes.

Ineffectiveness of Partial 

Advertising Bans

Partial advertising bans have commonly 

proven ineffective because even though 

the tobacco industry faces fewer viable 

options in the promotional mix, the 

total amount of promotional spending 

persists. The $15.1 billion spent on 

cigarette advertising and promotion in the 

United States during 2003 was a recordsetting level.193 Once one form of promotion 

has been banned, tobacco firms have tended 

to use other marketing strategies to continue 

communicating messages and imagery for 

their respective trademarks. The late 1960s 

and early 1970s, for example, marked a 

period in which U.S. cigarette advertising 

expenditures largely shifted from broadcast 

media to print. The tobacco industry’s shift 

in promotional spending reflected that, in 

accordance with the Public Health Cigarette 

Smoking Act, U.S. broadcast advertisements 

for cigarettes were no longer permissible, 

effective January 2, 1971. U.S. cigarette 

advertising expenditures doubled for 

magazines and increased more than fourfold 

for newspapers during one year alone 

(from 1970 to 1971).102,194 Several content 

analyses confirm that, largely as the result 

of the broadcast ban, the number of cigarette 

advertisements found in U.S. magazines 

increased dramatically during the 1970s.195–199

(See chapter 7 for a discussion of advertising 

bans as related to the influence of tobacco 

marketing on smoking behavior.)
83

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Removing cigarette advertising from 

the broadcast media first appeared to 

the tobacco control and public health 

communities to be a victory; over time, 

however, the desired results were not 

realized from this policy.194,200 Contrary 

to expectation, cigarette consumption 

initially increased following the broadcast 

ban. From 1968 to 1970, Fairness 

Doctrine antismoking messages were 

shown prominently on television and 

radio, but these spots were discontinued 

following the ban.201(pp.496–500) Furthermore, 

important changes in print advertising 

were observed as tobacco manufacturers 

shifted their advertising resources. 

According to King and colleagues,199

who analyzed visual aspects of cigarette 

magazine advertising from 1954 to 1986, 

pictures—as opposed to words—became 

the predominant means of communicating 

information to consumers. Their content 

analysis also revealed that models were 

increasingly engaged in activities, which 

suggests that the advertisements became 

increasingly lifestyle oriented. Weinberger 

and colleagues,196 meanwhile, found that 

U.S. tobacco manufacturers responded to 

the broadcast media ban by directing more 

resources toward print media advertising, 

evident by more frequent use of special 

positioning, color, and full-page or doublepage advertisements. Advertisements were 

typically placed on right-side pages and, 

during the observed period (1957 to 1977), 

were increasingly located on the back 

covers of magazines. They noted, however, 

that some of the observed changes, such 

as the increased use of color, could reflect 

innovations being used by magazine 

advertisers in general.

An additional consequence of the U.S. ban 

on broadcast advertising was that tobacco 

companies increasingly directed their 

resources toward sponsorship marketing. 

In fact, the tobacco industry’s involvement 

in sport and cultural sponsorships during 

the 1970s and 1980s largely contributed to 

the general development of sponsorship as a 

marketing discipline.202–204 Individual tobacco 

companies turned to sponsoring broadcast 

sports events as a means to compensate for 

lost broadcast advertising exposure, yet the 

promotional messages were not required 

to be accompanied by health warnings or 

countervailing communications.200,205,206

Even though cigarette advertising is not 

permitted on television in the United States, 

tobacco companies continue to receive 

millions of dollars’ worth of national 

television exposure for their brands through 

sponsoring sports events such as auto 

racing.121,207–209

The MSA’s 1998 ban on cigarette billboard 

advertising has prompted an increase in 

the prevalence of both interior and exterior 

tobacco advertising at retail outlets. Between 

February and June of 1999, Wakefield 

and colleagues conducted observations of 

cigarette advertising and promotion at the 

point of sale in 3,464 tobacco-selling retail 

stores in a total of 191 communities in the 

United States.210 They found that after the 

MSA ban on tobacco billboards took effect 

in April of that year, increases occurred in 

the presence of tobacco sales promotions 

(e.g., multipack discount offers, gift-withpurchase offers), the presence and extent of 

functional objects bearing cigarette brand 

names (e.g., clocks, change mats, shopping 

baskets), the prevalence and extent of 

exterior store advertising for tobacco, and 

the prevalence of interior advertising of 

tobacco products. According to the authors, 

the findings suggest that the cigarette 

manufacturers shifted at least some of their 

expenditures previously spent on billboard 

advertising to point-of-purchase marketing 

following the ban on billboard advertising 

imposed by the MSA.

Celebucki and Diskin211 studied the amount 

of cigarette advertising visible from outside 

of over-the-counter tobacco retailers in 

Massachusetts before and after the MSA. 

For the 556 tobacco retailers in the study, 
84

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

they found significant increases after the 

MSA in the prevalence of exterior cigarette 

advertising on the buildings, windows, and 

doors of gas stations and gas mini-marts. 

They also found that a greater amount of 

cigarette advertising visible from outside 

these retail establishments was associated 

with a higher occurrence of illegal sales of 

cigarettes to minors.

Point-of-purchase retail settings, 

as well as bars and nightclubs, have 

become important sites of promotion 

for U.S. tobacco manufacturers.46,47,212–214

The tobacco industry has also directed 

further resources toward public relations 

activities, personal selling, direct marketing 

campaigns, Internet advertising, package 

design, and trademark diversification.215–217

Pollay, a marketing professor at the 

University of British Columbia, remarks, 

“It’s like squeezing a balloon. You can shut 

down one media, but the problem just 

moves somewhere else.”218(p.2) This point 

is echoed by Saffer and Chaloupka,219 who 

argue that a limited set of advertising bans 

does not slow down advertising output but 

leads instead to shifts in media spending 

by the tobacco industry. In other words, 

when one media form is prohibited, the 

tobacco industry finds media “substitutes” 

(chapters 4 and 7).

Tobacco companies may change the types 

and targets of advertising within media as a 

way to mitigate the effects of rules that limit 

advertising and promotion. For example, 

three studies described below provide 

evidence that youth were exposed to higher 

levels of tobacco advertising in magazines 

after implementation of settlement 

agreements, even though these agreements 

sought to reduce such exposure. Hamilton 

and colleagues studied cigarette advertising 

in 19 magazines in which at least 15% of 

readers are youth under the age of 18 years. 

They found that cigarette advertising 

expenditures in these magazines increased 

dramatically after implementation of the 

MSA and then fell dramatically after the 

increase was reported prominently in the 

news media.220

King and Siegel221 reported data on 

advertising expenditures for 15 cigarette 

brands advertised in a total of 38 magazines, 

both before and after the MSA. They 

classified cigarette brands as “youth brands” 

if they were smoked by more than 5% of the 

smokers in the 8th, 10th, and 12th grades 

in 1998. They classified magazines as “youth 

oriented” if at least 15% of their readers 

or at least two million of their readers 

were 12 to 17 years old. The investigators 

found that expenditures on advertising 

of youth brands in youth-oriented 

magazines increased by 3.7% between 1995 

($56.4 million) and 1998 ($58.5 million)—

that is, before the MSA—but increased by 

15.2% to $67.4 million in 1999 (after the 

MSA). Expenditures then fell to a level 

slightly higher than the pre-MSA level in 

2000 ($59.6 million).

The Massachusetts Department of Public 

Health studied advertising before and 

after the Smokeless Tobacco Master 

Settlement Agreement (STMSA) for 

smokeless tobacco products in 12 “youth 

magazines” (those with at least 15% youth 

readership or more than two million 

youth readers).222 The agency found that 

smokeless tobacco manufacturers increased 

their advertising in youth magazines by 

136% after the STMSA, from $4.7 million 

in 1997 to $11.1 million in 2001. The 

increase was 161% (from $3.6 million to 

$9.4 million) for the largest smokeless 

tobacco manufacturer, United States 

Smokeless Tobacco Company, which is the 

only smokeless tobacco manufacturer to 

have signed the STMSA (which contains 

the same prohibition against youthtargeted promotions as the MSA signed by 

cigarette manufacturers). Youth exposed to 

smokeless tobacco ads included 7.2 million 

adolescents aged 12–17 years who are 

readers of Sports Illustrated (a magazine 
85

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

that received an average of $2.5 million 

each year in advertising revenue from the 

United States Smokeless Tobacco Company 

during the postsettlement period).

Companies frequently apply their brand 

names to new and different product 

categories (e.g., Ralph Lauren paint), and 

this trend has been increasing over the past 

decade. In the case of tobacco companies, 

this indirect advertising, also called brand 

extension or brand stretching, refers to 

the application of tobacco brand names, 

logos, or other distinctive elements of 

tobacco product brands (and their ads) 

to nontobacco products. Examples and 

citations are provided in chapter 4.

Colors and symbols associated with cigarette 

brands can be used in ways that facilitate 

the circumvention of tobacco advertising 

restrictions. For example, as noted above in 

the section on surreal cigarette advertising 

in the United Kingdom, the associations in 

advertisements between purple and Silk Cut 

cigarettes, and between red and Marlboro 

cigarettes, may be intended to allow cigarette 

companies to continue color-based brand 

promotions under severe marketing rules 

anticipated to exist in the future. In addition, 

B&H has been the sponsor of music concerts 

in Nigeria at which the brand’s gold color 

and the ampersand (&) in the brand’s name 

have been prominently featured. At one of 

these concerts, a large gold curtain, whose 

only imagery was three giant ampersands, 

hung behind the band and dominated the 

scene. This type of promotion, with sufficient 

repetition, could lay the groundwork for 

using a freestanding ampersand to market 

the cigarette brand at a future time when 

legislation might prohibit direct advertising 

and less subtle forms of indirect advertising. 

Indeed, Finn223 describes ads for B&H 

in the Far Eastern Economic Review in 

which images of birds, lights, a helicopter, 

a monorail, and a banner were used to 

construct an abstract depiction of the brand’s 

package. Finn comments that these ads, 

if they omitted the brand name and images 

of cigarettes and smoking, “could fall within 

the rules of poorly constructed legislation ... 

and point out the care that governments 

need to take in the formulation and wording 

of tobacco advertising legislation if it is to 

be watertight.”223(p.187)

Another reason why the impact of partial 

advertising bans has been limited is that they 

allow tobacco companies to avail themselves 

of imprecise language in the law to maintain 

or create channels of communications. 

For example, a seemingly comprehensive 

advertising ban passed in New Zealand 

exempted “price lists” and “price notices.” 

Tobacco companies then produced large, 

colorful ads with barely discernible prices 

shown in one corner, for prominent 

display in retail outlets.224 The state of 

New South Wales, Australia, banned most 

forms of tobacco advertising at the point 

of sale in 1993, including “dummy stock” 

jumbo-sized cigarette packs. In response, 

cigarette companies gave retailers large 

Perspex (acrylic plastic) display cabinets 

housing many cigarette cartons; the cartons 

were not easily accessible for purchase, 

but as “live stock” their display apparently 

did not breach the new law.225 The Tobacco 

Products Control Act adopted in Canada in 

1988 prohibited event sponsorships using 

tobacco product brand names but permitted 

sponsorships using corporate names. 

In response, as documented by Dewhirst, 

all three major Canadian tobacco companies 

quickly registered several of their cigarette 

brands as corporate entities so that these 

“shell” companies—named for cigarette 

brands—could sponsor events such as 

Export ‘A’ Inc. extreme sports and the Craven 

“A” Ltd. “Just for Laughs” comedy festival.226

Chapter 4 describes other communication 

channels and strategies through which 

tobacco marketers can overcome laws that 

restrict only traditional forms of tobacco 

advertising. These methods include the 

depiction of advertising imagery on the 
86

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

cigarette pack itself, Internet marketing, 

and the use of “viral” or “stealth” marketing 

(e.g., the “Lucky Strike Force, attractive 

couples working trendy neighborhoods ... 

proffering hot coffee and cell-phone calls to 

shivering smokers in winter or iced coffee 

and lounge chairs in spring and summer”).227

Facing an increasingly stringent regulatory 

environment, the tobacco industry has 

largely shifted its promotional spending 

from traditional mass media to integrated 

forms of communications. Similarly, the 

trend of moving away from traditional mass 

media promotion to sponsorship, public 

relations, direct marketing, relationship 

marketing, and sales promotion has been 

demonstrated increasingly by nontobacco 

firms that do not face nearly the same 

regulatory considerations. With audience 

fragmentation and a decline in the perceived 

effectiveness of television advertising, many 

firms have diverted resources to a variety of 

other media.228–230 Technology, including a 

greater use of databases, is another factor in 

explaining why marketing communication 

campaigns span more media for many 

firms.122 These broader trends in the 

marketing environment, along with the 

tobacco industry’s history of overcoming 

partial advertising bans, are reasons why 

bans on tobacco advertising and promotion 

must be comprehensive in order to be 

effective. The call for a comprehensive ban 

of tobacco advertising and promotion, by the 

WHO FCTC and others, requires discussion 

of whether this policy would violate federal 

statute or the First Amendment to the 

U.S. Constitution (see chapter 8).

Summary

The promotion of tobacco products during 

the past century has been a key factor in 

the success of the tobacco industry, to the 

point where the efforts of tobacco firms 

have long been held up by the advertising 

industry and others as exemplars for 

effective product marketing. Such efforts 

involve sophisticated targeting of population 

groups in specific market segments, as well 

as the development and promotion of a clear 

and consistent brand identity for individual 

tobacco products. In an environment in 

which marketing channels for tobacco 

have become increasingly restricted by 

legislation, the ability of tobacco firms 

to adapt their promotional strategies and 

maintain their brand images in the public 

eye serves as a testament to the power of 

their marketing activities.

Tobacco advertising, promotion, and 

sponsorship have increasingly come under 

scrutiny by public health officials and other 

health advocates. Such promotional efforts 

are seen as encouraging the continued use of 

an addictive product, resulting in substantial 

morbidity and premature mortality, and as 

being misleading or deceptive in presenting 

a brand image that obscures the health 

risks inherent in tobacco use. These factors, 

along with the tobacco industry’s failure to 

regulate itself in this area, have motivated 

ongoing attempts within the public health 

community to ban all forms of tobacco 

promotion.

Conclusions

1. The promotion of tobacco products 

involves sophisticated targeting and 

market segmentation of potential 

customers. Common market 

segmentation dimensions include 

demographics (e.g., age, gender, race/

ethnicity), geography (e.g., market 

density, regional differences within 

a domestic or international market), 

behavioral characteristics (e.g., occasions 

of cigarette use, extent of use, user’s 

smoking status), and psychographics 

(lifestyle analysis). 

2. Internal tobacco company documents 

reveal that two key typologies of 

cigarette consumers used by cigarette 
87

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

firms are “starters” (who frequently 

initiate smoking during adolescence) 

and “pre-quitters” (i.e., existing smokers 

who need reassurance).

3. The brand image of most tobacco 

products represents the end result 

of a multifaceted marketing effort 

involving brand identity, logos, taglines 

and slogans, pictorial elements, and 

the use of color. The development, 

enhancement, and reinforcement 

of this brand imagery are primary 

objectives of tobacco promotion. 

4. Tobacco companies have designed 

their communications of brand image 

to use principles relating to message 

repetition, consistency, and relevance to 

a contemporary audience. The brand’s 

image is built slowly and collectively by 

all of the accumulated associations and 

images of the communications strategy, 

such as social status, sophistication 

and social acceptance, athleticism and 

healthfulness, glamour and fashion, 

rewarded risk-taking and adventure, 

and masculinity or femininity. 

5. The key rationales cited for 

implementing a comprehensive ban 

on tobacco advertising and promotion 

include (1) the health consequences 

of tobacco use (including addiction); 

(2) the deceptive or misleading nature of 

several tobacco promotional campaigns; 

(3) the unavoidable exposure of youth to 

these campaigns; (4) the role of tobacco 

advertising and promotion in increasing 

tobacco use in the population, especially 

among youth; (5) the targeting of 

“at-risk” populations, including youth, 

women, and ethnic and racial minorities, 

through advertising and promotion; 

(6) the failure of the tobacco industry 

to effectively self-regulate its marketing 

practices; and (7) the ineffectiveness of 

partial advertising bans. 

6. Substantial evidence exists from the 

United States and several other countries 

that the tobacco industry does not 

effectively self-regulate its marketing 

practices.

7. Substantial evidence exists from the 

United States and several other countries 

that tobacco companies typically respond 

to partial advertising bans in ways that 

undermine the ban’s effectiveness. These 

responses include shifting promotional 

expenditures from “banned” media to 

“permitted” media (which may include 

emerging technologies and “new” 

media), changing the types and targets 

of advertising in permitted media, 

using tobacco-product brand names 

for nontobacco products and services, 

and availing themselves of imprecise 

clauses in the legislative text of the bans 

that allow them to continue to promote 

their products.
88

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

References

1. Advertising Age. 2005. The advertising 

century. Advertising Age. http://adage.com/

century.

2. Khermouch, G. 2003. America has image 

woes, not its brands: Despite foreign fears 

of the country’s go-it-alone attitude, the 

impact on its iconic product names has 

been negligible. Business Week, August 4. 

http://www.businessweek.com/@@

aHbSJIcQIZitQhcA/magazine/content/03

_31/b3844021_mz046.htm.

3. Business Week. 2003. The 100 top brands. 

Business Week, August 4. 

4. Shapiro, S. J., K. B. Wong, W. D. Perreault, 

and E. J. McCarthy. 2002. Basic marketing: 

A global-managerial approach. 10th 

Canadian ed. Toronto, ON: McGraw-Hill 

Ryerson.

5. Rothschild, M. L. 1987. Marketing 

communications: From fundamentals to 

strategies. Lexington, MA: D.C. Heath.

6. Lamb Jr., C. W., J. F. Hair Jr., and 

C. McDaniel. 1999. Marketing. 5th ed. 

Cincinnati, OH: South-Western College 

Publishing.

7. Aaker, D. A. 1996. Building strong brands.

New York: Free Press.

8. Ernster, V. L. 1985. Mixed messages for 

women: A social history of cigarette 

smoking and advertising. New York State 

Journal of Medicine 85 (7): 335–40. 

9. Boyd, T. C., C. J. Boyd, and T. B. Greenlee. 

2003. A means to an end: Slim hopes and 

cigarette advertising. Health Promotion 

Practice 4 (3): 266–77. 

10. Hutchinson, G. 1969. Philip Morris keeps 

climbing as brands mature on “pleasure” 

claim. Advertising Age, March 17.

11. Lasch, C. 1979. The culture of narcissism: 

American life in an age of diminishing 

expectations. New York: Norton.

12. Friedman, V., and Lorillard. 1973. The female 

smoker market. http://tobaccodocuments

.org/landman/03375503-5510.html.

13. U.S. Department of Health and Human 

Services. 2001. Women and smoking. 

A report of the Surgeon General. Rockville, 

MD: U.S. Department of Health and Human 

Services, Public Health Service, Office of 

the Surgeon General. http://www.cdc.gov/

tobacco/data_statistics/sgr/sgr_2001/index

.htm#full.

14. Wernick, A. 1991. Promotional culture: 

Advertising, ideology and symbolic 

expression. Newbury Park, CA: Sage.

15. U.S. Department of Health and Human 

Services. 1998. Tobacco use among U.S. 

racial/ethnic minority groups—African 

Americans, American Indians and Alaska 

Natives, Asian Americans and Pacific 

Islanders, and Hispanics: A report of the 

Surgeon General. Atlanta: U.S. Department 

of Health and Human Services, Centers for 

Disease Control and Prevention, National 

Center for Chronic Disease Prevention and 

Health Promotion, Office on Smoking and 

Health. http://www.cdc.gov/tobacco/data

_statistics/sgr/sgr_1998/index.htm. 

16. Balbach, E. D., R. J. Gasior, and 

E. M. Barbeau. 2003. R.J. Reynolds’ targeting 

of African Americans: 1988–2000. American 

Journal of Public Health 93 (5): 822–27. 

17. Gardiner, P. S. 2004. The African 

Americanization of menthol cigarette use 

in the United States. Nicotine & Tobacco 

Research 6 Suppl. 1: S55–S65. 

18. Sutton, C. D., and R. G. Robinson. 2004. 

The marketing of menthol cigarettes in the 

United States: Populations, messages, and 

channels. Nicotine & Tobacco Research

6 Suppl. 1: S83–S91. 

19. Pollay, R. W., J. S. Lee, and D. CarterWhitney. 1992. Separate but not equal: 

Racial segregation in cigarette advertising. 

Journal of Advertising 21:45–57. 

20. Brown & Williamson. 1984 Kool operational 

plan. 1984. Brown & Williamson. Bates 

No. 670249922/50102. http://legacy.library

.ucsf.edu/tid/qkx13f00.

21. McKinnon, J. 2001. The black population: 

Census 2000 brief. Washington, DC: 

U.S. Department of Commerce, Economics 

and Statistics Administration, U.S. Census 

Bureau. http://www.census.gov/prod/

2001pubs/c2kbr01-5.pdf.

22. Cummings, K. M., A. Hyland, E. Lewit, 

and D. Shopland. 1997. Discrepancies in 

cigarette brand sales and adult market 

share: Are new teen smokers filling the gap? 

Tobacco Control 6 Suppl. 2: S38–S43. 

23. Glantz, S. A., J. Slade, L. A. Bero, P. Hanauer, 

and D. E. Barnes. 1996. Cigarette papers.

Berkeley: Univ. of California Press.

24. Perry, C. L. 1999. The tobacco industry and 

underage youth smoking: Tobacco industry 

documents from the Minnesota litigation. 

Archives of Pediatrics and Adolescent 

Medicine 153 (9): 935–41. 
89

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

25. Cohen, J. B. 2000. Playing to win: Marketing 

and public policy at odds over Joe Camel. 

Journal of Public Policy and Marketing

19 (2): 155–67. 

26. Cummings, K. M., C. P. Morley, J. K. Horan, 

C. Steger, and N. R. Leavell. 2002. Marketing 

to America’s youth: Evidence from corporate 

documents. Tobacco Control 11 Suppl. 1: 

I5–I17. 

27. Goldberg, M. E., R. M. Davis, and 

A. M. O’Keefe. 2006. The role of tobacco 

advertising and promotion: Themes 

employed in litigation by tobacco industry 

witnesses. Tobacco Control 15 Suppl. 4: 

iv54–iv67. 

28. Pollay, R. W., and A. M. Lavack. 1993. The 

targeting of youths by cigarette marketers: 

Archival evidence on trial. Advances in 

Consumer Research 20: 266–71. 

29. Cunningham, R. 1995. R.J.R.-MacDonald 

Inc. v. Canada (A.G.): Reflections from the 

perspective of health. McGill Law Journal

40 (1): 229–77. 

30. Cunningham, R. 1996. Smoke and mirrors: 

The Canadian tobacco war. Ottawa, ON: 

International Development Research Centre.

31. Pollay, R. W. 1995. Targeting tactics in 

selling smoke: Youthful aspects of 20th 

century cigarette advertising. Journal of 

Marketing Theory and Practice 3 (1): 

1–22. 

32. Pollay, R. W. 1997. Who are they kidding? 

Tobacco marketing targets youth. Policy 

Options 18 (5): 7–11. 

33. Pollay, R. W. 2000. Targeting youth and 

concerned smokers: Evidence from 

Canadian tobacco industry documents. 

Tobacco Control 9 (2): 136–47. 

34. Dewhirst, T., and R. Sparks. 2003. 

Intertextuality, tobacco sponsorship of 

sports, and adolescent male smoking 

culture: A selective review of tobacco 

industry documents. Journal of Sport and 

Social Issues 27 (4): 372–98. 

35. Dewhirst, T. 2004. Smoke and ashes: Tobacco 

sponsorship of sports and regulatory issues 

in Canada. In Sports marketing and the 

psychology of marketing communication,

ed. L. R. Kahle and C. Riley, 327–51. 

Mahwah, NJ: Lawrence Erlbaum.

36. Hastings, G., and L. MacFadyen. 2000. A day 

in the life of an advertising man: Review of 

internal documents from the UK tobacco 

industry’s principal advertising agencies. 

British Medical Journal 321 (7257): 366–71. 

37. Carter, S. M. 2003. From legitimate 

consumers to public relations pawns: 

The tobacco industry and young Australians. 

Tobacco Control 12 Suppl. 3: iii71–iii78. 

38. Johnston, M. Young smokers: Prevalence, 

trends, implications, and related 

demographic trends. 31 Mar 1981. 

Philip Morris. Bates No. 1000390803/0855. 

http://legacy.library.ucsf.edu/tid/ftu74e00.

39. Achey, T. L., and C. H. Judge. Product 

information. 30 Aug 1978. Lorillard. Bates 

No. 83896794/6796. http://legacy.library

.ucsf.edu/tid/bat34c00.

40. Esty, W., and J. H. McCain. NFO preference 

share data: “Youth” market. 8 Mar 1973. 

R.J. Reynolds. Bates No. 508453918/3920. 

http://legacy.library.ucsf.edu/tid/fxn93d00.

41. Ling, P. M., and S. A. Glantz. 2002. Why and 

how the tobacco industry sells cigarettes 

to young adults: Evidence from industry 

documents. American Journal of Public 

Health 92 (6): 908–16. 

42. Lantz, P. M. 2003. Smoking on the rise 

among young adults: Implications for 

research and policy. Tobacco Control

12 Suppl. 1: i60–i70. 

43. Biener, L., and A. B. Albers. 2004. Young 

adults: Vulnerable new targets of tobacco 

marketing. American Journal of Public 

Health 94 (2): 326–30. 

44. Hammond, D. 2005. Smoking behaviour 

among young adults: Beyond youth 

prevention. Tobacco Control 14 (3): 181–85. 

45. Centers for Disease Control and Prevention. 

2005. Cigarette smoking among adults—

United States, 2003. Morbidity and 

Mortality Weekly Report 54 (20): 509–13. 

46. Katz, S. K., and A. M. Lavack. 2002. 

Tobacco related bar promotions: Insights 

from tobacco industry documents. Tobacco 

Control 11 Suppl. 1: i92–i101. 

47. Sepe, E., P. M. Ling, and S. A. Glantz. 2002. 

Smooth moves: Bar and nightclub tobacco 

promotions that target young adults. 

American Journal of Public Health 92 (3): 

414–19. 

48. Biener, L., A. L. Nyman, R. L. Kline, 

and A. B. Albers. 2004. Adults only: The 

prevalence of tobacco promotions in bars 

and clubs in the Boston area. Tobacco 

Control 13 (4): 403–8. 

49. Gilpin, E. A., V. M. White, and J. P. Pierce. 

2005. How effective are tobacco industry bar 

and club marketing efforts in reaching young 

adults? Tobacco Control 14 (3): 186–92.
90

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

50. Rigotti, N. A., S. E. Moran, and H. Wechsler. 

2005. US college students’ exposure to 

tobacco promotions: Prevalence and 

association with tobacco use. American 

Journal of Public Health 95 (1): 138–44. 

51. Ives, N. Tobacco firms seek to broaden 

appeal. Miami Herald, July 19.

52. Barnes, J. S., and C. E. Bennett. 2002. 

The Asian population: 2000. Census 2000 

brief. Washington: U.S. Department of 

Commerce, Economics and Statistics 

Administration, U.S. Census Bureau. 

http://www.census.gov/prod/2002pubs/

c2kbr01-16.pdf.

53. Guzmán, B. 2001. The Hispanic population: 

Census 2000 brief. Washington, DC: 

U.S. Department of Commerce, Economics 

and Statistics Administration, U.S. Census 

Bureau. http://www.census.gov/prod/

2001pubs/c2kbr01-3.pdf.

54. Altman, D. G., C. Schooler, and M. D. Basil. 

1991. Alcohol and cigarette advertising on 

billboards. Health Education Research 6 (4): 

487–90. 

55. Hackbarth, D. P., B. Silvestri, and W. Cosper. 

1995. Tobacco and alcohol billboards 

in 50 Chicago neighborhoods: Market 

segmentation to sell dangerous products to 

the poor. Journal of Public Health Policy

16 (2): 213–30. 

56. Imperial Tobacco. 1995. Trademark strategies 

and projects: 1995. http://smoke-free.ca/

defacto/D176;ITL441-TrademarkStrategies

AndProspects-1995.pdf.

57. Carter, S. M. 2003. The Australian cigarette 

brand as product, person, and symbol. 

Tobacco Control 12 Suppl. 3: iii79–iii86. 

58. Associated Press. 2004. Camel lighting fire 

over new cigarettes. Associated Press. 

59. Connolly, G. N. 2004. Sweet and spicy 

flavours: New brands for minorities and 

youth. Tobacco Control 13: 211–12. 

60. Basil, M. D., D. Z. Basil, and C. Schooler. 

2000. Cigarette advertising to counter 

New Year’s resolutions. Journal of Health 

Communication 5 (2): 161–74. 

61. Kotler, P., G. Armstrong, and 

P. H. Cunningham. 1998. Principles of 

marketing. 4th Canadian ed. Scarborough, 

ON: Pearson Education Canada.

62. Tye, J. B. 1992. Willy the Penguin and 

Joe Camel duke it out for the youth market. 

Tobacco Control 1 (2): 132–33. 

63. Chandra, S., and F. J. Chaloupka. 2003. 

Seasonality in cigarette sales: Patterns and 

implications for tobacco control. Tobacco 

Control 12 (1): 105–7. 

64. Wellman, R. J., and J. R. DiFranza. 2003. 

Seasonality in onset of youth smoking 

parallels seasonality in cigarette sales. 

Tobacco Control 12 (3): 339. 

65. Colwell, B., N. Ramirez, L. Koehly, 

S. Stevens, D. W. Smith, and S. Creekmur. 

2006. Seasonal variations in the initiation 

of smoking among adolescents. Nicotine & 

Tobacco Research 8 (2): 239–43. 

66. Dickson, P. R. 1982. Person-situation: 

Segmentation’s missing link. Journal of 

Marketing 46 (4): 56–64. 

67. Dewhirst, T., and A. Hunter. 2002. Tobacco 

sponsorship of Formula One and CART 

auto racing: Tobacco brand exposure and 

enhanced symbolic imagery through 

co-sponsors’ third party advertising. 

Tobacco Control 11 (2): 146–50. 

68. McCracken, G. 1989. Culture and 

consumption: New approaches to the 

symbolic character of consumer goods 

and activities. Journal of Marketing 53 (3): 

125–28. 

69. Pollay, R. W., and T. Dewhirst. 2001. 

Marketing cigarettes with low machinemeasured yields. In Risks associated with 

smoking cigarettes with low machinemeasured yields of tar and nicotine

(Smoking and tobacco control monograph 

no. 13, NIH publication no. 02-5074), 

199–235. Bethesda, MD: National Cancer 

Institute. http://cancercontrol.cancer.gov/

tcrb/monographs/13/index.html.

70. Delnevo, C. N., J. Foulds, U. Vorbach, and 

E. Kazimir. 2006. Seasonal variations in 

stage of change among quitline clients. 

Tobacco Control 15 (1): 70–71. 

71. Cook, B. L., G. F. Wayne, L. Keithly, and 

G. Connolly. 2003. One size does not fit 

all: How the tobacco industry has altered 

cigarette design to target consumer groups 

with specific psychological and psychosocial 

needs. Addiction 98 (11): 1547–61. 

72. R.J. Reynolds. TSB concept development. 

24 Aug 1983. R.J. Reynolds. Bates 

No. 504663478/3511. http://legacy.library

.ucsf.edu/tid/dua65d00.

73. Pollay, R. W., and T. Dewhirst. 2003. 

A premiere example of the illusion of 

harm reduction cigarettes in the 1990s. 

Tobacco Control 12 (3): 322–32. 

74. Kapferer, J.-N. 2004. The new strategic 

brand management: Creating and 
91

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

sustaining brand equity long term. 2nd ed. 

London: Kogan Page.

75. D’Alessandro, D. F., and M. Owens. 2001. 

Brand warfare: 10 rules for building the 

killer brand. New York: McGraw-Hill.

76. Muniz Jr., A. M., and T. C. O’Guinn. 2001. 

Brand community. Journal of Consumer 

Research 27: 412–32. 

77. McAlexander, J. H., J. W. Schouten, 

and H. F. Koenig. 2002. Building brand 

community. Journal of Marketing 66 (1): 

38–54. 

78. U.S. Department of Health and Human 

Services. 1994. Preventing tobacco use 

among young people. A report of the 

Surgeon General. Atlanta: U.S. Department 

of Health and Human Services, Public 

Health Service, Centers for Disease 

Control and Prevention, National Center 

for Chronic Disease Prevention and 

Health Promotion, Office on Smoking 

and Health. http://www.cdc.gov/tobacco/

data_statistics/sgr/sgr_1994/index.htm.

79. Dewhirst, T. L., and R. W. Pollay. 2001. 

Content analyses of cigarette advertising: 

A critical review of the literature. In The 

Proceedings of the 2001 Conference of 

the American Academy of Advertising, ed. 

C. R. Taylor, 46–51. Villanova, PA: American 

Academy of Advertising.

80. Ling, P. M., and S. A. Glantz. 2002. Using 

tobacco-industry marketing research to 

design more effective tobacco-control 

campaigns. JAMA: The Journal of the 

American Medical Association 287 (22): 

2983–89. 

81. Perry, A. 2002. Before the brand: Creating 

the unique DNA of an enduring brand 

identity. New York: McGraw-Hill.

82. Keller, K. L. 2003. Strategic brand 

management: Building, measuring, and 

managing brand equity. 2nd ed. Upper 

Saddle River, NJ: Prentice Hall.

83. Carter, D. E. 1999. Branding: The power of 

market identity. New York: Hearst Books 

International.

84. Rawsthorn, A. 2000. The world’s top 50 

logos. R.O.B. [Report on Business] 

Magazine 84–100. 

85. Ray, R. 2003. Is it mainly because of the tag 

line? The Globe and Mail, November 7.

86. Aaker, R. L. 1997. Dimensions of brand 

personality. Journal of Marketing Research

34 (3): 347–56. 

87. Fournier, S. 1998. Consumers and their 

Brands: Developing relationship theory in 

consumer research. Journal of Consumer 

Research 24 (4): 343–73. 

88. Aaker, J., S. Fournier, and S. A. Brasel. 

2004. When good brands do bad. Journal of 

Consumer Research 31 (1): 1–16. 

89. Gorn, G. J., A. Chattopadhyay, T. Yi, and 

D. W. Dahl. 1997. Effects of color as an 

executional cue in advertising: They’re in 

the shade. Management Science 43 (10): 

1387–1400. 

90. Fraser, T., and A. Banks. 2004. Designer’s 

color manual: The complete guide to color 

theory and application. San Francisco: 

Chronicle Books.

91. United Parcel Service. 2006. UPS advertising 

fact sheet. http://www.pressroom.ups.com/

mediakits/factsheet/0,2305,1225,00.html.

92. Sams, R. 2004. Online bank pitches for 

Baltimore. Baltimore Business Journal.

http://www.bizjournals.com/baltimore/

stories/2004/11/29/daily23.html.

93. Daniels, C. 2006. Orange gets juiced. 

Marketing Magazine, February 20. http://

www.marketingmag.ca/magazine/current/

feature/article.jsp?content=20060220

_74422_74422.

94. Wakefield, M., C. Morley, J. K. Horan, and 

K. M. Cummings. 2002. The cigarette 

pack as image: New evidence from tobacco 

industry documents. Tobacco Control 11 

Suppl. 1: i73–i80. 

95. British American Tobacco. Research and 

development/marketing conference. 1985. 

Bates No. 102198587/8662. http://bat.library

.ucsf.edu/tid/esm86a99.

96. Unnava, H., and R. E. Burnkrant. 1991. 

Effects of repeating varied ad executions on 

brand name memory. Journal of Marketing 

Research 28: 406–16. 

97. Haugtvedt, C. P., D. W. Schumann, 

W. L. Schneier, and W. L. Warren. 1994. 

Advertising repetition and variation 

strategies: Implications for understanding 

attitude strength. Journal of Consumer 

Research 21 (1): 176–89. 

98. Lane, V. R. 2000. The impact of ad repetition 

and ad content on consumer perceptions 

of incongruent extensions. Journal of 

Marketing 64 (2): 80–91. 

99. Janiszewski, C., and T. Meyvis. 2001. 

Effects of brand logo complexity, repetition, 

and spacing on processing fluency and 
92

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

judgment. Journal of Consumer Research

28 (1): 18–32. 

100. Pollay, R. W. 2000. How cigarette advertising 

works: Rich imagery and poor information. 

http://www.smoke-free.ca/defacto/

D057-Pollay-HowCigaretteAdvertisingWorks

.pdf.

101. Pollay, R. W., S. Siddarth, M. Siegel, 

A. Haddix, R. K. Merritt, G. A. Giovino, 

and M. P. Eriksen. 1996. The last straw? 

Cigarette advertising and realized market 

shares among youths and adults, 1979–1993. 

Journal of Marketing 60 (2): 1–16. 

102. Federal Trade Commission. 2007. Federal 

Trade Commission cigarette report for 

2004 and 2005. http://www.ftc.gov/reports/

tobacco/2007cigarette2004-2005.pdf.

103. Ries, L., and A. Ries. 1998. The 22 immutable 

laws of branding: How to build a product or 

service into a world-class brand. New York: 

HarperCollins.

104. Loken, B., and D. R. John. 1993. Diluting 

brand beliefs: When do brand extensions 

have a negative impact? Journal of 

Marketing 57 (3): 71–84. 

105. John, D. R., B. Loken, and C. Joiner. 1998. 

The negative impact of extensions: Can 

flagship products be diluted? Journal of 

Marketing 62 (1): 19–32. 

106. Wells, W., S. E. Moriarty, and J. Burnett. 

1989. Advertising: Principles and practice.

Englewood Cliffs, NJ: Prentice Hall.

107. Heckler, S. E., and T. L. Childers. 1992. 

The role of expectancy and relevancy in 

memory for verbal and visual information: 

What is incongruency? Journal of Consumer 

Research 18 (4): 475–92. 

108. Batra, R. 2004. The situational impact of 

brand image beliefs. Journal of Consumer 

Psychology 14 (3): 318–30. 

109. Garretson, J. A., and S. Burton. 

2005. The role of spokescharacters as 

advertisement and cues in integrated 

marketing communications. Journal of 

Marketing 69 (4): 118–32. 

110. Loken, B. 2006. Consumer psychology: 

Categorization, inferences, affect, and 

persuasion. Annual Review of Psychology

57: 453–85. 

111. New York Times. 1989. The business of 

racing: Corporate America has discovered 

motor racing, and CART in particular, as a 

marketing tool. New York Times, July 9.

112. Krugman, D. M. 2004. Written trial 

testimony of Dean M. Krugman, Ph.D., 

accepted December 14, 2004, United States 

of America, Plaintiff v. Philip Morris USA 

Inc. http://www.tobaccodocuments.org/

datta/KRUGMAND121404ER.html.

113. Dewhirst, T., and B. Davis. 2005. Brand 

strategy and integrated marketing 

communication (IMC): A case study of 

Player’s cigarette brand marketing. Journal 

of Advertising 34 (4): 81–92. 

114. Blair, J. G. 1989. Cowboys, Europe and 

smoke: Marlboro in the saddle. In The 

American West: As seen by Europeans 

and Americans, ed. R. Kroes, 360–83. 

Amsterdam: Free Univ. Press.

115. Rutherford, P. 1994. The new icons? The art 

of television advertising. Toronto, ON: Univ. 

of Toronto Press.

116. Ballin, S. 1993. Marlboro adventure team. 

Tobacco Control 2 (1): 43–45. 

117. Formula 1 Magazine. 2001. Schumacher 

set to sign $36m deal for Ferrari. Formula 1 

Magazine 1: 21. 

118. Saward, J. 2001. Money matters to 

sponsors—but who gets the best bang for 

their bucks? Grand Prix International

1 (Spring): 140–43. 

119. Associated Press. 2004. Records falling in 

F1. San Francisco Chronicle, August 16.

120. Hawaleshka, D. 2001. Grand prix wizardry. 

Maclean’s 114: 40–41. 

121. Blum, A. 1991. The Marlboro Grand Prix: 

Circumvention of the television ban on 

tobacco advertising. New England Journal 

of Medicine 324 (13): 913–17. 

122. Nowak, G. J., and J. Phelps. 1994. 

Conceptualizing the integrated marketing 

communications’ phenomenon: An 

examination of its impact on advertising 

practices and its implications for advertising 

research. Journal of Current Issues and 

Research in Advertising 16 (1): 49–66. 

123. Duncan, T. 2002. MP IMC: Using advertising 

and promotion to build brands with 

PowerWeb. New York: McGraw-Hill/Irwin.

124. Action on Smoking and Health. 2006. Tobacco 

advertising and promotion. Factsheet 19. 

http://www.newash.org.uk/ash_fx8ciaxy.htm.

125. Mindell, J. S. 1993. The UK voluntary 

agreement on tobacco advertising: 

A comatose policy? Tobacco Control 2 (3): 

209–14. 

126. Advertising Standards Authority. 2004. 

Background briefing: Cigarettes and 

tobacco. http://www.asa.org.uk/asa/focus/
93

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

background_briefings/Cigarettes+and

+Tobacco.htm.

127. Parker-Pope, T. 1996. Advertising: Tough 

tobacco-ad rules light creative fires. Wall 

Street Journal, October 9.

128. McIntosh, A. 1996. From eros to 

thanatos: Cigarette advertising’s imagery 

of violation as an icon into British 

cultural psychopathology. http://www

.alastairmcintosh.com/articles/1996_eros

_thanatos.htm.

129. York, P. 2003. The final cut. New Statesman,

March 3.

130. Lindstrom, M. 2003. Bring the background 

forward. http://www.clickz.com/showPage

.html?page=1583401.

131. Goldman, R. 1992. Reading ads socially.

London: Routledge.

132. Meyers-Levy, J., and A. M. Tybout. 1989. 

Schema congruity as a basis for product 

evaluation. Journal of Consumer Research

16 (1): 39–54. 

133. Hastings, G. B., H. Ryan, P. Teer, and 

A. M. MacKintosh. 1994. Cigarette 

advertising and children’s smoking: 

Why Reg was withdrawn. British Medical 

Journal 309 (6959): 933–37. 

134. Pollock, D. 1994. Cigarette advertising. 

British Medical Journal 309 (6966): 1437. 

135. Langan, C. R. 1998. Intertextuality in 

advertisements for Silk Cut cigarettes. 

http://www.aber.ac.uk/media/Students/

crl9502.html.

136. Lodge, D. 1989. Nice work. New York: 

Penguin Group.

137. Pollay, R. 1995. “Below the belt” cigarette 

advertising. Tobacco Control 4: 188–92.

138. Gawin, F. H., and M. Hayman. 1996. 

Scenes from Papua New Guinea: Tobacco 

advertising or no tobacco advertising? 

Tobacco Control 5 (3): 229–30. 

139. Brown-John, C. L. 1981. Canadian 

regulatory agencies: Quis custodiet ipsos 

custodes? [Who will guard the guards?].

Toronto, ON: Butterworth.

140. Meier, K. J. 1985. Regulation: Politics, 

bureaucracy and economics. New York: 

St. Martin’s Press.

141. U.S. Department of Health and Human 

Services. 2004. The health consequences of 

smoking: A report of the Surgeon General.

Atlanta: U.S. Department of Health and 

Human Services, Centers for Disease 

Control and Prevention, National Center 

for Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health. 

http://www.cdc.gov/tobacco/data_statistics/

sgr/sgr_2004/index.htm.

142. U.S. Department of Health and Human 

Services. 1988. The health consequences 

of smoking: Nicotine addiction. A 

report of the Surgeon General (DHHS 

publication no. [CDC] 88-8406). Atlanta: 

U.S. Department of Health and Human 

Services, Public Health Service, Centers 

for Disease Control, National Center for 

Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health. 

http://profiles.nlm.nih.gov/NN/B/B/Z/D/.

143. U.S. Department of Health and Human 

Services. 2006. The health consequences 

of involuntary exposure to tobacco smoke: 

A report of the Surgeon General. Atlanta: 

U.S. Department of Health and Human 

Services, Centers for Disease Control and 

Prevention, National Center for Chronic 

Disease Prevention and Health Promotion, 

Office on Smoking and Health. http://www

.cdc.gov/tobacco/data_statistics/sgr/sgr

_2006/index.htm.

144. California Environmental Protection 

Agency. 2005. Proposed identification 

of environmental tobacco smoke as a 

toxic air contaminant. Public hearing 

notice and ETS report. Sacramento, CA: 

California Environmental Protection 

Agency, Air Resources Board and Office of 

Environmental Health Hazard Assessment. 

http://www.arb.ca.gov/regact/ets2006/

ets2006.htm.

145. Hoyer, W. D., and D. J. MacInnis. 2000. 

Consumer behavior. 2nd ed. Boston: 

Houghton Mifflin.

146. Lanham [Trademark] Act, 15 U.S.C.

§ 1125(a) (1946).

147. Cohen, D. 1974. The concept of unfairness 

as it relates to advertising legislation. 

Journal of Marketing 38 (3): 8–13. 

148. United States v. Philip Morris USA, Civil 

Action No. 99-CV-02496GK (D.D.C.) 

(amended final opinion 2006). 

149. Hoek, J. 2006. An evaluation of regulatory 

responses governing the use of tobacco 

descriptors. Palmerston North, NZ: Massey 

Univ. http://www.sfc.org.nz/resources/

rrevaluationjanethoek.pdf.

150. Solow, J. L. 2001. Exorcising the ghost 

of cigarette advertising past: Collusion, 

regulation, and fear advertising. Journal of 

Macromarketing 21:135–45. 
94

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

151. Pollay, R. W. 1990. Propaganda, puffing and 

the public interest. Public Relations Review

16 (3): 39–54. 

152. White, L. C. 1988. Merchants of death: 

The American tobacco industry. New York: 

Beech Tree Books.

153. Miles, R. H., and K. S. Cameron. 1982. 

Coffin nails and corporate strategies.

Englewood Cliffs, NJ: Prentice Hall.

154. Davis, R. M. 1987. Current trends in 

cigarette advertising and marketing. 

New England Journal of Medicine 316 (12): 

725–32. 

155. Jarvis, M., and C. Bates. 1999. Why low tar 

cigarettes don’t work and how the tobacco 

industry has fooled the smoking public.

London: Imperial Cancer Research Fund 

and Action on Smoking and Health. http://

www.newash.org.uk/ash_ewyhn8vg.htm.

156. Kozlowski, L. T., N. A. Dreschel, 

S. D. Stellman, J. Wilkenfeld, E. B. Weiss, 

and M. E. Goldberg. 2005. An extremely 

compensatible cigarette by design: 

Documentary evidence on industry 

awareness and reactions to the Barclay 

filter design cheating the tar testing system. 

Tobacco Control 14 (1): 64–70. 

157. Goldberg, M. E., and L. T. Kozlowski. 1997. 

Loopholes and lapses in the “1997 Tobacco 

Agreement”: Some devils in the marketing 

details. Journal of Public Policy and 

Marketing 16 (2): 345–51. 

158. Canova, D., M. L. Myers, D. E. Smith, and 

J. Slade. 2001. Changing the future of 

tobacco marketing by understanding the 

mistakes of the past: Lessons from “Lights.” 

Tobacco Control 10 Suppl. 1: i43–i44. 

159. National Cancer Institute. 2001. Risks 

associated with smoking cigarettes with 

low machine-measured yields of tar and 

nicotine (Smoking and tobacco control 

monograph no. 13, NIH publication no. 

02-5074). Bethesda, MD: National Cancer 

Institute. http://cancercontrol.cancer.gov/

tcrb/monographs/13/index.html.

160. Kozlowski, L. T., and R. J. O’Connor. 2002. 

Cigarette filter ventilation is a defective 

design because of misleading taste, bigger 

puffs, and blocked vents. Tobacco Control

11 Suppl. 1: i40–i50. 

161. King, W., S. M. Carter, R. Borland, 

S. Chapman, and N. Gray. 2003. The 

Australian tar derby: The origins and fate 

of a low tar harm reduction programme. 

Tobacco Control 12 Suppl. 3: iii61–iii70. 

162. British American Tobacco Co., Ltd. The 

product in the early 1980s. 29 Mar 1976. 

Bates No. 110069974/9982. http://bat.library

.ucsf.edu/tid/dch50a99.

163. Kieling, R. F. Draft implications for Kent. 

31 Aug 1964. Bates No. 01140936/0953. 

http://legacy.library.ucsf.edu/tid/gtn99d00.

164. Wakeham, H. Hilton Head meeting of 

the cigaret company research directors 

February 14–16, 1968, or some thoughts on 

cooperative research in the tobacco industry. 

7 Mar 1968. Bates No. 94664625/4629. 

http://legacy.library.ucsf.edu/tid/yjs13c00.

165. Brown & Williamson. Young adult smoker 

life styles and attitudes. 1974. Bates 

No. 680109280/9289. http://legacy.library

.ucsf.edu/tid/apv04f00.

166. Analytical Research (Canada), and Analytical 

Research Institute. Contemporary consumer 

attitudes toward cigarettes, smoking 

and health: A motivation research study 

of developing trends in receptivity and 

resistance. Aug 1969. Brown & Williamson. 

Bates No. 680082943/3125. http://legacy

.library.ucsf.edu/tid/vkw04f00.

167. Short, P. L. 1997. Smoking and health 

item 7: The effect on marketing. http://

www.tobacco.neu.edu/litigation/cases/mn

_trial/TE10585.pdf.

168. Goldstein/Krall Marketing Resources. 

A qualitative exploration of smoker 

potential for a new entry in the ultra low 

tar market category (two focused group 

interviews). Jan 1979. Philip Morris. Bates 

No. 2040066740/6766. http://legacy.library

.ucsf.edu/tid/cyu35e00.

169. Tindle, H. A., N. A. Rigotti, R. B. Davis, 

E. M. Barbeau, I. Kawachi, and S. Shiffman. 

2006. Cessation among smokers of “light” 

cigarettes: Results from the 2000 national 

health interview survey. American Journal 

of Public Health 96 (8): 1498–504. 

170. Ryan, F. Consumer testing of B&W’s Capri, 

870202–870205. Philip Morris. 24 Feb 1987. 

Bates No. 2057762566/2577. http://legacy

.library.ucsf.edu/tid/nuu96e00.

171. Maitland, I. 1985. The limits of business selfregulation. California Management Review

27 (3): 132–47. 

172. Boddewyn, J. J. 1992. Global perspectives 

on advertising self-regulation. Westport, CT: 

Greenwood Publishing Group.

173. Pollay, R. W. 1994. Exposure of US youth to 

cigarette television advertising in the 1960s. 

Tobacco Control 3 (2): 130–33. 
95

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

174. Levin, H. J. 1967. The limits of selfregulation. Columbia Law Review 67 (4): 

603–44. 

175. Pollay, R. W. 1994. Promises, promises: 

Self-regulation of US cigarette broadcast 

advertising in the 1960s. Tobacco Control

3 (2): 134–44. 

176. Richards Jr., J. W., J. B. Tye, and P. M. Fischer. 

1996. The tobacco industry’s code of 

advertising in the United States: Myth and 

reality. Tobacco Control 5 (4): 295–311. 

177. Anderson, S. J., R. W. Pollay, and P. M. Ling. 

2006. Taking ad-Vantage of lax advertising 

regulation in the USA and Canada: 

Reassuring and distracting health-concerned 

smokers. Social Science and Medicine 63 

(8): 1973–85. 

178. Barbeau, E. M., W. DeJong, D. M. Brugge, 

and W. M. Rand. 1998. Does cigarette print 

advertising adhere to the Tobacco Institute’s 

voluntary advertising and promotion code: 

An assessment. Journal of Public Health 

Policy 19 (4): 473–88. 

179. American Tobacco Company. Cigarette 

advertising code. 1964. American Tobacco 

Company. 1964. Bates No. 980314442/4452. 

http://legacy.library.ucsf.edu/tid/aim85f00.

180. Mazis, M. B., D. J. Ringold, E. S. Perry, 

and D. W. Denman. 1992. Perceived age 

and attractiveness of models in cigarette 

advertisements. Journal of Marketing

56 (1): 22–37.

181. Russell, C. A. 2002. Investigating the 

effectiveness of product placements in 

television shows: The role of modality and 

plot connection congruence on brand 

memory and attitude. Journal of Consumer 

Research 29 (3): 306–18. 

182. Mekemson, C., and S. A. Glantz. 2002. How 

the tobacco industry built its relationship 

with Hollywood. Tobacco Control 11 Suppl. 

1: i81–i91. 

183. Davis, R. M., and L. A. Jason. 1988. The 

distribution of free cigarette samples to 

minors. American Journal of Preventive 

Medicine 4 (1): 21–26. 

184. Connolly, G. N. 1995. The marketing 

of nicotine addiction by one oral snuff 

manufacturer. Tobacco Control 4 (1): 73–79. 

185. Davis, R. M. 1996. Criminal deception. 

Alaska Medicine 38 (1): 43–48. 

186. California Department of Justice. 2002. 

Attorney general Lockyer praises $20 million 

fine against R.J. Reynolds for targeting 

minors with ads: San Diego court ruling 

marks fourth successful lawsuit against 

tobacco company in two years. Press release. 

Sacramento: California Department of 

Justice, Office of the Attorney General. http://

ag.ca.gov/newsalerts/release.php?id=863.

187. People of the State of Calif. v. R.J. Reynolds 

Tobacco Co., No: GIC 764118, 2002 

WL 1292994, at *4 (Cal. Superior Ct. 

June 6, 2002). 

188. Amos, A., G. Robertson, and A. Hillhouse. 

1987. Tobacco advertising and children: 

Widespread breaches in the Voluntary 

Agreement. Health Education Research 2 

(3): 207–14. 

189. Amos, A., A. Hillhouse, and G. Robertson. 

1989. Tobacco advertising and children—

The impact of the Voluntary Agreement. 

Health Education Research 4 (1): 51–57. 

190. Robertson, W., S. E. Rooney, N. J. Field, and 

N. R. Aston. 1998. Voluntary agreement for 

tobacco advertising at retail premises not 

being adhered to. British Medical Journal

316 (7124): 69. 

191. Chapman, S. 1980. A David and Goliath 

story: Tobacco advertising and selfregulation in Australia. British Medical 

Journal 281 (6249): 1187–90. 

192. Winstanley, M., S. Woodward, and N. Walker. 

1995. Tobacco in Australia: Facts and issues.

2nd ed. Carlton: Victorian Smoking and 

Health Program, Australia (Quit Victoria).

193. Federal Trade Commission. 2005. Federal 

Trade Commission cigarette report for 2003. 

http://www.ftc.gov/reports/cigarettes05/

050809cigrpt.pdf.

194. Teel, S. J., J. E. Teel, and W. O. Bearden. 

1979. Lessons learned from the broadcast 

cigarette advertising ban. Journal of 

Marketing 43 (1): 45–50. 

195. Feinberg, B. M. 1971. Content analysis 

shows cigarette advertising up twofold in 

14 magazines. Journalism Quarterly 48: 

539–42. 

196. Weinberger, M. G., L. Campbell, and 

F. D. DuGrenier. 1981. Cigarette advertising: 

Tactical changes in the pre and post 

broadcast era. In Advertising in a new age, 

proceedings of the annual conference of 

the American Academy of Advertising, ed. 

H. K. Hunt, 136–41. Provo, UT: American 

Academy of Advertising.

197. Warner, K. E. 1985. Tobacco industry 

response to public health concern: A content 

analysis of cigarette ads. Health Education 

Quarterly 12 (2): 115–27. 
96

3 . K e y P r i n c i p l e s o f P r o m o t i o n a n d R a t i o n a l e s f o r R e g u l a t i o n

198. Albright, C. L., D. G. Altman, M. D. Slater, 

and N. Maccoby. 1988. Cigarette 

advertisements in magazines: Evidence for 

a differential focus on women’s and youth 

magazines. Health Education Quarterly

15 (2): 225–33. 

199. King, K. W., L. N. Reid, Y. S. Moon, and 

D. J. Ringold. 1991. Changes in the visual 

imagery of cigarette ads, 1954–1986. 

Journal of Public Policy and Marketing

10 (1): 63–80. 

200. Warner, K. E. 1979. Clearing the airwaves: 

The cigarette ad ban revisited. Policy Analysis

5 (4): 435–50. 

201. U.S. Department of Health and Human 

Services. 1989. Reducing the health 

consequences of smoking: 25 years of 

progress. A report of the Surgeon General

(DHHS publication no. [CDC] 89-8411). 

Rockville, MD: U.S. Department of Health 

and Human Services, Public Health Service, 

Centers for Disease Control, National Center 

for Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health. 

http://profiles.nlm.nih.gov/NN/B/B/X/S.

202. Meenaghan, J. A. 1983. Commercial 

sponsorship. European Journal of 

Marketing 17 (7): 5–73. 

203. Otker, T., and P. Hayes. 1987. Judging the 

efficiency of sponsorship: Experience from 

the 1986 soccer World Cup. ESOMAR 

Congress 15: 3–8. 

204. Cornwell, T. B. 1995. Sponsorship-linked 

marketing development. Sport Marketing 

Quarterly 4 (4): 13–24. 

205. Ledwith, F. 1984. Does tobacco sports 

sponsorship act on television as advertising 

to children? Health Education Journal

43 (4): 85–88. 

206. Stoner, R. H. 1992. 200 MPH cigarette ads: 

A comparison of international restrictions 

on tobacco sports sponsorship. Hastings 

International and Comparative Law Review

15: 639–70. 

207. Siegel, M. 2001. Counteracting tobacco 

motor sports sponsorship as a promotional 

tool: Is the tobacco settlement enough? 

American Journal of Public Health 91 (7): 

1100–1106. 

208. Morrison, M., D. M. Haygood, and 

D. M. Krugman. 2006. Inhaling and 

accelerating: Tobacco motor sports 

sponsorship in televised automobile races, 

2000–2002. Sports Marketing Quarterly

15:207–16. 

209. Zwarun, L. 2006. Ten years and 1 master 

settlement agreement later: The nature and 

frequency of alcohol and tobacco promotion 

in televised sports, 2000 through 2002. 

American Journal of Public Health 96 (8): 

1492–97. 

210. Wakefield, M. A., Y. M. Terry-McElrath, 

F. J. Chaloupka, D. C. Barker, S. J. Slater, 

P. I. Clark, and G. A. Giovino. 2002. Tobacco 

industry marketing at point of purchase 

after the 1998 MSA billboard advertising 

ban. American Journal of Public Health

92 (6): 937–40.

211. Celebucki, C. C., and K. Diskin. 2002. 

A longitudinal study of externally visible 

cigarette advertising on retail storefronts 

in Massachusetts before and after the 

Master Settlement Agreement. Tobacco 

Control 11 Suppl. 2: ii47–ii53. 

212. Dewhirst, T. 2004. POP goes the power 

wall: Taking aim at tobacco promotional 

strategies utilised at retail. Tobacco Control

13 (3): 209–10. 

213. Ruel, E., N. Mani, A. Sandoval, Y. TerryMcElrath, S. J. Slater, C. Tworek, and 

F. J. Chaloupka. 2004. After the Master 

Settlement Agreement: Trends in the 

American tobacco retail environment from 

1999 to 2002. Health Promotion Practice

5 Suppl. 3: 99S–110S. 

214. Lavack, A. M., and G. Toth. 2006. Tobacco 

point-of-purchase promotion: Examining 

tobacco industry documents. Tobacco 

Control 15 (5): 377–84. 

215. Czaplewski, A. J., and E. M. Olson. 2003. 

Adaptive strategies of tobacco firms 

subsequent to the 1998 Master Settlement 

Agreement: An examination of emergent 

tobacco promotional mix efforts. Social 

Marketing Quarterly 9 (1): 3–17. 

216. Lewis, M. J., S. G. Yulis, C. Delnevo, and 

M. Hrywna. 2004. Tobacco industry direct 

marketing after the Master Settlement 

Agreement. Health Promotion Practice

5 Suppl. 3: 75S–83S. 

217. Sparks, R., T. Dewhirst, S. Jette, and 

A. Schweinbenz. 2005. Historical hangovers 

or burning possibilities: Regulation and 

adaptation in global tobacco and alcohol 

sponsorship. In Global sport sponsorship: 

A multidisciplinary study, ed. J. Amis 

and T. B. Cornwell, 19–66. Oxford: Berg 

Publishers.

218. Herring, H. B. 1999. Signs of bygone days. 

New York Times, April 25.
97

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

219. Saffer, H., and F. Chaloupka. 2000. The 

effect of tobacco advertising bans on tobacco 

consumption. Journal of Health Economics

19 (6): 1117–37. 

220. Hamilton, W. L., D. M. Turner-Bowker, 

C. C. Celebucki, and G. N. Connolly. 2002. 

Cigarette advertising in magazines: The 

tobacco industry response to the Master 

Settlement Agreement and to public 

pressure. Tobacco Control 11 Suppl. 2: 

ii54–ii58. 

221. King 3rd, C., and M. Siegel. 2001. The 

Master Settlement Agreement with the 

tobacco industry and cigarette advertising 

in magazines. New England Journal of 

Medicine 345 (7): 504–11. 

222. Massachusetts Department of Public 

Health. 2002. Smokeless tobacco 

advertising expenditures before and after 

the Smokeless Tobacco Master Settlement 

Agreement. Boston: Massachusetts 

Department of Public Health. http://

tobaccofreekids.org/pressoffice/release503/

smokeless.pdf.

223. Finn, J. 1995. Laying the groundwork for 

using loopholes in tobacco advertising 

“bans.” Tobacco Control 4 (2): 187–93. 

224. Weir, J. 1995. Tobacco advertising: The 

New Zealand experience. Tobacco Control

4 (1): 90–91. 

225. Chapman, S. 1994. How astute a tobacco 

marketeer are you? Tobacco Control 3 (1): 

74–75. 

226. Dewhirst, T. 1999. Tobacco sponsorship is 

no laughing matter. Tobacco Control 8 (1): 

82–84. 

227. Khermouch, G., and J. Green. 2001. 

Buzz marketing: Suddenly this stealth 

strategy is hot—but it’s still fraught with 

risk. Business Week, July 30. http://www

.businessweek.com/magazine/content/01

_31/b3743001.htm.

228. Duncan, T. R., and S. E. Everett. 1993. 

Client perceptions of integrated marketing 

communications. Journal of Advertising 

Research 33 (3): 30–39. 

229. Rust, R. T., and R. W. Oliver. 1994. The death 

of advertising. Journal of Advertising 23 (4): 

71–78. 

230. Kitchen, P. J., and D. E. Schultz. 1999. 

A multi-country comparison of the drive 

for IMC. Journal of Advertising Research

39 (1): 21–38. 

99

4

Types and Extent of Tobacco 

Advertising and Promotion 

This chapter examines the types and extent of tobacco advertising and promotion in the 

United States and their evolution over time. Areas discussed include

n	 A taxonomy of past and present channels used in advertising and promoting 

tobacco products

n	 A review of emerging promotional channels, such as packaging, viral marketing, 

and the Internet

n	 Expenditures for advertising and promotion, and trends over time, for cigarettes, 

cigars, and smokeless tobacco, using data from the Federal Trade Commission, 

the advertising trade press, and other sources as available

Despite restrictions on cigarette advertising from federal legislation adopted in 1969 and 

from the 1998 Master Settlement Agreement, cigarette marketing expenditures have 

increased substantially, peaking at $16.7 billion (in 2006 dollars) in 2003 and then dropping 

in 2005 (the latest year for which figures are available) to $13.5 billion (in 2006 dollars). 

Over time, expenditures have shifted dramatically from traditional print advertising to 

promotional activities, primarily price discounting. These trends have had a major impact 

on the milieu of media messages that affect tobacco-related attitudes and behaviors. 
100

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

Introduction

For at least 50 years, cigarettes have 

been one of the most heavily marketed 

consumer products in the United States. 

This chapter reviews the types and extent 

of tobacco advertising and promotion 

as well as how the scope and nature of 

tobacco marketing have changed over time. 

The first part of the chapter addresses the 

types of tobacco advertising and promotion 

used, including emerging marketing 

practices. The second part of the chapter 

reviews the extent of tobacco advertising 

and promotion and long-term trends in 

marketing expenditures. This chapter, like 

the monograph as a whole, focuses on the 

United States, but developments in other 

countries are occasionally mentioned for 

illustrative purposes. 

In 2005, the U.S. tobacco industry spent 

$13.5 billion (in 2006 dollars) on tobacco 

advertising and promotion. Since 1981, 

as cigarette consumption and sales in the 

United States have declined, tobacco industry 

expenditures on advertising and promotion 

have grown 10 times greater.1 The tobacco 

industry has mastered and dominated nearly 

all forms of communications media during 

the past 100 years. In the early 1900s, 

these included promotional items such as 

trading cards (often included with a pack of 

cigarettes). In the 1920s and 1930s, these 

forms of communications included print 

media such as magazine and newspaper 

advertising. In the 1940s and early 1950s, 

the tobacco industry was one of the prime 

sponsors of radio. In the 1950s and 1960s, 

the tobacco industry was predominant in 

television advertising.2,3 In the 1970s and 

1980s, tobacco manufacturers dominated 

sports and event sponsorships, billboards, 

and magazine advertising. In the 1980s and 

1990s, point-of-sale advertising, direct mail 

advertising, sponsorships, and promotions 

on the Internet became major marketing 

tools for cigarette manufacturers. Today, 

in response to factors such as restrictions on 

tobacco advertising, the mix of promotional 

channels has evolved further into areas 

such as promotional allowances and viral 

marketing techniques.

Information on the extent of tobacco 

advertising and promotion is important 

for several reasons. First, the pervasiveness 

of tobacco advertising and promotion 

determines the level of consumers’ 

exposure to marketing messages and 

images. The “dose” of exposure, in turn, 

is likely to correlate with the impact of 

media communications. (Impact might be 

measured using outcomes such as brand 

recognition, attitudes toward smoking, and 

smoking behavior.) However, susceptibility 

to smoking and receptivity to advertising 

and promotion vary among individuals and 

population subgroups (chapters 5 and 7), 

and it is important to measure relative 

exposure levels among them.

Second, widely dispersed tobacco advertising 

and promotion are likely to affect social 

norms concerning tobacco use. In outlining 

direct and indirect mechanisms by which 

advertising might increase tobacco 

consumption, the 1989 Surgeon General’s 

report points out this indirect effect: 

“the ubiquity and familiarity of tobacco 

advertising and promotion may contribute 

to an environment in which tobacco use is 

perceived by users to be socially acceptable, 

or at least less socially objectionable and 

less hazardous than it is in fact.”4(p.502)

Third, heavy spending for cigarette 

advertising in a particular media outlet 

tends to suppress coverage of smoking-andhealth issues in that medium5

 (chapter 9). 

Similarly, heavy spending for cigarette 

promotion, sponsorships, philanthropy, 

and public relations targeting certain 

sporting activities, cultural institutions, 

or community organizations (e.g., groups 

representing women or minorities) 

“may create political support for, or mute 
101

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

opposition to, the industry’s marketing and 

policy objectives.”4(p.502) These two effects 

provide additional indirect mechanisms by 

which tobacco advertising and promotion 

may increase tobacco consumption.4(p.502)

Fourth, “saturation” advertising facilitates 

the penetration of marketing messages 

into communities where more populations 

are found that are vulnerable to take up 

and maintain tobacco use, especially when 

communication channels are selectively 

chosen to reach those populations. 

Fifth, policymakers wishing to enact a 

comprehensive ban on tobacco advertising 

and promotion need to be aware of the 

many types of tobacco advertising and 

promotion, so as to avoid ambiguities in 

legislation that would allow manufacturers 

to shift marketing expenditures from 

“banned” media to “allowed” media 

(see below and chapters 3 and 8).

Finally, it is important to know the dose 

and duration of a population’s exposure 

to tobacco advertising and promotion 

to estimate the amount of “corrective 

communication” that may be needed to 

negate or overcome the effects of many years 

of protobacco marketing. Again, varying 

susceptibility to smoking and receptivity to 

advertising and promotion need to be taken 

into account in determining the optimal 

amount of corrective communication. In the 

civil (i.e., noncriminal) lawsuit waged by the 

U.S. Department of Justice (DOJ) against 

tobacco manufacturers, alleging violations 

of the Racketeer Influenced Corrupt 

Organizations (RICO) Act, the DOJ proposed 

extensive remedies including corrective 

communication concerning the adverse 

health effects of smoking and exposure to 

secondhand smoke, the addictiveness of 

smoking and nicotine, “low-tar” cigarettes, 

and the impact of tobacco marketing on 

youth.6 (Federal Judge Gladys Kessler, 

in a decision issued on August 17, 2006, 

concluded that “adoption of such a public 

education and countermarketing campaign 

would unquestionably serve the public 

interest.” However, she ruled that “under 

the narrow standard for §1964(a) remedies 

articulated in [Court of Appeals] Judge 

[David] Sentelle’s Opinion [United States v. 

Philip Morris USA Inc., et al., 396 F.3d 1190 

(D.C. Cir. 2004)], the Court cannot enter 

such a remedy because it is not specifically 

aimed at preventing and restraining future 

RICO violations.”7)

Sources of Data

Information on the types and extent of 

tobacco advertising and promotion comes 

from many sources, including the Federal 

Trade Commission (FTC), advertising trade 

publications such as Advertising Age and 

Adweek, research published in scholarly 

journals and reports, and the lay press. 

The FTC is a major source of data on 

tobacco advertising and promotional 

expenditures. The Federal Cigarette 

Labeling and Advertising Act of 1965 and 

the Public Health Cigarette Smoking Act 

of 1969 required the FTC to transmit an 

annual report to Congress concerning 

current practices and methods of cigarette 

advertising and promotion.4 These reports 

have been transmitted to Congress since 

1967.1,8 The Comprehensive Smokeless 

Tobacco Health Education Act of 1986 

required the FTC to report to Congress 

every other year on current advertising 

and marketing practices for smokeless 

tobacco products;4 ten such reports have 

been transmitted to Congress, with the first 

report issued in 1987 (but dated 1986) and 

the most recent issued in 2007.9,10 The FTC 

has obtained information on advertising and 

promotion from the largest cigarette and 

smokeless tobacco manufacturers through 

a compulsory data collection process.

Beginning with fiscal year 2000, the Federal 

Reports Elimination and Sunset Act of 

1995 (Public Law 104-66) terminated most 

periodic reporting requirements established 
102

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

before 1993, including those requiring the 

FTC to transmit to Congress reports on 

cigarette and smokeless tobacco advertising 

and promotion. A Senate Committee has 

reviewed the legislative history and detail 

surrounding that action.11 In April 2001, the 

FTC announced that it was soliciting public 

comments “to help it determine whether 

to continue to issue reports on the sales, 

advertising and promotion of cigarettes 

and smokeless tobacco products, as well as 

the formats for any such reports.”12(p.18640)

At least 98 public comments were submitted 

to the agency, almost all of which supported 

continued publication.12 As noted above, 

the FTC has continued to issue reports on 

cigarette and smokeless tobacco marketing 

since the sunset of statutory requirements.

The FTC has produced one report on cigar 

advertising and promotion13 that presented 

data on advertising and promotional 

expenditures for 1996 and 1997 (summarized 

later in this chapter). The agency collected 

these data “in response to information 

showing a resurgence of cigar use in 

the United States,” by issuing special 

orders to the five leading domestic cigar 

manufacturers at that time (Consolidated 

Cigar Corporation; General Cigar Co., Inc.; 

Havatampa Inc.; John Middleton Inc.; and 

Swisher International, Inc.).

Types of Tobacco 

Advertising and 

Promotion

FTC Definitions

To facilitate data collection, monitoring, 

and reporting, the FTC has developed 

categories and definitions of advertising and 

promotion expenditures, with particular 

reference to the tobacco industry. These 

categories, drawn from FTC reports on 

cigarette, cigar, and smokeless tobacco 

advertising and promotion (especially 

the cigarette report for 2004/20051), are 

presented below, alphabetically. As explained 

within the definitions, this classification 

system has been structured to avoid double 

counting of expenditures in more than 

one category. For example, expenditures 

for a magazine advertisement promoting 

a cigarette-sponsored event appear in the 

“sponsorships” category but are excluded 

from the “magazines” category.

Audiovisual. Audiovisual or video 

advertising on any medium of electronic 

communications not subject to the Federal 

Communications Commission’s jurisdiction, 

including screens at motion picture theaters, 

video cassettes, and monitors in stores, but 

excluding expenditures in connection with 

Internet advertising.

Company Web site. All expenditures 

associated with advertising on any company 

Internet Web site.

Coupons. All costs associated with coupons 

for the reduction of the retail price of 

tobacco products, whether redeemed at 

the point of sale or by mail, including 

all costs associated with advertising or 

promotion, design, printing, distribution, 

and redemption. However, when coupons 

are distributed for free tobacco products 

and no purchase or payment is required to 

obtain the coupons or tobacco products, 

these activities are considered as sampling 

rather than couponing. This category has 

been separate from the “retail-value-added” 

category in the FTC’s cigarette reports 

since 1997.

Direct mail. Advertising sent via direct mail 

to the consumer, excluding expenditures 

in connection with sampling, specialty 

item distribution, public entertainment, 

endorsements, sponsorships, coupons, retail 

value added, and Internet advertising.

Endorsements and testimonials. This 

category includes, but is not limited to, 
103

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

all expenditures made to procure tobacco 

use; the mention of a tobacco product 

or company name; the appearance of a 

tobacco product, name, or package; or other 

representation associated with a tobacco 

product or company, in any situation 

(e.g., motion pictures, stage shows, or 

public appearances by, or photographs of, 

a celebrity or public figure) in which such 

use, mention, or appearance may come to 

the public’s attention.

Internet—other. Internet advertising 

other than on the company’s own Web 

site, including on the World Wide Web, on 

commercial online services, and through 

electronic mail messages.

Magazines. Magazine advertising, but 

excluding expenditures in connection with 

sampling, specialty item distribution, public 

entertainment, endorsements, sponsorships, 

coupons, and retail value added.

Newspapers. Newspaper advertising, but 

excluding expenditures in connection 

with sampling, specialty item distribution, 

public entertainment, endorsements, 

sponsorships, coupons, and retail value 

added.

Outdoor. Billboards; signs and placards 

in arenas, stadiums, and shopping malls, 

whether they are open air or enclosed; 

and any other advertisements placed 

outdoors, regardless of their size, including 

those on cigarette retailer property; but 

excluding expenditures in connection with 

sampling, specialty item distribution, public 

entertainment, endorsements, sponsorships, 

coupons, and retail value added.

Point-of-sale (point-of-purchase) 

advertising. Advertising posted in retail 

outlets, but excluding expenditures in 

connection with outdoor advertising, 

sampling, specialty item distribution, public 

entertainment, endorsements, sponsorships, 

coupons, and retail value added. 

Price discounts. Price discounts paid to 

tobacco retailers or wholesalers to reduce 

the price of tobacco products to consumers, 

including off-invoice discounts, buy downs, 

voluntary price reductions, and trade 

programs, but excluding retail-value-added 

expenditures for promotions involving 

free tobacco products and expenditures 

involving coupons.

Promotional allowances—retail. Payments 

to tobacco retailers to facilitate the sale 

or placement of any tobacco product, 

including payments for stocking, shelving, 

displaying, and merchandising brands, 

volume rebates, and incentive payments, 

but excluding expenditures in connection 

with newspapers, magazines, outdoor, 

audiovisual, transit, direct mail, point of 

sale, and price discounts. 

Promotional allowances—wholesale.

Payments to tobacco wholesalers to 

facilitate the sale or placement of any 

tobacco product, including payments 

for volume rebates, incentive payments, 

value-added services, promotional 

execution and satisfaction-of-reporting 

requirements, but excluding expenditures 

in connection with newspapers, magazines, 

outdoor, audiovisual, transit, direct mail, 

point of sale, price discounts, and retail 

promotional allowances. 

Public entertainment—adult only.

Public entertainment events bearing 

or otherwise displaying the name or 

logo or an image of any portion of the 

package of any of a company’s tobacco 

products or otherwise referring or 

relating to tobacco products, which take 

place in an adult-only facility, including 

all expenditures made by the company 

in promoting and/or sponsoring such 

events. The definition for this category for 

cigars specifically mentions the inclusion 

of “dinners, wine or spirit tastings, and 

week­ends or other vacations featuring 

cigar smoking.”13
104

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

Public entertainment—general audience.

The same as “public entertainment—adult 

only,” except that the public entertainment 

events do not take place in an adult-only 

facility. 

Retail value added—bonus tobacco 

products. Retail-value-added expenditures 

for promotions involving free tobacco 

products (e.g., buy two packs, get one free), 

whether or not the free tobacco products 

are physically bundled together with the 

purchased tobacco products, including 

all expenditures and costs associated with 

the value added to the purchase of tobacco 

products (e.g., excise taxes paid for free 

cigarettes and increased costs under the 

Master Settlement Agreement [MSA]).

Retail value added—non-tobacco-product 

bonus. Retail-value-added expenditures 

for promotions involving free nontobacco 

items (e.g., buy two packs, get a cigarette 

lighter), including all expenditures and 

costs associated with the value added to the 

purchase of tobacco products.

Sampling distribution. Sampling of 

tobacco products, including the costs of 

the products, all associated excise taxes and 

increased costs under the MSA, and the cost 

of organizing, promoting, and conducting 

sampling. Sampling includes the distribution 

of tobacco products for consumer testing 

or evaluation when consumers are able to 

use the tobacco products outside of a facility 

operated by the company, but does not 

include the cost of actual clinical testing 

or market research associated with such 

tobacco product distributions. Sampling 

also includes the distribution of coupons for 

free tobacco products, when no purchase or 

payment is required to obtain the coupons 

or tobacco products. 

Specialty item distribution—branded.

All costs of distributing items other 

than cigarettes (whether the items are 

sold, redeemed by coupon, or otherwise 

distributed) that bear the name or logo 

or depict an image of any portion of the 

package of a tobacco product, including 

the costs of the items distributed but 

subtracting any payments received for the 

item. The costs associated with distributing 

nontobacco items in connection with 

sampling or retail-value-added programs 

are reported in those categories, not as 

specialty item distribution. Examples of 

specialty items distributed as part of tobacco 

promotions are sunglasses, key chains, 

calendars, sporting goods, T-shirts, caps, 

and other clothing.

Specialty item distribution—nonbranded.

The same as “specialty item distribution—

branded,” except that the specialty items 

do not bear the name or logo or depict an 

image of any portion of the package of a 

tobacco product.

Sponsorships. For cigarettes, this category 

is defined as sponsorships of sports 

teams or individual athletes but excludes 

endorsements.1 For smokeless tobacco, 

this category is called “sports and sporting 

events,” is duplicative of expenditures for 

other categories, and is defined as follows: 

“All costs associated with sponsoring, 

advertising or promotion of sports or 

sporting events, including football, weight 

lifting, sailing, rodeo, automobile, race 

car, funny car, motorcycle, bicycle, truck, 

monster truck, tractor-pull, fishing, and 

hunting events, competitions, tournaments, 

and races.”10(p.32) In the FTC’s report on 

cigar advertising and promotion,13 this 

category is called “sports” and also was 

duplicative of expenses reported in other 

categories.

Telephone. Telephone advertising, including 

costs associated with the placement of 

telemarketing calls or the operation of 

incoming telephone lines that allow 

customers to participate in any promotion 

or hear pre-recorded product messages; 

but excluding costs associated with having 
105

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

customer service representatives available 

for responding to consumer complaints or 

questions.

Television and radio. This category 

was used for the FTC’s report on cigar 

advertising and promotion,13 and was 

defined as advertising on any medium of 

electronic communications subject to the 

jurisdiction of the Federal Communications 

Commission such as broadcast television, 

cable television, and radio. For that 

report, this category was combined with 

the “audiovisual” category. Broadcast 

advertising has been prohibited by law 

for manufactured cigarettes (since 1971), 

smokeless tobacco (since 1986), and “little 

cigars” (since 1973) but is still permitted 

for other cigars, pipe tobacco, and roll-yourown cigarette tobacco4

 (chapter 8).

Transit. Advertising on or within private 

or public vehicles and all advertisements 

placed at, on, or within any bus stop, taxi 

stand, transportation waiting area, train 

station, airport, or any other transportation 

facility; but excluding expenditures in 

connection with sampling, specialty 

item distribution, public entertainment, 

endorsements, sponsorships, coupons, 

and retail value added.

All other. Advertising and promotional 

expenditures not covered by another category.

Indirect Advertising

Indirect advertising, a form of trademark 

diversification, is often used by 

manufacturers where partial advertising 

bans are in force. This term, also called 

brand sharing or brand stretching, refers 

to the application of cigarette brand 

names, logos, or other distinctive elements 

of cigarette brands (and their ads) to 

nontobacco products.14,15 For example, 

after enactment of a cigarette advertising 

ban in Norway in 1975, Camel boots 

were introduced in that country, with 

advertisements that were virtually identical 

to earlier ads for Camel cigarettes.16 Other 

examples include “Marlboro Classics” 

clothing, sold in at least 29 countries; 

Marlboro and Camel lighters, Pall Mall 

matches, Peter Stuyvesant Travel, and Camel 

footwear in France, following the tobacco 

advertising restrictions imposed by the 

Loi Veil legislation in 1976; Camel boots 

in Finland, after direct tobacco advertising 

was banned in 1976; “Camel adventures” 

(travel tours) in Sweden, after tobacco 

advertising was restricted in 1979; Liggett 

& Myers (L&M) matches, Camel scooters, 

Gauloises travel excursions, and Bastos 

cassettes in Belgium, after the enactment of 

advertising limits under the Royal Decree 

of 20 December 1982; the Benson & Hedges 

Bistro in Kuala Lumpur, Malaysia, where 

direct tobacco advertising is banned; Camel 

Trophy “adventure boots” in Turkey, after its 

1997 ban on tobacco advertising; and plain 

(nontobacco) pan masala as an advertising 

surrogate for tobacco-containing pan masala

in India, where advertising of tobacco 

products has been banned since 2004.14,17–21

A Web site description of a Marlboro Classics 

clothing store in Hong Kong reads,

Although Marlboro Classics clothing 

chain is part of the Marlboro cigarettes 

company, one thing is for sure: their 

clothes are a lot healthier, and better 

looking. There are great chinos, shirts, 

T-shirts and accessories, including shoes. 

You will walk out looking like you just did 

a photo shoot in the Wild West for, well, 

a cigarette advert. But nevertheless, the 

quality is high, the prices fair, and the style 

is definitely cool.22

Two R.J. Reynolds (RJR) France documents, 

“Communication Strategy and Strategic 

Plan 1992–1996” and “Worldwide Brands, 

Inc. Strategic Plan 1993–1997” describe 

how to circumvent legal restrictions by 

promoting nontobacco products and 

services bearing the Camel and Winston 
106

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

brand names.23,24 These documents were 

made public in a court judgment (Tribunal 

de Grande Instance de Paris 19 October 

1998).15 According to RJR France’s 1992–

1996 strategic plan,23(p.4)

Compared to most competitors, 

RJR France seems better prepared to 

successfully confront the new legal 

restrictions thanks to a larger number 

of available logo licensing activities, 

(Camel Trophy watches, Camel boots, 

Camel collection/shops, Winston wear) 

allowing a satisfactory communication 

continuity behind [the] Camel and 

Winston [brands].

Tobacco control research has also borne out 

the connection between brand stretching 

and promotion of the sponsoring tobacco 

products. Initial research shows that 

advertising for the nontobacco product or 

service is consistently seen as advertising 

for the sponsoring tobacco brand,25,26 while 

15-year-olds’ awareness of brand stretching 

is independently associated with being a 

smoker.27 Thus, indirect advertising serves 

as a powerful tool for maintaining a product 

brand identity, particularly in the absence of 

traditional promotional channels.

Advertising on the Package

As the “face” of the product being sold, 

packaging is always an important part 

of the firm’s advertising and promotion 

considerations. For cigarettes, packaging is 

even more important because the package 

is not opened once and discarded, as with 

many purchases, but is opened each time 

a cigarette is removed. The visibility of the 

package under these circumstances makes 

packaging an important advertising vehicle. 

An additional advantage of advertising 

on tobacco packaging is that it does not 

fall within any of the FTC’s categories 

of advertising and promotion; hence, 

expenditures for this marketing vehicle 

are not reported to the FTC.

Internal tobacco corporate documents 

make it clear that the industry understands 

and appreciates the value of packaging 

in influencing smokers and potential 

smokers. A 1963 Liggett & Myers report 

states, “The primary job of the package 

is to create a desire to purchase and try. 

To do this, it must look new and different 

enough to attract the attention of the 

consumer.”28(Bates no. TI3072-9042)

Philip Morris’s comment regarding its 

efforts to target women provides one 

example of how packaging is used to 

influence specific target markets or niches:

Some women admit they buy Virginia 

Slims, Benson & Hedges, etc. when 

they go out at night, to complement 

a desire to look more feminine and 

stylish....29(Bates no. 2060037888) Women are 

a primary target for our innovative 

packaging task.29(Bates no. 2060037905)

In appealing to the youth segment, 

Lorillard developed unique packaging for 

Zack (a new brand in the 1970s). “Zack’s 

strength in appealing to young adults is 

its unusual name, denim pack and graphic 

entity.”30(Bates no. 91260420) Similar strategies 

have been followed by Gauloises in France 

and Brown & Williamson (B&W) in the 

United States. Special package design 

for Légères, a brand made by Gauloises, 

portrays a seductive young female in a 

dungeons and dragons setting.31 Referring 

to an innovative Kool package that 

opens as a book and has rounded corners 

and vivid colors, B&W vice president 

Ludo Cremers commented, “The response 

from consumers is ‘this is a pack to be 

seen with’.”32(p.C11)

Many other examples of new cigarette 

packaging shapes or materials33 and vivid 

or creative imagery on cigarette packs34–36

have been reported. A collector of cigarette 

packs—who claims to have collected more 

than 33,500 cigarette packs from more than 
107

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

140 countries, dating from the 1890s to 

the present—has more than 1,700 images 

and illustrations of cigarette packs on 

the collection’s Web site.37 It includes, 

for example, dozens of different images of 

Camel iconography (including Joe Camel) 

on cigarette packs sold in Argentina, Austria, 

France, Germany, Italy, Mexico, Norway, 

Switzerland, and the United States.37

Packaging accessories provide yet another 

channel for advertising imagery. In 

Hong Kong, Philip Morris introduced a 

plastic outer cover for Marlboro cigarette 

packs, featuring a series of images of the 

Marlboro cowboy. Besides presenting 

powerful visuals of the “Marlboro Man,” the 

cover also seems designed to obscure the 

health warning on the underlying pack.38

Cigarette package design can be an 

important feature of in-store advertising. 

An American Tobacco Company 

memorandum stated that “an integrated 

package design look can provide for a 

greater in-store presence,”39(Bates no. 94600013)

and Wakefield and colleagues explained 

that “the arrangement of packs at the 

point of purchase themselves become an 

advertisement for the brand family.”40(p.i76)

Similarly, a British American Tobacco 

report states, 

Given the consequences of a total ban on 

advertising, a pack should be designed to 

give the product visual impact as well as 

brand imagery.... The pack itself can be 

designed so that it achieves more visual 

impact in the point of sale environment 

than its competitors.41(Bates no. 102699354)

Colors on packaging, like the colors in 

traditional advertising (chapter 3), can 

contribute to brand image. For example, 

tobacco companies have used lighter 

colors on packages to convey a sense of a 

lighter and perhaps healthier cigarette. 

Cigarette Packaging as Seen by the Tobacco Industry

The impact of cigarette packaging was explored in detail in one study of industry documents. 

This study concluded that pack imagery has significant effects on an individual’s perception 

of the cigarette product and encourages trial smoking, and in highly competitive or restricted 

environments, the pack acts as an advertisement that creates or reinforces brand imagery.a

When the pack shows signs of weakness, redesign is quick to follow:

Marlboro is significantly under-represented in the 27.5% menthol category. The existing Marlboro 

Menthol has a 0.2 market share, or less than 1% of the category.... Three new products have been 

developed.... The full flavor pack has been redesigned to achieve a fresher more contemporary look 

while preserving the basic identity of the original.b

British American Tobacco focused on packaging even when it considered selling individual 

cigarettes to people in less-developed countries: “The brand image must be enhanced by the 

new packaging ... if you just say, this is a cheap cigarette ... they’re not going to go for it.”c

In addition, cigarette packages have been designed to appeal to particular target groups, such as 

young adults or women.

a

Wakefield, M., C. Morley, J. K. Horan, and K. M. Cummings. 2002. The cigarette pack as image: New evidence 

from tobacco industry documents. Tobacco Control 11 Suppl. 1: i73–I80.

b

Fuller, S. Marlboro menthol. 30 Sep 1987. Philip Morris. Bates No. 2048517809/7813. http://legacy.library

.ucsf.edu/tid/jqm92e00. 

c

Muggli, M. E., and R. D. Hurt. 2003. Listening between the lines: What BAT really thinks of its consumers in 

the developing world. Tobacco Control 12 (1): 104.
108

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

In a 1979 report, RJR pointed to lighter 

colors for the Camel’s filter brand as 

playing a key role in creating the image of 

“reduced strength”: 

Refinements in the [Camel Filter brand] 

Package consist mainly of increasing the 

amount of white space on the pack and 

lightening the brown color tones, ... to give 

the revised package the appearance of 

reduced strength.42(Bates no. 500566631)

A Canadian ministerial advisory committee 

on tobacco control concluded,

The colours and designs of cigarette 

packages continue to reinforce the notion 

that some brands are less harmful. The hue 

and density of the colours applied within 

a brand family follow a natural spectrum 

of intensity, with the lightest colours 

matched to the ‘lightest’ brand.43(p.10)

The committee recommended a ban on 

the use of “deceptive descriptors such as 

‘light’ and ‘mild’ on cigarette packaging 

and marketing ... [and] the use of other 

words, colours or devices that result in 

an erroneous perception of a difference 

in health risks and/or tar/nicotine 

deliveries.”43(p.11) (emphasis added)

Beyond the issue of perceiving products as 

light or mild, tobacco packaging has been 

shown in general to both reinforce brand 

imagery and reduce the impact of health 

warnings.44–47 Conversely, when fewer 

brand image cues appear on the packaging, 

adolescents are able to recall nonimage 

health information more accurately.47

Plain packaging limits the ease with which 

consumers associate particular images with 

cigarette brands and significantly influences 

smoking behavior.44 Thus, packaging not 

only plays a role in product branding 

but can also be used effectively in policy 

interventions designed to counter the 

desirability of smoking.

Viral (or Stealth) Marketing

One strategy that tobacco marketers have 

used increasingly is called viral or buzz

marketing or, more pejoratively, as stealth

or guerilla marketing. It is described as the 

situation in which “the advertiser creates an 

environment in which the idea can replicate 

and spread. It’s the virus that does the work, 

not the marketer.”48(p.26) Examples might 

include paying teens to talk to their friends 

about a product or to infiltrate a chat room, 

commissioning footpath graffiti, or creating 

Web sites or sponsoring events that support a 

Integrating Packaging and Marketing: The “Kool Mixx” Campaign

One example of combining custom packaging with merchandising for an integrated product 

marketing effort was Brown & Williamson’s 2004 hip-hop music-themed “Kool Mixx” campaign 

for Kool cigarettes. The campaign included (1) a series of limited-edition cigarette packs featuring 

artists’ renditions of the elements of hip-hop culture—“MC-ing” (rapping), “disc jockeying” 

(DJ-ing), break dancing, and creating graffiti art; (2) a “Mixx Stick” radio, free with the purchase 

of a limited-edition two-pack set; (3) free magazine subscriptions for various hip-hop themed 

magazines; (4) an interactive Kool Mixx compact disc featuring video clips of Kool Mixx events 

and interviews and performances from rappers, DJs, graffiti artists, and dancers; (5) “Mixx”-

branded desktop wallpaper to be downloaded to the user’s computer; (6) three “test your hip-hop 

skills” interactive games; (7) a selection of audio tracks; and (8) DJ software enabling the user to 

create original music mixes.a

a

Hafez, N., and P. M. Ling. 2006. Finding the Kool Mixx: How Brown & Williamson used music marketing to 

sell cigarettes. Tobacco Control 15 (5): 359–66.
109

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

product but without overt brand imagery.49,50

The labels for this marketing activity reflect 

how it works: the marketers orchestrate 

a “tsunami of chatter”49—or buzz—that 

helps an idea or product spread like a virus. 

Commercial sponsorship is surreptitious so 

that consumers believe they are discovering 

something on their own—hence, the 

descriptors “stealth” and “guerrilla.”50

Although the terms viral marketing and 

stealth marketing are relatively new, 

they are not different from two other 

concepts familiar to social scientists. 

A parallel, earlier concept familiar to 

communication researchers is the multistep 

flow in persuasion efforts. This process 

refers to the fact that those around us can 

and do influence us, but this influence 

comes as a consequence of the media 

messages to which we are all exposed.51

A bandwagon effect represents a similar 

concept that R.J. Reynolds recognized 

decades ago. Widespread exposure to a 

brand’s advertising creates an initial focus 

on the brand. A bandwagon, or virus, then 

allows the brand’s share of the market 

to grow. Once 30% of underage smokers 

adopt a brand, its lasting success in the 

marketplace is said to be ensured.52

An article on stealth marketing in Business 

Week49 describes the use of the technique to 

reinvigorate a well-known cigarette brand:

Brown & Williamson Tobacco Corp. and 

its ad agency, Bates, decided to add buzz 

to Lucky Strike’s equation. The result was 

the Lucky Strike Force, attractive couples 

working trendy neighborhoods such as 

Miami’s South Beach, New York’s Soho, 

and Santa Monica, Calif., proffering hot 

coffee and cell-phone calls to shivering 

smokers in winter or iced coffee and 

lounge chairs in spring and summer. ‘Send 

up a smoke signal, and we’ll be there,’ local 

teaser ads urged. The Strike Force has 

helped the onetime icon edge back toward 

broad availability. ‘As a marketer, you hope 

to have your consumer do your marketing 

for you,’ explains Sharon Smith, director of 

Lucky Strike. ‘It is credible, less expensive, 

and enormously believable.’ 

The Internet has played a crucial role in 

viral marketing. Camel was the sponsor of 

a German Web site for a new rock band, 

featuring English headings such as “party 

previews,” “love parade,” and “Berlin 

fashion,” and a picture of the members of a 

mixed-sex band fondling each other nude.53

A nontobacco example is the Web-based 

company Tremor. With 280,000 teens (1% of 

total teenage population), the firm, which 

is formally linked to major (nontobacco) 

marketers, seeks to involve teenagers in 

the marketing process. One example of the 

process is the naming of the movie Eurotrip.

More than 60,000 Tremor members 

submitted title suggestions after reviewing 

a brief movie synopsis. Dreamworks, the 

movie’s producer, narrowed down the list, 

picked its favorites, and then chose the 

official title. The winning title had been 

submitted by 20 Tremor members.54

Although not formally linked to tobacco 

firms, Internet “virtual teen smoking clubs” 

make positive smoking images for youths the 

norm.55 Ribisl55 reviews a number of sites, 

including (1) http://www.smokingcelebs

.com/teenceleb.html, one of a dozen or 

more Web sites dedicated to smoking by 

celebrities; (2) online clubs, such as the 

Yahoo! Club “Smoking_Girls_in_Movies” 

or the newsgroup alt.smokers.glamour; 

(3) Teen Smokers Home Page, described as 

a “place for teen smokers to hang out”; and 

(4) Badteengirlssmokingden, a Yahoo! site 

that has almost 1,500 members. In addition, 

teen smokers participate in online polls and 

message boards. 

British American Tobacco (BAT) has 

developed an independent Web site that 

features BAT retailers who appear to offer 

independent advice on nightlife to young 

people. The youth are directed to bars, clubs, 
110

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

or restaurants where BAT cigarettes are 

being sampled or promoted.56

Another approach to viral, or stealth, 

marketing is embodied by trend influence 

marketing, which involves an alliance 

among the tobacco industry, the alternative 

press, and bars and nightclubs.57 The 

alternative press includes free periodicals 

distributed in trendy nightclubs and found 

at stores and coffee houses frequented by 

the club crowd. These periodicals, which 

lend “hip credibility” to the advertised 

brands, have become a major outlet for 

modern tobacco marketing. A sampling 

of two prominent alternative weeklies 

(one in San Francisco and the other in 

Philadelphia) found a dramatic increase 

in tobacco advertising from 1994 to 1999: 

the number of ads increased from 8 to 

337 in the San Francisco weekly, and 

from 8 to 351 in the Philadelphia weekly.58

In addition, smoking “hipsters” are recruited 

clandestinely (from the bar and nightclub 

scene) to surreptitiously sell tobacco 

products to unsuspecting young adults in 

bars and elsewhere.57

BAT’s “Project Whisper,” a good example of a 

viral strategy, was intended to capitalize on 

social interactions within bars to influence 

bar patrons: 

The rationale of Project Whisper is 

straightforward—influence an opinion 

leader with your product communication 

and you are at the same time achieving 

dissemination of that communication 

throughout his sociometric network. 

An additional aspect of this type of 

communication is that it typically takes 

place where a high degree of opinion 

transfer and modelling behaviour is 

observed. This is seen in the British public 

house or night club, and has equivalent 

phenomena in all societies.59(Bates no. 542003684)

Young marketers (or “roachers”) are hired 

by tobacco companies to sell cigarettes in 

trendy bars and clubs in Sydney, Australia. 

Selected for their good looks, style, and 

charm, the roachers often appear at special 

dance events where tents filled with bean 

bags, a bar, and a DJ help them create 

“fantastic themed sales points.”60

Viral marketing techniques are spread 

across several of the FTC’s categories of 

advertising and promotion, but some of 

these techniques may not be captured 

by those categories. In addition, a clear 

definition of viral marketing for purposes 

of estimating the extent of its use has 

not been developed, so no information is 

available on expenditures and trends for 

viral marketing of tobacco products. 

Internet Marketing

Aside from its use in viral marketing, as 

described above, the Internet has been used 

to actually sell tobacco products. In a 2002 

study, Ribisl55 found 195 Internet cigarette 

vendors in the United States. A majority of 

vendors (105) were in New York State, and 

most of these were in the western part of 

the state on Indian reservations. A total of 

88 Web sites sold other tobacco products: 

42%, cigars; 39%, smokeless tobacco; 18%, 

clove cigarettes; and 8%, bidis.

The 2001 National Household Survey on 

Drug Abuse found that 3.3% of 12- to 

17-year-olds reported having purchased 

cigarettes over the Internet at least once 

during the past month.20 Data from 

additional studies indicate that buying 

cigarettes on the Internet is easier than in 

retail outlets, suggesting the potential for 

future growth. As one example, a youth 

tobacco purchase survey found that four 

11- to 15-year-olds were successful in 

76 (92%) of 83 attempts to purchase 

cigarettes via the Internet.55

States have taken a variety of steps to 

attempt to control tobacco sales over the 

Internet to ensure that state tobacco taxes 
111

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

are applied and that illegal sales to minors 

do not occur.61 However, the extent to which 

these actions may have reduced Internetbased tobacco sales and marketing is unclear.

In March 2000, an attorney with Philip Morris 

Corporate Services commented on the use of 

the company’s Australian Web site: 

As you are no doubt aware, our ability 

to communicate about the Company 

and its positions through traditional 

media is severely restricted. As a 

result, the website takes an [sic] added 

significance.”62(Bates no. 2072557317A)

Nevertheless, the attorney added that “the 

site will be purely an information site and 

will not have any elements of marketing, 

branding or e-commerce.”62(Bates no. 2072557317A)

As noted above, the FTC now requires 

tobacco manufacturers to report to the 

agency their expenditures on advertising 

and promotion, according to several 

categories, two of which pertain to the 

Internet: (1) expenditures associated with 

advertising on any of the tobacco company’s 

Internet Web sites (“Company Web site”); 

and (2) expenditures for Internet advertising 

other than on the company’s own Web 

site, including on the World Wide Web, on 

commercial online services, and through 

electronic mail messages (“Internet—

other”). From 1996 to 2001, there was 

only one (combined) category for Internet 

expenditures, and for these years, the major 

cigarette companies reported the following 

expenditures for Internet advertising: 

$432,000 (1996); $215,000 (1997); $125,000 

(1998); $651,000 (1999); $949,000 (2000); 

and $841,000 (2001). The companies 

reported a 285% increase in spending for 

advertising on company Web sites from 

2002 ($940,000) to 2005 ($2,675,000). 

For those four years, however, they reported 

no expenditures for “Internet—other” 

advertising, such as banner ads on thirdparty Web sites or direct mail advertising 

using e-mail.1 The major smokeless tobacco 

companies, using one combined category 

for Internet advertising, reported no 

expenditures for that category before 2000 

but reported spending $155,405 in 2000 and 

$413,000 in 2005, a 266% increase.10

In a repeated cross-sectional survey of 

New Jersey adults, the proportion of Internet 

users reporting exposure to online tobaccoproduct advertising increased from 6.9% in 

2001 to 15.6% in 2002 to 17.8% in 2005. 

The 2005 survey showed significantly higher 

recall of online tobacco-product advertising 

among those aged 18–24 years than among 

older groups.63 The 2004 National Youth 

Tobacco Survey found that 34.1% of middle 

school students and 39.2% of high school 

students reported seeing advertisements for 

tobacco products on the Internet.64

In a 2003 fact sheet on Internet tobacco 

marketing (http://www.tobaccofreekids

.org/research/factsheets/pdf/0081.pdf), the 

Campaign for Tobacco-Free Kids reported 

that RJR had created a Web site to sell 

Eclipse cigarettes, a product purported 

to lower the risks of smoking.65 When 

the Web site (now located at http://www

.tobaccopleasure.com/ECL/home.aspx) was 

reviewed in February 2007, it discussed 

“The Eclipse Concept,” including assertions 

that the product “responds to concerns 

about certain illnesses caused by smoking, 

including cancer” and “reduces secondhand 

smoke by 80%.” The site explained how 

to use the product and promoted “special 

introductory offers”: (1) two free coupons for 

$4 off three packs or a carton, and (2) “Give 

3 adult friends our Eclipse Get-Acquainted 

Form and get a $4.00 off coupon for each 

friend that signs up.” Persons requesting 

coupons had to go through a registration 

process; a question on how the registrant 

heard about the Web site included the 

following response choices: direct mail, from 

a friend, magazine, newspaper, alternative 

weekly/local city publication, phone, 

cigarette pack, cigarette carton, bar coasters/
112

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

napkins, matchbooks, retail display, pocket 

card, other. The site offered a store locator, 

a “Smokers’ Bulletin Board,” and a list of 

135 “key publications and presentations 

relevant to the scientific evaluation of 

Eclipse.” The Web site informed visitors 

that it was no longer selling Eclipse online, 

but that the product was available for 

purchase via a toll-free telephone number.

As reviewed in chapter 8, the European 

Union’s directive on tobacco advertising 

bans tobacco promotion on the Internet, and 

the World Health Organization’s (WHO’s) 

Framework Convention on Tobacco Control 

(FCTC) mentions Internet advertising in 

the context of Article 13, which directs 

each party to the treaty to ban all tobacco 

advertising, promotion, and sponsorship 

“in accordance with its constitution or 

constitutional principles.”66(p.11)

Kenyon and Liberman have explored the 

challenges of regulating tobacco advertising 

on the Internet.67 A presentation at the 

13th World Conference on Tobacco OR 

Health in July 2006, for example, reported a 

27% increase in the number of protobacco 

Web sites on the Russian-speaking Internet 

since 2004, most of which violated 

advertising norms such as age restrictions.68

Video Games

Video games are a $9.4 billion business 

in the United States, with sales higher 

than that of the movie box office. There 

are 100 million video gaming consoles in 

households, 60 million handheld games, 

and growing numbers of game-enabled cell 

phones. The average gamer is 29 years of 

age. Younger audiences, in particular, regard 

video games as a more important form of 

entertainment than television.69 According 

to Nielsen Media Research data, males aged 

18–34 years now spend as much time with 

video games as with television; yet, while 

advertisers spent more than $8 billion in 

2003 to try to reach that market segment, 

less than $15 million was spent on video 

games as an advertising vehicle.70

In 2003–2004, Nielsen data recorded a 

significant drop in television viewership 

among young males, seemingly in favor of 

video games. This has triggered a major 

initiative on the part of the advertising 

industry to explore the use of video games 

for marketing purposes. In fact, video 

games are becoming a significant part of the 

advertiser’s media planning strategy. Major 

marketers, including McDonald’s, PUMA, 

P&G, AT&T Wireless, Nokia, Coca Cola’s 

Sprite, and Nestlé’s Butterfinger, have 

embedded their brands into some of the 

most popular video games.69 Massive, a firm 

in partnership with Viacom, is developing 

a system for inserting ads into video games 

and tracking their impact.71 The firm 

conducted a survey of gamers 12–36 years 

of age. Of these, 70% thought ads in video 

games would greatly enhance the quality 

and realism of the gaming experience and 

indicated they would feel more positive 

about a brand or product advertised in 

a video game.72 A 2004 survey of nearly 

1,000 males aged 18–34 years, conducted 

by Activision and Nielsen Entertainment, 

found that 52% of “heavy gamers” like 

games to contain real products and 35% of 

male gamers agree that advertising in video 

games helps them decide which products 

to buy (http://news.gamewinners.com/

index.php/news/92/).

Just as the tobacco industry has begun to 

use the Internet as a strategic advertising 

vehicle in reaching target audiences, 

tobacco control advocates have concern 

that video games will be used in the same 

way. The Entertainment Software Rating 

Board is an independent rating system 

established by the computer and video 

game industry in 1994. Its “Principles and 

Guidelines,” established by its Advertising 

Review Council (ARC), states as a basic 

principle, “Companies must not specifically 

target advertising for entertainment 
113

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

software products rated ‘Teen,’ ‘Mature,’ 

or ‘Adults Only’ to consumers for whom 

the product is not rated as appropriate.” 

Among the core guidelines that the ARC 

indicates it will focus on with concern is the 

following: “glamorizing, encouraging and/or 

depicting the consumption of alcohol.” 

However, there is no statement with regard 

to tobacco products.73 Even if tobacco 

advertisers formally avoid the teen category, 

any placement in the mature (M) category 

might influence them as well, given the 

breadth of appeal of these games to youth.

Some game content incorporates or features 

tobacco products. A review of 396 video 

games indicated that 6 of these involved 

tobacco and/or alcohol.74 In one video game, 

The Chronicles of Riddick: Escape from 

Butcher Bay (rated M), cigarettes are used 

as a reward, with each pack revealing some 

aspect of a new, related Riddick movie. 

In this video game, cigarettes are made 

to seem “cool” and the cigarette warning 

labels are mocked.75

In Halo 2 (rated M), the most popular 

video game for the Xbox game console 

for almost two years after its debut in 

November 2004,76 a character named 

Sergeant Major Avery Johnson smokes a 

cigar and discarded cigars are featured. 

On a Web site devoted to “Xbox Hints and 

Tips,” a hint entitled “Johnson’s Cigar In 

Cairo Station” is described as follows:

In the first level, as soon as you get off 

the lift do not go on the train. Instead, 

look to your right to find a trash can. 

Go over to it, crouch, and look in between 

the can and the wall. There should be a 

Johnson Cigar burning away. Additionally, 

go to the armory. As you are coming up 

the stairs, you will hear the man shooting 

his shotgun and talking. Kill the Elites 

and go through the door. Jump over the 

turret and look to the right. Jump on the 

lights sticking out of the wall, then jump 

over the rail. Get on one of the beams 

and jump off it onto one of the rails. 

There will be a small room with no doors. 

Jump onto that and bash the trash can. 

When you look on the floor, you will see 

Johnson’s cigar.77

A posting on an online forum for Halo

explains that Sergeant Johnson “obviously 

wasn’t aloud [sic] to smoke on ‘Cairo Station’ 

so he hid his cigar behind a trash can.”78

That posting includes two screenshot images 

and a downloadable game-playing videoclip 

showing the discarded cigar.

Another Web site devoted to “Halo 2 cheats” 

includes a posting (entitled “Smoke a cigar”) 

about another appearance of the cigar in 

this game:

On the first level if you go to the boxes 

near the sheild [sic] re-charger and hit 

them all together u will c a cigar in the 

middle then take out your battle rifle and 

shoot it your screen should turn white and 

then if you die you will see a cigar on the 

floor next to your body. This only works on 

legendary and should give u extra power in 

your melee.79

It is unclear whether the images and usages 

of cigars were built into Halo 2 as the result 

of paid advertising (i.e., product placement). 

The MSA [Section III, subsection (e)] bans 

“payment or other consideration” to promote 

tobacco products “in any motion picture, 

television show, theatrical production or 

other live performance, live or recorded 

Xbox game “Halo 2” character Sergeant Major Avery 

Johnson with cigar
114

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

performance of music, commercial film or 

video, or video game” (emphasis added).80(p.18)

Cigar manufacturers, however, are not parties 

to the MSA between the major cigarette firms 

and 46 state attorneys general. 

When viewing a Web site description 

of the cigar “cheat code” in Halo 2,81 a 

banner advertisement for cigar accessories 

was visible at the top of the Web page. 

This illustrates the complex (and often 

unpredictable) interplay between video 

games, the Internet, and digital advertising. 

More research is needed to track the 

appearance and use of tobacco products in 

video games, to determine whether these 

depictions are the result of paid promotion 

or “artistic” design, and to evaluate their 

impact on video game players’ attitudes 

and behaviors related to tobacco use 

(see chapter 10).

Paid Placement of Tobacco 

Products in Movies

The portrayal of tobacco use and the 

appearance of tobacco products, brand 

names, and brand imagery in movies 

and other entertainment media can 

occur in exchange for promotional fees 

(product placement) or because of artistic 

(noncommercial) decision making by 

producers. Strong evidence links the 

placement of cigarette products in 

films and on television with adolescent 

smoking.82–85 Product placement is a form 

of promotion, is captured by the FTC’s 

categories of advertising and promotion, 

and is the focus of this section. Chapter 10, 

on the other hand, focuses on both 

paid and unpaid depictions of tobacco 

in entertainment media, in the context 

of examining the role of these media in 

promoting or discouraging tobacco use. 

A chronology of events developed by 

Mekemson and Glantz86 in reviewing the paid 

placement of tobacco products in movies is 

presented in table 4.1. The discussion below, 

reviewing the evidence available (largely 

through internal corporate documents), is 

also drawn from Mekemson and Glantz.86

R.J. Reynolds. Executives of the public 

relations firm charged with developing 

product placements for R.J. Reynolds 

recognized the importance of tying 

celebrities to smoking on (and off) the 

screen: “Our primary objective will 

remain ... to have smoking featured in a 

prominent way, especially when it is tied to 

celebrities.”87(Bates no. 503579240) The firm detailed 

one placement in a James Bond movie: 

For a financial consideration of [U.S.] 

$10,000 ... Sean Connery, and other 

principal players, will smoke Winston 

and Camel cigarettes. A Salem Spirit 

billboard will be used in an action scene. 

No other cigarette company will be 

represented.88(Bates no. 503579592)

Other placements by Rogers & Cowan for 

R.J. Reynolds include those in The Jazz 

Singer, Backroads, Cannonball Run, Pennies 

from Heaven, and Blowout.86

Philip Morris. Philip Morris products were 

placed in more than 191 movies between 

1978 and 1988; 48 were rated PG, 10 were 

PG-13, 91 were R, and 1 was G (The Muppet 

Movie). Among the movies listed during 

that period were Grease, Rocky II, Airplane, 

Little Shop of Horrors, Crocodile Dundee, 

Cigar accessories advertised to “Halo 2” players
115

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 4.1 Chronology of Tobacco Industry Activities Related to Smoking in Motion Pictures, 

1972–2001

1972 Productions Inc.,a a movie and television company, informs R.J. Reynolds (RJR) that product placement in movies is 

“better than any commercial that has been run on Television or any magazine, because the audience is totally unaware 

of the sponsor involvement.” 

1978 Philip Morris begins working with Charles Pomerance to place tobacco products in movies. 

1979 Brown & Williamson (B&W) contracts with the product placement firm of Associated Film Promotions for placing B&W 

products in movies.

1979 Philip Morris pays to have Marlboros featured in the movie Superman II.

1980 RJR contracts with Rogers & Cowan to develop a relationship with the television and movie industry that includes 

product placement, providing free products to key entertainment industry workers, and promoting star use of RJR 

products through national media.

1982 American Tobacco contracts with Unique Product Placement (UPP) to place American Tobacco products in films.

1982 Rogers & Cowan reports to RJR that it has arranged to have Sean Connery and others smoke Winston and Camel 

cigarettes in Never Say Never Again for $10,000.

1983 In the spring, B&W launches a campaign placing cigarette ads in 3,000 movie theatres. During July, a Kool ad is run during 

the G-rated Disney film Snow White in Boston; antismoking activists create extensive controversy. 

1983 In the fall, B&W implements a critical audit of relationship with Associated Film Promotions, questioning the 

effectiveness and control of the product placement program.

1984 B&W cancels product placement and in-theatre ad programs. 

1984 Twentieth Century Fox Licensing and Merchandising Corporation seeks tobacco company product placement agreements 

that would feature products and guarantee exclusivity in films for $20,000 to $25,000 per film. 

1988 Philip Morris pays $35,000 for the use of Larks in the James Bond movie License to Kill and for rights to run a media 

promotion effort to coincide with the movie’s opening in Japan.

1989 A Philip Morrisb marketing study notes that most “strong, positive images for cigarettes and smoking are created and 

perpetuated by cinema and television.”

1989–90 Congressman Thomas Luken’s Subcommittee on Transportation, Tourism, and Hazardous Materials conducts public 

hearings on product placement.

1990 The Federal Trade Commission (FTC) conducts an inquiry into product placement activities of various tobacco firms. 

1990 RJR International contracts with Rogers & Cowan International for the placement of RJR products in films produced 

outside the United States. 

1990 Cigarette companies modify the voluntary Cigarette Advertising and Promotion Code to prohibit paid product placement.

1991 After declining through the 1960s, 1970s, and 1980s, the frequency of smoking in the movies begins a rapid increase. 

1992 The UPP contract with American Tobacco is modified to limit UPP’s engagements with filmmakers to reactive efforts 

rather than proactive ones.

1996–97 The FTC notes that expenditures by the cigar industry for “celebrity endorsements, and appearances, and payment for 

product placement in movies and television more than doubled between 1996 and 1997.”c

1998 The Cigar Manufacturers’ Association adopts a voluntary policy discouraging (but not outlawing) paid and donated cigar 

placements in movies and on television. 

1998 The Master Settlement Agreement prohibits participating cigarette manufacturers from product placement activities.

2000 The average amount of smoking in movies exceeds levels observed in the 1960s.

2001 Studies of films during the 1990s find continuing brand use depiction in movies with about 80% of the exposures being 

Philip Morris products, primarily Marlboro; identifiable brand use by high-profile stars is higher than before the tobacco 

industry’s voluntary restrictions on product placement in movies.

Note. From Mekemson, C., and S. A. Glantz. 2002. How the tobacco industry built its relationship with Hollywood. Tobacco Control

11 Suppl. 1: 81–91.

a

Richards, R. P. We are about to go into production with the motion picture, “Run Sheep Run,” a suspense, thriller, set in 

Los Angeles. 25 Aug 1972. R.J. Reynolds. Bates No. 500201423/1424. http://legacy.library.ucsf.edu/tid/ylm89d00.

b

Kelly Weedon Shute Advertising. Philip Morris cigarette marketing—A new perspective. Nov 1989. Bates No. 2501057693/7719. 

http://legacy.library.ucsf.edu/tid/lti49e00.

c

Federal Trade Commission. 1999. Cigar sales and advertising and promotional expenditures for calendar years 1996 and 1997. 

http://www.ftc.gov/os/1999/07/cigarreport1999.htm.
116

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

Die Hard, Who Framed Roger Rabbit, and 

Field of Dreams.86

A contract between Leo Burnett, the 

agency for Marlboro/Philip Morris, and 

the producers (Danjaq S.A; Switzerland) 

documents an exclusive placement of 

Lark cigarettes in a James Bond movie, 

License to Kill, in return for $350,000. 

Another contract documents placement of 

Marlboro in Superman II for £20,000.86,89

Brown & Williamson. B&W contracted 

with the product placement firm AFP, 

which arranged to pay $500,000 to 

Sylvester Stallone for using B&W tobacco 

products “in no less than five feature 

films.”90(Bates no. 685083119) A 1983 audit of 

AFP revealed that B&W paid $965,500 to 

Kovoloff, of which $575,000 was for movies 

that had not yet been released.91 B&W 

was prepared to pay $100,000–$200,000 

“on special movie placement where a 

star actually smokes our brand ... and 

where our presence in the movie is more 

apparent.”92(Bates no. 680118052)

Liggett and American Tobacco. Hearings 

held in 1989 by the Subcommittee on 

Transportation and Hazardous Materials, 

Committee on Energy and Commerce, 

U.S. House of Representatives—under the 

leadership of Subcommittee Chairman 

Thomas A. Luken—revealed that Liggett 

paid $30,000 to place Eve cigarettes in 

Supergirl and that American Tobacco paid 

$5,000 to have Lucky Strike appear in 

Beverly Hills Cop.83

Cigars. General Cigar Company, Inc. 

contracted with the product placement 

firm Keppler Entertainment Inc. for 

$27,000 to place its products on the 

television shows Friends, Baywatch, 

Mad About You, Spin City, Suddenly Susan,

and Third Rock from the Sun.86 As late as 

1996 and 1997, “Expenditures on celebrity 

endorsements and appearances, and 

payment for product placements in movies 

and television, more than doubled.”12 It was 

only in 1998 that the Cigar Association of 

America formally precluded paid placement 

in movies and on television. 

Paid Placement in Movies Made in 

India and Nigeria

Information on paid placement of tobacco 

products in movies by U.S. tobacco firms has 

surfaced through congressional hearings and 

investigations and the disclosure of previously 

secret tobacco industry documents. In the 

absence of similar investigations and industry 

document disclosure in other countries, 

it is difficult to determine whether tobacco 

depictions in movies made outside the 

United States are the result of promotional 

payments from tobacco companies. However, 

circumstantial evidence suggests that paid 

placement of tobacco products is occurring in 

India, which has the world’s largest motionpicture industry (including Bollywood, the 

popular Hindi-language film industry), and in 

Nigeria, whose film industry (Nollywood) has 

become the world’s third largest.93

The Burning Brain Society in Chandigarh, 

India, with support from WHO and the 

Indian Ministry of Health and Family 

Welfare, studied the appearance of tobacco 

scenes in a random sample of 110 Hindi 

movies released in 2004 and 2005.94 They 

found that 98 (89%) of the movies contained 

tobacco scenes, 74 (67%) showed the main 

protagonist using tobacco, and 30 (27%) 

trivialized or mocked the dangers of tobacco 

use. A key observation is that 45 (41%) of 

the movies displayed a specific brand of 

tobacco (usually a shot of the cigarette pack) 

or include a verbal mention of the brand 

name. More than 90% of brand appearances 

were for cigarettes made by Philip Morris 

(Marlboro) or ITC (Wills and Gold Flake). 

By contrast, a WHO study found 62 brand 

exposures in 395 high-revenue Bollywood 

movies released during 1990–2002 (16%, 

assuming that each exposure occurred in 
117

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

a different film).95 Goswami and Kashyap 

suggest that the increase in brand exposures 

in movies released in 2004–2005 occurred 

because of tobacco industry efforts to 

circumvent the Cigarettes and Other 

Tobacco Products Act, 2003, which banned 

all forms of direct and indirect tobacco 

advertising as of 2004.94

Although movie producers may choose 

to portray tobacco use in films for artistic 

or other noncommercial purposes, such 

portrayals would typically not use overt 

brand identifications (e.g., close-up shots 

of cigarette packs or cartons). Thus, the 

substantial increase in brand exposures in 

Indian movies, coinciding with legislative 

restrictions on tobacco advertising, 

suggests that paid placement is occurring. 

Further suggestive evidence comes from 

disclosures by several Indian movie actors, 

producers, and directors that they have 

received requests from tobacco companies 

for tobacco brand endorsements or product 

placements.94 One movie producer-director 

in India said that his company had rejected 

approaches from tobacco companies, 

explaining that “we are in a comfortable 

position and we can be responsible”; 

he added, however, that “there are many 

needy producers who will do anything for 

money. Corruption is part of our culture 

and money overrules everything.”95(p.20)

Tobacco depictions in Bollywood movies, 

whether resulting from paid placement or 

“artistic” design, are particularly worrisome 

to public health advocates because of 

the popularity of Bollywood movies. 

India produces about 1,000 films a year 

(accounting for more than one-quarter 

of the global film production by volume), 

in more than eight languages, seen by 

more than 188 million persons each year. 

An estimated 15 million people watch a 

Bollywood (Hindi-language) film each day. 

Cable and satellite television features more 

than 10 movie channels showing movies 

around the clock. Four of these channels 

show 5–10 movies per week, reaching 

60%–70% of the cable and satellite audience 

each week. Pirated copies of films are viewed 

in India by an estimated 230,000 people 

each day. Mainstream Indian films target 

an estimated 250 million youth in India, 

and the films appeal to millions of diaspora 

Indians in South Asia, the Middle East, and 

parts of the United Kingdom, United States, 

Europe, and Africa.94–96

Nollywood, Nigeria’s “thriving” straightto-video film industry, produces more than 

400 movies each year. Most are filmed for less 

than $15,000 within two weeks’ time; they 

are then copied onto videocassettes and sold 

in open-air markets for about $3.97 The 

organization Environmental Rights Action/

Friends of the Earth Nigeria (ERA/FoEN) 

screened a random sample of 10 new 

Nollywood movies.98 A program manager for 

ERA/FoEN reported that “smoking scenes, 

mostly unnecessary and of no value to 

the plot, were prevalent,”98 and that brand 

placements occurred in 6 of the 10 movies. 

As noted above in the case of Bollywood 

movies, the visibility of brand placements 

in several of the movies suggests that paid 

product placement has occurred. Another 

spokesperson for ERA/FoEN reported that 

all but one of the 10 movies had smoking 

scenes, and the one movie lacking a smoking 

scene had an image of an actor smoking 

on the sleeve of the video compact disc.98

The frequent depiction in Nollywood movies 

of smoking and tobacco brand names, and 

the likelihood of paid brand placements, are 

as worrisome to public health advocates as 

are similar occurrences in Bollywood movies. 

Nollywood movies are popular across the 

African continent and are brought to Europe 

and North America by expatriates, where they 

are distributed to the African diaspora.93,97

Restrictions on Cigarette Placements 

in Movies

In 1990, the Cigarette Advertising and 

Promotion Code introduced a voluntary 
118

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

ban on paid product placement in the 

United States; however, it did not include 

a prohibition on providing free products, 

signs, or other props. As noted above, the 

MSA provided legal backing for the ban 

on paid product placement of any type, 

including paid placement in motion pictures 

and commercial films or videos.80 The major 

U.S. cigarette firms have denied paying 

for product placement in movies since the 

Federal Trade Commission began to request 

information on such payments in 1989.83

The FCTC (chapter 8) calls on each 

country that has ratified the treaty to 

enact a comprehensive ban of all tobacco 

advertising, promotion, and sponsorship 

“in accordance with its constitution or 

constitutional principles” (Article 13).66(p.11)

The treaty’s definitions of “tobacco 

advertising and promotion” and “tobacco 

sponsorship” (Article 1) includes paid 

placement: “‘tobacco advertising and 

promotion’ means any form of commercial 

communication, recommendation or 

action with the aim, effect or likely effect 

of promoting a tobacco product or tobacco 

use either directly or indirectly,”66(p.4) and 

“‘tobacco sponsorship’ means any form 

of contribution to any event, activity or 

individual with the aim, effect or likely 

effect of promoting a tobacco product or 

tobacco use either directly or indirectly.” 

By April 2008, 154 countries had become 

parties to the FCTC, including India 

(in 2004) and Nigeria (in 2005) but 

excluding the United States.

On May 31 (World No Tobacco Day), 2005, 

the health minister of India announced new 

rules banning all scenes showing smoking, 

cigarette packs, or tobacco advertisements 

in movies and television programs, to 

become effective as law in August of that 

year.96,99 After intense opposition arose 

from the Information and Broadcasting 

Ministry and the film industry, the Indian 

government set aside the ban and began 

to explore alternative control strategies, 

including (1) movie industry self-regulation, 

using a self-regulatory body similar to the 

Advertising Standards Council of India, to 

vet films before sending them to a censor 

board for certification, and (2) certification 

of films showing smoking scenes as “A”—

only for adult viewing.100–102

Chapter 10 reviews strategies and efforts to 

reduce tobacco exposures in entertainment 

media (e.g., movie rating systems and 

self-regulation) and to modify viewers’ 

response to exposures through, for example, 

antitobacco advertising in theaters and 

“media literacy” interventions (educational 

approaches to help viewers better understand 

media influence).

Extent of Tobacco 

Advertising and 

Promotion

As mentioned earlier, the FTC has issued 

reports on expenditures for tobacco 

advertising and promotion, providing 

annual data on expenditures for 1970–2005 

for cigarettes, for 1996–1997 for cigars, 

and for 1985–2005 for smokeless tobacco. 

The FTC reports are the most readily 

available sources of quantitative data on 

the extent of tobacco advertising and 

promotion. Information on the extent of 

tobacco advertising and promotion is useful 

for (1) assessing the level of consumers’ 

exposure to marketing messages and 

images, particularly among vulnerable 

populations; (2) understanding how 

marketing affects social norms concerning 

tobacco use; (3) predicting whether 

cigarette advertising will suppress coverage 

of smoking-and-health issues in various 

media; (4) informing policymakers on 

how to avoid or close loopholes in tobacco 

advertising bans; and (5) determining the 

amount of corrective communications 

needed to negate or overcome the effects of 

many years of protobacco marketing.
119

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Expenditures on Advertising and 

Promotion for Cigarettes

From 1940 to 2005, the tobacco industry 

spent about $250 billion on cigarette 

advertising and promotion—averaging more 

than $10 million per day. (Unless otherwise 

stated, all figures for cigarette marketing 

expenditures presented in this section are 

adjusted to 2006 values, using the consumer 

price index for all items.) In 2005, the last 

year for which figures are available, the 

industry spent just over $13.5 billion1—

or $37 million per day ($36 million in 

unadjusted dollars). The unadjusted 

expenditure in 2005 is equivalent to $63 per 

person aged 18 years and older, or $47 per 

capita for the entire population (using 2000 

census data). The total annual expenditures 

from 1970 to 2005 (in 5-year increments 

until 1995, and then annually) are presented 

in table 4.2.

As indicated in table 4.2, total expenditures 

climbed from $1.9 billion in 1970 to 

$7.1 billion in 1997. Since the MSA, the 

rate of increase has climbed dramatically, 

with the total almost doubling from 1997 

(just prior to the settlement coming into 

effect) to $13.5 billion in 2005.1 Figure 4.1 

shows the increase in cigarette advertising 

and promotional expenditures from 1970 to 

2005 using both adjusted and unadjusted 

dollar figures. Expenditures peaked in 2003 

at $16.6 billion and dropped during the 

subsequent two years to $13.5 billion.

The nature of the expenditures, following 

the definitions provided earlier, are detailed 

in table 4.3. The “price discounts” category 

now accounts for the overwhelming 

percentage of advertising and promotional 

expenditures (77.3% in 2004 and 74.6% 

in 2005). (For the sake of convenience, 

the term marketing expenditures is often 

used below to refer to advertising and 

promotional expenditures.) Because this 

category was not previously broken out 

separately, it is difficult to determine its rate 

of growth relative to previous years. Once 

the “price discounts” category is extracted, 

the two categories that earlier accounted 

for the bulk of marketing expenditures are 

now considerably diminished: 

1. In 2005, just under $1 billion, or 

just under 7% of total marketing 

expenditures, was spent on “promotional 

allowances.” 

2. Because the FTC cigarette reports had 

listed “coupons” together with the 

“retail-value-added” category until 

1997, the two categories are combined 

in table 4.4 for comparative purposes. 

Expenditures for this category were, 

Table 4.2 Cigarette Advertising and 

Promotional Expenditures in 

the United States, 1970–2005 

(in millions of dollars)

Year

Total Expenditures

Unadjusted ($) Adjusted ($)a

1970 361.0 1,875.7 

1975 491.3 1,841.0 

1980 1,242.3 3,039.4 

1985 2,476.4 4,639.8 

1990 3,992.0 6,157.5 

1995 4,895.2 6,475.5 

1996 5,107.7 6,562.9 

1997 5,660.0 7,109.4 

1998b 6,733.2 8,327.7 

1999 8,237.6 9,968.2 

2000 9,592.6 11,230.4 

2001 11,216.2 12,775.1 

2002 12,466.4 13,970.1 

2003 15,146.0 16,594.8 

2004 14,150.0 15,101.3 

2005 13,111.0 13,533.9 

Note. Federal Trade Commission. 2007. Federal Trade commission 

cigarette report for 2004 and 2005. http://www.ftc.gov/reports/

tobacco/2007cigarette2004-2005.pdf.

a

Adjusted to 2006 dollars, using the consumer price index 

(all items).

b

Year the Master Settlement Agreement was signed.
120

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

in 2004, $1.5 billion, or 10% of total 

marketing expenditures, and in 2005, 

$1.7 billion, or 12% of total marketing 

expenditures.1

The predominance of price discounts among 

the cigarette industry’s marketing activities 

is an effective marketing tool, given smokers’ 

sensitivity to cigarette prices, especially those 

who are young or in otherwise vulnerable 

population groups. The price elasticity 

of demand for cigarettes is –0.3 to –0.5, 

meaning that a 10% increase in price will 

reduce overall cigarette consumption by 

3%–5%.103 Moreover, studies indicate that 

adolescents and young adults are two to three 

times more sensitive to cigarette price than 

are adults.103 In addition, there is evidence 

indicating greater cigarette price sensitivities 

among low-income persons, less-educated 

persons, and minority populations.103 Thus, 

price-discount promotions—by making 

cigarettes more affordable—will tend to 

increase cigarette sales and will undercut 

the impact of cigarette tax increases on 

cigarette consumption.104

As can be seen in table 4.5, from 1970 to 

2005 the pattern of marketing expenditures 

shifted dramatically: from 82% allocated 

for advertising in “measured media” 

(i.e., syndicated marketing research 

services estimate the audiences for 

magazines, television, radio, newspapers, 

and billboards) in 1970 to almost 0% in 

2005. Correspondingly, the percentage 

of marketing expenditures devoted to 

promotional activities increased during this 

period, from 18% to almost 100%.

The cigarette industry’s shift away from 

advertising in measured media is also 

reflected in data on the advertisingto-sales (A-S) ratio for cigarettes in 

comparison to other products and services. 

The A-S ratio—the ratio of advertising 

Figure 4.1 Cigarette Advertising and Promotional Expenditures in the United States, 

1970–2005

$0

$2

$4

$6

$8

$10

$12

$14

$16

$18

1970 1980 1985 1990 1995 2000 2005

1975

Unadjusted expenditures

Adjusted expenditures

Expenditures (in billions of dollars)

Year

Note. Source of data: Federal Trade Commission. 2007. Federal Trade Commission cigarette report for 2004 and 2005.

http://www.ftc.gov/reports/tobacco/2007cigarette2004-2005.pdf. Adjusted expenditures are adjusted to 2006 dollars using the 

consumer price index (all items).
121

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

expenditures to net sales—is a measure of 

the intensity of advertising for a particular 

company or industry. The trade magazine 

Advertising Age publishes annual data on 

the A-S ratio for the 200 industries with 

the largest dollar volume of advertising in 

measured media. As shown in table 4.6, 

the median A-S ratio for these industries 

typically ranges from 0.8% to 3.0%. The 

A-S ratio for cigarettes was substantially 

higher than the median value in past 

decades, with correspondingly high rankings 

among the top-200 advertisers. However, 

for four of the past five years (2002–06), 

the A-S ratio for cigarettes was less than the 

median value, and cigarettes ranked in the 

Table 4.3 Cigarette Advertising and Promotional Expenditures in the United States, 2005 

(in millions of dollars)

Advertising medium/promotional activitya

Expenditures Percentage 

of total 

expendituresc Unadjusted ($) Adjusted ($)b

Newspapers 1.6 1.7 —

Magazines 44.8 46.2 —

Outdoor 9.8 10.1 —

Transit 0.0 0.0 —

Point of sale 182.2 188.1 1.4

Price discounts 9,776.1 10,091.5 74.6

Promotional allowances—retail 435.8 449.9 3.3

Promotional allowances—wholesalers 410.3 423.5 3.1

Promotional allowances—other 1.5 1.5 —

Sampling distribution 17.2 17.8 —

Specialty item distribution—branded 5.3 5.5 —

Specialty item distribution—nonbranded 225.3 232.6 1.7

Public entertainment—adult only 214.1 221.0 1.6

Public entertainment—general audience 0.15 0.2 —

Sponsorships 30.6 31.6 —

Direct mail 51.8 53.5 —

Endorsements and testimonials 0.0 0.0 —

Coupons 870.1 898.2 6.6

Retail value added—bonus cigarettes 725.0 748.4 5.5

Retail value added—noncigarette bonus 7.5 7.7 —

Company Web site 2.7 2.8 —

Internet—other 0.0 0.0 —

Telephone 0.06 0.1 —

Otherd 99.0 102.2 1.0

Total 13,111.0 13,533.9 100.0

Note. Federal Trade Commission. 2007. Federal Trade Commission cigarette report for 2004 and 2005. http://www.ftc.gov/reports/

tobacco/2007cigarette2004-2005.pdf.

a

See “FTC Definitions” earlier in this chapter for explanation of terms.

b

Adjusted to 2006 dollars, using the consumer price index (all items).

c

Figures are rounded to nearest percentage point; “—” indicates values of less than 1%.

d

Expenditures for audiovisual are included in the “other” category to avoid disclosure of individual company data.
122

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

Table 4.4 Cigarette Advertising and Promotional Expenditures in the United States, 1995–2005 

(in billions of dollarsa)

Total advertising 

and promotional 

expenditures ($)

Expenditures 

on promotional 

allowancesb

Expenditures on

coupons & retail

value addedb

Expenditures on

price discountsc

($) (%) ($) (%) ($) (%)

1995 6.414 2.444 38 1.766 28 — —

1996 6.501 2.737 42 1.666 26 — —

1997 7.042 3.034 43 1.894 27 — —

1998 8.249 3.527 43 2.670 32 — —

1999 9.873 4.247 43 3.704 38 — —

2000 11.124 4.539 41 4.823 43 — —

2001 12.647 5.020 40 6.048 48 — —

2002 14.000 1.997 14 1.806 13 8.627 63

2003 16.594 2.098 13 1.477 9 11.842 71

2004 15.101 1.060 7 1.497 10 11.665 77

2005 13.534 0.907 7 1.654 12 10.095 75

Note. Federal Trade Commission. 2007. Federal Trade Commission cigarette report for 2004 and 2005. http://www.ftc.gov/reports/

tobacco/2007cigarette2004-2005.pdf.

a

Adjusted to 2006 dollars, using the consumer price index (all items). Figures are rounded to nearest million.

b

Percentages represent the share of total expenditures devoted to the category listed.

c

Price discounts were itemized separately beginning in 2002. 

Table 4.5 Cigarette Advertising and Promotional Expenditures in the 

United States, 1970–2005, with Relative Emphasis on Advertising 

Versus Promotion (in millions of dollarsa)

Advertising 

expenditures in 

measured mediab

Promotional 

expenditures

and “others”c

($) (%) ($) (%) Total ($)

1970 1,526 82 332 18 1,858

1975 1,228 67 596 33 1,824

1980 1,915 64 1,096 36 3,011

1985 1,730 38 2,867 62 4,597

1990 1,276 21 4,823 79 6,099

1995 740 12 5,674 88 6,414

2000 413 4 10,711 96 11,124

2003 171 1 16,424 99 16,594

2004 126 1 14,976 99 15,101

2005 58 0 13,475 100 13,534

Note. Federal Trade Commission. 2007. Federal Trade Commission cigarette report for 2004 and 2005.

http://www.ftc.gov/reports/tobacco/2007cigarette2004-2005.pdf.

a

Adjusted to 2006 dollars, using the consumer price index (all items).

b

Advertising expenditures include newspapers, magazines, outdoor, and transit.

c

Promotional expenditures include point of sale, promotional allowances, sampling distribution, 

specialty item distribution, public entertainment, direct mail, endorsements/testimonials, Internet, 

coupons, retail value added, and all others.
123

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

lower one-half of the top 200 industries for 

advertisement spending (table 4.6). 

In a ranking of total domestic advertising 

spending in measured media by industry, 

“cigarettes & tobacco” ranked 29th 

in both 2004 and 2005.105 The largest 

industries in advertising spending in each 

of those years were automotive, retail, 

and telecom/Internet/Internet service 

provider, respectively. Again, this relatively 

low ranking for cigarettes is likely related 

to the cigarette industry’s movement of 

its marketing dollars into promotional 

activities during the past few decades.

Until 1980, when advertising in measured 

media dominated the tobacco industry’s 

marketing portfolio, each of the major 

companies was ranked among the largest 

advertisers across all industries.106–113

As seen in table 4.7, in 1955 L&M/Liggett 

was ranked as the 17th-largest advertiser 

in the United States, spending $70 million 

in measured media. In 1980, Philip Morris 

was ranked as the third largest, spending 

$782 million. Also in 1980, RJR was ranked 

as the 5th-largest advertiser in the country, 

spending $720 million. In 1965, each of 

the six major tobacco firms was among the 

25 leading national advertisers (table 4.7). 

In 2005, Altria Group (the corporate 

name adopted by Philip Morris in 2003) 

was the 20th leading advertiser in the 

United States, spending $1.49 billion on 

advertising that year ($1.53 billion in 2006 

dollars).105 Other cigarette companies 

were not among the 100 leading national 

advertisers in 2005, probably because of the 

shift of the cigarette industry’s marketing 

efforts from advertising in measured media 

Table 4.6 Advertising-to-Sales Ratios (expressed as percentages) for 

Selected Product Categories, 1975–2006

A-S ratios for the top-200 advertisersa A-S ratios for cigarettes

Mean (%) Median (%) Range (%) A-S Ratio (%) Rank

1975 1.8 0.8 0.1–20.1 8.0 11

1980 2.0 1.3 0–10.7 6.3 11

1985 2.5 1.8 0–16.7 4.2 42

1990 3.4 2.4 0.3–18.8 3.9 61

1995 3.2 2.4 0.2–18.1 4.1 47

1997 3.53 2.7 0.3–17.4 5.9 33

1998 3.80 2.7 0.1–14.9 8.2 27

1999 3.84 3.0 0.3–27.1 3.9 70

2000 4.17 3.0 0.1–22.1 2.9 98

2001 4.14 2.95 0.1–46.3 8.4 25

2002 3.78 2.4 0.1–61.2 1.8 116

2003 3.50 2.5 0.1–38.4 1.8 116

2004 3.10 2.2 0.0–15.8 4.0 53

2005 3.22 2.2 0.0–30.4 1.6 115

2006 3.27 2.2 0.1–18.4 2.2 100

Note. Sources of data: Advertising Age (1975–1995). Data for 1975: October 19, 1981, p. 42. Data for 

1980: August 17, 1981, p. 38. Data for 1985: September 15, 1986, p. 60. Data for 1990: September 16, 

1991, p. 32. Data for 1995: August 14, 1995, p. 26. Data for 1997–2006: http://adage.com/datacenter/

article.php?article_id=106575. A-S ratio = advertising-to-sales ratio (advertising expenditures as a 

percentage of net sales). 

a

The 200 industries with the largest dollar volume of advertising in measured media.
124

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n Table 4.7 Cigarette Company Advertising Expenditures, 1945–1980 (in millions of dollarsa

)

L&M/Liggett Lorillard/Loews Am. Tobacco B&W/BAT RJR Philip Morris No. 1 Ranked 

Company AE ($) Rank AE ($) Rank AE ($) Rank AE ($) Rank AE ($) Rank AE ($) Rank AE ($)

1945 17 57.120

—

—

— 28 40.971 26 33.932 21 49.400 P&G 317.471

1950 13 69.772 22 46.734 8 80.966 90

— 11 74.285 20 46.639 P&G 226.052

1955 17 70.396 18 68.258 9 130.279 62 24.469 10 114.748 36 38.734 GM 334.4411960 26 126.782 18 170.007 12 198.706 17 170.706 9 232.481 15 175.883 GM 832.4691965 20 226.975 21 222.127 11 371.479 24 210.439 8 446.881 19 241.290 P&G 1,136.9021970 28 187.138

—

— 13 304.337 21 242.650 7 436.383 12 346.585 P&G 978.994

1975 24 190.582

—

— 23 212.276 30 173.252 6 420.400 9 341.976 P&G 1,045.259

1980 95 199.120

—

— 40 218.993 31 194.400 5 719.605 3 781.701 P&G 1,335.167

Note. Expenditures are for advertising in measured media for all tobacco and nontobacco products sold by each company. Sources of data: Advertising Age (1946–1981). Data for 1945: April 22, 1946, p. 2. 

Data for 1950: February 28, 1951, p. 59. Data for 1955: March 26, 1956, pp. 120–21. Data for 1960: August 28, 1961, p. 43. Data for 1965: August 29, 1966, p. 45. Data for 1970: August 30, 1971, p. 24. Data 

for 1975: August 23, 1976, p. 30. Data for 1980: September 10, 1981, p. 12. “—“ signifies that the company’s advertising expenditures ranked below the top 100 for that time period. L&M = Liggett & Myers; Am. = American; B&W = Brown & Williamson; BAT = British American Tobacco; RJR = R.J. Reynolds; AE = adjusted expenditures; P&G = Proctor & Gamble; GM = General Motors.aAll figures adjusted to 2006 dollars, using the consumer price index (all items).
125

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 4.8 Cigarette Company Advertising Expenditures for Selected Brands in Selected Years between 1972 and 2000 (in millions of dollarsa

)

Philip Morris Lorillard Loews R.J. Reynolds BAT/B&W

Marlboro

($)

Merit

($)

Virginia 

Slims

($)

Benson & 

Hedges

($)

Newport 

($)

Kent

($)

TRUE

($)

Camel

($)

Winston

($)

Salem

($)

Kool

($)

Capri

($)

Carlton

($)

Raleigh

($)

2000 110 33 47

—

—

—

—

—

—

—

—

—

—

—

1999 115 39 37 24

—

—

— 54 66

—

—

—

—

—

1998 166 32 34 22

—

—

— 96 71

—

—

—

—

—

1997 144 33 35 22

—

—

— 78 44

—

—

—

—

—

1996 143 35 40 22

—

—

— 62 5 — 57 25 24

—

1995 172 39 35 35

—

—

— 36 20

— 70 25 23

—

1994 131 42 34 55

—

—

— 44 17

— 45 22 21

—

1993 106 14 24 6 48 12

— 60 25 5 29 21

— 8

1992 123 45 27 14 52 8 — 33 21 14 8 20

— 7

1991 150

— 41

— 65 21

— 50 67 14 29 27

— 14

1990 132

— 68

— 81 15

— 48 29 39 9 23

— 2

1989 164 88 72 61 79 10 13 44 39 48 32 48

—

—

1988 203 94 54 98 75 15 12 41 52 60 33 53

—

—

1978 133 136

— 92

— 39 49 110 128 134 114

— 73 36

1977 138 141

— 92

— 96 35 21 146 112 95

— 74 31

1976 111 157

— 49

— 80 43 23 108 86 81

— 75 21

1975 82

—

— 54

— 62 27 37 117 89 75

— 37 20

1974 104

—

— 75

— 61 33 46 133 88 69

— 15 42

1973 94

—

— 73

— 70 31 30 99 91 72

— 10 34

1972 102

—

— 74

— 59 30 32 105 84 96

— 0 34

Note. Source of data: Advertising Age (1979–2001). “—“ indicates not available. BAT = British American Tobacco; B&W = Brown & Williamson.aAll figures adjusted to 2006 dollars, using the consumer price index (all items).
126

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

to promotional activities, as well as the 

increasing market share—and advertising 

“share of voice”—of Altria/Philip Morris. 

Table 4.8 documents how much money 

was committed for selected brands in 

selected years, from 1972 to 2000. Since 

1976, Philip Morris has consistently 

committed more than $100 million per year 

to advertising for Marlboro, the industry’s 

dominant brand. In 2005, the Marlboro brand 

had 40% of the market and Philip Morris 

brands overall had 50% of the market.114

Table 4.9 demonstrates another metric in 

measuring the success of the advertising 

and promotional efforts for Marlboro. In 

2006, the Marlboro brand was estimated to 

be worth $21.35 billion in brand equity—

the 12th most valuable brand worldwide.115

Marlboro has also achieved stature in annual 

and semiannual rankings by Advertising Age

of the “top 200 brands” (according to total 

measured U.S. advertising spending). 

For example, Marlboro was ranked as 

71 in 1997, 67 in 1998, 126 in 1999, and 

142 in 2000,116 surpassing in 2000 “brands” 

that are entire companies, such as FedEx 

delivery services, Toys “R” Us stores, and 

Victoria’s Secret women’s apparel. The 

Camel cigarette brand was ranked as 163 in 

1997 and 138 in 1998.116

Table 4.10 shows the percentage of total 

advertising expenditures in three media 

(outdoor, magazines, and newspapers) that 

were devoted to cigarette advertising, for 

1984, 1985, and 1988. Consistent with the 

shift in cigarette marketing expenditures 

from advertising in measured media to 

promotional activities (table 4.5), the 

percentage of total advertising expenditures 

devoted to cigarette advertising declined in 

each of these media, from 21.1% to 16.9% 

for outdoor media, from 8.4% to 5.7% 

for magazines, and from 1.0% to 0.4% 

for newspapers.117,118 These trends have 

continued, as reflected in the declining 

expenditures for cigarette advertising 

in newspapers, magazines, and outdoor 

media from 1988 to 2005;1 during that 

time, cigarette advertising expenditures 

fell (in 2006 dollars) from $180.3 million 

to $1.6 million for newspapers, from 

$605.1 million to $46.2 million for 

magazines, and from $544.1 million to 

$10.1 million for outdoor media. The drop 

in cigarette advertising in outdoor media 

in the years following 1998 was due in 

large part to the MSA’s ban on billboard 

cigarette advertising.

Table 4.9 Global Brand Equity for Leading 

Brands, 2006 (in billions of dollars)

1 Coca-Cola $67.00

2 Microsoft $56.93

3 IBM $56.20

4 GE $48.91

5 Intel $32.32

6 Nokia $30.13

7 Toyota $27.94

8 Disney $27.85

9 McDonald’s $27.50

10 Mercedes-Benz $21.80

11 Citi $21.46

12 Marlboro $21.35

13 HP $20.46

14 American Express $19.64

15 BMW $19.62

16 Gillette $19.58

17 Louis-Vuitton $17.61

18 Cisco $17.53

19 Honda $17.05

20 Samsung $16.17

21 Merrill Lynch $13.00

22 Pepsi $12.69

23 Nescafe $12.51

24 Google $13.38

25 Dell $12.26

Note. Source of data: Business Week. 2006, http://bwnt

.businessweek.com/brand/2006. IBM = International Business 

Machines; GE = General Electric; HP = Hewlett-Packard; 

BMW = Bavarian Motor Works.
127

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

According to the Media Records 

classification system used in the 1980s,117,118

national advertising expenditures for 

products and services were classified into 

major categories (e.g., alcoholic beverages, 

automotive products, foods, tobacco, and 

transportation) and subcategories (e.g., beer, 

passenger cars, nonalcoholic beverages, 

cigarettes, and airlines). By using the 

subcategories in this classification system, 

it was found that cigarettes were the most 

heavily advertised product or service in 

outdoor media and the second most heavily 

advertised product or service in magazines 

(after passenger cars) in both 1985 and 

1988. For newspaper advertising, cigarettes 

were ranked third (after passenger cars and 

airlines) in 1985 and sixth in 1988.117,118

The nature of the cigarettes both advertised 

and purchased changed over the decades, 

with “light” cigarettes (defined as less 

than 15 milligrams of “tar”) coming to 

dominate both categories. Figure 4.2 

illustrates (1) the trend with regard to 

the percentage of the tobacco industry’s 

advertising and promotion dollars that 

were allocated annually to light cigarettes 

from 1967 to 1998, the years for which 

the FTC reported these data in their 

annual reports on cigarettes;119 and (2) the 

annual percentage of total cigarette sales 

represented by light cigarettes. Until the 

1990s, the percentage of dollars allocated 

to advertising and promotion for light 

cigarettes exceeded their share of the 

market. Two possible explanations for this 

disparity are that the low-tar segment 

of the market is more competitive than 

higher-tar segments, or the companies 

were trying to drive smokers toward low-tar 

brands, perhaps in the hope that healthconscious smokers would be less likely to 

quit if they switched to a brand perceived 

as less hazardous.117 For most of the 1990s, 

perhaps because of a “ceiling effect” (both 

percentages could realistically go only so 

high), the two sets of percentages were 

more closely aligned. The 2000 FTC report 

(presenting data for 1998) was the last 

report that provided the percentage of 

the industry’s sales and marketing dollars 

allocated to light cigarettes. Chapter 5 

reviews the content of advertisements for 

low-tar cigarettes and other brands aimed 

at “concerned smokers.”

Expenditures on Advertising and 

Promotion for Cigars

As mentioned above, the FTC has 

produced one report on cigar advertising 

and promotion,13 which presents data on 

advertising and promotional expenditures 

for 1996 and 1997. Total expenditures for 

cigar advertising and promotion in the 

United States increased by 32% from 1996 

($30.9 million) to 1997 ($41.0 million), 

coinciding with substantial increases in 

cigar sales volume and revenues. The largest 

expenditure categories in 1997 were 

promotional allowances (39.8% of total 

marketing expenditures), magazines (24.1%), 

and point of sale (13.0%) (table 4.11). 

Table 4.10 Percentage of Total Advertising Expenditures in Selected 

Media Devoted to Cigarette Advertising, United States, 

1984–1988

1984 (%) 1985 (%) 1988 (%)

Outdoor media 21.1 22.3 16.9

Magazines 8.4 7.1 5.7

Newspapers 1.0 0.8 0.4

Note. Sources of data: Davis, R. M. 1987. Current trends in cigarette advertising and marketing. New 

England Journal of Medicine 316 (12): 725–32. Centers for Disease Control and Prevention. 1990. 

Cigarette advertising—United States, 1988. Morbidity and Mortality Weekly Report 39 (16): 261–65.
128

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

As noted above, broadcast advertising has 

been prohibited by law for manufactured 

cigarettes (since 1971), smokeless tobacco 

(since 1986), and “little cigars” (since 1973) 

but is still permitted for other cigars, pipe 

tobacco, and roll-your-own cigarette 

tobacco. The FTC report on advertising for 

cigars showed that cigar manufacturers 

spent $327,000 in 1996 and $325,000 in 

1997 on television, radio, and audiovisual 

advertising. The report also noted

Some portion of the $339,000 reported 

as expenditures for endorsements and 

product placements was money spent to 

place cigars on television shows. Moreover, 

the extent of cigar advertising on television 

and radio is greater than simply the major 

manufacturers’ expenditures reported 

herein. For instance, it has come to the 

Commission’s attention that individual 

cigar retailers in several parts of the 

country have run cigar advertisements 

recently on local television and radio 

stations.13

Because of the FTC’s belief that cigars and 

other tobacco products should be regulated 

in a consistent manner, it recommended 

“that Congress enact legislation prohibiting 

the advertisement of cigars on television, 

radio, or any other electronic media 

regulated by the Federal Communications 

Commission.”13

The National Cancer Institute’s Smoking 

and Tobacco Control Monograph 9 includes 

a chapter on the marketing and promotion 

of cigars.120 It reviews the content of cigar 

advertisements and provides data on 

advertising expenditures in measured media 

for cigar brands sold by seven different 

Figure 4.2 Share of Market for Light Cigarettes and Percentage of Marketing Expenditures 

Devoted to Light Cigarettes, 1967–1998

0

10

20

30

40

50

60

70

80

90

Percentage

Year

1967 1970 1975 1980 1985 1990 1995 1998

Domestic market share

Percentage of marketing expenditures

Note. Source of data: Federal Trade Commission. 2000. Report to Congress for 1998 pursuant to the Federal Cigarette Labeling 

and Advertising Act. http://www.ftc.gov/reports/cigarettes/cig98rpt.pdf. Light cigarettes are defined as < 15 mg of tar. 

Percentage of marketing expenditures is the proportion of total cigarette advertising and promotional expenditures devoted to 

light cigarettes.
129

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

cigar manufacturers. The chapter presented 

three conclusions:

1. Cigar use began to increase in the 

United States after promotional 

activities for cigars increased beginning 

in 1992.

2. Promotional activities for cigars 

have increased the visibility of cigar 

consumption, normalized cigar use, 

and broken down barriers to cigar use.

3. Although the use of sex and celebrity to 

sell cigarettes has been forbidden by the 

cigarette industry’s voluntary code since 

1965, these appeals are a regular feature 

of cigar marketing.120(p.217)

Expenditures on Advertising and 

Promotion for Smokeless Tobacco

The FTC’s 2007 report on smokeless tobacco10

provides detailed data on expenditures 

for advertising and promotion in 2005, 

the most recent data available. The total 

amount spent (a small amount compared 

with that spent on cigarette advertising and 

promotion) was $258.9 million. The largest 

categories (using 2006 dollars) were “price 

discounts” ($102.9 million, or 40% of the 

total), “coupons” ($29.5 million, or 11% of 

the total), and “sampling” ($29.1 million, or 

11% of the total). “Point of sale” accounted 

for $21.4 million (8%), and “magazines” 

Table 4.11 Cigar Advertising and Promotional Expenditures for Years 

1996 and 1997 (in millions of dollarsa)

Type of Advertising

1996 1997

$ % of total $ % of total

Magazines 6.63 21.4 9.88 24.1

Newspapers 0.19 0.6 0.67 1.6

Television, radio, audiovisual 0.33 1.1 0.33 0.8

Internet 0.08 0.3 0.22 0.5

Outdoor 0.04 0.1 0.05 0.1

Transit 0.0 0.0

Point of sale 3.84 12.4 5.23 13.0

Coupons and retail value added 3.91 12.7 2.72 6.7

Direct mail 0.21 0.7 0.24 0.6

Endorsements and product 

placements

0.14 0.5 0.34 0.8

Promotional allowances 12.36 40.0 16.29 39.8

Promotional items 0.31 0.9 0.66 1.6

Public entertainment 0.69 2.2 1.02 2.5

Sampling 0.31 1.0 0.42 1.0

All other 1.89 6.1 2.91 7.0

Total expenditures 30.91 100.0 40.98 100.1b

Sportsc 0.37 1.2 0.38 0.9

Note. Source of data: Federal Trade Commission. 1999. Cigar sales and advertising and promotional 

expenditures for calendar years 1996 and 1997. http://www.ftc.gov/os/1999/07/cigarreport1999.htm.

a

Figures are in nominal (unadjusted) dollars rounded to the nearest million.

b

Total percentages are not exact due to rounding.

c

”Sports” includes all expenses (reported in any other category) in sponsoring or promoting sports 

activities or sports figures in connection with a sport.
130

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

for $21.7 million (8%). Table 4.12 lists 

the advertising categories, the dollars 

spent in each category by the smokeless 

tobacco companies, and the percentage 

of total marketing expenditures spent in 

that category. Various aspects of smokeless 

tobacco advertising have been described 

elsewhere121–124 and in chapters 3 and 5.

Shift in Emphasis by the Tobacco 

Industry to In-Store Promotion

Importance of Convenience Stores to 

the Cigarette Industry

Considerable evidence exists for how and 

why the tobacco industry has shifted its 

resources from advertising in measured 

media to promotion in and around stores, 

particularly convenience stores.125 There is 

also considerable evidence indicating how 

this shift has influenced target populations.

About 60% of all cigarettes sold in the 

United States are purchased in convenience 

stores.126,127 In a ranking of the top 10 

in-store product categories for the 

convenience store industry (in terms 

of consumer sales, excluding gasoline), 

cigarettes and “other tobacco” (cigars, 

smokeless tobacco, and loose tobacco) 

ranked first and fifth, respectively, in 2005.128

These two categories accounted for 34.5% 

and 2.8%, respectively, of convenience 

stores’ in-store sales in 2003.127

Table 4.12 Smokeless Tobacco Advertising and Promotional Expenditures 

by Category for 2005 (in millions of dollarsa)

Expenditure ($) % of totalb

Newspapers 0.5 <1

Magazines 21.7 8

Outdoor 0.2 <1

Audio, visual 0.1 <1

Transit 0 0

Direct mail 8.5 3

Point-of-sale 21.4 8

Price discounts 102.9 40

Promotional allowances 16.5 6

Sampling 29.1 11

Specialty item distribution 0.2 <1

Public entertainment 0.3 <1

Endorsements & testimonials 0.4 <1

Sponsorships 4.3 2

Coupons 29.5 11

Retail value added 14.2 5

Company websites 0.3 <1

Internet—other 0.4 <1

Telephone 0.1 <1

All other 8.3 3

Total 258.9 100

Note. Source of data: Federal Trade Commission. 2007. Smokeless tobacco report for the years 2002–2005.

http://www.ftc.gov/reports/tobacco/02-05smokeless0623105.pdf.

a

Adjusted to 2006 dollars, using the consumer price index (all items).

b

Rounded to nearest percentage point.
131

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

In a national study conducted for the Pointof-Purchase Advertising Institute (now called 

Point-of-Purchase Advertising International, 

or POPAI), customers were interviewed 

regarding products they had purchased at 

120 stores of five retail chains. The 2002 

report indicates that, on average, customers 

recalled in-store advertising for 29% of 

products purchased. Among the 10 products 

listed in the report, cigarettes ranked 

highest, followed by carbonated beverages, 

coffee, food service, noncarbonated 

beverages, beer, candy/gum/mints, salty 

snacks, sweet snacks, and milk.129

Mechanics of Promotional 

Allowances

As discussed above, cigarette industry 

expenditures for promotional allowances 

accounted for just under $1 billion in 

2005, or 7% of the industry’s marketing 

expenditures during that year (table 4.4). 

Philip Morris/Altria, the largest tobacco 

company, presents retailers with three levels 

or “category merchandise options” (CMOs) 

for displaying Philip Morris products and the 

commensurate remuneration received for 

adopting each option. Dipasquale explains 

how the CMOs work:

All require that Philip Morris brands get 

the percentage of shelf space equal to the 

company’s share of sales in that location, 

determined by averaging share of market 

and share in that store. The amount of 

space is the same at each level; only the 

configuration of the display changes.126

CMO3 (“Horizontal Set”) is the highest 

retail merchandising level, at which 

Philip Morris pays the highest incentive, 

90 cents per carton, to retailers. At this 

level, Philip Morris gets the most desirable 

shelf space—a horizontal portion at 

the very top of the fixture. The bottom 

horizontal portion can be stocked as the 

retailer chooses. At this level, competitors’ 

permanent (more than 30 days) signs are 

prohibited outside the store or anywhere 

inside the store beyond the tobacco fixture. 

CMO2 (“Combination Set”) is the second 

level. At this level, Philip Morris brands are 

placed in a vertical and horizontal L-shaped 

combination beginning at the top left of the 

fixture. The retailer gets 60 cents per carton 

at this level.

CMO3 (“Vertical Set”) is the lowest level. 

At this level, Philip Morris brands are placed 

vertically in the middle of the tobacco 

fixture, allowing the retailer to choose how 

to stock the vertical space on either side. 

The retailer gets 40 cents per carton at 

this level.

Observational Assessments of the 

Shift to In-Store Promotion

The shift to in-store promotion during 

recent decades and, particularly since the 

MSA in 1998, is evidenced not only in 

the marketing expenditure data reported 

annually by the industry to the FTC, but 

also in empirical observational studies 

of retail outlets. In 1999, the presence of 

tobacco point-of-purchase advertising was 

examined in a national U.S. study covering 

3,000 retail outlets. Almost all stores (92%) 

had some form of tobacco point-of-purchase 

advertising. Four of five (80%) had interior 

tobacco point-of-purchase advertising. 

More than two-thirds (69%) had at least 

one tobacco-branded functional item 

(e.g., counter change mats or shopping 

baskets). More than one-third (36%) had selfservice cigarette pack placement, and onequarter (25%) had multipack discounts.130

Significant increases in tobacco promotion 

have been noted from the period just 

before implementation of the billboard 

ban (pursuant to the MSA) to the period 

just after the settlement. These included 

increases in (1) the percentage of stores 
132

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

carrying interior store advertising for 

tobacco products and the extent of that 

advertising; (2) the percentage of stores 

carrying exterior advertising for tobacco 

products and the extent of that advertising; 

(3) the percentage of stores carrying a range 

of promotions, including gift with purchase, 

cents-off promotions, and multipack 

discounts; and (4) the percentage of stores 

carrying tobacco-related functional objects 

and the extent to which these objects were 

in the store.131

In 2001, a cross section of 586 California 

retailers was found to have more than 

17 tobacco point-of-purchase ads, on 

average, in or around the store. More than 

four-fifths of these (85%) were located 

within four feet of the counter; 11% had 

large exterior signs—in violation of the 

MSA; 48% had ads at or below child level 

(three feet); and 23% had cigarette product 

displays next to candy.132

Concerns about the heavy volume and high 

visibility of tobacco promotions at the point 

of sale are heightened given the frequency 

of youth shopping at convenience stores. 

When asked where they have shopped 

during the past 30 days, 44% of adolescents 

aged 12–17 years mentioned convenience 

stores (behind shopping malls and centers 

[58%] and discount stores [45%]), and 

52% of teenagers aged 16–17 years cited 

convenience stores (second only to shopping 

malls and centers [63%]).133 In a study of 

more than 3,000 students in grades 9–12 

who smoked, Wakefield and colleagues 

found that their cigarette brand preferences 

correlated with the brands most heavily 

advertised in the convenience stores within 

a one-mile radius of their schools.134

Summary

Tobacco products remain among the most 

heavily promoted consumer products in the 

United States. The allocation of cigarette 

marketing expenditures has changed 

dramatically in recent decades, shifting from 

traditional print advertising to promotional 

activities. Cigarette marketing at the point 

of sale increased substantially after the 

1998 MSA prohibited cigarette advertising 

on billboards.

In response to the changing regulatory 

climate, tobacco firms are exploring new 

ways to promote their products, such 

as viral marketing and a presence on 

the Internet. In the meantime, tobacco 

marketing expenditures overwhelmingly 

involve discounting and promotional 

allowances for in-store marketing, together 

with other channels such as coupons and 

specialty item distribution. Leading cigarette 

brands, especially Marlboro, still maintain 

substantial brand equity, even within today’s 

regulatory environment, and continue to 

rank as leading brands among consumer 

products in the United States.

Data on trends in tobacco advertising 

and promotion highlight the economic 

importance of effective marketing efforts 

for tobacco industry interests. These 

trends, combined with shifts in marketing 

expenditures across categories of advertising 

and promotion, underscore the need to 

critically examine the evolution of tobacco 

advertising and promotional efforts. Such 

an examination, in turn, must continue 

to inform ongoing tobacco control efforts 

aimed at reducing the morbidity and 

mortality associated with smoking and 

other forms of tobacco use.

Conclusions

1. Cigarettes are one of the most heavily 

marketed products in the United States. 

Between 1940 and 2005, U.S. cigarette 

manufacturers spent about $250 billion 

(in 2006 dollars) on cigarette advertising 

and promotion. In 2005, the industry 

spent $13.5 billion (in 2006 dollars) on 
133

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

cigarette advertising and promotion 

($37 million per day on average). 

2. Most of the cigarette industry’s 

marketing budget is allocated to 

promotional activities, especially for 

price discounts, which accounted for 

75% ($10.1 billion in 2006 dollars) 

of total marketing expenditures in 

2005. From 1970 to 2005, the pattern 

of marketing expenditures shifted 

dramatically; the proportion of 

expenditures allocated for advertising 

in “measured media” decreased from 

82% in 1970 to almost none in 2005. 

Measured media include television, 

radio, newspapers, magazines, and 

billboards. Correspondingly, the 

proportion of marketing expenditures 

devoted to promotional activities 

increased from 18% to almost 100%.

3. During the past three decades, 

Philip Morris has consistently 

committed more than $100 million per 

year (in 2006 dollars) to advertising 

for Marlboro, the industry’s dominant 

brand, which currently has 40% of the 

U.S. market share. In 2006, the Marlboro 

brand was the 12th most highly valued 

brand worldwide, with an estimated 

$21.4 billion in brand equity.

4. Expenditures for smokeless tobacco 

advertising and promotion reached 

$259 million (in 2006 dollars) in 2005. 

The five largest categories of expenditure 

were price discounts (40%), coupons 

(11%), sampling (11%), point of sale 

(8%), and magazines (8%).

5. Cigarette advertising and promotion 

are heavy in volume and high in 

visibility at the point of sale, particularly 

in convenience stores. Cigarette 

marketing at the point of sale increased 

substantially after the 1998 Master 

Settlement Agreement, which included 

a ban on cigarette advertising on 

billboards. About 60% of all cigarettes 

sold in the United States are purchased 

in convenience stores, where cigarettes 

are the top in-store product category in 

terms of consumer sales.

6. As cigarette advertising is being curtailed 

in some traditional media, cigarette 

companies are exploring the use of new 

or nontraditional media for distributing 

protobacco messages and images, 

including the Internet and cigarette 

packages. In addition, cigarette firms 

(like other companies) are experimenting 

with viral (stealth) marketing to create a 

“buzz” about a product.
134

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

References

1. Federal Trade Commission. 2007. Federal 

Trade Commission cigarette report for 

2004 and 2005. http://www.ftc.gov/reports/

tobacco/2007cigarette2004-2005.pdf.

2. Pollay, R. W. 1994. Exposure of US youth to 

cigarette television advertising in the 1960s. 

Tobacco Control 3 (2): 130–33. 

3. Pollay, R. W. 1994. Promises, promises: 

Self-regulation of US cigarette broadcast 

advertising in the 1960s. Tobacco Control

3 (2): 134–44. 

4. U.S. Department of Health and Human 

Services. 1989. Reducing the health 

consequences of smoking: 25 years of 

progress. A report of the Surgeon General

(DHHS publication no. [CDC] 89-8411). 

Rockville, MD: U.S. Department of Health 

and Human Services, Public Health Service, 

Centers for Disease Control, National Center 

for Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health. 

http://profiles.nlm.nih.gov/NN/B/B/X/S/.

5. Warner, K. E. 1985. Cigarette advertising 

and media coverage of smoking and health. 

New England Journal of Medicine 312 (6): 

384–88. 

6. United States v. Philip Morris USA, Civil 

Action No. 99-CV-02496GK (D.C.C.) 

(United States’ final proposed finding of fact, 

incorporating errata of August 16, 2005). 

http://www.usdoj.gov/civil/cases/tobacco2/

US%20Executive%20Summary%

20Redacted%2020050815.pdf.

7. United States v. Philip Morris USA, Civil 

Action No. 99-CV-02496GK (D.D.C.) 

(amended final opinion 2006).

8. Federal Trade Commission. 1967. Federal 

Trade Commission report to Congress 

pursuant to the Federal Cigarette Labeling 

and Advertising Act. http://legacy.library

.ucsf.edu/tid/qjf92f00.

9. Federal Trade Commission. 1986. Federal 

Trade Commission report to Congress 

pursuant to the Comprehensive Smokeless 

Tobacco Health Education Act of 1986. http://

legacy.library.ucsf.edu/tid/ofk98c00.

10. Federal Trade Commission. 2007. 

Smokeless tobacco report for the years 

2002–2005. Washington, DC: Federal Trade 

Commission. http://www.ftc.gov/reports/

tobacco/02-05smokeless0623105.pdf.

11. U.S. Congress. Senate. 1999. Federal Reports 

Elimination and Sunset Act amendments 

of 1999. Report of the Committee on 

Governmental Affairs, United States Senate, 

to accompany S. 1877 to amend the Federal 

Report Elimination and Sunset Act of 1995. 

106th Congress, 1st Session. http://www

.senate.gov/~govt-aff/s1877_main.htm.

12. Federal Register. 2001. Federal Trade 

Commission. Cigarette and smokeless 

tobacco reports; Request for public 

comment. Federal Register 66 (69): 18640.

13. Federal Trade Commission. 1999. Cigar 

sales and advertising and promotional 

expenditures for calendar years 1996 

and 1997. http://www.ftc.gov/os/1999/07/

cigarreport1999.htm.

14. Davis, R. M. 2000. The effects of tobacco 

advertising, promotion, and sponsorship.

Expert report submitted to the Canadian 

Department of Justice. http://legacy.library

.ucsf.edu/tid/qmp11b00.

15. U.K. Department of Health. 2002. 

Consultation on the draft: Tobacco 

advertising and promotion (sponsorship) 

transitional regulations; tobacco advertising 

and promotion (point of sale) regulations; 

tobacco advertising and promotion 

(brandsharing) regulations. http://oldash.

org.uk/html/advspo/pdfs/consultation.pdf.

16. Kjønstad, A. 1985. An attempt to circumvent 

the ban on cigarette advertising in Norway. 

New York State Journal of Medicine 85: 

403–4. 

17. Simpson, D. 1994. Paris and beyond. 

Tobacco Control 3 (4): 302–7. 

18. Joossens, L. 2001. How to circumvent 

tobacco advertising restrictions: The 

irrelevance of the distinction between 

direct and indirect advertising. http://www

.globalink.org/tobacco/docs/eu-docs/

0102joossens.shtml.

19. Slade, J., and R. K. White. 1996. Marlboro 

classics: Sheep’s clothing. Tobacco Control

5 (4): 340–41. 

20. U.S. Department of Health and Human 

Services. 2002. How youths get cigarettes. 

The NHSDA Report. Rockville, MD: 

U.S. Department of Health and Human 

Services, Public Health Service, Substance 

Abuse and Mental Health Services, Office 

of Applied Studies. http://www.oas.samhsa

.gov/2k2/YouthCigs/YouthCigs.cfm.

21. Sushma, C., and C. Sharang. 2005. Pan 

masala advertisements are surrogate for 

tobacco products. Indian Journal of Cancer

42 (2): 94–8. 
135

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

22. OAG. 2007. Marlboro classics. http://www

.igougo.com/attractions-reviews-b49160-

Hong_Kong-Marlboro_Classics.html.

23. R.J. Reynolds France. 1992. Communication 

strategy and strategic plan 1992–1996. 

http://tobaccodocuments.org/misc_trial/

RJRFRANCEPLAN1992-96.html.

24. Worldwide Brands, Inc. 1993. Worldwide 

Brands Inc., strategic plan, 1993–1997. 

http://tobaccodocuments.org/misc_trial/

WBIPLAN1993-97.html.

25. Aitken, P. P., D. S. Leathar, and 

F. J. O’Hagan. 1985. Children’s perceptions 

of advertisements for cigarettes. Social 

Science and Medicine 21 (7): 785–97. 

26. University of Strathclyde. 2001. Tobacco 

brand stretching: A report prepared for the 

Department of Health. Glasgow: Univ. of 

Strathclyde, Centre for Tobacco Control 

Research.

27. MacFadyen, L., G. Hastings, and 

A. M. MacKintosh. 2001. Cross-sectional 

study of young people’s awareness of and 

involvement with tobacco marketing. 

British Medical Journal 322 (7285): 513–17. 

28. Arthur D. Little. Development of cigarette 

packaging. 14 Oct 1963. Liggett and Myers. 

Bates No. T130729022–9058. http://legacy

.library.ucsf.edu/tid/yiq76d00.

29. Marketing Perceptions. 1992. Untitled 

research report. Philip Morris. http://legacy

.library.ucsf.edu/tid/afe72e00.

30. Lancaster, W. Zack tracking/attitude 

research request. 19 Aug 1974. Lorillard. 

Bates No. 91260420. http://legacy.library

.ucsf.edu/tid/jvr90e00.

31. Simpson, D. 1999. France: Packaging is kids 

stuff. Tobacco Control 8 (4): 362. 

32. Ives, N. 2002. Kool cigarettes in new flavors 

draw criticism. New York Times, March 9.

33. Swanson, M. G. 2006. Australia: Health 

warnings canned. Tobacco Control 15 (3): 

151. 

34. Slade, J. 1997. The pack as advertisement. 

Tobacco Control 6 (3): 169–70. 

35. Wakefield, M., and T. Letcher. 2002. My pack 

is cuter than your pack. Tobacco Control

11 (2): 154–66. 

36. Simpson, D. 2002. Hong Kong: Marlboro tries 

it on (the pack). Tobacco Control 11 (3): 171. 

37. Martin, S. 2008. Svein Martin’s home page. 

http://home.online.no/~smpeders/ind-a.htm.

38. Simpson, D. 2006. Hong Kong, China: 

Marlboro pack sleeves. Tobacco Control

15 (1): 6. 

39. Bogie, J. C. Approval recommendation: 

Lucky Strike package design exploratory. 

7 Jan 1991. American Tobacco Company. 

Bates No. 970530514-970530521. http://

legacy.library.ucsf.edu/tid/vty85f00.

40. Wakefield, M., C. Morley, J. K. Horan, and 

K. M. Cummings. 2002. The cigarette 

pack as image: New evidence from tobacco 

industry documents. Tobacco Control

11 Suppl. 1: i73–i80. 

41. Miller, L., T. Hirji, and R. P. Ferris. Principles 

of measurement of visual standout in 

pack design report number RD 2039. 

23 May 1986. British American Tobacco. 

Bates No. 102699346/9502. http://bat.library

.ucsf.edu/tid/bks46a99.

42. Etzel, E., E. N. Monahan, and I. Ece. 

Camel filter revised packaging test: 

Consumer research proposal. 2 Mar 1979. 

R. J. Reynolds. Bates No. 500566627–6632. 

http://legacy.library.ucsf.edu/tid/qxb79d00.

43. Gauvin, G. 2001. Putting an end to 

deception: A report to the Canadian 

Minister of Health. Ottawa, ON: Ministerial 

Advisory Council on Tobacco Control. 

http://www.cctc.ca/cctc/EN/fundamentals/

cessation/basics/Putting_an_End_to

_Deception.pdf/view. 

44. Goldberg, M. E., J. Liefeld, K. Kindra, 

J. Madill-Marshall, J. Lefebvre, 

N. Martohardjono, and J. Vredenburg. 

1995. When packages can’t speak: Possible 

impacts of plain and generic packaging of 

tobacco products. Expert panel report to 

Health Canada. Ottawa, ON: Health Canada, 

Office of Tobacco Control.

45. Rootman, I., and B. R. Flay. 1995. A study 

on youth smoking: Plain packaging, health 

warnings, event marketing and price 

reductions. Key findings. Toronto: Univ. 

of Toronto.

46. Carr-Greg, M. R. C., and A. J. Gray. 1993. 

Generic packaging: A possible solution to 

the marketing of tobacco to young people. 

World Smoking and Health 18 (2): 11–13. 

47. Beede, P., and R. Lawson. 1992. The effect 

of plain packages on the perception of 

cigarette health warnings. Public Health

106 (4): 315–22. 

48. Godin, S. 2001. Unleashing the ideavirus.

New York: Hyperion.

49. Khermouch, G., and J. Green. 2001. 

Buzz marketing: Suddenly this stealth 

strategy is hot—but it’s still fraught with 

risk. Business Week, July 30. http://www
136

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

.businessweek.com/magazine/content/

01_31/b3743001.htm.

50. Carter, S. M. 2003. Going below the line: 

Creating transportable brands for Australia’s 

dark market. Tobacco Control 12 Suppl. 3: 

iii87–iii94. 

51. Assael, H. 1995. Consumer behavior and 

marketing action. 5th ed. Cincinnati: 

SouthWestern College Publishing.

52. Burrows, D. S. Strategic research report. 

Younger adult smokers: Strategies and 

opportunities. 29 Feb 1984. R.J. Reynolds. 

Bates No. 50677795/8042. http://legacy

.library.ucsf.edu/tid/tei44d00.

53. Kaufman, L. 1997. Tobacco: Stealth 

marketing. Newsweek, March 3. 

54. Tremor News. 2004. Dreamworks studios 

delivers sneak preview. http://www.tremor

.com/news/story_public.aspx?news_id=18.

55. Ribisl, K.M. 2003. The potential of the 

Internet as a medium to encourage and 

discourage youth tobacco use. Tobacco 

Control 12 Suppl. 1: i48–i59. 

56. Simpson, D. 2001. BAT’s Internet marketing 

plan. Tobacco Control 10 (2): 92. 

57. Goold, S. 2003. USA: The battle for the bars. 

Tobacco Control 12 (1): 6–7. 

58. Sepe, E., and S. A. Glantz. 2002. Bar and 

club tobacco promotions in the alternative 

press: Targeting young adults. American 

Journal of Public Health 92 (1): 75–78. 

59. British American Tobacco Company 

Limited. Product communication in the 

context of varying degrees of advertising 

restriction. Oct 1999. Bates No. 542003674–

542003685. http://library.ucsf.edu/tobacco/

batco/html/14000/14026/index.html.

60. Benns, M. 2004. Good-looking guerillas 

push smokes. Sydney Morning Herald,

February 29.

61. Banthin, C. 2006. Public health policy for 

Internet cigarette retailers. St. Paul, MN: 

Tobacco Control Legal Consortium. 

www.wmitchell.edu/tobaccolaw/resources/

Banthin012506.pdf.

62. Windholz, E. L. Australian Website—

Status report. 30 Mar 2000. Philip Morris. 

Bates No. 2072557317A/7318. http://legacy

.library.ucsf.edu/tid/gjz95c00.

63. Hrywna, M., C. D. Delnevo, and J. M. Lewis. 

2007. Adult recall of tobacco advertising 

on the Internet. Nicotine and Tobacco 

Research 9 (11): 1103–07.

64. Centers for Disease Control and Prevention. 

2005. Tobacco use, access, and exposure 

to tobacco in media among middle and 

high school students—United States, 2004. 

Morbidity and Mortality Weekly Report

54 (12): 297–301.

65. Slade, J., G. N. Connolly, and D. Lymperis. 

2002. Eclipse: Does it live up to its health 

claims? Tobacco Control 11 Suppl. 2: 

ii64–ii70. 

66. World Health Organization. 2005. WHO 

Framework Convention on Tobacco Control 

(WHO FCTC). http://www.who.int/tobacco/

framework/WHO_FCTC_english.pdf.

67. Kenyon, A. T., and J. Liberman. 2006. 

Controlling cross-border tobacco: 

Advertising, promotion and sponsorship—

Implementing the FCTC. Univ. of Melbourne 

Legal Studies Research Paper No. 161. 

http://papers.ssrn.com/sol3/papers

.cfm?abstract_id=927551.

68. Koryagin, D. A., and O. Lezhneva. 2006. 

Tobacco advertising in the Russian 

Internet—Case study. Paper presented at 

the 13th World Conference on Tobacco 

OR Health, Washington, DC. http://2006

.confex.com/uicc/wctoh/techprogram/

P6894.HTM.

69. Stanley, T. L. 2004. Joystick nation. 

Advertising Age 75 (12): 1–2. 

70. Kharif, O., and S. Baker. 2004. Advertisers 

take aim at gamers. Business Week, June 22. 

http://www.businessweek.com/technology/

content/jun2004/tc20040622_2673_tc150

.htm.

71. Delaney, K. J. 2004. Another player aims 

to shoot ads to videogamers. Wall Street 

Journal, May 12.

72. Massive Incorporated. 2004. Research. 

http://web.archive.org/web/20040724053553/

http://www.massiveincorporated.com/

research.htm.

73. Advertising Review Council, ed. 2008. 

Principles and guidelines for responsible 

advertising practices. New York: Advertising 

Review Council, Entertainment Software 

Rating Board. https://www.esrb.org/ratings/

principles_guidlines.jsp.

74. Haninger, K., and K. M. Thompson. 2004. 

Content and ratings of teen-rated video 

games. JAMA: The Journal of the American 

Medical Association 291 (7): 856–65. 

75. Emery, G. 2004. Programs: “Riddick” 

revels in butchery, profanity. Reuters News 

Service, June 30.

76. Wikipedia. 2007. Halo 2. http://en.wikipedia

.org/wiki/Halo_2.
137

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

77. Game Daily. 2007. Game Daily: The definitive 

voice of games. http://www.gamedaily.com/

games/halo-2/xbox/game-cheats/list/300/0.

78. High Impact Halo. 2006. Sarge’s cigar. 

http://www.highimpacthalo.org/forum/

showthread.php?t=12699.

79. Gamez.com Network. Game Cheat Codes 

Database. http://cheats.gamez.com/cheats/

xbox/halo_2/175.html.

80. National Association of Attorneys General. 

1998. Master Settlement Agreement and 

amendments. Washington, DC: National 

Association of Attorneys General. http://

www.naag.org/backpages/naag/tobacco/msa.

81. AZGameCheats.com. 2007. Halo 2. http://

www.azgamecheats.com/content/xbox/729.

82. Hart, P. 1996. Product placement comes of 

age in Canada. Marketing 101 (44): 20. 

83. Chapman, S., and R. M. Davis. 1997. 

Smoking in movies: Is it a problem? 

Tobacco Control 6 (4): 269–71. 

84. Dalton, M. A., J. D. Sargent, M. L. Beach, 

L. Titus-Ernstoff, J. J. Gibson, M. B. Ahrens, 

J. J. Tickle, and T. F. Heatherton. 2003. 

Effect of viewing smoking in movies on 

adolescent smoking initiation: A cohort 

study. Lancet 362 (9380): 281–85. 

85. Cummings, K. M., C. P. Morley, J. K. Horan, 

C. Steger, and N. R. Leavell. 2002. Marketing 

to America’s youth: Evidence from corporate 

documents. Tobacco Control 11 Suppl. 1: 

I5–I17. 

86. Mekemson, C., and S. A. Glantz. 2002. How 

the tobacco industry built its relationship 

with Hollywood. Tobacco Control 11 

Suppl. 1: i81–i91. 

87. Cowan, W. Activity report. 9 Nov 1982. 

R. J. Reynolds. Bates No. 503579586–9591. 

http://legacy.library.ucsf.edu/tid/dow85d00.

88. Devaney, F. Activity report. 10 Aug 1982. 

R.J. Reynolds. Bates No. 503579539/9541. 

http://legacy.library.ucsf.edu/tid/dyx62d00.

89. Magnus, P. 1985. Superman and the Marlboro 

woman. The lungs of Lois Lane. New York 

State Journal of Medicine 85 (7): 342–43. 

90. Stallone, S. Letter to B. Kovoloff of B & W 

Tobacco. 28 Apr 1983. Brown & Williamson. 

Bates No. 6850883119. http://legacy.library

.ucsf.edu/tid/cuf33f00.

91. Scott, D. R. [Internal correspondence: 

Movie placement.] Memorandum. 

26 Oct 1983. Brown & Williamson. Bates 

No. 680517197. http://legacy.library.ucsf

.edu/tid/xcj04f00.

92. Brown & Williamson. Product movie 

placement. Bates No. 680118048/8052. 

http://legacy.library.ucsf.edu/tid/ccv04f00.

93. Vasagar, J. 2006. Welcome to Nollywood. 

The Guardian, March 23. http://film

.guardian.co.uk/features/featurepages/

0,,1737425,00.html.

94. Burning Brain Society, H. Goswami, and 

R. Kashyap. 2006. Tobacco in movies and 

impact on youth: A study on tobacco in 

Indian movies released in 2004, 2005 

[and] influence of movies on youngsters.

Chandigarh, India: Burning Brain 

Society. http://www.burningbrain.org/pdf/

tobaccoinmovies.pdf.

95. World Health Organization. 2003. Bollywood: 

Victim or ally? A WHO study on the portrayal 

of tobacco in Indian cinema. http://www

.who.int/tobacco/wntd/2003/en/bollywoodexesum.pdf.

96. Ramaswamy, A. 2005. Bollywood fumes 

at onscreen smoking ban. http://www

.int.iol.co.za/index.php?set_id=1&click

_id=126&art_id=qw1117968301935R131.

97. Tucker, N. 2005. Nollywood, in a starring 

role. Washington Post, February 5.

98. Haruna, G. 2007. Promotion of smoking... 

Nollywood’s bad example. This Day,

February 26. http://blogsofbainbridge

.typepad.com/africa/2007/02/promotion

_of_sm.html.

99. Agence France Presse. 2005. India bans 

smoking scenes in movies and on TV in 

anti-tobacco campaign. Agence France 

Presse: http://www.smoke-free.ca/movies/

bollywood_hollywood.htm.

100. Times of India. 2005. Govt goes back 

on tobacco ban. Times of India, July 6. 

http://timesofindia.indiatimes.com/

articleshow/1161658.cms.

101. Indlaw Communications Pvt. Limited. 

2006. Ban on smoking scenes to be deferred 

till July 31. http://www.indlawnews.com/

110e4714c2c561939960bfed8f7939c8.

102. Chauhan, C. 2006. Govt moves to stub out 

smoking scenes on TV. Hindustan Times,

November 6. http://htnext.in/news/181

_1837621,0011.htm.

103. U.S. Department of Health and Human 

Services. 2000. Reducing tobacco use: 

A report of the Surgeon General. Atlanta: 

U.S. Department of Health and Human 

Services, Centers for Disease Control and 

Prevention, National Center for Chronic 

Disease Prevention and Health Promotion, 
138

4 . T y p e s a n d E x t e n t o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

Office on Smoking and Health. http://www

.cdc.gov/tobacco/data_statistics/sgr/sgr

_2000/index.htm.

104. Pierce, J. P., T. P. Gilmer, L. Lee, E. A. Gilpin, 

J. de Beyer, and K. Messer. 2005. Tobacco 

industry price-subsidizing promotions may 

overcome the downward pressure of higher 

prices on initiation of regular smoking. 

Health Economics 14 (10): 1061–71. 

105. Advertising Age. 2006. 100 leading national 

advertisers: Profiles of the top 100 U.S. 

marketers in this 51st annual ranking. 

Advertising Age, June 26:6–8. http://adage

.com/images/random/lna2006.pdf.

106. Advertising Age. 1946. Advertisers spending 

$3,000,000 or more in 1945. Advertising 

Age, April 22:1. 

107. Advertising Age. 1951. 100 leading magazine 

and broadcast advertisers. Advertising Age,

February 26:59. 

108. Advertising Age. 1956. 100 top magazine 

and broadcast advertisers in 1955. 

Advertising Age, March 26:120–21. 

109. Advertising Age. 1961. 100 leading 

national advertisers: Grouped by products. 

Advertising Age, August 28:43. 

110. Advertising Age. 1966. How their media 

expenditures compared in 1965. Advertising 

Age, August 29:45. 

111. Advertising Age. 1971. 100 leaders’ media 

expenditures compared in 1970. Advertising 

Age, August 30:24. 

112. Advertising Age. 1976. 100 leaders’ media 

expenditures compared in 1975. Advertising 

Age, August 23:30. 

113. Advertising Age. 1981. 100 leaders’ media 

expenditures compared in 1980. Advertising 

Age, September 10:12. 

114. Altria Group. 2006. Altria Group: 2005 

annual report. http://www.altria.com/

download/pdf/investors_AltriaGroupInc

_2005_AnnualRpt.pdf.

115. Business Week. 2003. The 100 top brands. 

Business Week, August 4. 

116. Advertising Age. 2006. MegaBrands index. 

http://adage.com/datacenter/article?article

_id=106349.

117. Davis, R. M. 1987. Current trends in cigarette 

advertising and marketing. New England 

Journal of Medicine 316 (12): 725–32. 

118. Centers for Disease Control and Prevention. 

1990. Cigarette advertising—United States, 

1988. Morbidity and Mortality Weekly 

Report 39 (16): 261–65. 

119. Federal Trade Commission. 2000. Report 

to Congress for 1998 pursuant to the 

Federal Cigarette Labeling and Advertising 

Act. Washington, DC: Federal Trade 

Commission. http://www.ftc.gov/reports/

cigarettes/cig98rpt.pdf.

120. Slade, J. 1998. Marketing and promotion of 

cigars. In Cigars: Health effects and trends

(Smoking and tobacco control monograph 

no. 9, NIH publication no. 98-4302), 

195–219. Bethesda, MD: National Cancer 

Institute. http://cancercontrol.cancer.gov/

tcrb/monographs/9/index.html.

121. Massachusetts Department of Public Health. 

2002. Smokeless tobacco advertising 

expenditures before and after the Smokeless 

Tobacco Master Settlement Agreement.

Boston: Massachusetts Department of 

Public Health. http://tobaccofreekids.org/

pressoffice/release503/smokeless.pdf.

122. Connolly, G.N. 1995. The marketing 

of nicotine addiction by one oral snuff 

manufacturer. Tobacco Control 4 (1): 73–79. 

123. Ernster, V. L. 1989. Advertising and 

promotion of smokeless tobacco products. 

In Smokeless tobacco use in the United 

States (Monograph no. 8, NIH publication 

no. 89-3055), 87–94. Bethesda, MD: National 

Cancer Institute.

124. Braverman, M. T., C. N. D’Onofrio, and 

J. M. Moskowitz. 1989. Marketing smokeless 

tobacco in California communities: 

Implications for health education. NCI 

Monographs 8: 79–85. 

125. Goldberg, M. E., R. M. Davis, and 

A. M. O’Keefe. 2006. The role of tobacco 

advertising and promotion: Themes 

employed in litigation by tobacco industry 

witnesses. Tobacco Control 15 Suppl. 4: 

iv54–iv67. 

126. Dipasquale, C. 2002. Store wars: With 

advertising options dwindling, tobacco 

marketers take the battle to convenience 

stores. Advertising Age, January 14:4–8. 

127. National Association of Convenience Stores. 

2004. Convenience stores rebound in 2003. 

“Real” sales increase, strong pretax profits 

reverse three-year slide. NASC SOI annual 

report. Alexandria, VA: National Association 

of Convenience Stores.

128. NACS Online. 2006. The convenience store 

industry. http://www.nacsonline.com/NACS/

Resource/PRToolkit/FactSheets/prtk_fact

_ecoimpact.

129. Blatt, D. 2002. P-O-P Measures Up: 

Convenience Channel Study. Introduction 
139

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

and Consumer Insights. Slide presentation. 

Washington, DC: Point-Of-Purchase 

Advertising International.

130. Centers for Disease Control and Prevention. 

2002. Point-of-purchase tobacco 

environments and variation by store 

type—United States, 1999. Morbidity and 

Mortality Weekly Report 51 (9): 184–87. 

131. Wakefield, M. A., Y. M. Terry-McElrath, 

F. J. Chaloupka, D. C. Barker, S. J. Slater, 

P. I. Clark, and G. A. Giovino. 2002. Tobacco 

industry marketing at point of purchase 

after the 1998 MSA billboard advertising 

ban. American Journal of Public Health

92 (6): 937–40.

132. Feighery, E., K. Ribisl, N. Shleicher, and 

S. Halvorson. 2001. Cigarette advertising 

and promotional strategies in retail outlets: 

Results of a statewide survey in California. 

Tobacco Control 10 (1): 184–88. 

133. Magazine Publishers of America. 2003. 

Where teens shop. New York: Magazine 

Publishers of America. www.magazine.org/

content/files/teenprofile04.pdf.

134. Wakefield, M. A., E. E. Ruel, F. J. Chaloupka, 

S. J. Slater, and N. J. Kaufman. 2002. 

Association of point-of-purchase tobacco 

advertising and promotions with choice of 

usual brand among teenage smokers. Journal 

of Health Communication 7 (2): 113–21. 

141

5

Themes and Targets of Tobacco 

Advertising and Promotion

As with any consumer product, tobacco industry marketing efforts show clear evidence of 

targeting specific population subgroups and using themes and strategies designed to build 

brand loyalty and market share. This chapter provides an overview of specific themes and 

population targets employed in tobacco advertising and promotion based on studies of 

marketing materials and tobacco industry documents.

n	 Key tobacco marketing themes include taste and satisfaction, implied harm 

reduction, affinity with desirable social characteristics, brand loyalty, and 

smokers’ rights.

n	 Specific targeting criteria for tobacco advertising and promotion can include age, 

gender, race or ethnicity, and sexual orientation. Such groups can be targeted 

directly—for instance, by focusing on rugged individualism for men or weight 

control for women—or indirectly through adult themes such as independence 

or peer acceptance that also appeal to young smokers.

n	 Tobacco brands are frequently designed to appeal to specific market segments or 

population subgroups, such as blue-collar women, African Americans, and young 

adult smokers.

In addition to advertising, promotional channels for tobacco products can include 

affinity magazines, direct mail, coupons for gift catalogs, and promotional booths at 

targeted venues as well as other niche-market efforts. Marketing objectives for these 

channels range from creating new markets to attracting young smokers who are making 

their long-term brand choice. Understanding targeted marketing is also an important 

consideration in designing tobacco control efforts.
142

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

Introduction

As explained in chapter 3, the practice 

of targeting marketing efforts to specific 

population subgroups is a general principle 

of marketing strategy and is therefore 

common to most consumer marketing 

efforts. In addition, consumer marketing 

seeks to develop and associate images or 

themes appealing to the target audience 

with a consumer product, so that when 

consumers purchase the product, they 

subscribe to the image associated with it. 

In these respects, tobacco is no different 

from any other consumer product. However, 

to the extent that such targeted marketing 

efforts have resulted in greater smoking 

uptake and less smoking cessation in 

the targeted subgroups, such marketing 

practices have contributed to the enormous 

tobacco-related harms and costs faced by 

modern American society. 

While chapter 7 presents details on the 

effects of tobacco marketing on tobacco use, 

this chapter aims to provide a descriptive 

overview of population subgroups that have 

been targeted by specific tobacco industry 

marketing strategies, and to give examples 

of how these strategies have been pursued, 

so that readers can appreciate the nature 

and scope of this activity. It also examines 

the campaign themes and strategies 

used to reach these specific subgroups to 

provide background and context to these 

targeted marketing efforts. The chapter is 

not exhaustive but provides examples of 

images and appeals that have been made to 

specific population subgroups. In general, 

the chapter focuses on the United States, 

using data drawn from published studies 

of tobacco advertising materials and 

industry documents, but examples from 

other countries are used when informative 

or illustrative. 

In 1969, the U.S. Congress was considering 

legislation that would, among other things, 

ban cigarette advertising on television 

and radio. The tobacco industry offered 

to voluntarily discontinue advertising 

cigarettes on the broadcast media if 

Congress would give the cigarette companies 

an exemption from antitrust laws to 

allow them to take this action in concert. 

(Ultimately, Congress refused to grant such 

an exemption and instead passed a statutory 

ban.) In testimony before Congress about 

the industry’s offer, Joseph F. Cullman III, 

chairman of the board of directors and 

chief executive officer of Philip Morris and 

chairman of the executive committee of the 

Tobacco Institute, explained how cigarette 

companies would market their products 

after leaving the broadcast media:

It is the intention of the cigarette 

manufacturers to continue to avoid 

advertising directed to young persons; to 

abstain from advertising in school and 

college publications; not to distribute 

sample cigarettes or engage in promotional 

efforts on school and college campuses; 

not to use testimonials from athletes 

or other celebrities who might have 

special appeal to young people; to avoid 

advertising which represents that cigarette 

smoking is essential to social prominence, 

success, or sexual attraction; and to refrain 

from depicting smokers engaged in sports 

or other activities requiring stamina or 

conditioning beyond those required in 

normal recreation.1(Bates no. 2023375863)

The themes and targets that Cullman said 

would be avoided in cigarette advertising 

were among those used extensively by 

cigarette companies in the years to come.

Tobacco corporations have long identified 

segments of the population with strong 

potential as customers. Their research 

has produced tailored brand lines and 

sophisticated messages delivered through 

the communication channels with the 

greatest likelihood of reaching these groups. 

The objectives of these targeted marketing 
143

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

activities are likely to include encouraging 

smoking initiation, establishing and 

maintaining brand loyalty, increasing 

tobacco consumption, and averting 

cessation efforts2 (see chapter 7 for an 

overview of effects of tobacco marketing 

on smoking behavior). Less direct but 

still potent public relations efforts are 

aimed at the leadership of varied groups to 

discourage opposition to tobacco marketing 

activities and to salvage tobacco corporate 

reputations; such public relations efforts 

are discussed further in chapter 6.

Segmentation, 

Tailoring, and Targeting

From the early days of organized tobacco 

marketing, there have been products and 

messages aimed at particular demographic 

and psychographic groups, beginning with 

adult males in the 1920s, then moving 

to youth and young adults, women, and 

specific ethnic populations. This breakdown 

is done, according to Pollay and colleagues,3

to maximize sales and profits, using unique 

combinations of advertising, packaging, 

distribution channels, prices, and other 

strategies to catch the interest of specific 

market segments. As discussed in detail 

in chapter 3, these segments may be 

defined by demographic variables such 

as gender, ethnicity, or age. They may 

also be segmented according to a group’s 

needs, values, and aspirations, described 

below as psychographic niches, and once 

characterized by the industry as “tobaccographics” population groups.4

Several studies (described below) review the 

evolution of major tobacco corporations’ 

plans of the 1970s, 1980s, and 1990s for 

market segments that are defined by the 

population, traits, values, and needs of 

potential smokers. Targeting becomes 

increasingly important as consumer 

presence is fragmented across a growing 

multiplicity of communication channels 

(cable television, Internet, etc.), which 

makes it difficult to market effectively to 

the entire population.

Philip Morris, the largest tobacco corporation 

in the United States, has developed 

marketing plans and product lines based 

on consumer attitudes, aspirations, and 

lifestyles. According to Ling and Glantz’s5

review of industry documents, the young 

adult categories include groups such as 

Enlightened Go-Getters, 90s Traditionalists, 

Mavericks, 50s Throwbacks, Uptown Girls, 

and Macho Hedonists. Marlboro, for example, 

would appeal to the 50s Throwbacks, while 

Marlboro Lights are for Uptown Girls. 

This same analysis describes R.J. Reynolds’s 

plan for the early 1990s in which the 

company identified young adult smoker 

segments with personal concerns about 

smoking, social guilt about their image and 

their sidestream smoke, “smart” or “quality” 

or price-sensitive shoppers, and young 

smokers with an irreverent approach to life 

or concerns about originality and status. 

Both corporations tackle young adult price 

concerns by using marketing strategies such 

as free samples and coupons in locations 

where young adults take on new behaviors—

for example, bars, colleges, workplaces, 

and the military.

In a similar vein, Cook and colleagues6

reviewed industry documents to identify 

market segments based on psychological 

needs such as obesity reduction, stress 

relief, and personal image. They found 

that new tobacco products were designed 

and old tobacco brands extended to meet 

the specific needs of identified segments. 

Product design features may vary by taste, 

size, tar and nicotine levels, sidestream 

smoke, filtration, price, and packaging with 

specific psychographic market segments in 

mind for each set of features.5,6

Campaigns are tailored for these niches by 

using special models, messages, settings, 

values, and product features. Camel’s virile 
144

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

male model of the late 1970s, the “Turk,” 

is a case in point of a campaign designed 

to grab the attention and appeal to the 

desires of male aspirants to the Turk’s 

lifestyle. His look was dark and handsome, 

and he appeared to live an adventurous 

outdoor life surrounded by sexy women.7

The stylish imagery of Winston’s metalflask–shaped S-2 cigarette package was 

aimed at young trend-setting males. Basic’s 

pricing strategies and folksy direct mail 

newsletters are geared toward a different 

niche: price-conscious, established, older 

smokers. The new Camel Exotic Blends are 

expansions of the Camel line designed for 

trend-setting young adults and flavored to 

appeal to newer smokers.

Campaigns target or reach specific groups 

via channels used by concentrations of 

these populations at times when they may 

be persuaded to initiate smoking or may 

be making other kinds of changes in their 

lives. One can identify important target 

populations and the brands aimed at them 

by examining the types of magazines and 

tobacco-sponsored events used by certain 

brands to reach narrow populations of 

interest. Magazines have long been used 

by tobacco companies to reach specific 

demographic and lifestyle audiences.8

Events also appeal to relatively narrow 

fan bases. The U.S. Smokeless Tobacco 

Corporation (USST) has placed Skoal 

free-sample booths at motorcycle races 

and Copenhagen booths at Professional 

Rodeo Cowboys Association (PRCA) 

rodeos, reaching a high proportion of 

young males.9,10 Often, channels are 

combined for a comprehensive campaign 

“narrowcast” through multiple channels 

reaching the same group. This method 

is exemplified by the Kool Mixx DJ 

(disc jockey) campaign using “poets of 

urban hip hop,” models, settings, and 

language of urban nightlife to reach young 

African Americans. The channels include 

a series of urban tobacco-sponsored bar 

nights with samples of newly designed 

Kool Fusion specialty-flavored menthol 

cigarettes, advertisements with a Kool Mixx 

CD (compact disc) attached to the 

advertisement in Rolling Stone and Vibe,

direct mail promotions, and a DJ Web 

site, all designed to reach young urban 

African Americans.11

Personalized direct marketing opportunities, 

such as the hundreds of bar promotions 

announced for Marlboro in California in 

early 2004 (California Department of Justice, 

e-mail correspondence to Tess Boley Cruz, 

June 2004), or coupons collected from 

smokers,12 have been used to reach specific 

recipients for a more personal marketing 

relationship via direct mail promotions. Once 

individual smokers have been entered into a 

tobacco company’s direct mail list, by virtue 

Copenhagen booth at PRCA Rodeo, Rancho Mission 

Viejo, California, 2002

Kool Mixx CD cover, included with the Kool advertisement 

in Vibe magazine and in bar promotions in 2004
145

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

of their willingness to exchange their name 

and address for free tobacco samples or 

prizes, they may receive discount coupons, 

glossy promotional brochures, and lifestyle 

magazines for a particular demographic and 

psychographic group. A free promotional 

magazine mailed to smokers in 2003 features 

an array of Virginia Slims advertisements 

and related lifestyle stories. Each issue of this 

magazine, All Woman, carries articles tailored 

for each decade of life between ages 20 and 

60, as well as fashion images for women 

from slight to full body sizes. Several of 

these promotional magazines exist, each 

geared to a different lifestyle and appealing 

to different types of smokers. Another 

magazine, Unlimited, by Marlboro, features 

outdoor sports such as snowboarding, auto 

racing, and bull riding. Basic Times for 

Basic cigarettes features occupations that 

might appeal to middle-aged smokers, such 

as appraising antiques. Heartland for USST 

features turkey shooting, deer hunting, and 

rodeo. CML for Camel provides features on 

urban evening entertainment. Flair and 

Real Edge for Brown & Williamson and P.S.

for Newport focus on a fun and social lifestyle 

for young adults. The models and stories 

are designed for specific types of smokers 

on the corporations’ direct mail lists. People 

usually end up on these direct mail lists after 

providing personal information in a tobaccorelated coupon exchange, bar promotion, 

or brief survey form attached to a direct mail 

or Internet promotion.13

Populations may be targeted by public 

relations and philanthropic efforts aimed 

at the leadership of priority populations. 

The rationale for this approach is described in 

chapter 6. Donations such as R.J. Reynolds’s 

support of Hispanic Chambers of Commerce14

and Philip Morris’s support of African 

American scholarships15 might undermine 

potential opposition to the tobacco 

companies and their marketing activities, 

help legitimize their products among 

members of the recipient groups, and build 

allies in antiregulation campaign efforts.

Dominant Themes

From the 1960s until the late 1980s, 

the Federal Trade Commission reviewed 

tobacco advertising and promotional 

themes in its annual reports to Congress 

pursuant to the Federal Cigarette Labeling 

and Advertising Act16–21 and identified 

examples of three approaches used at 

the time of the reports. Most tobacco 

advertising has been dominated by these 

three common themes that are easily 

recognized in today’s marketing messages: 

satisfaction, assuaging anxieties, and 

association with desirable outcomes.

Satisfaction

Many aspects of tobacco use are portrayed 

by advertisers as satisfying, but taste has 

been one of the mainstays, with claims of 

freshness, mildness, and strength. Salem, 

for example, classically offered a taste 

“as fresh as Springtime,”17(p.7) and Winston 

has suggested, “Taste isn’t everything. 

It’s the only thing.”19(p.4) In 2003 and 2004, 

Camel’s “Pleasure to Burn” campaign 

carried out this theme with nightclub 

performers and bartenders proffering flavor 

choices from Camel’s older classics, newer 

All Woman magazine sent by Phillip 

Morris to women smokers on the 

corporation’s direct mail list, Fall 2003
146

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

Exotic Flavors, and Turkish Gold brand 

families: “Rich and Classic,” “Exotic and 

Indulgent,” and “Mellow Turkish.”22

Reducing Anxiety

The second major theme seeks to allay 

anxieties about health hazards by discussing 

filters, low tar, and low nicotine16–19,23

(see chapters 3 and 4). These themes are 

exemplified by True’s advertising line in 

1976: “Considering all I’d heard, I decided 

to either quit or smoke True. I smoke 

True.”24(p.i25) The image focuses on a healthy 

female tennis player thoughtfully touching 

her head. It conveys the impression 

that the low tar and nicotine yields of 

this product make it as safe as quitting. 

Expenditures devoted to the advertising and 

promotion of low-tar cigarettes have usually 

exceeded their market share, suggesting 

that manufacturers have attempted to 

move smokers to low-yield cigarettes to 

discourage health-conscious smokers from 

quitting (see chapter 4). This same message 

of reducing smoker anxiety continues to this 

day with new product lines such as Eclipse 

and Advance, designed to appeal to smokers 

concerned about health risks.

In a content analysis of cigarette 

advertisements in selected issues of 

Time magazine, for selected years from 

1929 to 1984, Warner25 found that large 

percentages of ads emphasized health themes 

(e.g., special filters or low tar yield) instead of 

conventional cigarette ad imagery in all of the 

years of major smoking-and-health “events” 

(with the possible exception of 1964, the year 

when the first Surgeon General’s report on 

smoking and health was published).25

Altman and colleagues26 analyzed cigarette 

advertisements appearing from 1960 to 1985 

in eight popular magazines: Rolling Stone, 

Cycle World, Mademoiselle, Ladies’ Home 

Journal, Time, Popular Science, TV Guide, 

and Ebony. They found that cigarette ads 

increasingly emphasized “healthy” cigarettes 

(i.e., containing an explicit low-tar or lownicotine appeal), up to the peak year of 1979, 

when 82% of all cigarette ads contained this 

theme. The Institute of Medicine,27 in a report 

on tobacco harm reduction, published a table 

(table 3-1 in that report) of health-related 

text messages used in advertisements for 

cigarettes and “potential reduced-exposure 

products” (PREPs) from 1927 to 2000.

Additional information on this theme appears 

in the section, “Concerned Smokers.”

Desirable Associations

The third dominant set of themes associates 

smoking with persons, ideas, places, 

outdoor and athletic activities, personality 

characteristics, success (social, sexual, etc.), 

slimness, and other conditions considered 

desirable by target groups. Possibly the most 

well-known campaign of this type would 

be Marlboro’s long-running association 

of smoking with the macho, independent, 

mature Marlboro cowboy and the rugged 

country in which he lives. Virginia Slims 

cigarettes are associated with women’s 

liberation, slenderness, and success, in 

advertisements that claim “You’ve come 

a long way, Baby.”17(p.8) In both cases, the 

theme of individualism runs strong. King 

and colleagues28 studied eight different types 

Camel “Pleasure to Burn” advertisement
147

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

of magazines from the 1950s to the 1980s 

and found that the themes of individualism/

solitariness and recreation were the themes 

most frequently portrayed in almost all 

magazine types studied. Another common 

association has been “coolness,” promoted 

as a quality of smoking menthol cigarettes 

and in the bar-themed campaigns aimed at 

young adults. Sutton and Robinson29 have 

identified three messages in 2004 that the 

industry uses for its “coolness” category: 

ethnic awareness, fresh/refreshing/cool/

clean/crisp, and youthfulness/silliness/fun. 

Kool cigarettes have capitalized on the 

pairing of ethnic awareness with youthful 

fun, exemplified by the Kool Fusions 

campaign featuring hip hop artists and their 

related lifestyle. Newport demonstrates 

the last category in its images of young 

African American and Latino couples at play.

Smoking has been associated with 

sporting and a healthy outdoor life in 

numerous advertisements as well as in 

promotions linked with specific events. 

Early advertisements for True, Vantage, 

Virginia Slims, and others typically displayed 

sports scenes or accessories. Magazine 

advertisements in 2003 and 2004 have paired 

Winston with surfing, Skoal with soccer, 

and Basic with canoeing. Sports sponsorship 

was broadened in 1982 and 1983 with 

R.J. Reynolds’s support of soccer, rodeo, and 

skiing and Philip Morris’s support of tennis.30

In the late 1990s and early 2000s, tobacco 

brand and corporate sponsorship helped 

motor sports and rodeos become prime-time 

entertainment across the United States, and 

such sponsorship helped various tobacco 

brands become distinctly associated with 

the lifestyles of those sports.10

In their study of cigarette advertising in 

magazines from 1960 to 1985, Altman and 

“Come to where the flavor is. 

Come to Marlboro Country.” 

A direct mail promotion with a 

coupon insert for “Buy 1 Pack 

Get 1 Free” sent to an adult 

smoker in California, October 

2002

“Come to Marlboro Country,” a direct mail promotional flyer sent to a California 

adult smoker in 2002

Newport Menthol cigarette advertisement 

“Full of Pleasure!” in TV Y Novelas, 2002
148

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

colleagues26 assessed the frequency of use 

of the “vitality of smoking” 26(Bates no. TIMN459458)

theme, with the subcategories of adventure/

risk appeal (e.g., rock climber, sailor, 

race car driver), recreation (e.g., tennis, 

surfing), and erotic/romantic appeal 

(e.g., scantily dressed models, romantic 

settings). They found that ads during this 

period increasingly associated smoking 

with vitality, and significant increases were 

noted for each of the three subcategories 

of vitality. In peak years, the proportions 

of ads using themes of adventure/risk and 

erotic/romantic appeal were 30% to 40% 

(1983–85) and 38% (1985), respectively.

As noted above, tobacco industry 

spokesperson Joseph Cullman III promised 

to Congress in 1969 that cigarette advertising 

would “refrain from depicting smokers 

engaged in sports or other activities requiring 

stamina or conditioning beyond those 

required in normal recreation.”1(Bates no. 2023375863)

Nevertheless, cigarette advertisements have 

shown smoking by persons who appear 

to have just completed vigorous physical 

activity. Examples include a tennis player 

smoking Kent cigarettes, and a ballet dancer 

smoking Vantage cigarettes.31

Cullman also testified that the cigarette 

manufacturers would “avoid advertising 

which represents that cigarette smoking is 

essential to social prominence, success, or 

sexual attraction.”1(Bates no. 2023375863) However, 

these themes have appeared prominently 

in cigarette advertisements. A Barclay ad 

showed a man in a tuxedo lighting his 

cigarette, next to a woman drinking from a 

champagne glass—apparently in the back of 

a limousine. An ad for Ritz cigarettes, which 

bear the name and logo of fashion designer 

Yves Saint Laurent, also showed a man and 

woman in formal evening attire. A Vantage 

ad showed an architect above the slogan, 

“The Taste of Success.”

Advertisements for More and Barclay 

showed women in provocative poses, 

alongside slogans with double entendre: 

“I’m More satisfied” and “The pleasure is 

back.” A Benson & Hedges ad showed a man 

and woman sharing pajamas, with copy 

that explained, “He likes the bottoms.... 

She likes the tops.... But there’s one thing 

they agree on. Benson & Hedges.” In an 

essay about “below the belt” cigarette 

advertising, Pollay32 provided many examples 

of cigarette ads containing sexual imagery, 

symbolism, and innuendo. Sansores and 

colleagues33 found that 77% of a sample of 

1,186 adolescents in Mexico City reported 

perceiving sexual content in the traditional 

Camel advertisement showing a camel 

Kent tennis player Ritz couple in formal attire
149

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

next to a pyramid. This ad was judged by 

members of the Department of Research 

in Tobacco Smoking and COPD at the 

National Institute of Respiratory Diseases 

in Mexico City as having “unquestionable 

sexual content,”33(p.2018) and male adolescent 

participants perceived a naked man 

embedded in the picture of the camel.

Packaging design has also been intended 

to create specific associations and may be 

designed with an eye to circumventing 

various advertising restrictions.34

Colors are used to further the illusion of 

taste and reduced risk, with green packages 

(menthol) suggesting coolness, red 

packages suggesting full taste, and white 

packages giving the impression of low tar 

and safety while preserving satisfaction 

(see chapter 3).24,34 Mainstream brands have 

experimented with packaging that makes a 

strong lifestyle statement (see chapter 4). 

R.J. Reynolds redesigned its Winston 

packs and billboards to feature the first 

part of the name “Wins” on the front, and 

created a flask-shaped, curved pack for its 

high-tech “S-2” campaign. Kool cigarettes 

were given away in free samples and test 

markets in 2004 in a new blue and green 

Smooth Fusions pack that unfolds like a 

book and, in bar promotions, features a 

cardboard wrapper that can be reused on 

fresh packs sporting a three-dimensional 

Hip Hop DJ. Camel’s new Exotics blends 

were distributed in 2003 in flat metal and 

cardboard packs featuring flavors, colors, 

and images signifying style and innovation. 

Industry documents suggest that these 

types of changes create a brand image that 

snags the smoker’s attention in the stores, 

repeats a positive impression in the smoker’s 

mind every time a cigarette is removed, 

and creates a positive public persona that 

associates the smoker with the brand image 

whenever the pack is pulled out in public or 

laid on the countertop of a bar.34

Loyalty and Bonuses

Two additional themes have been less 

dominant but still long-standing: loyalty 

and bonuses. The first of these themes extols 

loyalty to a brand with slogans such as, 

“I’d walk a mile for a Camel,” and “I’d rather 

fight than switch.”16 Direct mail promotions 

to smokers and password-protected Web 

sites for smokers provide direct and indirect 

appeals such as coupons, gifts, and lifestyle 

magazines for the user who stays on the 

mailing list.35

The second theme offers bonuses such 

as extra cigarette length, “buy-one-getone-free” offers, coupons, and other price 

I’m More satisfied Barclay’s “The Pleasure Is Back”
150

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

promotions to smokers concerned about 

price.12,16,36 In the 1980s, a number of 

discount and generic brands of cigarettes 

emerged for price-sensitive smokers.20,37 Five 

of the six companies selling cigarettes at that 

time introduced brand extensions containing 

25 cigarettes per pack; Marlboro 25’s were 

advertised with the slogan “5 more smokes 

for the long working day.”37 In the late 

1980s and 1990s, promotional offers adding 

nontobacco “specialty items” to a pack of 

cigarettes became increasingly common38

(see also chapter 4). For example, in 1989, 

Philip Morris offered a free CD featuring 

hit songs by Tina Turner, Eddie Money, and 

Cheap Trick with the purchase of a threepack of Parliament cigarettes; CBS Records 

produced 330,000 CDs for the promotion.39

Price discounts have become the dominant 

category of promotional spending by 

cigarette companies, accounting for about 

three-quarters of cigarette advertising and 

promotional expenditures38 in 2004 and 

2005 (see also chapter 4).

Targeting of Population 

Subgroups

Although major themes are aimed at 

potential psychographic types (attributes 

relating to personality, values, attitudes, 

interests, or lifestyles), they also appeal to 

specific demographic groups that are the 

cornerstone of tobacco sales or are ripe 

for expansion. These market segments, 

described below, include groups such 

as men, women, youth, young adults, 

African Americans, and gay men.

Men

In the first decades of the 20th century, the 

leading tobacco advertising target in the 

United States was men, representing 95% 

of the market.4 Although numerous other 

market segments have arisen, men continue 

to dominate, smoking more and using 

Missing Themes: Health Hazards and Addictiveness

Two themes that tobacco companies have avoided in branded advertising are the health hazards 

and addictiveness of smoking. As discussed earlier in this chapter, specific brands of tobacco 

products have adopted marketing themes designed to assuage smokers’ health concerns, ranging 

from the overt health claims of early to mid-twentieth century advertising to the later focus on 

the implied harm reduction of low-tar and low-nicotine cigarettes.

Some tobacco manufacturers have sponsored unbranded advertising on the dangers of smoking 

and the undesirability of smoking by youth, including Philip Morris’s “Talk. They’ll listen” 

campaign aimed at parentsa and Lorillard’s youth smoking prevention campaign, “Tobacco Is 

Whacko if You’re a Teen”;b however, these messages have generally been less effective than 

those sponsored by public health authorities.c,d These programs are explored in further detail 

in chapters 11 and 12 of this monograph.

a

Fairclough, G. 2002. Study slams Philip Morris ads telling teens not to smoke: How a market researcher who 

dedicated years to cigarette sales came to create antismoking ads. Wall Street Journal, May 29.

b

Sussman, S. 2002. Tobacco industry youth tobacco prevention programming: A review. Prevention Science

3 (1): 57–67.

c

Farrelly, M. C., C. G. Healton, K. C. Davis, P. Messeri, J. C. Hersey, and M. L. Haviland. 2002. Getting to the 

truth: Evaluating national tobacco countermarketing campaigns. American Journal of Public Health 92 (6): 

901–7.

d

Wakefield, M., Y. Terry-McElrath, S. Emery, H. Saffer, F. Chaloupka, G. Szczypka, B. Flay, P. O. O’Malley, 

L. Johnston. 2006. Effect of televised, tobacco company-funded smoking prevention advertising on youth 

smoking-related beliefs, intentions and behavior. American Journal of Public Health 96 (12): 2154–60. 
151

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

more smokeless tobacco than do women 

in all demographic groups. In 2006, adult 

smoking prevalence (ages 18 and older) was 

23.9% for men and 18.0% for women.40

Much of the cigarette and smokeless 

tobacco advertising during the past several 

decades features men depicted as strong, 

powerful, macho, rugged, and independent. 

Chapter 3 describes in detail the integrated 

marketing communications used by 

Philip Morris to associate these masculine 

characteristics with the quintessential 

male brand—Marlboro. Winston cigarettes, 

according to a marketing plan for 1984, 

were aimed at males aged 18–34 years, 

and the brand was positioned “to focus 

on the key differentiating wants of 

Virile Segment smokers ... [including] 

rugged masculinity.”41(Bates no. 505415129)

David Goerlitz, who was the “Winston Man” 

in 42 advertisements in the brand’s 

“Search and Rescue” advertising series, 

has described his role in the campaign, 

which “showed myself and other young 

men hanging out of helicopters and off the 

edge of cliffs, looking rugged and healthy 

under blue skies.”42,43 In the early 1980s, 

several advertisements for Camel cigarettes 

showed men (and associated “gear”) in 

rustic scenes, with the slogan, “Where a 

man belongs.”44

Two male subgroups that have been targeted 

by tobacco advertising and promotion are 

military service members and blue-collar 

workers. Tobacco industry efforts to reach 

these groups are described below.

Military Service Members

The U.S. military includes 1.4 million active 

duty personnel stationed worldwide.45

Smoking prevalence among members 

of the military is considerably higher 

(33.8% in 2002) than the U.S. Department 

of Defense (DoD) goal of 20%.46 Smoking 

diminishes short-term troop health and 

readiness47,48 and significantly increases 

medical and training costs.49,50 At the same 

time, the military is a fertile field for tobacco 

sales because of its size, the opportunity 

to attract young men near the typical 

age of smoking uptake who fit a specific 

socioeconomic and cultural profile, and 

potential carryover of profits to civilian 

markets.51 An R.J. Reynolds marketing 

document on the “Military YAS [young 

adult smokers] Initiative” reported several 

key findings, including (1) the military 

attracts “classic downscale smoker types ... 

blue collar, less educated, high school, 

poor academic performance, limited job 

prospects, part of ‘wrong crowd,’ in trouble 

with authorities”;52(Bates no. 507358566/8567) and 

(2) “Military YAS carry brand preferences 

back into civilian market.”52(Bates no. 507358573)

Thus, soldiers were an early target audience, 

beginning in World War I, when they 

were supplied with cigarettes in massive 

numbers.4,53 During World War II, the 

Korean War, and the Vietnam War, free 

samples were a part of combat rations 

and were easily obtained at low cost from 

the commissaries on military bases. 

President Roosevelt characterized the 

product as an essential wartime material.54

Cigarettes have been advertised in 

publications targeted to military service 

members, including Army Times, Navy 

Times, and Air Force Times.37

The tobacco industry used distinctive 

promotional methods such as in-store 

tobacco merchandising, sponsorships, and 

brand development to target the military, 

both in the United States and abroad during 

times of conflict.51 For example, Joseph 

and colleagues51 found tobacco company 

documents describing unusual point-ofpurchase marketing techniques; efforts 

to target military spouses; military motor 

sport sponsorship; and carnivals, picnics, 

and “mini-war games” with company versus 

company competitions. R.J. Reynolds 

considered new brand concepts for the 

young military adult such as “rest and 
152

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

relaxation” and Double Eagles, which were 

described as “a cigarette for the younger 

adult military smoker who is looking for a 

product ... and an image which positively 

supports his decision to serve in the armed 

forces.”55 Philip Morris developed the 1776 

brand for the military market, its pack 

consisting of an embossed flag design with 

gold, red, white, and blue colors.56

Although tobacco companies in the past 

distributed free cigarettes to the military, 

the DoD stopped this practice in 1986.53

However, during Operation Desert Storm 

in October 1990, Philip Morris and Brown 

& Williamson distributed free tobacco 

products to U.S. Army soldiers stationed 

in Saudi Arabia.51 In 1990, Philip Morris 

also embarked on a “voice card” advertising 

program for Marlboro cigarettes, at a 

cost of $1 million. It was designed to get 

national coverage through USA Today and 

Newsweek magazine and was communicated 

via military base newspapers to soldiers 

stationed in Saudi Arabia. Family members 

in the United States would be provided a 

10-second voice message, recorded with a 

computer chip, to be inserted into a holiday 

greeting card from Marlboro.51 As the 

advertising explained,

To a service member stationed in the 

Gulf, what could be more appreciated 

than hearing a friendly voice from home. 

If someone you love is overseas and 

involved in Operation Desert Shield, now 

you can send them your love in a unique 

holiday card, free. It’s called Voice Card. 

And it carries your personal ten-second 

message that plays back when a button is 

pressed inside the card. Below is a list of 

military installations where you can record 

a Voice Card on November 9th, 10th, 

11th.... Your Voice Card is a holiday gift 

from Marlboro.57

The issue of tobacco promotion 

and the military came to national 

attention in relation to the conflict in 

Iraq. In a November 2004 photo essay 

for the Los Angeles Times, photographer 

Luis Sinco documented the battle of 

Fallujah.58 One picture, of the new 

“Marlboro Man,” resonated with news 

editors across the United States, and 

suddenly the photograph of Marine 

Lance Corporal James Blake Miller, a 

20-year-old “country boy” from tobaccogrowing Kentucky, was everywhere. His 

bloodied nose, smudged camouflage, and 

dangling cigarette portrait were splashed 

across the pages of hundreds of newspapers, 

and he was praised in evening television 

newscasts and in pro-war opinion pieces 

as the embodiment of the noble American 

fighting spirit.58 The New York Post,

published by Rupert Murdoch, who has sat 

on the board of directors of Philip Morris, 

placed Blake’s picture on the front page, 

with the headline, “Marlboro men kick 

butt in Fallujah.” The image provided the 

tobacco industry, especially the Marlboro 

brand, a bonanza of free publicity.

The different price structure of military 

stores (commissaries and exchanges)—

including limits on the markup of wholesale 

prices and exemptions from state and 

local taxes (including those imposed on 

tobacco products)—has permitted the sale 

The new “Marlboro Man” as depicted by 

the New York Post in November 2004
153

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

of discount cigarettes to the military.45,51

Smith and colleagues45 undertook an 

analysis of internal tobacco industry 

documents, searches of government and 

military Web sites and newspaper databases, 

and interviews with key informants to 

document why cigarettes continue to be 

sold in the military at discounted prices. 

Efforts to try to raise the price of tobacco 

products in the military began in the mid1980s, but opposition quickly emerged. 

Some military officials viewed tobacco use 

as a “right” and low prices as a “benefit.” 

Others raised issues of authority, and some 

saw the change as threatening the stores. 

Smith and colleagues concluded that the 

tobacco industry successfully exploited 

complex relationships among the Congress, 

the DoD, commissaries and exchanges, 

and private industry, obstructing change 

for more than a decade.45 They found that 

leadership from the secretary and assistant 

secretary of defense, presidential support, 

and procedural maneuvering finally resulted 

in a modest price increase in 1996 and again 

in 2001, but even then, high-level military 

officials were apparently threatened with 

retaliation from protobacco congressmen.45

The U.S. military still makes tobacco 

available at discount prices to members of 

the military.

Blue-Collar Workers (the Working 

Class)

Several themes have been used to 

capture the male market, including 

freedom, independence, success with 

women, adventure, and virility. Industry 

documents by R.J. Reynolds identify a 

critical market as the working-class “virile 

segment,” which is “younger, more male, 

less well educated and contains fewer 

blacks,”59(Bates no. 505921999) with about onethird having a moderate income under 

$25,000 and two-thirds having educational 

attainment lower than a college degree. 

Their ideal image is adventurous, geared 

for fitting in, taking risks, with lots of sex 

appeal. They would most likely smoke 

Marlboro, Camel, or Winston.60

Blue-collar workers smoke at a much 

higher rate than do white-collar workers.60

Cigarette companies reach blue-collar 

workers through advertising in magazines 

such as Field & Stream, Popular Mechanics, 

Car and Driver, Outdoor Life, Road & Track, 

Hot Rod, and Motor Trend, which in 

aggregate accounted for about 9% of total 

tobacco industry spending on magazine 

advertisements in 1994.61

Early Spokespersons—and Early Victims

Following World War II, television arose as a major cultural force in the United States, with strong 

support from cigarette manufacturers. Many shows, such as Hennessy and Topper, and stars, such as 

John Wayne, Desi Arnaz, and Ronald Reagan, were shown smoking or promoting specific products,a

creating an early theme that associated cigarettes with glamour and success.

In time, many television personalities and entertainers who promoted cigarettes or were featured 

in tobacco advertising later died from diseases—such as lung cancer and emphysema—that were 

caused by smoking. Roswell Park Cancer Institute, as part of its tobacco documents archive, 

maintains a Web site called the “Hall of Shame,”b

 detailing the deaths of celebrities such as Wayne 

and Arnaz, and tobacco advertising pitchmen such as Nat King Cole and Ed Sullivan, that were 

caused by smoking.

a

Ingram, B. 2004. Video vault: Cigarette advertising on TV. http://www.tvparty.com/vaultcomcig.html.

b

Roswell Park Cancer Institute. 2006. Tobacco Industry Hall of Shame: Once shining stars snuffed out by 

tobacco and smoking-caused illnesses. http://roswell.tobaccodocuments.org/hall_of_shame.htm.
154

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

The working class can be reached through 

other media as well. An R.J. Reynolds 

spokesperson was quoted in Business Week

as follows:

Blue-collar people read the sports pages, 

and we will make every effort to place 

Winston in newspapers. We also know 

that they’re impressed with out-of-home 

advertising because that gives them 

comfort when they see their brand in 

the marketplace.62(p.52)

The marketing of a cigarette brand aimed at 

blue-collar women (Dakota) is described in 

the following section, “Women.”

Some of the most popular male-oriented 

campaigns have combined the ideals 

identified by R.J. Reynolds (adventurous, 

geared for fitting in, taking risks, and 

lots of sex appeal) into an image of a selfreliant, rugged, and independent male 

using a seemingly full-flavored tobacco. 

This approach is found in the Marlboro 

cowboy, the Camel Turk, the Copenhagen 

bull-riding champion, the Player 

weekend sports adventurer, and others. 

For example, Imperial Tobacco positioned 

Players cigarettes to convey a man “free 

to choose friends, music, clothes, own 

activities, to be alone if he wishes,” but 

not lonely, and self-reliant with “nobody 

to interfere.”63(Bates no. 689451814) The male 

smoker is autonomous, accepted, athletic, 

and admired.4

Advertisements tended to show men in a 

man’s world, according to the Federal Trade 

Commission analysis of advertisements in 

1967. This report found that women are 

generally excluded unless they are attracted 

to the man or willing to be a member 

of the gang. “Men who are men are not 

reticent about being liked by women,” 

the report states, offering examples such 

as the Pall Mall advertisements including 

a close-up of a woman who is won over by 

a man who might offer her this brand of 

cigarettes.64(pp.14–15)

This image of a man’s world is carried 

out in advertising campaigns aimed 

predominantly at male consumers. USST 

captured this image on a Web site featured 

in a Copenhagen advertisement in Playboy

magazine in 2004. The Web site for adults65

leads to a video called The Spirit and 

Tradition of Copenhagen, in which a folksy 

announcer states, “And just like the men 

who use it, Copenhagen is committed 

to being the best. That’s the spirit of a 

man, the spirit of America, the spirit and 

tradition of Copenhagen.” The background 

imagery rotates among pictures of men 

engaged in repairing oil rigs, logging, 

working in construction, welding, racing 

cars, riding bulls, and hunting deer, with 

frequent breakaway images of these men 

sampling tobacco.

Sports sponsorship provides additional 

opportunities to pair tobacco with imagery 

that would appeal to men and to sign 

up attendees for compelling direct mail 

promotions (see chapter 6 for a further 

discussion of tobacco sponsorship). In 2001, 

tobacco sponsorship included Winston’s 

association with the National Association 

World Champion All-Around 

Cowboy Ty Murray states, 

“The three priorities in my life 

are my horse, my rope and my 

Copenhagen. But not necessarily 

in that order.”
155

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

of Stock Car Auto Racing (NASCAR);*

Skoal racing teams at National Hot Rod 

Association (NHRA) events; the Players, 

Kool, and Marlboro teams at Championship 

Auto Racing; and Copenhagen booths at 

PRCA and professional bull-riding events.10

All of these activities appeal to a large 

and loyal fan base dominated by white 

males. In both the cowboy and the racing 

imagery, the independent male has been a 

heroic figure.66(p.179)

Women

Tobacco marketing to women was launched 

in the 1920s with campaign messages 

that resonate in advertisements for 

women today. American Tobacco urged 

women to “Reach for a Lucky instead 

of a sweet,” playing directly to concerns 

about body weight.67,68(p.267) During this 

same era, the company represented 

cigarettes as “symbols of freedom” and 

organized a display of several women 

walking and smoking their “torches of 

freedom” in New York’s Easter parade.69(p.386)

Leo Burnett combined the two women’s 

themes of weight control and liberty in 

the 1960s with the launch of the decadeslong campaign, “You’ve Come a Long Way, 

Baby,” pairing Virginia Slims cigarettes 

with stereotypes of thin, capable, and 

independent women.68 Direct mail materials 

for women continue these themes, 

exemplified by the magazine All Woman,

which is produced for Virginia Slims 

users of all ages. In a content analysis of 

Virginia Slims advertisements from 1970 

to 1996, Boyd and colleagues68 found a 

consistent emphasis on values of beauty, 

independence, and sexual desirability, and 

on the message that thinness was a link 

between tobacco use and success.

The 1970s and 1980s saw the advent of 

a succession of brands aimed at women, 

including Kim and Eve—and in the 1990s, 

Satin—with packaging that featured 

sophistication and femininity, such as 

designs on the cigarette, softer or pastel 

colors, and long slim packs.34 Eve cigarettes, 

for example, had a feminine floral design 

on the paper with the advertising caption, 

“Farewell to the ugly cigarette. Smoke 

pretty. Eve.”70(Bates no. 03375509) Marketed during 

the 1990s, Capri was the first “ultra-slim 

cigarette” whose advertising attempted to 

tap the need of busy women to indulge in 

an escapist fantasy.71 Satin cigarettes urged 

women to spoil themselves with satin and 

offered a satin pouch in which to carry the 

pack.71,72 Ritz, billed as the first “designer 

cigarette,” bore the logo of the fashion 

designer Yves Saint Laurent on its package 

and filter tip.37 However, these women’s 

brands represent only 5% to 10% of the 

market, with most female smokers selecting 

brands, such as Marlboro, that appeal to a 

wide array of audiences.73

Many of the women’s brands have been 

marketed with promotional strategies that 

have been used more and more heavily 

by cigarette companies (see chapter 4). 

Beginning in 1971, Virginia Slims was 

marketed aggressively for many years 

through sponsorship of professional 

women’s tennis tournaments, and in later 

years, through the “V Wear” catalog of 

clothing and accessories.72 Empty packs 

of Eve Lights were redeemable for a free 

pair of Silkies panty hose or a discounted 

Anne Rothschild chemise.37 During the 

introduction of Newport Slim Lights, which 

was targeted to women as an extension of 

the gender-neutral brand Newport, a free 

package of Aziza eye shadow came with the 

purchase of two packs of cigarettes.74

Women represented a growth market 

for tobacco companies for decades in the 

United States and, later, worldwide. In 1990, 

an editorial in the Tobacco Reporter reflected 

this interest: “Women are becoming more 

*

Winston withdrew sponsorship in 2003, and the event is now called the Sprint Cup.
156

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

independent and, consequently, adopting 

less traditional lifestyles. One symbol of 

their newly discovered freedom may well 

be cigarettes.”75

Several other themes, in addition to 

those listed above, have characterized 

campaigns aimed at women, including 

glamour, fashion or style, sophistication, 

and romance. In the 1930s and for decades 

afterwards, Chesterfield advertisements 

linked smoking to glamour, featuring 

Hollywood stars such as Rita Hayworth, 

Betty Grable, and Dorothy Lamour, while 

Camel cigarettes were endorsed in the 1950s 

by Joan Crawford.72 In the 1980s, Salem 

used imagery filled with springtime softness 

and romance to appeal to women and to 

convey the freshness of menthol. Later 

imagery in cigarette advertisements directed 

at women emphasized slimness, equality, 

and independence, along with attractiveness, 

social success, style, romance, and sassiness. 

These separate themes are often united 

by an overarching concern with self-image, 

acceptance, and independence.72

A series of campaigns aimed at blue-collar 

women and less-educated women, including 

R.J. Reynolds’s Dakota and Camel cigarette 

campaigns, has taken a different direction. 

Both Philip Morris and R.J. Reynolds 

consider the blue-collar market, both 

men and women, to be critical.60 Dakota, 

introduced around 1990, was designed 

to appeal to young adult, less educated, 

“virile females” who appreciate traditional 

“masculine” values such as independence 

and self-control, who might work in 

service or factory jobs, and who might 

otherwise smoke Marlboro cigarettes.72,73,76

The campaign was pulled after protests 

by antitobacco advocacy groups and poor 

performance in test marketing.72 Camel 

cigarettes have featured a female Joe Camel 

and branded merchandise products for 

women, offered in exchange for Camel Cash 

coupons. Doral has also stepped in with a 

campaign aimed at gutsy, edgy, but also 

fashion-loving women. Winston and 

Marlboro have been the main brand 

sponsors of automobile sports in the 1990s, 

with women representing a large portion, 

though not majority, of this fan base.72

Many campaigns specifically aimed at 

women downplay or avoid health issues, 

reserving those messages for campaigns 

targeting concerned smokers (who happen 

to be predominantly female; see discussion 

in the section, “Concerned Smokers”). 

For decades after the first fears of lung 

cancer emerged in the 1950s, there was a 

quiet emphasis on images showing health, 

vitality, sexiness, and attractiveness, while 

text receded in importance.77 Women’s 

magazines that relied heavily on cigarette 

advertising revenues were found to be less 

likely to carry articles about the health 

hazards of tobacco (see chapter 9),67,77 and 

tobacco company direct mail magazines 

such as All Woman and Flair (see section 

above on “Segmentation, Tailoring, and 

Targeting”) tout a healthy lifestyle despite 

the association with smoking.78

Women were recognized by tobacco 

companies as the first and primary market 

for menthol cigarettes in the United States 

during the 1950s and 1960s, and were 

targeted with early advertising images that 

associated menthol with gentle outdoor 

scenes, romance, and springtime. Since that 

time, women have been one of the most 

significant demographic groups (in addition 

to African Americans) among the 25% of 

smokers who use menthol cigarettes.29

The American Council on Science 

and Health (ACSH)79 examined the 

publication of smoking-related content 

during 2001 and 2002 in 15 magazines, 

most of which are targeted to women: 

Cosmopolitan, Elle, Family Circle, Glamour, 

Good Housekeeping, Harper’s Bazaar, 

Health, Ladies’ Home Journal, Prevention, 

Reader’s Digest, Redbook, Self, Shape, 

Vogue, and Woman’s Day. Material evaluated 
157

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

included articles primarily about smoking, 

references to negative effects of smoking, 

references that portrayed smoking in 

a positive fashion, and advertisements 

(either for cigarettes or by antismoking 

campaigns). The study found that 390 pages 

of cigarette advertisements appeared in 

these magazines during the two years, 

ranging from 0 for six of the magazines to 

13 for Family Circle. Among nine magazines 

studied by ACSH in both 1981 and 2001, 

cigarette advertising decreased from more 

than 1,300 pages in 1981 to 210 pages in 

2001. Among 10 magazines studied by 

ACSH in 1997–98, 1999–2000, and 2001–02, 

the numbers of cigarette advertising pages 

per issue were 2.9, 4.3, and 1.5, respectively, 

for this period. Despite the decrease in 

the volume of cigarette advertising in 

these magazines over time, due in part to 

the Master Settlement Agreement (MSA) 

(see chapter 3), ACSH noted that the nine 

magazines carrying cigarette advertising in 

2001–02 published 390 pages of cigarette 

ads but only four antismoking articles with 

a minimum of one full page of text.79

Rosenberg and Siegel80 conducted a 

comprehensive study of tobacco company 

sponsorships during the period 1995–99. 

They identified 2,733 tobacco-sponsored 

events, programs, and organizations in the 

United States, involving all 50 states, with 

total tobacco company funding exceeding 

$365 million. Those sponsorships included 

33 events, programs, or organizations 

related to women, for which the tobacco 

industry’s total financial support exceeded 

$4.0 million. The individual events, 

programs, and organizations are listed in 

a detailed report by Siegel.81

Youth

It has been documented that male- and 

female-targeted marketing campaigns 

initially influenced young smokers of 

each sex.82 The battle among the tobacco 

corporations for the youth market in 

particular has been fierce because of the 

industry’s recognition that most smokers 

do not change brands once they have settled 

on a first steady choice.4 Despite tobacco 

industry claims that it does not market to 

youth, the corporations’ own documents 

reveal decades of research and development 

of strategic plans designed to capture the 

youth market. The industry conducted survey 

and focus group research into the smoking 

behavior of teenagers, developed highly 

competitive marketing proposals, designed 

products that eliminated harsh taste, 

featured coded words such as “smooth” and 

“mild,” tailored the packaging, and coupled 

lower prices with value-added promotions; 

all of these were features intended to appeal 

to beginning smokers.4,5,83 To recruit starters, 

brand images communicated independence, 

freedom, and sometimes peer acceptance.4

These advertising images portrayed 

smokers as attractive and autonomous, 

accepted and admired, athletic, and at 

home in nature.

Along with tailored messages and packaging, 

communication channels have also been 

used to deploy brand messages and images 

to high numbers of youth in locations 

that can catch their attention and aid in 

the association of the brand with fun or 

a certain lifestyle.83 From 1960 to 1966, 

the Flintstones television cartoon featured 

the lead characters smoking Winston 

cigarettes during the closing commercials.84

Magazines carried tobacco advertising 

that reached large numbers of youth. 

In an analysis of tobacco advertising in 

magazines, the brands that were most 

popular among adolescents were more likely 

than brands popular with adults to run in 

magazines with high youth readerships.85,86

Sports and entertainment magazines 

with high youth readership, such as 

Sports Illustrated and Rolling Stone, have 

been a mainstay of tobacco advertising, with 

reductions following the advent of the MSA 

of 1998, which restricted marketing 

to youth.86 Chapters 4 and 10 provide 
158

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

greater detail on advertising in magazines, 

tobacco product placement, and portrayal 

of smoking in movies.

The MSA banned tobacco billboards, which 

were another channel (if not the leading 

one) that reached large numbers of youth. 

In an analysis of billboard expenditures 

and related business documents in 1998, 

Davis87 concluded that tobacco companies 

dominated outdoor advertising in locations 

where people live and shop, and that the 

billboards were highly visible, difficult to 

ignore, and a leading source of tobacco 

advertising exposure among youth. Point-ofpurchase marketing is also an effective way 

to reach youth who are frequent visitors to 

convenience stores.88

Sports sponsorship in communities and 

on television has permitted Winston, 

Marlboro, Copenhagen, and Skoal to reach 

large numbers of youth and young adults 

in settings that facilitate sampling and 

promotions and to associate the brands with 

the allure of racing and rodeo heroes.9,10,89

Tobacco-sponsored adult-only sampling 

booths at these events are restricted to 

adults but create appealing and sometimes 

mysterious exhibits with large exterior wall 

space for brand advertisements (see the 

Copenhagen booth), along with the added 

value of being a “forbidden fruit” restricted 

to adult smokers. Automobile racing, 

motorcycle racing, and rodeo themes 

continue to resonate through all levels 

and locations of brand advertising and 

promotions for Winston, Players, Marlboro, 

Copenhagen, and Skoal. NASCAR, in 

particular, has gained additional leverage with 

youth through its non–tobacco-sponsored 

promotions to youth in toy stores, on cereal 

and chip packages, in fast food “kiddie” meals, 

and on Saturday morning television.9,10

R.J. Reynolds’s Camel campaign is a good 

example of what a carefully targeted 

and tailored campaign can achieve in 

the population for which it is designed. 

When the cartoon character Smooth 

Joe Camel was introduced in 1988, Camel 

cigarettes had been most popular among 

men over the age of 65 and had just 0.5% of 

the youth market.90 By 1991, its share in the 

youth market increased sharply to 32.8%, 

and recognition of the cartoon character was 

greater among youth than among adults.91

As a cartoon character, Joe had an obvious 

appeal to children, but the product also had 

sugar added to the tobacco, and the word 

“smooth” in the message played on the 

interest of potential smokers unused to the 

harshness of cigarettes.83,92

Perhaps in response to the success 

of Joe Camel (who was “retired” by 

R.J. Reynolds in 1997 in the midst of 

public and legal attacks on the campaign), 

Brown & Williamson test-marketed a 

modern youth-oriented version of the 

cartoon advertising model “Willy the 

Penguin” for its Kool cigarette brand 

in 1991. Willy was described as having 

“the biceps of Hulk Hogan, a Vanilla Ice 

hairdo, Spike Lee high top sneakers, and a 

Bart Simpson attitude.”93(p.133)

The smoother, milder taste of menthol 

cigarettes also appeals as a starter cigarette 

for youth, used by close to one-half of 

middle school students who smoked in 

1999. The tobacco companies were aware of 

this tendency, according to a Philip Morris 

tracking study that reported that Newport 

had the youngest franchise of any cigarette 

brand in 1984, with more than one-half of 

its smokers under age 24. The message in 

menthol-related advertisements at that time 

and since has stressed “cool” lifestyles and 

young people having lots of fun together, 

both important themes for youth and 

young adults.29,83

Skoal Bandits, a smokeless tobacco product 

consisting of moist snuff packaged in teabaglike pouches, is another youth-targeted 

starter brand. The lower pH of the snuff in 

this product decreases nicotine absorption 
159

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

in the mouth and therefore reduces the 

harshness of the taste for the new user.94,95

The pouch avoids the “messiness” of 

loose tobacco in the mouth, which also 

facilitates use among young initiates. 

Industry documents describe a “graduation 

process” in which youth begin smokeless 

tobacco use with Skoal Bandits, and then, 

after developing tolerance to the modest 

bioavailability of its nicotine content, 

they graduate to higher nicotine brands. 

Marketing activities have targeted college 

students (on campuses and at warm-weather 

student vacation sites), and advertisements 

have provided instructions on how to use 

the products.96

The most successful campaign among 

youth has been the long-standing Marlboro 

man. While the western imagery, cowboys, 

and horses would appeal to the youngest 

child, this campaign features the themes of 

independence and freedom from authority—

both messages that address important issues 

for adolescents.4,83

These three cigarette brands (Marlboro, 

Newport, and Camel) and their evolving 

imagery continue to be popular among 

children. Marlboro is the leading choice 

of teens, used by 48.0% of smokers in this 

age group, followed by Newport (23.2%) 

and Camel (10.1%), according to the 2005 

National Survey on Drug Use and Health.97

Rosenberg and Siegel,80 in their study of 

tobacco company sponsorships during 

the period 1995–99 (described above), 

identified 11 tobacco-sponsored events, 

programs, or organizations related to 

youth, with the tobacco industry’s total 

financial support exceeding $8.8 million. 

The individual events, programs, and 

organizations are listed in a detailed report 

authored by Siegel.81

Chapter 7 reviews other evidence that youth 

are exposed to, and affected by, tobacco 

advertising and promotion.

Young Adults

In the late 1970s, the term young adult

began to replace terms such as youth and 

young smoker in the tobacco industry’s 

internal documents. Cummings and 

colleagues concluded that this shift was 

in part an effort by the tobacco industry 

to dodge claims that tobacco marketing 

targeted youth, despite stated plans to 

promote cigarettes near high schools and 

other youth-oriented locations.83 Young 

adult was more than simply a euphemism 

for youth. There has been keen tobacco 

industry interest in the 18- to 25-year-old 

target population because this age range is 

a time of transition and experimentation 

and because most new smokers stay with 

the brand they first use regularly.4,98,99

There is even an acronym found in tobacco 

industry documents—FUBYAS—that refers 

to young adult smokers who are choosing 

their first usual brand.60 A successful 

tobacco brand must attract young smokers 

who will ideally (from the manufacturer’s 

perspective) go through a series of stages 

leading from experimentation, to loyalty 

to a particular brand, to increased 

consumption as they age and become 

mature smokers.100,101 Because every day 

approximately 4,000 adolescents between 

the ages of 12 and 17 initiate cigarette 

smoking,102 the early years are critically 

important in helping young adult smokers 

settle on a brand for life, thus helping 

tobacco companies gain total brand share.

Tobacco marketing has been aimed at 

“tunnels of influence” through which 

young adults travel frequently and in which 

they are experimenting and experiencing 

changes in their lives, such as colleges, 

fraternities, bars, and the military.100

Bars have been identified as locations in 

which young adults are open to trying 

new things, influenced by friends and 

alcohol, receptive to tobacco marketing, 

and thinking mainly about having a good 

time.98,100 In a survey of 10,904 students 
160

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

enrolled in 119 nationally representative 

four-year colleges and universities during 

the 2000–2001 school year, Rigotti and 

colleagues103 found that 8.5% of respondents 

had attended a bar, nightclub, or campus 

social event where free cigarettes were 

distributed. Tobacco sponsorship of 

promotions at urban bars appears to have 

risen in the 1990s.104

Coupled with restrictions on tobacco 

marketing in locations accessible to youth, 

tobacco companies are using bars for a 

variety of promotions. In the first six months 

of 2004, more than 10,000 tobacco-sponsored 

bar nights were announced in California, 

many representing locations where the 

marketing staff would stop for a few minutes 

to see if any potential smokers might be 

interested in a free sample.105 In some 

cases, these promotional methods are used 

surreptitiously (i.e., without disclosure of 

the corporate sponsorship). This is referred 

to as “stealth marketing,” “buzz marketing,” 

or “undercover marketing,”106 a subject 

discussed in more detail in chapter 4.107

Tobacco promotions have also occurred at 

sponsored racing and rodeo events, with 

booths restricted to adults. The event could 

be corporate sponsored, such as Supercross 

motorcycle racing and professional 

rodeos (with USST sponsorship), or brand 

sponsored, such as NHRA racing (with 

Skoal sponsorship). In both cases, Skoal 

and/or Copenhagen booths (see page 144 

for an example) can pass out promotional 

literature, coupons, and even free samples, 

as long as distribution is restricted to adults. 

At these types of events, there is a large 

young adult population.9,10

Industry documents reveal that music, 

sports, and social activities are important 

environments for young adults and can 

help associate smoking with a fun, normal 

adult life.100 Because the number of smokers 

in this age group far exceeds the number 

under the age of 18, growth in marketing 

aimed at this critical target population is 

likely to occur.

Racial and Ethnic Populations

Racial and ethnic populations in the 

United States represent a wide array of 

opportunities for growth in sales of tobacco 

products as well as support from community 

leaders for industry legislative initiatives. 

Prevalence of tobacco use among some of 

these populations is higher than among 

the general population, and quit rates are 

lower.108,109 These characteristics make 

racial and ethnic groups attractive targets of 

tobacco marketing, as described below.

African Americans

Tobacco advertising and promotion to 

African Americans have been marked by 

special products, imagery, themes, and 

locations designed to reach and appeal to 

black audiences. Around 1900, the American 

Tobacco Company advertised Bull Durham 

smoking tobacco with the caricatured images 

of blacks that were commonly used in that 

era. In the final decades of the 20th century, 

before the MSA banned cigarette billboards, 

several studies found disproportionately high 

rates of cigarette advertisements on billboards 

in predominantly African-American urban 

areas.87,110,111(p.221) Tobacco companies have run 

American Tobacco Company advertisement for 

Bull Durham tobacco
161

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

advertisements in predominantly AfricanAmerican publications since the 1940s, when 

Philip Morris first recognized the significance 

of this market.112 In a comparison of cigarette 

advertisements in Life and Ebony magazines 

from 1950 to 1965, Pollay and colleagues3

found more athlete endorsements, fewer 

brands, and a later introduction of filtered 

products in Ebony than in Life. They also 

found that the models and spokespersons in 

Ebony were predominantly black.

Special tobacco products, mostly menthols, 

were developed and promoted originally 

to women and then increasingly to 

African Americans.113 A senior marketing 

official of R.J. Reynolds stated, in a speech 

in 1988, that, “Where menthol smokers 

make up only 29 percent of the general 

market, almost 70 percent of Black smokers 

choose a menthol brand. That’s why special 

advertising and promotions for Salem 

cigarettes make a lot of sense in Black media 

and Black communities.”114(Bates no. 507714730)

Brown & Williamson, along with other 

companies, has been proactive in 

advertising to African-American men by 

using darker-skinned models, language 

associated with the black experience, and 

masculine imagery, which resulted in 

Kool’s becoming the top-selling cigarette 

in this population in 1969.29 An example 

from 2004 of this approach is Brown & 

Williamson’s Kool Mixx DJ campaign via 

bars, featuring DJ competitions and tobacco 

samples, special lighters with a green flame 

that matches the color of a Kool cigarette 

package, a CD with hip-hop music with the 

Kool brand on the outside, and a copy of 

VIBE magazine. Similar promotions ran in 

retail outlets and magazines (see Newport’s 

“Full of Pleasure!” menthol cigarette 

advertisement, page 147).11 This campaign 

sparked a protest among multiple groups in 

the United States. When observations were 

conducted by tobacco control advocates 

in bars in southern California, materials 

from a Kool bar night were collected, 

including Kool bar napkins, a lighter with 

a green flame, packs of Kool cigarettes, 

coupons, and a Kool Mixx plastic bag. 

These materials served as evidence that 

permitted court actions in three states to 

halt distribution of some of the promotional 

items (California Department of Justice, 

Standing Up to Targeted Marketing—the Uptown Protest

One product designed to be promoted to African Americans, Uptown cigarettes, was developed 

by R.J. Reynolds in 1990 to be test-marketed in Philadelphia. It was intended to compete with 

Newport (Lorillard), which had an 80% share of the young adult African-American market. 

Package design and colors were tested with this market in mind, with tar and nicotine levels 

that were higher than in most other menthol brands. While Newport advertising portrayed a 

fun, stylish, mainstream sensibility, Uptown focused more on status, style, and premium quality. 

Both brands drew on urban nightlife and music themes. African-American community groups 

organized a coalition to oppose this introduction of Uptown, forcing R.J. Reynolds to withdraw 

the planned product launch.a,b Although this achievement was significant and brought national 

attention to tobacco targeting practices, it did not deter R.J. Reynolds from using many of the 

Uptown marketing strategies to promote its other menthol products, such as themes focused on 

urban nightlife, and the use of escape or fantasy settings in its advertisements.a

a

Balbach, E. D., R. J. Gasior, and E. M. Barbeau. 2003. R.J. Reynolds’ targeting of African Americans: 

1988–2000. American Journal of Public Health 93 (5): 822–27.

b

Sutton, C. D., and R. G. Robinson. 2004. The marketing of menthol cigarettes in the United States: 

Populations, messages, and channels. Nicotine & Tobacco Research 6 Suppl. 1: S83–S91.
162

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

e-mail correspondence to Tess Boley Cruz, 

June 2004).

African-American opposition to targeted 

tobacco advertising has been loud and 

visible in the Kool Mixx and Uptown 

protests. However, much opposition to the 

industry’s practices has been countered by 

corporate giving to pivotal community and 

arts groups, education scholarships, fashion 

shows, career fairs, and appointments in 

the top ranks and board rooms of the major 

tobacco corporations.3,15,112 Black publishers 

have been the recipients of special events 

and awards, along with substantial tobacco 

advertising revenues. Black opinion leaders 

have been courted and enlisted as allies 

to defuse antitobacco efforts from within 

and outside their communities and as a 

frontline force to advance the industry’s 

positions.112 Philip Morris could claim that it 

supported the African-American community 

by purchasing advertising space in black 

publications, hiring and promoting AfricanAmerican models, promoting diversity hiring 

and employee retention, and supporting 

African-American organizations.115

Rosenberg and Siegel,80 in their study of 

tobacco company sponsorships during the 

period 1995–99 (described above), identified 

78 tobacco-sponsored events, programs, 

or organizations related to minorities, 

with the tobacco industry’s total financial 

support exceeding $2.0 million. Fourteen 

of the sponsorships appear in the category 

“Minorities—African American.”81

Hispanics

A similar pattern of concentrated magazine 

advertising, development of special brands, 

and support for community leaders can be 

found in both the African American and 

Hispanic populations.

As early as 1979, Brown & Williamson had 

produced a report on the Hispanic market, 

followed by a series of similar reports by 

Philip Morris. An investigation of tobacco 

industry documents116 describes their 

recommendations. The reports reflect a 

clear grasp of the regional differences, 

cultural festivals, and business leadership 

groups available for special promotions. 

For example, the “1994 Marlboro Hispanic 

Marketing Plan” by Philip Morris identified 

the largest Cinco de Mayo events in the 

nation for promotions that would lead to 

the collection of names for the corporation’s 

direct mail databases, resulting in more 

than 90,000 names generated.117 The main 

target was development of Marlboro brand 

loyalty among young adult males, followed 

by young adult females, primarily through 

retail visibility and coupon catalogues. The 

corporation recognized that automobile 

racing was a popular sport among Hispanics, 

so they used this theme in stores and through 

direct mail, along with the Marlboro music 

shows at cultural festivals and fairs. The other 

prominent tobacco advertising themes 

identified in industry documents were quality 

(Viceroy and Marlboro), fun and sociable 

occasions (Newport), and authenticity 

(Winston). The concept of low cost was 

equated with low quality, and therefore to be 

avoided. The reports by Philip Morris and by 

R.J. Reynolds show a preoccupation with the 

Spanish-speaking smoker, in some cases with 

special efforts directed to the border area. 

Lorillard’s Newport was similarly promoted 

to young Spanish-speaking smokers in 

an effort to capture the Hispanic menthol 

market, using advertising that emphasized 

sociability and fun (see “Full of Pleasure!” 

advertisement, page 147).

Philip Morris, with its specially targeted 

brand Rio in the 1960s, its advertising for 

Marlboro and Virginia Slims, and its public 

relations campaigns, has been the leading 

advertiser to Hispanics.3,111(p.220) In 1999, 

Philip Morris launched a new Virginia Slims 

campaign that seemed aimed at several 

ethnic women’s populations, including 

whites, Hispanics, African Americans, 

and Asian Americans, with the slogan, 
163

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

“Find Your Voice,” suggesting that each 

woman uphold her own unique form of 

expression.111 The advertisements ran in 

women’s magazines and were delivered 

in direct mail to smokers. Some of these 

advertisements were in Spanish in Spanishlanguage magazines. This campaign 

produced a united response among several 

ethnic networks and women’s organizations 

nationwide. However, the protest was not 

completely successful, and the campaign 

lasted through 2002.

Both Philip Morris and R.J. Reynolds 

used various methods, including financial 

support of groups and events; donations; 

recognition of Hispanic leaders, publishers, 

and politicians; and participation of industry 

staff on community and arts boards. Many 

business alliances, such as the Hispanic 

Chambers of Commerce, from the national 

to local levels, received support from 

R.J. Reynolds. The Cinco de Mayo festivals, 

supported first through Marlboro-brand 

sponsorships and then through Philip Morris 

support, reached out to leaders as well as 

to potential consumers. The industry lent 

its support to these groups to encourage 

opposition to tobacco regulations, taxes, 

and legislation, as well as to gain access to 

grassroots movements that would be willing 

to convey the industry’s message and to gain 

goodwill for its political agenda (Bialous, 

Cruz, and Baezconde-Garbanati unpublished 

manuscript).9,10,14

Rosenberg and Siegel,80 in their study of 

tobacco company sponsorships during the 

period 1995–99 (described above), identified 

78 tobacco-sponsored events, programs, 

or organizations related to minorities. 

At least 14 of the sponsorships are related 

to Hispanics81 and include support for 

dance companies, theater groups, ethnic 

festivals, an art exposition, conferences, 

and leadership development.

Asian Americans and Pacific Islanders

There has been relatively little research about 

tobacco marketing aimed at Asian Americans 

and Pacific Islanders. Billboards and stores 

in predominantly urban Asian American 

communities have been found to carry more 

tobacco advertising compared with other 

urban neighborhoods and to be less likely 

to carry health warnings compared with 

white neighborhoods.111

Rosenberg and Siegel,80 in their study of 

tobacco company sponsorships during 

the period 1995–99 (described above), 

found at least three sponsorships related 

to Asian Americans. These sponsorships 

provided support for the Asian American 

Expo (in El Monte, California), dinners held 

by the Congressional Asian Pacific American 

Caucus in association with presidential 

inaugural activities, and publication of 

a directory of Asian Pacific American 

organizations.81

Investigations of tobacco industry 

documents provide additional information. 

Beginning in the 1980s, four major tobacco 

corporations commissioned reports on the 

marketing possibilities in the Asian American 

population groups and found promise of 

growth markets because of high population 

growth, high smoking rates in countries 

“Find Your Voice” campaign for Virginia 

Slims in Buen Hogar Magazine, 2002
164

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

of origin, increasing consumer power, and 

high brand loyalty to American products 

as a way to assimilate. In addition, the 

majority of convenience store owners in key 

locations were Asian Americans, making 

them an important group to cultivate. 

The heterogeneity of the various population 

groups and the lack of well-developed 

Asian American media, however, were 

barriers to market expansion.118

Philip Morris developed a three-pronged 

strategy to deal with these issues. First, the 

“push” strategy would promote trade 

relations with Asian American business 

owners through cultural sensitivity training 

of Philip Morris sales staff, promoting 

special retail sales materials, and special 

business-to-business programs involving 

support of business associations. Second, the 

“pull” strategy would involve marketing to 

consumers with special promotions, events 

such as exhibition of a Marlboro race car and 

promotions during the Chinese New Year, 

and tailored advertising materials. One of 

the themes that emerged as important 

was upward mobility associated with 

smoking. The third strategy was corporate 

goodwill, which was sought by supporting 

organizations such as political groups, 

women’s organizations, arts and culture 

groups, senior centers, and food banks. 

R.J. Reynolds and Brown & Williamson 

used similar approaches.118

The types of products promoted are less clear. 

However, there is a high rate of menthol 

cigarette use in some Asian countries and 

among Asian American youth smokers, 

second only to African Americans.29

In 1990, Japan Tobacco Inc. began advertising 

Japan’s best-selling Mild 7 cigarette brand on 

billboards in the Koreatown and Little Tokyo 

areas of Los Angeles. Mild 7 packages were 

stacked in displays in restaurants and 

stores. Retailers reported that demand for 

the cigarettes was strong. The marketing 

manager at JATICO, Japan Tobacco’s U.S. 

arm, stated that the brand, although 

originally imported for Japanese tourists, 

was also wanted by Asian Americans.119

In 2004, R.J. Reynolds began a national 

advertising campaign for a new Camel brand 

named Kauai Kolada. The advertisements, 

which appeared in several magazines, 

including Time, Sports Illustrated, People,

and Stuff, featured a hula girl promoting the 

pineapple- and coconut-flavored cigarette. 

Although the campaign used Hawaiian 

imagery, it was likely aimed at a much 

broader audience. Kauai residents, tobacco 

control advocates, the governor of Hawaii, 

and the mayor of Kauai criticized the 

campaign for being culturally insensitive 

and using Hawaiian images and the name 

of Kauai to market cigarettes to young 

people.120–122 “I am appalled that this company 

has chosen to use the Kauai name to market 

a product that kills,” said Kauai Mayor 

Bryan Baptiste. “The word ‘Kauai’ is not just 

the name of our home. It is representative of 

our culture and our community.”123

American Indians and Alaska Natives

Despite relatively high rates of tobacco 

use compared with the general 

R.J. Reynolds Tobacco Company 

advertisement for Kauai Kolada 

variant of Camel cigarettes
165

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

population,111,124 there is almost no 

published literature on tobacco marketing 

to American Indians or Alaska Natives. 

A study by Hodge and colleagues125

found that among 1,000 internet sites 

selling tobacco, 52 were identified as 

American Indian sites, with 77% of these 

sites owned by American Indians. These 

types of tobacco sales outlets provide 

colorful and appealing advertisements, 

easily accessible products, and very low 

costs. In turn, the individual and tribal 

owners reap profits that may blunt 

opposition to or critical awareness of the 

negative effects of tobacco use among 

American Indians.

There are limited examples of cigarette 

advertisements that have featured either 

American Indian themes or images. 

For example, American Spirit cigarettes 

liberally use traditional imagery in all their 

product and promotional materials and 

provide support for the arts in New Mexico. 

Joe Camel once sported an American Indian 

eagle feather headdress.126

There have also been some efforts by 

Philip Morris to fund American Indian 

leaders, causes, and community groups. 

Rosenberg and Siegel,80 in their study of 

tobacco company sponsorships during 

the period 1995–99 (described above), 

identified 78 tobacco-sponsored events, 

programs, or organizations related to 

minorities. Six of the sponsorships are 

related to American Indians.81 These 

gifts, each from Philip Morris, went 

to the American Indian College Fund, 

Dull Knife Memorial College, First Nations 

Development Institute (to alleviate 

hunger in Native American communities), 

Joslyn Art Museum (to support an exhibit 

of drawings by Plains Indians), Red Earth 

Native American Cultural Festival, 

and teacher development programs at 

tribal colleges. However, there is no 

documentation as yet of clear and persistent 

targeting of American Indians.

Lesbian, Gay, Bisexual, and 

Transgender Populations

Advertising aimed at lesbian, gay, bisexual, 

and transgender (LGBT) populations initially 

was largely covert, coded to be sexually 

ambiguous in ways that would resonate with 

gay audiences and avoid charges of blatant 

targeting. For example, a Virginia Slims 

advertisement in the early 1990s featured a 

man and a woman walking together while the 

woman looked over her shoulder at a woman 

behind her. The caption, “If you always 

follow the straight and narrow, you’ll never 

know what’s around the corner,” contains 

language that could be read two different 

ways by straight women and lesbians.127(p.66)

An ad for Montclair cigarettes (c. 1991) 

featured a male model who, according to 

the Detroit News, “looked to many like an 

aging, effeminate homosexual—captain’s 

cap on head, pinky ring (no marriage ring), 

dapper ascot—shrieking in pleasure over 

his cigarette.”128(p.158)

Industry documents reveal another covert 

effort called Project SCUM (subculture urban 

marketing), developed by R.J. Reynolds to 

market Camel and Red Kamel to “consumer 

subcultures” in the San Francisco area 

between 1995 and 1997. The special targets 

were rebellious Generation X’ers (i.e., youth) 

in the Castro and Tenderloin districts with a 

large LGBT population, including portions 

of these populations with high rates of illicit 

drug use. The plans were apparently not 

carried out, but the documents reveal the 

interest in these populations.15

Gay and lesbian audiences have been 

an attractive target because smoking 

prevalence among those populations 

is substantially higher than among the 

straight population.15,115,129–132 To reach 

this audience, tobacco companies have 

directed advertising and promotions to 

magazines such as The Advocate, Genre,

and Out, with a high percentage of gay 

readers; bars frequented by LGBT crowds; 
166

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

and outdoor signs featuring images such 

as the Marlboro Man in predominantly gay 

neighborhoods. These marketing efforts have 

been complemented by corporate donations 

such as Philip Morris’s support for LGBT 

and HIV-related causes or organizations.115

Loyalty to brands and companies advertising 

through these channels or supporting these 

organizations is reported to be high, due to 

neglect of the LGBT market by traditional 

advertisers and corporate sponsors.15,130

LGBT magazines may be more dependent 

on tobacco accounts because of the historic 

neglect by other advertising revenue 

sources.130 This population, in turn, may 

be especially vulnerable because smoking 

has been sensualized on Internet sites and 

in magazines featuring gay and lesbian 

imagery, counterbalanced by relatively thin 

antitobacco efforts in LGBT communities.130

Concerned Smokers

Tobacco corporations work hard to avoid 

losing customers and they have developed 

many products and messages to counter 

the major “health scares” of the past 

50 years.24,29 The messages are typically 

not designed to promote all cigarettes as 

safe, but rather the idea that some brands 

are less hazardous than others. As noted 

above, reducing anxiety among smokers has 

been a major theme in tobacco advertising. 

In the 1950s, filters emerged with health 

claims such as L&M’s “Just What the 

Dr. Ordered” and Life’s “The Secret to Life 

is in the Filter,” implying that the risks 

of smoking were greatly reduced, if not 

eliminated, by these products.24 Menthol 

filters entered the mainstream in the late 

1950s and early 1960s, with Salem, Newport, 

and Kool first positioned as remedial- or 

medicinal-type products, then repositioned 

as providing a positive and refreshing 

taste.24,29 Following the Surgeon General’s 

1964 report, Philip Morris aimed menthol 

advertising at women, anticipating that 

they would be the most receptive to a 

“health cigarette.”24

By 1973, a significant number of brands, 

characterized by the industry as a “new 

low-delivery segment” of the market, were 

designed either to be or to give the illusion 

of being low-yield cigarettes (low tar and/or 

low nicotine) or to reduce risk through 

filtration. The balance was challenging 

because the products and their claims 

were intended to assuage guilt and prevent 

health-conscious smokers from quitting, 

but the lower nicotine levels made it also 

likely that the users would be less addicted 

and thus more able to quit.24

Philip Morris overcame this hurdle with 

Merit in 1976. The full-page advertisements 

appeared to proclaim a technological 

breakthrough that married taste and low 

tar. The advertisements were text-heavy 

to give the impression of science news, 

with headlines that shouted: “National 

Smoker Study: Merit Science Works!” 

Even the product name was designed to 

communicate virtue.24

Other new products, with virtuous-sounding 

names such as FACT, Real, and Long Life, 

were launched along with brand extensions 

such as Marlboro Lights. Models were 

shown engaging in outdoor activities such 

as skiing that were in keeping with valuing 

health. Industry documents suggest it was 

the marketing impression of well-being, 

intelligence, and harmony with nature 

rather than the factual basis that mattered 

in an era of increasing news about the 

dangers of smoking.4 “Light” and “ultralight” 

cigarettes were designed to convey the 

impression of lower yield when the actual 

absorption of tobacco smoke constituents 

from these brands was similar to that 

experienced with regular brands.

For decades, this marketing strategy worked. 

In 1996, 6 of 10 smokers in California 

thought that these labels indicated low 

tar or nicotine or a related health claim, 

and even more smokers used such brands.133

These results appear to run counter to 
167

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

industry documents that have suggested 

most smokers are unconvinced that lowtar cigarettes are safer, instead lumping all 

cigarettes together as risky.4 According to 

the national Adult Use of Tobacco Surveys 

conducted in 1970, 1975, and 1986, 21% to 

25% of smokers believed that the kind of 

cigarettes they smoked were less hazardous 

than others.2

Products have also been designed and 

promoted to allay concerns about 

secondhand smoke and to improve the 

social acceptability of smoke.92 Memos 

from Philip Morris, Brown & Williamson, 

and R.J. Reynolds in the 1980s and early 

1990s describe efforts to develop additives 

and technologies that could reduce or 

mask the odor, visibility, and irritation of 

secondhand smoke. In 1989, R.J. Reynolds 

introduced Chelsea cigarettes, which 

were reintroduced as Horizon in 1990;92

both brands were marketed with identical 

claims as “the first cigarette that smells 

good,” backed up by “scratch ‘n sniff” boxes 

in their advertisements. Several tobacco 

products have been introduced to address 

concerns about secondhand smoke. Newer 

products such as Omni and Accord convey 

the impression that they have broken away 

from the others to offer reduced risk to the 

smoker. R.J. Reynolds claims that Eclipse, 

a product that looks and can be inhaled like 

a cigarette, heats rather than burns tobacco. 

In 2004, its Web site claimed it “may present 

less risk,” “reduces secondhand smoke 

by 80%,” and “leaves no lingering odor” 

and suggested that the best choice for 

smokers worried about smoking is to quit 

and the next-best choice may be Eclipse 

(see chapter 4).134

These products—collectively referred to 

as potential reduced-exposure products 

(PREPs)27—appear to be a key effort by 

the industry to protect against smoking 

cessation in the face of mounting concern 

about the risks of smoking and exposure 

to secondhand smoke. PREPs may also 

R.J. Reynolds advertisement for Eclipse 

www.newcig.com, 2004

R.J. Reynolds advertisement for Chelsea cigarettes

R.J. Reynolds advertisement for Horizon 

cigarettes
168

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

be intended to allow tobacco companies 

to reinvent themselves as corporations 

responsive to the criticisms leveled against 

the industry.

Religious Groups

Although little research has been published 

on tobacco industry targeting of religious 

groups, Blum and Fitzgerald135 describe 

many ways in which tobacco companies 

“have found religion.” They point out, 

for instance, that cigarette advertising 

has appeared in the Jewish-oriented 

publications Hadassah Magazine and 

Jewish World Review. The editor of 

Hadassah Magazine told the New York State 

Journal of Medicine that their policy 

of accepting tobacco advertising would 

continue, despite complaints, “unless the 

people who say there are surely other sources 

of revenue, can show them to me.”135(p.448)

However, the magazine changed its mind 

two years later, when it published a fullpage announcement on the back cover of 

its January 1987 issue. Below the boxed 

Surgeon General’s warning ran this headline 

in huge, bold letters: “We will never print this 

warning again.” Text at the bottom explained:

HADASSAH MAGAZINE is clearing the air. 

Starting with this issue, we will no longer 

accept advertisements for tobacco products. 

We are quitting cigarette ads cold turkey, 

with a discomfort similar to that felt by 

smokers who have just quit; the main 

withdrawal symptom will be the loss of 

20 percent of our annual ad revenue. Our 

reason for quitting cigarette ads is also the 

same as that of the smoker—to promote 

health. We won’t be printing the Surgeon 

General’s warning again because there will 

be nothing in our pages to warn against.

The magazine editor elaborated on the 

decision in a column inside the publication.136

A 1969 “study of ethnic markets” by 

R.J. Reynolds indicates that the company 

spent $206,000 advertising in “Jewish 

media” in 1969.137 The document also notes:

Since 1961, R.J. Reynolds has recognized 

the existence and importance of the 

separate and distinct Jewish market by 

advertising its products with specially 

directed copy appeals, promotions, 

sampling, and other merchandising 

activities. This has been accomplished 

through the utilization of the Joseph 

Jacobs Organization. While compensated 

as Jewish media sales representatives, they 

have functioned as a Reynolds advertising 

agency at no extra cost.137(Bates no. 501989455)

In a “Jewish Market 1981 Annual 

Marketing Plan,” R.J. Reynolds (RJR)138

outlined strategies to target low-tar and 

ultra–low-tar (ULT) cigarette brands to 

Jews throughout the United States. The 

“media objective” was to “establish an 

effective presence for the priority ULT 

brands in national Jewish media and in the 

top 10 Jewish markets (70% of the Jewish 

population).”138(Bates no. 506053152) The document 

outlined plans to (1) spend $582,000 on 

advertising in national Jewish newspapers 

and national and local Jewish magazines; 

(2) use the Joseph Jacobs Organization to 

distribute free cigarette samples “at selected 

gatherings of Jewish people”138(Bates no. 506053168)

(budgeted at $30 million); (3) use pointof-sale advertising in Jewish retail outlets; 

and (4) “implement block parties to generate 

RJR opportunity brand presence in Jewish 

neighborhoods”138(Bates no. 506053168) (budgeted 

at $20 million).

Blum and Fitzgerald135 drew attention to a 

poorly publicized facet of the relationship 

between tobacco companies and prominent 

religious organizations. Several Jewish and 

Christian organizations—including the 

National Conference of Christians and Jews, 

Catholic Charities USA, the Anti-Defamation 

League of B’nai B’rith, the United Jewish 

Appeal/Federation of Jewish Philanthropies 

of New York, and the American Jewish 
169

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Committee—hosted dinners in honor of 

tobacco company executives. Full-page ads 

promoting the dinners were published in 

the U.S. Tobacco & Candy Journal (later 

renamed the U.S. Distribution Journal), 

a trade publication for tobacco distributors. 

Blum and Fitzgerald135 listed several of 

these events that were held in 1984. Further 

examples include the following:

n The National Conference of Catholic 

Charities honored Vincent and 

Ellen Buccellato, Vice President/Sales, 

Philip Morris USA, on April 17, 1990, 

at a $300-a-plate dinner at the Marriott 

Hotel in Chicago.139

n The Anti-Defamation League gave a “Man 

of the Year Award” to Yancey W. Ford Jr., 

Executive V.P.-Sales, R.J. Reynolds 

Tobacco Company, on October 28, 1993, 

at a $350-a-plate dinner at the 

Grand Hyatt Hotel in New York City.140

The religious groups benefit from the 

funds raised by the dinners themselves—

bolstered, presumably, by other financial 

support from the tobacco companies 

whose executives were honored. The 

tobacco companies benefit from the public 

relations value of the awards, from the 

opportunity to market their products to 

a target audience, and from strengthened 

relationships with important community 

organizations. As these relationships 

mature, the religious groups might be 

expected (or asked by the companies) to 

side with the industry in opposing tobacco 

control legislation or to mute their 

support for it.

Financial support for exhibits, events, 

or facilities that are important to a 

religious group is another means by which 

tobacco companies can align themselves 

with that group. In 1983, for example, 

Philip Morris was a $3 million sponsor of the 

Vatican Art Tour, which was advertised in 

The New York Times, The Washington Post,

and other publications (see chapter 6).135

Extensive media coverage of the tour 

included photos of Philip Morris executives 

with church dignitaries, museum officials, 

patrons of the arts, politicians, and the 

First Lady. The ads promoting the tour listed 

the company’s cigarette brands but did not 

include the Surgeon General’s warning.

The following year, Philip Morris sponsored 

the national tour of “The Precious Legacy,” 

which displayed Jewish artwork confiscated 

from persons killed in the Nazi holocaust. 

The exhibition, according to Blum and 

Fitzgerald,135 broke attendance records at 

the San Diego Museum of Art and other 

venues. In 1992, Philip Morris sponsored 

an exhibit at the Jewish Museum at the 

New York Historical Society, entitled 

“Bridges and Boundaries: African Americans 

and American Jews”; the exhibit was 

advertised in Jewish Week.141 In 1993, 

UST Inc. (now USST), the nation’s largest 

manufacturer of smokeless tobacco 

products, gave a 5-year, $280,000 grant to 

the Yale Divinity School to underwrite the 

school’s urban ministries program.142,143

In his study of tobacco company 

sponsorships during the period 1995–99, 

Siegel81 found three religious groups that 

had received tobacco industry funding: 

Interfaith AIDS Ministry of Greater 

Danbury144 (Danbury, CT), Christian Relief 

Services Charities145 (Lorton, VA), and 

Jewish Community Council of Greater 

Coney Island146 (New York City).

In the Philippines, which is predominantly 

Catholic, images of R.J. Reynolds cigarette 

brands (Camel, Winston, and More) appear 

on calendars featuring religious icons such 

as the Virgin Mary, Jesus (as a baby and an 

adult), and St. Teresa of Avila.147,148

Other Populations

Tobacco companies have continued to pursue 

a full range of marketing practices in other 

countries, especially those where restrictions 
170

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

on marketing practices fall behind those of 

the United States. Western brand imagery 

features heavily in branded cigarette 

advertising in many other countries, 

especially low-income nations.149–151

Most of the groups discussed in this chapter 

have been important targets of tobacco 

industry marketing activities. However, 

this list is by no means exhaustive, as many 

other groups may have been targeted in 

ways that have largely escaped attention 

or commentary by health advocates and 

the media. Some groups may have been 

targeted with marketing approaches that 

were less prominent or shorter in duration 

compared with those aimed at the groups 

mentioned above.

Prisoners, for example, have been targeted 

by tobacco companies. Years ago, Lorillard 

offered free athletic equipment to prison 

inmates in exchange for empty packages of 

Newport cigarettes and Beechnut chewing 

tobacco.152

Given the competitiveness of the cigarette 

market, it is likely that manufacturers will 

continue to pursue niche markets with 

targeted communications through narrowly 

defined channels. Observational research 

and further analyses of tobacco industry 

documents are needed to identify targeted 

marketing activities that are less well known 

than those described above.

Summary

Targeted advertising and promotion of 

tobacco products represents an important 

tool for the tobacco industry in the growth 

and market share of its products. A symbiotic 

relationship exists among the development 

and branding of tobacco products, the 

segmentation of specific target markets, 

and the themes and marketing techniques 

used to effectively reach subpopulations 

within these market segments.

Themes in tobacco advertising and 

promotion have evolved over time to 

focus on areas such as product taste and 

satisfaction, affinity with desirable social 

characteristics, and the perception of 

reduced health risk. These, in turn, are 

focused on demographic subgroups that 

include men, women, racial and ethnic 

minorities, and gays and lesbians, as well as 

populations seen as likely to smoke, such 

as military personnel, blue-collar workers, 

or people undergoing life transitions to 

places such as work or college. A wide 

variety of tobacco industry advertising and 

promotional channels serve to connect 

these groups with the brand identity of 

specific tobacco products.

Such targeted marketing efforts represent 

an important subject for further study. 

Research in this area will help elucidate 

the dynamics of subpopulations most 

susceptible to smoking and the necessity 

for greater community awareness and 

policy interventions pertaining to targeted 

marketing activities. Understanding the 

successful marketing of tobacco products 

to specific groups can provide deeper 

insight into the needs and motivations of 

those who choose to smoke.

Conclusions

1. Tobacco advertising has been dominated 

by three broad themes: providing 

satisfaction (taste, freshness, mildness, 

etc.), assuaging anxieties about the 

dangers of smoking, and creating 

associations between smoking and 

desirable outcomes (independence, social 

success, sexual attraction, thinness, etc.).

2. Targeting various population groups—

including men, women, youth and 

young adults, specific racial and ethnic 

populations, religious groups, the 

working class, and gay and lesbian 

populations—has been strategically 

important to the tobacco industry.
171

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

3. The tobacco industry has become 

increasingly sophisticated in applying 

market research to population 

segments in order to design products, 

messages, communication channels, 

and promotions more aligned with the 

needs and susceptibilities of particular 

market segments. This research results 

in more efficiency, greater reach, and 

increased effectiveness for marketing 

activities aimed at targeted populations.

4. Little attention has been paid to 

understanding tobacco marketing 

aimed at American Indians and Alaska 

Natives, despite their high prevalence 

of tobacco use.

5. Targeted marketing of tobacco products 

to specific groups such as youth, women, 

and minorities has become a focus for 

monitoring and protest by antitobacco 

advocates and community groups.
172

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

References

1. Cullman III, J. Cigarette Advertising and 

Labeling Hearing before the Consumer 

Subcommittee of the Committee on 

Commerce, United States Senate, NinetyFirst Congress, First Session on H.R. 6543 

to Extend Public Health Protection with 

Respect to Cigarette Smoking, and for Other 

Purposes. 22 Jul 1969. Philip Morris. Bates 

No. 2023375857/5874. http://legacy.library

.ucsf.edu/tid/ucb77e00.

2. U.S. Department of Health and Human 

Services. 1989. Reducing the health 

consequences of smoking: 25 years of 

progress. A report of the Surgeon General

(DHHS publication no. [CDC] 89-8411). 

Rockville, MD: U.S. Department of Health 

and Human Services, Public Health Service, 

Centers for Disease Control, National Center 

for Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health. 

http://profiles.nlm.nih.gov/NN/B/B/X/S/

3. Pollay, R. W., J. S. Lee, and D. CarterWhitney. 1992. Separate but not equal: 

Racial segregation in cigarette advertising. 

Journal of Advertising 21:45–57. 

4. Pollay, R. W. 2000. Targeting youth and 

concerned smokers: Evidence from 

Canadian tobacco industry documents. 

Tobacco Control 9 (2): 136–47. 

5. Ling, P. M., and S. A. Glantz. 2002. Using 

tobacco-industry marketing research to 

design more effective tobacco-control 

campaigns. JAMA: The Journal of the 

American Medical Association 287 (22): 

2983–89. 

6. Cook, B. L., G. F. Wayne, L. Keithly, and 

G. Connolly. 2003. One size does not fit 

all: How the tobacco industry has altered 

cigarette design to target consumer groups 

with specific psychological and psychosocial 

needs. Addiction 98 (11): 1547–61. 

7. Advertising Age. 1981. Advertising as per 

cent of sales, by industry: 1975 data from 

Federal Trade Commission. Advertising Age,

October 19:42. 

8. Basil, M. D., C. Schooler, D. G. Altman, 

M. Slater, C. L. Albright, and N. Maccoby. 

1991. How cigarettes are advertised in 

magazines: Special messages for special 

markets. Health Communication 3 (2): 

75–91. 

9. Cruz, T. B., E. Feighery, D. V. Schuster, 

M. Wenten, P. Jouharzadeh, J. B. Unger, and 

L. A. Rohrbach. 2003. Tobacco marketing 

efforts in California. In Independent 

evaluation of the California Tobacco 

Control Prevention and Education 

Program: Waves 1, 2, and 3 (1996–2000),

13–42. Sacramento: California Department 

of Health Services.

10. Cruz, T. B., P. Jouharzadeh, M. Wenten, 

and J. B. Unger. 2003. Tobacco sponsored 

events in California, 2001. A brief report 

of the TIME Project. Los Angeles: Univ. of 

Southern California.

11. Tobacco Industry Monitoring Evaluation. 

Listserv. March 19, 2004. Upcoming tobacco 

bar and adult-only facility promotions.

12. Sumner, W., and D. G. Dillman. 1995. 

A fist full of coupons: Cigarette continuity 

programmes. Tobacco Control 4 (3): 245–52. 

13. Cruz, T. B., D. V. Schuster, and J. B. Unger. 

2002. Direct mail marketing of tobacco 

after the Master Settlement Agreement. 

Paper presented at the 130th annual 

meeting of the American Public Health 

Association, Philadelphia.

14. Portugal, C., T. B. Cruz, L. Espinoza, 

M. Romero, and L. Baezconde-Garbanati. 

2004. Countering tobacco industry 

sponsorship of Hispanic/Latino organizations 

through policy adoption: A case study. Health 

Promotion Practice 5 Suppl. 3: 143S–156S. 

15. Washington, H. A. 2002. Burning love: 

Big tobacco takes aim at LGBT youths. 

American Journal of Public Health 92 (7): 

1086–95. 

16. Federal Trade Commission. 1967. Federal 

Trade Commission report to Congress 

pursuant to the Federal Cigarette Labeling 

and Advertising Act. http://legacy.library

.ucsf.edu/tid/qjf92f00.

17. Federal Trade Commission. 1972. Report 

to Congress pursuant to the Public Health 

Cigarette Smoking Act. http://legacy.library

.ucsf.edu/tid/aks11a00.

18. Federal Trade Commission. 1974. Report 

to Congress pursuant to the Public Health 

Cigarette Smoking Act. Washington, DC: 

Federal Trade Commission. http://legacy

.library.ucsf.edu/tid/zvl59c00.

19. Federal Trade Commission. 1977. Report 

to Congress pursuant to the Public Health 

Cigarette Smoking Act. Washington, DC: 

Federal Trade Commission. http://legacy

.library.ucsf.edu/tid/mya34f00.

20. Federal Trade Commission. 1986. Report to 

Congress pursuant to the Federal Cigarette 
173

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Labeling and Advertising Act, [for] 1984.

Washington, DC: Federal Trade Commission. 

http://legacy.library.ucsf.edu/tid/sly42f00.

21. Federal Trade Commission. 1991. Report to 

Congress for 1989 pursuant to the Federal 

Cigarette Labeling and Advertising Act.

Washington, DC: Federal Trade Commission. 

http://legacy.library.ucsf.edu/tid/zyd11f00.

22. Balbach, E. D., R. J. Gasior, and 

E. M. Barbeau. 2003. R.J. Reynolds’ targeting 

of African Americans: 1988–2000. American 

Journal of Public Health 93 (5): 822–27. 

23. Pollay, R. W., and T. Dewhirst. 2001. 

Marketing cigarettes with low machinemeasured yields. In Risks associated with 

smoking cigarettes with low machinemeasured yields of tar and nicotine

(Smoking and tobacco control monograph 

no. 13, NIH publication no. 02-5074), 

199–235. Bethesda, MD: National Cancer 

Institute.

24. Pollay, R. W., and T. Dewhirst. 2002. The 

dark side of marketing seemingly “light” 

cigarettes: Successful images and failed fact. 

Tobacco Control 11 Suppl. 1: I18–I31. 

25. Warner, K. E. 1985. Tobacco industry 

response to public health concern: A content 

analysis of cigarette ads. Health Education 

Quarterly 12 (2): 115–27. 

26. Altman, D. G., M. D. Slater, C. L. Albright, 

and N. Maccoby. 1987. How an unhealthy 

product is sold: Cigarette advertising 

in magazines, 1960–1985. Journal of 

Communication 37 (4): 95. 

27. Institute of Medicine. 2001. Clearing the 

smoke: Assessing the science base for 

tobacco harm reduction, ed. K. Stratton, 

P. Shetty, R. Wallace, and S. Bondurant. 

Washington, DC: National Academies 

Press. http://www.nap.edu/openbook/

0309072824/html.

28. King, K. W., L. N. Reid, Y. S. Moon, and 

D. J. Ringold. 1991. Changes in the visual 

imagery of cigarette ads, 1954–1986. 

Journal of Public Policy and Marketing

10 (1): 63–80. 

29. Sutton, C. D., and R. G. Robinson. 2004. 

The marketing of menthol cigarettes in the 

United States: Populations, messages, and 

channels. Nicotine & Tobacco Research

6 Suppl. 1: S83–S91. 

30. Federal Trade Commission. 1985. Report to 

Congress pursuant to the Federal Cigarette 

Labeling and Advertising Act, for the years 

1982–1983. Washington, DC: Federal Trade 

Commission. http://legacy.library.ucsf.edu/

tid/nvo52f00.

31. Davis, R. M. 1996. Criminal deception. 

Alaska Medicine 38 (1): 43–48. 

32. Pollay, R. W. 1995. “Below the belt” cigarette 

advertising. Tobacco Control 4 (2): 188–92. 

33. Sansores, R. H., G. Giraldo-Buitrago, 

C. Reddy, and A. Ramirez-Venegas. 2002. 

Sexual content of advertisements and the 

smoking process in adolescents. Chest

121 (6): 2016–22. 

34. Wakefield, M., C. Morley, J. K. Horan, and 

K. M. Cummings. 2002. The cigarette pack as 

image: New evidence from tobacco industry 

documents. Tobacco Control 11 Suppl. 1: 

i73–i80. 

35. Lewis, M. J., C. D. Delnevo, and J. Slade. 

2004. Tobacco industry direct mail 

marketing and participation by New Jersey 

adults. American Journal of Public Health

94 (2): 257–59. 

36. Richards, J. W., J. R. DiFranza, C. Fletcher, 

and P. M. Fischer. 1995. R J Reynolds’ 

Camel Cash: Another way to reach kids. 

Tobacco Control 4 (3): 258–60. 

37. Davis, R. M. 1987. Current trends in cigarette 

advertising and marketing. New England 

Journal of Medicine 316 (12): 725–32. 

38. Federal Trade Commission. 2007. Federal 

Trade Commission cigarette report for 

2004 and 2005. http://www.ftc.gov/reports/

tobacco/2007cigarette2004-2005.pdf.

39. Rothenberg, R. 1989. The media business: 

Advertising; special CD is offered in cigarette 

promotion. New York Times. March 29.

40. Centers for Disease Control and Prevention. 

2007. Cigarette smoking among adults—

United States, 2006. Morbidity and Mortality 

Weekly Report 56 (44): 1157–61.

41. R.J. Reynolds. Winston family 1984 (840000) 

annual marketing plan. VI. Winston 

marketing strategy summary. 15 Nov 1983. 

R.J. Reynolds. Bates No. 505415128/5137. 

http://legacy.library.ucsf.edu/tid/bcb25d00.

42. Goerlitz, D. Statement of David Goerlitz, 

former model for Winston cigarettes, before 

the Subcommittee on Transportation 

and Hazardous Materials, Committee on 

Energy and Commerce, U.S. House of 

Representatives. 25 Jul 1989. American 

Tobacco. Bates No. 980172423/2428. http://

legacy.library.ucsf.edu/tid/rmw84f00.

43. Goerlitz, D., and G. LaForest. 1999. Before 

the smoke screen. Voorhees, NJ: Gladstone 

Publishing.
174

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

44. Tobacco Documents Online. 2007. Advertising 

collections. http://tobaccodocuments.org/

advertising.

45. Smith, E. A., V. S. Blackman, and 

R. E. Malone. 2007. Death at a discount: 

How the tobacco industry thwarted tobacco 

control policies in US military commissaries. 

Tobacco Control 16 (1): 38–46. 

46. Bray, R. M., L. L. Hourani, K. L. Rae, 

J. A. Dever, J. M. Brown, A. A. Vincus, 

M. R. Pemberton, M. E. Marsden, 

D. L. Faulkner, and R. Vandermaas-Peeler. 

2003. 2002 Department of Defense survey 

of health related behaviors among military 

personnel (Report no. RTI/7841-006-FR). 

Research Triangle Park, NC: RTI 

International.

47. Conway, T. L., and T. A. Cronan. 1992. 

Smoking, exercise, and physical fitness. 

Preventive Medicine 21 (6): 723–34. 

48. Zadoo, V., S. Fengler, and M. Catterson. 

1993. The effects of alcohol and tobacco 

use on troop readiness. Military Medicine

158 (7): 480–84. 

49. Helyer, A. J., W. T. Brehm, and L. Perino. 

1998. Economic consequences of tobacco 

use for the Department of Defense, 1995. 

Military Medicine 163 (4): 217–21. 

50. Klesges, R. C., C. K. Haddock, C. F. Chang, 

G. W. Talcott, and H. A. Lando. 2001. The 

association of smoking and the cost of 

military training. Tobacco Control 10 (1): 

43–47. 

51. Joseph, A. M., M. Muggli, K. C. Pearson, 

and H. Lando. 2005. The cigarette 

manufacturers’ efforts to promote tobacco 

to the U.S. military. Military Medicine

170 (10): 874–80. 

52. R.J. Reynolds. 1989. Military YAS initiative. 

R.J. Reynolds. Bates No. 507358562/8574. 

http://legacy.library.ucsf.edu/tid/hrb34d00.

53. Blake, G. H. 1985. Smoking and the military. 

New York State Journal of Medicine 85: 

354–56. 

54. Kluger, R. 1996. Ashes to ashes. New York: 

Alfred A. Knopf.

55. R.J. Reynolds. 1985. Project MP. R.J. Reynolds. 

http://www.rjrtdocs.com/rjrtdocs/index.wmt?

tab=home.

56. Hall, T. 1985. Smokers in military are firm’s 

market for 1776 cigarette. Wall Street 

Journal, February 13.

57. Burnett, L. 1990. Operation Desert Shield. 

Philip Morris USA. http://www.pmdocs.com/

cgi-bin/rsasearch.asp.

58. Shatenstein, S. 2005. USA: The smokin’ 

Marlboro man of Fallujah. Tobacco Control

14 (1): 5–6. 

59. R.J. Reynolds. 1983. Virile segment: 

The right stuff. R.J. Reynolds. Bates No. 

505921966/2005. http://legacy.library.ucsf

.edu/tid/zxd94d00.

60. Barbeau, E. M., A. Leavy-Sperounis, and 

E. D. Balbach. 2004. Smoking, social class, 

and gender: What can public health learn 

from the tobacco industry about disparities 

in smoking? Tobacco Control 13 (2): 

115–20. 

61. Federal Register. U.S. Department of 

Health and Human Services, Food and 

Drug Administration. 1996. Regulations 

restricting the sale and distribution of 

cigarettes and smokeless tobacco products 

to protect children and adolescents; Final 

rule. Federal Register August 28, 1996; 

61 (168): 44596.

62. Business Week. 1980. Cigarette sales keep 

rising. Business Week, December 15. 

63. Marketing Strategy and Planning. Projects 

Stereo/Phoenix final report. Feb 1985. Brown 

& Williamson. Bates No. 689451753/1861. 

http://legacy.library.ucsf.edu/tid/gjb60f00.

64. Federal Trade Commission. 1968. Report to 

Congress pursuant to the Federal Cigarette 

Labeling and Advertising Act. Washington, 

DC: Federal Trade Commission. http://

legacy.library.ucsf.edu/tid/isn15f00.

65. U.S. Smokeless Tobacco Company. 2006. 

Company Web site. http://www.freshcope.com.

66. U.S. Department of Health and Human 

Services. 1994. Preventing tobacco use 

among young people. A report of the 

Surgeon General. Atlanta: U.S. Department 

of Health and Human Services, Public 

Health Service, Centers for Disease Control 

and Prevention, National Center for Chronic 

Disease Prevention and Health Promotion, 

Office on Smoking and Health. http://www

.cdc.gov/tobacco/data_statistics/sgr/sgr

_1994/index.htm.

67. Ernster, V. L. 1985. Mixed messages for 

women: A social history of cigarette 

smoking and advertising. New York State 

Journal of Medicine 85 (7): 335–40. 

68. Boyd, T. C., C. J. Boyd, and T. B. Greenlee. 

2003. A means to an end: Slim hopes and 

cigarette advertising. Health Promotion 

Practice 4 (3): 266–77. 

69. Bernays, E. L. 1965. Biography of an 

idea: Memoirs of public relations counsel 
175

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Edward L. Bernays. New York: Simon and 

Schuster.

70. Friedman, V., and Lorillard. 1973. The female 

smoker market. http://tobaccodocuments

.org/landman/03375503-5510.html.

71. Anderson, S. J., S. A. Glantz, and P. M. Ling. 

2005. Emotions for sale: Cigarette advertising 

and women’s psychosocial needs. Tobacco 

Control 14 (2): 127–35. 

72. U.S. Department of Health and Human 

Services. 2001. Women and smoking. 

A report of the Surgeon General. Rockville, 

MD: U.S. Department of Health and Human 

Services, Public Health Service, Office of 

the Surgeon General. http://www.cdc.gov/

tobacco/data_statistics/sgr/sgr_2001/index

.htm#full.

73. Barbeau, E. M., N. Krieger, and 

M. J. Soobader. 2004. Working class matters: 

Socioeconomic disadvantage, race/ethnicity, 

gender, and smoking in NHIS 2000. American 

Journal of Public Health 94 (2): 269–78. 

74. Gloede, W. F. 1986. Newport has slim chance. 

Advertising Age, February 10. 

75. Zimmerman, C. 1990. Growth is watchword 

for Asian tobacco industry [editorial]. 

Tobacco Reporter 117 (6): 4. 

76. Amos, A. 1990. How women are targeted by 

the tobacco industry. World Health Forum

11 (4): 416–22. 

77. O’Keefe, A. M., and R. W. Pollay. 1996. 

Deadly targeting of women in promoting 

cigarettes. Journal of the American Medical 

Women’s Association 51 (1–2): 67–69. 

78. Lewis, M. J., S. G. Yulis, C. Delnevo, and 

M. Hrywna. 2004. Tobacco industry direct 

marketing after the Master Settlement 

Agreement. Health Promotion Practice

5 Suppl. 3: 75S–83S. 

79. Weiser, R. 2004. Smoking and women’s 

magazines: 2001–2002. http://www.acsh.org/

publications/pubID.1004/pub_detail.asp.

80. Rosenberg, N. J., and M. Siegel. 2001. 

Use of corporate sponsorship as a tobacco 

marketing tool: A review of tobacco industry 

sponsorship in the USA, 1995–99. Tobacco 

Control 10 (3): 239–46. 

81. Siegel, M. 2001. Tobacco industry 

sponsorship in the United States, 1995–1999.

http://web.archive.org/web/20030216213558/

dcc2.bumc.bu.edu/tobacco/introduction

.htm.

82. Pierce, J. P., and E. A. Gilpin. 1995. 

A historical analysis of tobacco marketing 

and the uptake of smoking by youth in 

the United States: 1890–1977. Health 

Psychology 14 (6): 500–508. 

83. Cummings, K. M., C. P. Morley, J. K. Horan, 

C. Steger, and N. R. Leavell. 2002. Marketing 

to America’s youth: Evidence from corporate 

documents. Tobacco Control 11 Suppl. 1: 

I5–I17. 

84. Ingram, B. 2004. Video vault: Cigarette 

advertising on TV. http://www.tvparty.com/

vaultcomcig.html.

85. King 3rd, C., M. Siegel, C. Celebucki, and 

G. N. Connolly. 1998. Adolescent exposure 

to cigarette advertising in magazines: An 

evaluation of brand-specific advertising 

in relation to youth readership. JAMA: 

The Journal of the American Medical 

Association 279 (7): 516–20. 

86. Lieberman, A. 2004. The effect of 

enforcement of the Master Settlement 

Agreement on youth exposure to print 

advertising. Health Promotion Practice

5 Suppl. 3: 66S–74S. 

87. Davis, R. M. 1998. Report by Ronald M. Davis, 

M.D., F.A.I.R. v. City of Chicago, 97 C 7619. 

http://www.globalink.org/tobacco/docs/

misc-docs/davis.shtml.

88. Henriksen, L., E. C. Feighery, 

N. C. Schleicher, H. H. Haladjian, and 

S. P. Fortmann. 2004. Reaching youth at the 

point of sale: Cigarette marketing is more 

prevalent in stores where adolescents shop 

frequently. Tobacco Control 13 (3): 315–18. 

89. Blum, A. 1991. The Marlboro Grand Prix: 

Circumvention of the television ban on 

tobacco advertising. New England Journal 

of Medicine 324 (13): 913–17. 

90. DiFranza, J. R., and B. F. Aisquith. 1995. 

Does the Joe Camel campaign preferentially 

reach 18 to 24 year old adults? Tobacco 

Control 4 (4): 367–71. 

91. DiFranza, J. R., J. W. Richards, P. M. Paulman, 

N. Wolf-Gillespie, C. Fletcher, R. D. Jaffe, 

and D. Murray. 1991. RJR Nabisco’s cartoon 

camel promotes camel cigarettes to children. 

JAMA: The Journal of the American Medical 

Association 266 (22): 3149–53. 

92. Connolly, G. N., G. D. Wayne, D. Lymperis, 

and M. C. Doherty. 2000. How cigarette 

additives are used to mask environmental 

tobacco smoke. Tobacco Control 9 (3): 

283–91. 

93. Tye, J. B. 1992. Targeting kids? Who, us? 

Willy the Penguin and Joe Camel duke it out 

for the youth market. Tobacco Control 1 (2): 

132–33. 
176

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

94. Henningfield, J. E., A. Radzius, and 

E. J. Cone. 1995. Estimation of available 

nicotine content of six smokeless tobacco 

products. Tobacco Control 4 (1): 57–61. 

95. Djordjevic, M. V., D. Hoffmann, T. Glynn, 

and G. N. Connolly. 1995. US commercial 

brands of moist snuff, 1994—Assessment of 

nicotine, moisture, and pH. Tobacco Control

4 (1): 62–66. 

96. Connolly, G. N. 1995. The marketing 

of nicotine addiction by one oral snuff 

manufacturer. Tobacco Control 4 (1): 73–79. 

97. Substance Abuse and Mental Health Services 

Administration. 2007. Cigarette brand 

preferences in 2005. http://oas.samhsa.gov/

2k7/cigBrands/cigBrands.htm.

98. Biener, L., and A. B. Albers. 2004. Young 

adults: Vulnerable new targets of tobacco 

marketing. American Journal of Public 

Health 94 (2): 326–30. 

99. Wechsler, H., N. A. Rigotti, J. GledhillHoyt, and H. Lee. 1998. Increased levels 

of cigarette use among college students: 

A cause for national concern. JAMA: 

The Journal of the American Medical 

Association 280 (19): 1673–78. 

100. Ling, P. M., and S. A. Glantz. 2002. Why and 

how the tobacco industry sells cigarettes 

to young adults: Evidence from industry 

documents. American Journal of Public 

Health 92 (6): 908–16. 

101. Wayne, G. F., and G. N. Connolly. 2002. How 

cigarette design can affect youth initiation 

into smoking: Camel cigarettes 1983–93. 

Tobacco Control 11 Suppl. 1: I32–I39. 

102. Substance Abuse and Mental Health 

Services Administration. 2006. Results 

from the 2005 National Survey on Drug 

Use and Health: National findings (DHHS 

publication no. SMA 06-4194). NSDUH 

Series H-30. Rockville, MD: U.S. Department 

of Health and Human Services, Substance 

Abuse and Mental Health Services 

Administration, Office of Applied Studies. 

http://oas.samhsa.gov/nsduh/2k5nsduh/

2k5results.pdf.

103. Rigotti, N. A., S. E. Moran, and H. Wechsler. 

2005. US college students’ exposure to 

tobacco promotions: Prevalence and 

association with tobacco use. American 

Journal of Public Health 95 (1): 138–44. 

104. Sepe, E., and S. A. Glantz. 2002. Bar and 

club tobacco promotions in the alternative 

press: Targeting young adults. American 

Journal of Public Health 92 (1): 75–78. 

105. Tobacco Industry Monitoring Evaluation. 

Listserv. September 24, 2004. Upcoming 

tobacco bar and adult-only facility 

promotions.

106. Khermouch, G., and J. Green. 2001. Buzz 

marketing: Suddenly this stealth strategy is 

hot—but it’s still fraught with risk. Business 

Week, July 30. http://www.businessweek.com/

magazine/content/01_31/b3743001.htm.

107. 60 Minutes. 2004. Undercover marketing 

uncovered. CBS News, July 25. http://www

.cbsnews.com/stories/2004/07/22/60minutes/

main631317.shtml?source=search_story.

108. Emery, S., E. A. Gilpin, C. Ake, A. J. Farkas, 

and J. P. Pierce. 2000. Characterizing 

and identifying “hard-core” smokers: 

Implications for further reducing smoking 

prevalence. American Journal of Public 

Health 90 (3): 387–94. 

109. Gilpin, E. A., and J. P. Pierce. 2002. 

Demographic differences in patterns 

in the incidence of smoking cessation: 

United States 1950–1990. Annals of 

Epidemiology 12 (3): 141–50. 

110. Stoddard, J. L., C. A. Johnson, S. Sussman, 

C. Dent, and T. Boley-Cruz. 1998. Tailoring 

outdoor tobacco advertising to minorities 

in Los Angeles County. Journal of Health 

Communication 3 (2): 137–46. 

111. U.S. Department of Health and Human 

Services. 1998. Factors that influence 

tobacco use among four racial/ethnic 

minority groups. In Tobacco use among 

U.S. racial/ethnic minority groups—

African Americans, American Indians 

and Alaska Natives, Asian Americans and 

Pacific Islanders, and Hispanics. A report of 

the Surgeon General, 207–56. Atlanta: U.S. 

Department of Health and Human Services, 

Public Health Service, Centers for Disease 

Control and Prevention, National Center 

for Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health. 

http://www.cdc.gov/tobacco/data_statistics/

sgr/sgr_1998/index.htm.

112. Yerger, V. B., and R. E. Malone. 2002. African 

American leadership groups: Smoking with 

the enemy. Tobacco Control 11 (4): 336–45. 

113. Gardiner, P. S. 2004. The African 

Americanization of menthol cigarette use 

in the United States. Nicotine & Tobacco 

Research 6 Suppl. 1: S55–S65. 

114. R.J. Reynolds, and J. T. Winebrenner. Special 

effects for special markets. 21 Jul 1988. 

R.J. Reynolds. Bates No. 507714729/4731. 

http://legacy.library.ucsf.edu/tid/dqu61d00.
177

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

115. Smith, E. A., and R. E. Malone. 2003. 

The outing of Philip Morris: Advertising 

tobacco to gay men. American Journal of 

Public Health 93 (6): 988–93. 

116. Bialous, S. A. 2000. The tobacco industry 

strategies to target U. S. Hispanics. Report 

submitted to the California Hispanic/Latino 

Tobacco Education Network. San Francisco: 

Univ. of California.

117. Philip Morris. The 1994 Marlboro Hispanic 

Marketing Plan. 1993. Philip Morris. Bates 

No. 2042374074/4081. http://legacy.library

.ucsf.edu/tid/qzk72e00.

118. Muggli, M. E., R. W. Pollay, R. Lew, and 

A. M. Joseph. 2002. Targeting of Asian 

Americans and Pacific Islanders by 

the tobacco industry: Results from the 

Minnesota Tobacco Document Depository. 

Tobacco Control 11 (3): 201–9. 

119. Koeppel, D. 1990. Japan’s Mild 7 cigarette 

targets Asians in the U.S. Adweek’s Marketing 

Week 31 (33): 4–5. 

120. Reyes, B. J. 2004. Governor says cigarette 

campaign ruins island image. Associated 

Press, August 3.

121. Dingeman, R. 2004. Cigarette’s use of 

Kaua’i name draws objections. Honolulu 

Advertiser, July 27.

122. Honolulu Star-Bulletin. 2004. Ban flavored 

cigs as lure for youths. Editorial. Honolulu 

Star-Bulletin, July 30.

123. Associated Press. 2004. Camel lighting fire 

over new cigarettes. http://web.archive.org/

web/*/http://www.forbes.com/associatedpress/

feeds/ap/2004/07/28/ap1473834.html.

124. Unger, J. B., S. Shakib, T. B. Cruz, 

B. R. Hoffman, B. H. Pitney, and 

L. A. Rohrbach. 2003. Smoking behavior 

among urban and rural Native American 

adolescents in California. American Journal 

of Preventive Medicine 25 (3): 251–54. 

125. Hodge, F. S., B. A. Geishirt Cantrell, 

R. Struthers, and J. Casken. 2004. American 

Indian Internet cigarette sales: Another 

avenue for selling tobacco products. 

American Journal of Public Health 94 (2): 

260–61. 

126. Reuters. 1999. Indian tribes to file tobacco 

lawsuit. Reuters News Service, June 15.

127. Goebel, K. 1994. Lesbian and gays face 

tobacco targeting. Tobacco Control 3 (1): 

65–67. 

128. Davis, R. M. 1993. Filler. Tobacco Control

2: 158. http://tc.bmjjournals.com/cgi/

reprint/2/2/156.pdf.

129. Arday, D. R., B. R. Erdin, G. A. Giovino, and 

D. E. Nelson. 1993. Smoking, HIV infection, 

and gay men in the United States. Tobacco 

Control 2: 156–58. 

130. Tobacco Technical Assistance Consortium. 

2004. LBGT populations and tobacco.

2nd ed. CD-ROM. Atlanta: Emory Univ.

131. Ryan, H., P. M. Wortley, A. Easton, 

L. Pederson, and G. Greenwood. 2001. 

Smoking among lesbians, gays, and bisexuals: 

A review of the literature. American Journal 

of Preventive Medicine 21 (2): 142–49. 

132. Stevens, P., and L. M. H. J. M. Carlson. 2004. 

An analysis of tobacco industry marketing 

to lesbian, gay, bisexual, and transgender 

(LGBT) populations: Strategies for 

mainstream tobacco control and prevention. 

Health Promotion Practice 5 Suppl. 3: 

129S–134S. 

133. Gilpin, E. A., S. Emery, M. M. White, and 

J. P. Pierce. 2002. Does tobacco industry 

marketing of ‘light’ cigarettes give smokers a 

rationale for postponing quitting? Nicotine & 

Tobacco Research 4 Suppl. 2: S147–S150. 

134. R.J. Reynolds. 2008. Eclipse. https://www

.tobaccopleasure.com/dtclogin.aspx?

brand=ECL.

135. Blum, A., and K. Fitzgerald. 1985. How 

tobacco companies have found religion. 

New York State Journal of Medicine 85: 

445–50. 

136. Tigay, A. M. 1987. Editors’ wrapup: Smoke 

signal. Hadassah Magazine, January: 6. 

137. Holland, G. A study of ethnic markets. 

Sep 1969. R.J. Reynolds. Bates No. 

501989230/9469. http://legacy.library.ucsf

.edu/tid/kkn29d00.

138. R.J. Reynolds. Jewish Market 1981 (810000) 

Annual Marketing Plan. 14 Jul 1980. 

R.J. Reynolds. Bates No. 506053148/3171. 

http://legacy.library.ucsf.edu/tid/jkb05d00.

139. National Conference of Catholic Charities. 

1990. Advertisement. U. S. Distribution 

Journal 217 (2): 8. 

140. Anti-Defamation League. 1993. 

Advertisement. U. S. Distribution Journal

September 15. 

141. Jewish Week. 1992. Advertisement. Jewish 

Week, April 3–9. 

142. Lew, J. B. 1993. Letter to the editor. Yale 

Alumni Magazine 57 (3): 4. 

143. Yale Alumni Magazine. 1993. Divinity 

school gift draws anti-tobacco fire. Yale 

Alumni Magazine 57 (3): 10. 
178

5 . T h e m e s a n d T a r g e t s o f To b a c c o A d v e r t i s i n g a n d P r o m o t i o n

144. Interfaith AIDS Ministry of Greater Danbury. 

2006. Mission not impossible! http://www

.danbury.org/interfaith.

145. Christian Relief Services Charities. 

2006. Company Web site. http://www

.christianrelief.org.

146. Jewish Community Council of Greater 

Coney Island. 2006. Company Web site. 

http://www.coney-island.org.

147. Villanueva, W. G. 1997. Nothing is sacred 

on the Philippine smoking front. Tobacco 

Control 6 (4): 357–59. 

148. Simpson, D. 2001. Philippines: Sacred and 

profane. Tobacco Control 10 (3): 204–5. 

149. Amos, A., and M. Haglund. 2000. From social 

taboo to “torch of freedom”: The marketing 

of cigarettes to women. Tobacco Control

9 (1): 3–8. 

150. Hafez, N., and P. M. Ling. 2005. How 

Philip Morris built Marlboro into a global 

brand for young adults: Implications for 

international tobacco control. Tobacco 

Control 14 (4): 262–71. 

151. Wen, C. P., T. Chen, Y. Y. Tsai, S. P. Tsai, 

W. S. Chung, T. Y. Cheng, D. T. Levy, 

C. C. Hsu, R. Peterson, and W. Y. Liu. 2005. 

Are marketing campaigns in Taiwan by 

foreign tobacco companies targeting young 

smokers? Tobacco Control 14 Suppl. 1: 

i38–i44. 

152. Gloede, W. F. 1985. Hey, Louie! Save da pack. 

Advertising Age, November 18: 98. 
179

6

Tobacco Companies’ Public 

Relations Efforts: Corporate 

Sponsorship and Advertising

Tobacco industry advertising and promotional efforts often are aimed directly toward 

the sale of industry products. However, corporate public relations activities also can have 

an important impact on the public images of and attitudes toward individual tobacco 

companies. This chapter examines the nature and potential impact of such efforts, 

including

n	 Corporate sponsorship of events and organizations, the latter of which often 

target key segments of the public in areas such as the arts, minority interests, 

or community relief

n	 Corporate advocacy advertising in areas such as youth smoking, which has 

been shown to favorably influence public attitudes toward individual tobacco 

companies

n	 Corporate image advertising, ranging from spotlighting charitable assistance to 

rebranding the image of a tobacco company and/or its parent corporation, which 

has also been shown to favorably influence public attitudes toward individual 

tobacco companies

Further research is needed on the impact of these types of public relations efforts on 

antismoking efforts and public attitudes, as well as on how such activities affect global 

markets for tobacco products.
180

6 . To b a c c o C o m p a n i e s ’ P u b l i c R e l a t i o n s E f f o r t s

Introduction

This chapter describes the tobacco industry’s 

use of sponsorship, corporate advertising, 

and public relations advertising in the 

United States, particularly when it is intended 

to cultivate a favorable image of corporate 

social responsibility. It complements the 

discussion of the industry’s relationship with 

the news media provided in chapter 9.

Since the 1988 Master Settlement 

Agreement (MSA), corporate sponsorship 

and corporate advertising have become 

increasingly important for tobacco 

companies. Tobacco companies, as with 

many companies, are interested in furthering 

their public images and interests, as well 

as in building their corporate and product 

brand identities. Corporate image campaigns 

have been on the rise among U.S. companies. 

Corporate social responsibility initiatives, 

such as corporate philanthropy, community 

involvement, cause-related marketing, and 

support for minority programs,1–4 have 

increased in particular. This trend is also 

described in Fortune magazine’s cover story 

in 2004 on “Corporate America’s Social 

Conscience”5 and the billions spent annually 

by companies on social causes.6 The Web 

sites of more than 80% of Fortune 500 

companies were found, in 1998, to address 

corporate social responsibility issues,7

and efforts have increased since then. 

The perception among business leaders is 

that corporate social responsibility is an 

economic necessity in today’s national and 

international marketplace.8,9 Compared with 

product-based advertising (discussed in 

chapters 3, 4, and 5), these types of public 

relations efforts generally focus on raising 

the visibility of and defining how the public 

views the organization itself.10

Although corporate advertising by tobacco 

companies has been around for many 

decades, corporate image campaigns have 

become more integrated. As reviewed by 

Szczypka and colleagues,11 Philip Morris’s 

first campaign began in October 1999 

with the slogan, “Working to make a 

difference: The people of Philip Morris.” 

It portrayed the company as providing 

charitable contributions to communitybased organizations and preventing the 

sale of cigarettes to minors. Another 

campaign, with the slogan, “Things are 

changing,” began in July 2000, one day 

after the punitive damages verdict in the 

Engle class-action trial in Miami, Florida.12

In June 2003, a series of advertisements 

focused on www.philipmorrisusa.com, 

directing viewers to Philip Morris’s 

corporate Web site for information about 

youth smoking prevention, quitting 

smoking, and the health effects of smoking. 

Corporate image advertising of Philip Morris 

was considerably greater in 1998 and 1999 

as compared with advertising of its leading 

brand, Marlboro.13 Examples of corporate 

image campaigns used by Philip Morris are 

discussed throughout this chapter.

The relative newness of the topic posed 

certain limitations in preparing this chapter. 

First, corporate expenditure data are difficult 

to determine. A footnote to the Federal 

Trade Commission’s (FTC’s) annual report 

on cigarette advertising and promotion 

summarizes the tobacco industry’s 

expenditures on public entertainment 

events that display corporate brand names 

but not cigarette brands or logos ($806,000 

in 2005).14 The FTC report also includes 

sponsorship of sports teams and athletes 

($30.6 million in 2005)14 but does not 

distinguish dollars spent on events bearing 

the name of a company (e.g., Philip Morris 

Mixed Doubles bowling championship) from 

those bearing the name of a cigarette brand 

(e.g., Virginia Slims Women’s Legend Tennis 

Tour). As Cruz15 reports, sponsorship data 

for individual tobacco companies can be 

obtained through commercial marketing 

firms, but such data are expensive to 

customize and are frequently incomplete. 

Other sponsorship sources (e.g., newspaper 
181

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

advertisements, corporate Web sites, and 

state tobacco control programs) do not 

reflect systematic monitoring of events.15

Another difficulty is separating corporate 

advertising from brand expenditure data. 

Although tobacco company names typically 

differ from their cigarette brands, in 

some cases the corporate entity and its 

products share the same name (e.g., Fortune 

cigarettes, sold outside the United States, 

are manufactured and sold by the Fortune 

Tobacco Company).

In addition to accurately accessing 

expenditure data, the newness of the topic 

of corporate image campaigns poses the 

problem of limited academic research. Unlike 

many of the tobacco topics addressed in 

other chapters of this monograph, answers 

to questions about the effectiveness of these 

campaigns are often inconclusive. In fact, 

only recently have companies (whether in 

tobacco or other industries) shown increased 

interest in promoting their company images, 

and most of the available academic research 

occurs outside the domain of tobacco 

marketing. To provide additional insight 

into corporate public relations strategies for 

which tobacco industry data are lacking, this 

chapter includes a description of research 

findings on corporate social responsibility 

about companies other than those in the 

tobacco industry. A call for more research 

on the tobacco companies’ public image 

campaigns is emphasized throughout this 

chapter as well as in chapter 15.

Despite the limitations of reviewing research 

on corporate public relations campaigns, 

this topic and its potential impact on 

tobacco product sales and on resistance to 

tobacco policy legislation warrant careful 

attention. In addition to an analysis of 

expenditures by tobacco companies on 

public relations campaigns, key questions 

to be addressed in this chapter include 

(1) whether tobacco corporate image 

campaigns are successful in improving 

the public’s perceptions of the credibility, 

trustworthiness, social responsibility, and/or 

attitudes concerning tobacco companies; 

(2) whether enhancing these perceptions 

of tobacco companies increases sales of 

tobacco products or reduces the likelihood 

or urgency of quitting among smokers; 

and (3) whether corporate sponsorship and 

corporate advertising have effects on jury 

perceptions and public or legislative support 

for tobacco control policies. This chapter 

also describes how some of the industry’s 

public relations messages are tailored 

and targeted to opinion leaders, ethnic 

minorities, and women. The perceptions 

of these groups could improve tobacco 

companies’ success with the financial 

community, in state legislatures, during 

trials, and in the court of public opinion. 

This chapter examines these key questions 

in the context of two elements of corporate 

brand image and public relations that are 

becoming increasingly common among 

U.S. companies and that represent two of 

the more visible approaches used by tobacco 

companies: corporate sponsorship and 

corporate advertising.

For this review, the literature in electronic 

databases such as PsycINFO and MEDLINE 

was examined by using the search terms, 

“tobacco industry attitudes,” variations of 

“tobacco corporate industry with image,” 

“public opinion sponsorship,” “social 

responsibility,” and “corporate advocacy.” 

The same search terms were used in 

tobacco industry documents until the term 

PM21 (“Philip Morris in the 21st Century,” 

a public relations campaign) was obtained, 

and then that name was searched as well. 

Other source materials were forwarded 

by knowledgeable reviewers. Advertising 

expenditure data came from Advertising Age

and the annual FTC reports on cigarette 

marketing. To locate research outside of the 

tobacco industry on corporate sponsorship, 

corporate advertising, and corporate social 

responsibility, the three primary journals 

in the marketing discipline (Journal of 

Marketing, Journal of Marketing Research,
182

6 . To b a c c o C o m p a n i e s ’ P u b l i c R e l a t i o n s E f f o r t s

and Journal of Consumer Research) were 

searched for the 1995–2005 time period. 

The search was supplemented with a small 

number of additional papers referenced in 

selected marketing and advertising articles.

Public-Image 

Problems of the 

Tobacco Companies

Negative images of the tobacco industry in 

the United States and other countries are 

well documented. An annual Harris public 

opinion poll (2004) comparing U.S. adults’ 

perceptions of 15 industries found that the 

tobacco industry was ranked the lowest in 

the public’s esteem.16 In another survey in 

California (2002), 83% of 7,000 adults agreed 

that tobacco companies generally provide 

some dishonest information about their 

products to the public.17 In the same study, 

88% of the 15,000 students in grades 8 and 

10 who were surveyed agreed that tobacco 

companies try to get young people to start 

smoking by using advertisements that are 

attractive to youth. The American Legacy 

Foundation’s (Legacy’s) survey (2004) of 

approximately 10,000 U.S. adolescents 

(aged 12–17 years) conveyed a similar 

impression.18 Of those surveyed, 78% agreed 

that tobacco companies lie and 67% said they 

try to get people to start smoking. In data 

from Australia published in 1999, 80% of 

800 adults expressed their belief that tobacco 

companies either mostly do not or never 

tell the truth about smoking and tobacco’s 

addictiveness.19 In Ontario, Canada, 75% of 

1,600 adults (2003) reported that the tobacco 

industry never or rarely tells the truth about 

the health effects of smoking.20 In addition, 

adolescents in Ontario surveyed in 2003 were 

more distrustful of the tobacco industry than 

those surveyed two years earlier.21

Public opinion about individual tobacco 

companies is not as uniformly negative. 

The four largest companies in the U.S. 

tobacco industry are Philip Morris USA 

(owned by Altria Group); R.J. Reynolds, 

which bought Brown & Williamson to 

form Reynolds American; the Lorillard 

Tobacco unit of Loews Corporation; and 

Liggett Group, owned by Vector Group. 

Few Americans connect these companies 

with the tobacco products they produce and 

market. Henriksen and Fortmann conducted 

a study about young adults’ opinions of 

Philip Morris and its television advertising.22

They found that between 36% and 43% 

of the 218 participants failed to identify 

the corporation with tobacco products, 

depending upon how this knowledge was 

measured.22 Some respondents mistakenly 

associated Philip Morris with light bulbs 

and electronics (Philips), tools (Phillips 

head screwdriver), the talent agency 

(William Morris), or stomach medication 

(Phillips’ Milk of Magnesia). In an opinion 

poll commissioned by Philip Morris in 

September 1999, between one-third and 

one-half of 2,078 adults said they had never 

heard of the company or its competitors 

(figure 6.1).23 Although relatively few adults 

expressed favorable opinions of any tobacco 

company, R.J. Reynolds fared better than 

the others. Its relative popularity in this and 

other polls has been attributed to aligning 

its corporate identity with Nabisco, its 

nontobacco subsidiary until 1999.24

In addition to negative public opinion, 

tobacco companies have faced increasing 

litigation and have come under greater 

scrutiny with the release of corporate tobacco 

documents under the Master Settlement 

Agreement. As Szczypka and colleagues state, 

two lawsuits filed in 1999 placed significant 

pressure on the industry, particularly on 

Philip Morris11—(1) a multibillion dollar suit 

was filed by the U.S. Department of Justice 

against the tobacco companies and industry 

groups for costs due to diseases caused by 

smoking and (2) the Engle class action suit 

in Florida asked jurors to award $200 billion 

in punitive damages to people suffering 

from diseases caused by tobacco. In 2006, 
183

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

a U.S. District Court25 ruled in the first 

case that the tobacco industry defendants 

had violated federal racketeering laws and 

engaged in deceptive practices to market 

a highly addictive product causing human 

suffering and loss, but that judgment is 

under appeal. In the Engle case, although the 

Florida Supreme Court26 in 2006 upheld a 

ruling against “excessive” punitive damages 

and against filing class-action suits against 

the industry, the court approved findings that 

smoking causes cancer and other diseases 

and that tobacco companies marketed 

“defective and unreasonably dangerous” 

products. These trials were well publicized 

and placed additional pressure on the tobacco 

industry to improve its public image.

In summary, the public has held the tobacco 

industry in low esteem and perceived it to 

be dishonest in communicating information 

about its products. Adolescents, too, 

report being distrustful of the industry. 

They believe the industry is dishonest 

about tobacco’s addictiveness and that 

tobacco companies try to entice young 

people to start smoking. Public perceptions 

of individual tobacco companies have 

been less negative, partly due to the 

lack of awareness by the general public 

about tobacco company names and their 

connection to individual cigarette brands. 

Finally, increased litigation against tobacco 

companies and potential punitive damage 

awards made by jurors also has threatened 

the industry’s reputation.

Against this backdrop of negative public 

perceptions of the tobacco industry in 

general, low awareness of individual 

tobacco companies, and increased litigation, 

corporate public relations activities on 

the part of individual tobacco companies 

represent a means to enhance the public 

image of the companies and influence public 

perception. In tobacco trial testimony, 

Roy Marden, then-director of external 

affairs of Philip Morris Companies, stated 

that increasing communications efforts 

was “particularly imperative in light of the 

facts that the antis’ vilification ads are back, 

our negative numbers are up, & the next 

round of PM 21 [Philip Morris campaign] 

ads will not be tobacco-related.”27

Figure 6.1 Public Opinion of Tobacco Companies: Roper Poll of 2,078 Adults, September 1999

0%

60%

10%

20%

30%

40%

50%

70%

80%

90%

100%

Brown & Williamson Philip Morris R.J. Reynolds

14%

34%

52%

26%

41%

33%

38%

27%

35%

Favorable

Unfavorable

Never heard of

Percent

Companies

Note. A random-digit-dial survey asked respondents whether or not they had heard of the companies and, if so, whether their 

opinion was favorable or unfavorable. From Roper Starch Worldwide. PM21 progress to date: A summary of survey findings from 

September 1999 to August 2001. Oct 2001. Philip Morris. Bates No. 2085220338/0414. http://legacy.library.ucsf.edu/tid/fav12c00.
184

6 . To b a c c o C o m p a n i e s ’ P u b l i c R e l a t i o n s E f f o r t s

Building a corporate brand image through 

public relations is an effort to strengthen 

and change public perceptions of the 

company, variously referred to as corporate 

image, reputation, and brand equity.10,28–30

The primary tools of public relations include 

publications, events, news, speeches, 

lobbying, public service activities, and 

identity media.29,30 In much the same way 

that tobacco companies use marketing 

media to portray positive product imagery 

(described in chapter 3), they use public 

relations media to portray positive corporate 

imagery. A tobacco company, for example, 

might use public relations media to improve 

its corporate image by neutralizing negative 

opinions, by persuading those without 

opinions of the company to think favorably 

of it, and/or to improve its company’s image 

relative to competitors or to the industry 

overall. A tobacco company might also aim 

to enhance its credibility and legitimacy 

by redefining or obscuring its association 

with tobacco products. Industry documents 

for Philip Morris describe corporate 

objectives to improve company image, 

increase company credibility, and establish 

“a foundation of acceptability” for company 

actions.31 One strategy was to “enhance the 

position of Philip Morris as the reasonable/

responsible industry leader and work to 

give the company a legitimate ‘seat at 

the table.’”31(Bates no. 2073434686)

Corporate Sponsorship

The sponsorship of sports, arts, 

entertainment, and social causes (also 

called event marketing) is an established 

communications tool used by both tobacco 

and nontobacco companies for building 

brand equity. Sponsorship refers to 

investments in causes or events to support 

corporate objectives, such as increasing 

brand awareness or enhancing corporate 

image.32 Creyer and Ross33 note that 

sponsorship is viewed more favorably by 

consumers than other forms of cause-related 

marketing, such as giving money or gifts to 

charity organizations each time consumers 

purchase a company’s product or service 

(e.g., a charitable donation contingent on 

a consumer’s cigarette pack purchase).33,34

According to an Independent Evaluation 

Group (IEG) Sponsorship Report, a leading 

national resource for sponsorship research, 

spending on sponsorship by North American 

companies increased from $850 million in 

1985 to $10.3 billion in 2003.35 As noted 

earlier, separating corporate and brand 

sponsorship expenditures is difficult. 

Data that combine them indicate that 

Philip Morris and R.J. Reynolds ranked 20th 

and 41st among the top 80 companies for 

annual sponsorship expenditures in 2003, 

each spending between $25 million and 

$50 million.35

Much research addresses the costs and 

consequences of cigarette product advertising 

and promotions (see chapters 4 and 7). 

However, comparatively little is known about 

tobacco industry sponsorship. In one of the 

more comprehensive studies, a 2001 review 

by Rosenberg and Siegel,36 data purchased 

from the International Events Group were 

combined with Internet research to describe 

tobacco sponsorships from 1995 to 1999. 

The five largest tobacco companies at the 

time spent a minimum of $365.4 million 

to sponsor at least 2,733 events or causes, 

with four times as many sponsorships 

for Philip Morris as for the other tobacco 

companies combined. Rodeo, motor, and 

other sports attracted the largest investment 

($226.8 million), antihunger organizations 

received the second largest investment 

($104.2 million), and the remainder 

supported a variety of special audiences 

(e.g., youth, women, and minorities) or 

issues (e.g., acquired immune deficiency 

syndrome, domestic violence, education, 

the environment, and government). 

Chapter 4 reviews sponsorship activities 

that promote cigarette brand names 

(e.g., Marlboro, Camel, Newport, and Kool). 
185

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

The remainder of this section focuses on 

sponsorship that promotes corporate brand 

names (e.g., Brown & Williamson, Lorillard, 

Philip Morris, and R.J. Reynolds).

For decades, tobacco companies have 

sponsored philanthropic events and causes, 

such as the arts and minority organizations.37

For example, Philip Morris reported grants 

totaling $9.3 million to 295 arts and 

cultural organizations in 2003, including 

recipients with obvious appeal to ethnic/

racial minorities (e.g., Grupo de Artistas 

Latinoamericanos, Alvin Ailey American 

Dance Theater, and Asia Society) and to 

children (e.g., Big Apple Circus).38 In 1998, 

Philip Morris contributed $2.1 million to 

57 organizations in the United States to 

fund meals for the elderly. The program 

partnered with the National Meals on 

Wheels Foundation.36 Some sponsorships 

have led to naming rights. For example, 

Brown & Williamson made a $3 million 

contribution to Kentucky’s University 

of Louisville’s athletic department in 

1996 for completion of the club level 

and a training facility, which led to the 

naming of the stadium’s club facility as 

the Brown & Williamson Club. Other 

sponsorships with title associations 

include the R.J. Reynolds Forest Aviary at 

the North Carolina Zoological Park, the 

Philip Morris Mixed Doubles Championship 

bowling tournament, the Brown & 

Williamson Derby Fest at the Kentucky Derby 

Festival, and the Philip Morris Center for 

Organizational Renewal at Catawba College.36

The rationale behind corporate sponsorship 

activities is to (1) promote awareness of 

tobacco company names and/or logos 

among people in attendance at sponsored 

events, (2) increase perceptions that 

the company is socially responsible and 

decrease perceptions that the company is 

socially irresponsible, (3) increase overall 

liking for the company, (4) create or 

strengthen the identity of the company as 

being associated with a particular target 

market or lifestyle, (5) show support for 

a social issue or community, (6) increase 

favorable associations with the company’s 

products, and/or (7) increase merchandising 

or promotional opportunities.29 It may 

also generate media exposure to reach a 

considerably larger audience.

Big Tobacco and Vatican Art

A 1983 grant in excess of $3 million for the Vatican art treasures exhibition at New York City’s 

Metropolitan Museum of Art garnered much publicity for Philip Morris. A company document 

describes the significance of Philip Morris’s sponsorship:

Explaining the exhibition to the general public proved to be an unparalleled opportunity to promote 

Philip Morris as well as the Vatican Collections. We did it through radio and television interviews, 

feature stories in newspapers and magazines, public service announcements, films run by the Public 

Broadcasting Service and placed in over 70 movie houses, and in a brochure given to museum visitors.a

The year-long exhibit was seen by 2 million people.b

When the Roman Catholic Archbishop of New York, Terence Cardinal Cooke, led a prayer at a 

banquet celebrating the Vatican exhibit, a Philip Morris vice president remarked, “We are probably 

the only cigarette company on this Earth to be blessed by a cardinal.”c

a

Philip Morris Corporate Relations and Communications. 1983. Washington relations summer jobs ’83. 

http://tobaccodocuments.org/usc_tim/2048090822-0833.html.

b

Blum, A., and K. Fitzgerald. 1985. How tobacco companies have found religion. NY State Journal of Medicine

85: 445–50.

c

Rosenblatt, R. 1994. How do tobacco executives live with themselves? New York Times, March 20.
186

6 . To b a c c o C o m p a n i e s ’ P u b l i c R e l a t i o n s E f f o r t s

Perceptions that the public has about a 

company, called corporate brand image 

associations, can be formed or strengthened 

when a brand becomes linked to a sporting 

event, social issue, or other sponsorship 

element. In the process, the tobacco 

company becomes linked with causes or 

events that are important to a particular 

target group. The pre-existing associations 

people have about the sporting event or 

social issue may become connected in 

memory to the company or brands that 

sponsor that event. This is similar to the 

way an image of a brand benefits from 

the positive attributes of a celebrity who 

endorses it (see chapter 10) or an appealing 

lifestyle associated with the branded 

product (see chapter 3). The corporate 

brand associations that transfer from 

the sporting event or social cause to the 

company sponsor could include general 

affective associations (such as fun, exciting, 

and liking) or more specific associations 

(such as credible, rugged, health-conscious, 

and compassionate).

In the special case in which the company 

name is the same as its product name 

(e.g., the Philip Morris brand of cigarettes 

is sold in the Philippines), advertising and 

sponsorship using the corporate name may 

benefit the cigarette sales of the brand that 

shares the corporate name. (See chapter 3 

for a discussion of “shell” companies with 

cigarette brand names and how corporate 

sponsorship can be used to promote a brand 

if the brand and company names are the 

same.) By associating tobacco companies 

with positive social values and institutions, 

corporate sponsorship also is expected to 

cultivate goodwill for perceived generosity. 

For instance, Yerger and Malone report 

that radio programming to honor Black 

History Month associated Philip Morris with 

African-American accomplishments, and 

billboards for the National Urban League 

advertised the R.J. Reynolds logo with that 

of a prominent civil rights organization.39

Such associations serve to counter negative 

perceptions and negative publicity about the 

industry,40 particularly among consumers 

who may be otherwise difficult to reach. 

One type of tobacco sponsorship has 

involved community and educational 

programs for youth, including partnerships 

with the 4-H, Boys and Girls Clubs of 

America, baseball camps, and other 

community organizations. In one case, 

Philip Morris provided schools throughout 

the country with covers for school books 

with the message, “Think. Don’t Smoke.” 

and the name of Philip Morris.41 The book 

covers were criticized by some schools as 

delivering an underlying message about 

a cigarette, which generated considerable 

news coverage. In a systematic review of 

tobacco industry transcripts from tobacco 

litigation cases from 1992 to 2002, Wakefield 

and colleagues42 present industry responses 

to this issue. Ellen Merlo, Vice President of 

Corporate Affairs at Philip Morris, reported 

that even though the company had changed, 

they would “think long and hard because 

maybe people are not yet ready for us to 

supply something like a book cover.”43 The 

implication was that the problem rested with 

the community, who had not yet accepted 

the new, responsible tobacco company 

policies.42 The book covers were not 

portrayed as a merchandising tool associated 

with corporate sponsorship, yet regardless 

“Think. Don’t Smoke.” book cover 

from Youth Smoking Prevention by 

Philip Morris
187

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

of intent, providing book covers to youth 

would have similar effects as other forms of 

merchandising: favorable associations with 

the book covers (such as education-focused 

or health-conscious) could extend to the 

tobacco company sponsor.

Tobacco Corporate Sponsorship 

Effects on Consumer Perceptions 

and Sales

A question raised at the start of this chapter 

is whether and how tobacco corporate 

sponsorships benefit the tobacco companies. 

Unfortunately, research has not adequately 

addressed this issue. In particular, more 

research is needed on whether tobacco 

corporate sponsorships have been successful 

in enhancing the public’s perception of 

the credibility, trustworthiness, and social 

responsibility of the tobacco sponsors. 

Studies of industries other than tobacco 

suggest that a company’s association 

with positively perceived events or 

causes enhances consumers’ perceptions 

of corporate social responsibility.44–47

For example, research on event sponsorships 

in domains other than tobacco has found 

that sponsorships increase people’s favorable 

associations to the company sponsor.46,47

Socially responsible corporate activity may 

also represent a competitive advantage 

because of its positive effects on company 

reputation,48 setting apart one company 

from others. As Bhattacharya and Sen9

argue, efforts by companies to engage in 

socially responsible actions are more likely 

to have a positive effect, and set the company 

apart from competitors, when people view 

the company as a pioneer in its socially 

responsible policies and when the company’s 

integrated marketing communications 

create a consistent message. 

Bhattacharya and Sen9 also note that a key 

determinant of the success of corporate 

social responsibility activity is whether 

consumers support the cause. For example, 

if people support a social cause, sporting 

event, or cultural activity sponsored by a 

particular company, they are more likely 

to view the company’s social responsibility 

favorably. People attending events (whether 

sponsored by tobacco or other companies) 

are likely to be strong supporters of those 

causes and may transfer those positive 

feelings to the sponsoring company. 

Consumers attending the event may also 

identify with the cause as having traits that 

overlap with the consumer’s self-concept 

(e.g., civic-minded, or compassionate).9,49

To the extent that the corporate image 

campaign signals that the company has 

the desired traits of the cause and the 

consumer’s self-image, the consumer is more 

likely to favorably evaluate the company. 

Overall, when a company behaves in a way 

that is viewed as socially responsible, people 

often infer that the company has desirable 

traits that resemble their own sense of self.1

A second question posed earlier is whether 

enhancing corporate social responsibility, 

trustworthiness, credibility, or attitudes 

toward the tobacco company increases sales 

of tobacco products. Further research is still 

needed in this area, and data pertaining to 

effects of corporate sponsorships on sales 

of individual branded tobacco products 

were not identified in the literature search. 

However, research in other industries shows 

that a positive relationship exists between a 

company’s socially responsible actions and 

consumers’ attitudes toward the company 

and its products.33,50,51 Further, the link 

between corporate social responsibility and 

financial performance, while mixed, is mostly 

favorable.52 Brown and Dacin50 found that 

a company’s record of social responsibility 

positively increased people’s attitudes toward 

the company, which, in turn, increased 

people’s preferences for a new product by 

the company. Creyer and Ross33 found a 

positive relationship between consumers’ 

preferences for a company’s products and 

the extent to which the company’s ethics 

exceeded their expectations. 
188

6 . To b a c c o C o m p a n i e s ’ P u b l i c R e l a t i o n s E f f o r t s

Just as corporate social responsibility can 

enhance a company’s image and product 

sales, the reverse effects may occur when a 

company is viewed as socially irresponsible. 

In fact, when people are exposed to events or 

causes sponsored by a company, sometimes 

they engage in causal attributions about the 

motives of the company or message source. 

In such cases, the positive effects of corporate 

social responsibility may be reduced or 

reversed when consumers are suspicious 

about corporate motives.32,48,53 For example, 

Szykman and colleagues54 found that when 

people viewed a message discouraging 

drinking and driving that was sponsored by 

the nonprofit organization Mothers Against 

Drunk Driving (MADD), they rated the 

motives of the sponsor as generally positive 

and serving the society. However, those who 

viewed the same advertisement sponsored 

by Anheuser-Busch for Budweiser beer 

rated the sponsor’s motives as negative and 

self-serving. Consumers’ overall attitudes 

toward the sponsors, that is, overall attitudes 

toward MADD or toward Budweiser, were 

left unchanged by the drinking-and-driving 

advertisement.54 Other research is more 

cautionary and finds that consumers feel 

less favorably toward spokespersons they 

regard as having self-serving or suspicious 

motives.55,56 It is, therefore, in the interest 

of companies—tobacco companies, in 

this case—to neutralize negative public 

opinion and make people less skeptical of 

their motives.

Negative corporate social responsibility 

associations have also been found to have a 

negative effect on the company’s products.50

Goldberg and Hartwick,57 in an experiment 

analyzing the combined effects of a 

company’s reputation and advertisements 

on product evaluations, found that when 

participants had a negative evaluation of 

a company because of a bad reputation, 

advertisements by the company were 

viewed as less credible and the products 

advertised were rated less favorably than 

when participants had a positive evaluation 

of a company on the basis of its reputation. 

Another study, by Creyer and Ross,33 found 

that when a hypothetical cereal company 

was described as having deliberately deceived 

consumers, subsequent publicity about the 

company’s sponsorship of a children’s charity 

increased the amount of money consumers 

were willing to pay for the company’s 

products.33 Clearly, more research is needed 

on tobacco sponsorship to determine when 

such campaigns improve a company’s 

reputation and credibility and when they do 

harm. Using media to increase the public’s 

awareness of corporate sponsorship may 

serve to minimize the public’s perceptions 

of a tobacco company’s lack of social 

responsibility in the marketplace.

Some organizations have refused tobacco 

industry sponsorship. According to Stone 

and Siegel,58 organizations cited two reasons 

for their opposition: (1) concern that tobacco 

funds undermine a mission to improve 

overall health, and (2) concern that public 

association with a tobacco company would 

damage the organization’s credibility.58

Future research should examine whether 

pairing a tobacco company sponsor with 

a well-liked cause or event harms the 

recipient’s reputation as much as it is 

believed to help that of the sponsor. If so, 

such evidence may further discourage 

organizations from accepting tobacco money.

In summary, while research on the effects of 

tobacco corporate sponsorships is limited, 

research on other industries suggests that 

sponsorships not only enhance perceptions 

of the company but also that companies 

perceived as socially responsible benefit 

through more positive perceptions of the 

company’s products. Research on companies 

with negative reputations is only suggestive. 

While one study suggested that a negative 

reputation hurts the consumers’ perceptions 

of the company’s products, another study 

suggested that these negative perceptions 

can be offset by perceptions of a socially 

responsible sponsorship. On the basis of 
189

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

findings reported earlier that the public 

views tobacco companies as dishonest and 

is distrustful of their motives, tobacco 

companies may have much to gain in 

changing these perceptions and presenting 

their companies as socially responsible. 

Tobacco Corporate Sponsorship 

Effects on Tobacco Control Policy

A third question posed at the beginning 

of this chapter is whether corporate 

sponsorships have effects on jury perceptions 

and other forms of public support for 

tobacco control policies. While research is 

limited in this area as well, some evidence 

exists that tobacco companies have used 

corporate sponsorship to influence opinion 

leaders. In opposition to a New York City 

proposal to ban smoking in most restaurants 

and public places, Philip Morris threatened 

to relocate its corporate headquarters and 

persuaded art institutions to lobby the 

city council.59 Although many arts groups 

felt obliged to voice support for their 

corporate patron, the smoking ban passed. 

In other efforts to defeat tobacco control 

legislation and promote its policy agenda, 

the industry has compelled the organizations 

it supported to write letters on its behalf.39

Corporate philanthropy has been described 

as improving a company’s strategic focus 

and competitive context.60 These examples 

of sponsorship by the tobacco industry were 

more strategic than philanthropic. 

Corporate Advertising

Corporate advertising is often designed 

to promote an organization’s image or 

viewpoint, rather than to sell particular 

products or services.61 Statements from the 

senior vice president for communications 

at Philip Morris serve to illustrate the value 

of advertising a youth access program: 

“It wouldn’t be a bolt out of the blue that a 

tobacco company like Philip Morris doesn’t 

have a lot of credibility. Our short-term goal 

is to make people aware of our position on 

youth smoking. Our long-term goal is to 

raise the credibility of this company.”62 Even 

when consumers do not explicitly connect 

a company’s products to the company 

name, corporate image advertising may be 

beneficial to a company. In addition to the 

findings reported about the benefits to the 

company regarding corporate sponsorship, 

including building awareness and favorable 

image associations, corporate advertising 

may also be used to influence public opinion 

on issues and make a favorable impression 

on the financial community.29 Corporate 

advertising by cigarette companies can 

also have a broad reach. According to 

U.S. Nielsen data for 1999–2003, the 

mean number of monthly exposures to 

antismoking advertisements was greater 

for those sponsored by tobacco companies 

than for those sponsored by public health 

agencies by a factor of 1.57:1 among 

households and 1.11:1 among youth.63

Typologies of corporate advertising 

distinguish between corporate image/

institutional advertisements, which aim 

to establish or enhance the sponsor’s 

reputation as a good corporate citizen, and 

corporate advocacy advertisements, which 

aim to influence public opinion and policy 

on issues that concern the corporation.64–66

However, the two categories are not 

mutually exclusive as advertisers expect 

audiences to think well of organizations 

that take appropriate stands on key issues.67

Indeed, the broad aim of all corporate 

advertising is to create an environment that 

is more favorable to the sponsor.68,69

Direct advocacy takes the form of a 

persuasive argument, presenting facts or 

arguments that portray the sponsor positively 

and its opponent negatively.64 An example 

is the 1954 newspaper advertisement, titled 

“A Frank Statement to Cigarette Smokers,”

in which the tobacco industry questioned 

research implicating smoking as a cause of 
190

6 . To b a c c o C o m p a n i e s ’ P u b l i c R e l a t i o n s E f f o r t s

cancer, promised consumers that cigarettes 

were safe, and pledged its cooperation to 

safeguard the public’s health.70,71 To defuse 

negative publicity surrounding accusations 

that tobacco companies manipulated nicotine 

in cigarettes, Philip Morris sponsored a 

newspaper advertisement that dismissed 

the allegations as innuendo and offered its 

denials as “facts smokers and nonsmokers 

should know.”72,73

Indirect advocacy typically characterizes 

a corporation as serving a public interest 

and its activities as the preferred solutions 

to issues of public concern.64 For example, 

newspaper advertisements that unveiled 

a youth access program to enhance the 

public’s perception of the credibility of 

Philip Morris would be considered indirect 

advocacy ads. These advertisements helped 

Philip Morris avoid strong legislation on 

sales to minors and attempted to persuade 

lawmakers and opinion leaders that the 

company did not want minors to have 

access to cigarettes.74

The next sections review the few published 

studies on this topic to address whether 

the tobacco industry’s youth smoking 

prevention advertisements have succeeded 

or failed as public relations tools as well 

as consider the impact of corporate image 

advertising on charitable assistance. 

Tobacco Corporate Advertising 

Effects on Company Perceptions 

and Sales 

The first issue addressed in this section 

is whether corporate image advertising 

has been successful in enhancing the 

public’s perceptions of the credibility, 

trustworthiness, social responsibility, and/or 

attitudes concerning tobacco companies. 

Although this question was difficult to 

answer for corporate sponsorship (due to 

the paucity of research), a few studies have 

been conducted on corporate advertising, 

both with regard to the youth smoking 

prevention advertisements and with regard 

to other corporate image advertising. 

Also addressed in this section is whether 

corporate advertising influences sales 

of tobacco products, intentions to start 

smoking, or intentions to quit smoking.

Youth Smoking Prevention 

Advertisements

The tobacco industry’s forays into youth 

smoking prevention, and the criticisms of 

these efforts, are not new.75–78 Mass media 

campaigns focusing on youth smoking 

prevention have been sponsored by both 

Philip Morris and Lorillard. In 1998, 

Philip Morris launched a $100 million 

campaign consisting of several television 

and magazine advertisements aimed 

at youth with the slogan “Think. Don’t 

Smoke.” and advertisements targeting 

parents with the slogan “Talk. They’ll 

Listen.” These campaigns portray the first 

positive images of tobacco companies on 

television in the more than 30 years since 

televised cigarette advertisements were 

banned on January 2, 1971.22 The target 

audience for the “Think. Don’t Smoke.” 

“Think. Don’t Smoke.” from Youth 

Smoking Prevention campaign by 

Philip Morris
191

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

campaign, according to 

Philip Morris, was youth 

aged 10–14.78 In 1999, 

Philip Morris launched a 

campaign with the slogan, 

“Talk. They’ll Listen.” focused 

on parental responsibility 

for talking to children 

about smoking. In court 

testimony on the tobacco 

company youth smoking 

campaign, Philip Morris 

witnesses stressed the 

seriousness of their efforts 

in trying to reduce smoking 

among youth, rather than 

their use of the campaign 

for public relations 

purposes.42 As evidence for 

the seriousness of their efforts, witnesses 

pointed to the amount of funding given to 

youth smoking prevention. Increases in 

funding, however, have tended to coincide 

with increases in tobacco litigation cases.42

In 1999 and 2000, Philip Morris was the 

single largest antismoking advertiser 

in the United States, even in states with 

aggressive antitobacco media campaigns.79

Although the “Think. Don’t Smoke.” 

advertisements ceased in 2002, similar 

prevention advertisements appeared on 

Music Television (MTV) in Europe and 

Australia.

Between 1999 and 2004, Lorillard’s 

prevention advertisements with the 

“Tobacco Is Whacko if You’re a Teen” slogan 

appeared widely in teen magazines and 

on cable television, including the most 

popular shows for adolescents on ESPN 

(Entertainment and Sports Programming 

Network), MTV, and Warner Brothers 

stations.77 The budget for this campaign 

was about $13 million.80 Eventually, the 

company replaced its advertisements aimed 

at youth with advertisements targeting 

parents. Formerly known as “Take 10,” 

the subsequent Lorillard prevention 

campaign featured the slogan, “Parents. 

The best thing between kids and cigarettes.” 

According to Nielsen data, the tobacco 

companies’ prevention advertisements 

aimed at youth appeared as often in all 

television households as in households 

with the “target” adolescent audience63

(see chapter 5). The fact that the youth 

smoking prevention advertising targeted 

all television households rather than solely 

youth, along with the emphasis placed 

on the amount of money spent on youth 

smoking prevention, seem to indicate 

the advertising campaign, was, at least in 

part, a public relations strategy intended 

to reduce the general public’s negative 

perceptions of the tobacco companies.

Consistent with the goals of corporate image 

advertising, the youth smoking prevention 

advertisements promoted more positive 

attitudes toward tobacco companies. In a 

telephone survey of a representative sample 

of U.S. adolescents (aged 12–17 years), 

sponsored by the Legacy Media Tracking 

Studies and analyzed and reported by Farrelly 

and colleagues,81 those who reported seeing 

any one Philip Morris advertisement were 

significantly less likely than unexposed peers 

to agree with statements, such as “cigarette 

“Talk. They’ll Listen.” from Youth 

Smoking Prevention campaign by 

Philip Morris

From “Tobacco Is Whacko if You’re a 

Teen” campaign by Lorillard
192

6 . To b a c c o C o m p a n i e s ’ P u b l i c R e l a t i o n s E f f o r t s

companies deny that cigarettes cause 

disease,” and “I would like to see cigarette 

companies go out of business.”81(p.904)

Moreover, exposure to additional 

Philip Morris advertisements reinforced 

these attitudes. Because the data are crosssectional, it also is plausible that adolescents 

who held more favorable opinions about 

cigarette companies were more attentive 

to Philip Morris advertisements (an effect 

of selective exposure). However, the 

survey results are consistent with those 

of a randomized controlled trial, reported 

by Henriksen and colleagues,82 in which 

California adolescents (aged 14–17 years) 

who viewed Philip Morris or Lorillard 

tobacco use prevention advertisements 

expressed significantly greater sympathy 

toward the tobacco industry than did 

comparison group members who viewed 

either antismoking advertisements from 

Legacy or advertisements about drunk 

driving.82 Industry sympathy was measured 

by agreement with statements such as 

“cigarette companies get too much blame 

for young people smoking” and “cigarette 

companies should have the same right to sell 

cigarettes as other companies have to sell 

their products.”82(p.15)

Wakefield and colleagues42 argue that, 

given the sophisticated methods available 

Youth Smoking Prevention: Researching the Tobacco Industry Agenda

Analysis of tobacco industry documents identifies several motivations for tobacco industry youth 

smoking prevention programs. For example, Landman and colleaguesa reveal that the industry 

promoted its youth smoking prevention programs to discourage restrictions on marketing and 

other legislation that it found threatening. In one case, in 1991, Philip Morris stated that “youth 

initiatives,” if successful, would lead to a “reduction in legislation or banning our sales and 

marketing activities.”b

Landman and colleagues also found that industry program themes and messages consistently 

downplayed the health effects of smoking to frame it as an “adult choice.” As one example, 

Tobacco Institute Vice President Anne Duffin, in 1985, sought advice from a tobacco industry law 

firm about how to avoid mentioning the health consequences of smoking in a brochure, called 

“Helping Youth Decide.” “Because of criticism from the antis [antismokers] on HYD [Helping 

Youth Decide], I’d like to get our own scenario in on cigarettes—not touching on any health 

implications, but positing that youngsters don’t need to smoke to look ‘grown up,’ needn’t blindly 

follow the examples of others, etc.” [italics added by Landman and colleagues].a(p.919) Documents 

revealed that motivations for youth smoking campaigns also included (1) building alliances with 

third parties, such as youth and tobacco control groups, which had the “youth credibility” that 

the industry itself lacked, and (2) giving Philip Morris a legitimate reason to continue its research 

on teenage smoking patterns.c

Carter’s analysis showed that international efforts with identical strategies were being deployed 

in Australia, with an ultimate aim of creating a “global brand” for industry youth smoking 

prevention efforts, with tangible benefits for tobacco industry stakeholders.d

a

Landman, A., P. M. Ling, and S. A. Glantz. 2002. Tobacco industry youth smoking prevention programs: 

Protecting the industry and hurting tobacco control. American Journal of Public Health 92 (6): 917–30.

b

Slavitt, J. J. TI youth initiative. Philip Morris. 12 Feb 1991. Bates No. 2500082629/2634. http://legacy.library

.ucsf.edu/tid/sj119e00.

c

Philip Morris. 2004. Welcome to Philip Morris USA Youth Smoking Prevention’s Teenage Attitudes and 

Behavior Study. http://www.philipmorris.com/policies_practices/ysp/research.asp.

d

Carter, S. M. 2003. From legitimate consumers to public relations pawns: The tobacco industry and young 

Australians. Tobacco Control 12 Suppl. 3: iii71–iii78.
193

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

to these companies for determining the 

effectiveness of advertising campaigns, the 

considerable funding of the youth smoking 

prevention programs, and the companies’ 

insistence on the seriousness of their efforts, 

one source of data for the effectiveness of 

these programs should be the cigarette 

companies themselves. However, according 

to court testimony from 1992 to 2003, the 

companies did not make any assessments 

about the effects of their campaign on 

youth smoking. Instead, company witnesses 

focused on advertising reach as a measure 

of effectiveness (for example, 90% of 10- to 

14-year-olds had seen the advertisements) 

and on qualitative data.42 Industry documents 

in the 1990s, reported by Landman and 

colleagues,77 also show evidence that tobacco 

companies measured media “hits,” program 

awareness, and corporate image perceptions, 

rather than the effectiveness of their 

programs in reducing teen smoking.77

Academic research exists, however, on 

the effectiveness of these youth smoking 

campaigns in curbing smoking intentions 

and behavior. Evidence reviewed in 

chapter 12 suggests that the tobacco 

companies’ prevention advertisements 

have failed as antismoking messages.82–85

Even worse, in the case of advertisements 

targeting parents, the messages succeeded 

as prosmoking messages.81,86 Following 

exposure to these advertisements, youth in 

grades 10 and 12 showed stronger approval 

of smoking, stronger intentions to smoke 

in the future, and increased likelihood 

of smoking.86

In other research, by Donovan and 

colleagues,87 of Western Australian youth, 

tobacco industry youth smoking prevention 

advertisements showed mixed support in 

effectiveness on reducing desire to smoke 

in the future, with results varying by 

message theme and smoker status. However, 

across both smoker and nonsmoker 

groups, message believability was high. 

The authors conclude that these corporate 

advertisements increase credibility of the 

advertising message, which could increase 

positive attitudes toward the tobacco 

industry and, in turn, reduce criticism from 

youth groups in the community.

Other Corporate Image Advertising

Most of the available data on other corporate 

image advertising involves analysis of 

various Philip Morris campaigns. In 1999, 

Philip Morris launched a $250 million 

media campaign to advertise its charitable 

assistance for the elderly and for homeless 

adolescents, as well as for victims of 

domestic violence, midwestern floods, and 

war-torn Bosnia.88 Featuring the slogan, 

“Working to make a difference. The people 

of Philip Morris,” television and magazine 

advertisements promoted the corporate 

name and logo, flanked by the more 

recognizable symbols of its Kraft Foods and 

Miller Brewing subsidiaries. Combining 

these advertisements with those about 

youth smoking prevention accounted for a 

dramatic increase in Philip Morris corporate 

advertising, peaking at $317.5 million in 

2000 (figure 6.2).13,89,90 Between 1999 and 

2001, following the MSA, Philip Morris 

spent three to five times more money to 

advertise its corporate brand name than it 

spent to advertise its top-selling brand of 

cigarettes. The quantity and content of its 

advertising suggested an unprecedented 

effort to increase the company’s visibility 

and cultivate a new corporate image.

In an experimental study, reported by 

Henriksen and Fortmann,91 testing 

the effectiveness of the Philip Morris 

corporate advertisements, young adults 

(aged 18–27 years) in California evaluated 

corporate advocacy advertisements from 

Pfizer and Chevron followed by either four 

Philip Morris advertisements about youth 

smoking prevention, four Philip Morris 

advertisements about community service, 

or four Anheuser-Busch advertisements 

about preventing underage drinking.91
194

6 . To b a c c o C o m p a n i e s ’ P u b l i c R e l a t i o n s E f f o r t s

Although Philip Morris smoking prevention 

advertisements were perceived to be less 

credible than the company’s community 

service advertisements, the two types of 

advertisements improved corporate image 

perceptions almost equally well. Groups 

exposed to any Philip Morris advertisements 

rated the company’s image more favorably 

than did the comparison group. The 

advertisements were most effective among 

those who were unaware that Philip Morris 

is a tobacco company.

Tobacco industry documents, too, show 

improved corporate image perceptions 

due to Philip Morris’s corporate 

advertisements.11 Before launching their 

“Things are changing” advertisements, 

focus group data reported in company 

documents in May 2000 showed 

increased beliefs that “Philip Morris is 

working to change for the better,” and 

“Philip Morris is open and honest about 

their products and business practices.” 

After launching its Web campaign in 

June 2003, Philip Morris’s public relations 

firm collected opinion survey data 

among U.S. adults, oversampling certain 

target groups (e.g., African Americans, 

Hispanics, and opinion leaders). The first 

reported that 81% of people who saw the 

advertisements had a positive impression 

of them, and 55% gave Philip Morris a 

favorable rating for addressing tobacco 

issues. The advertisements also were 

reported as more credible than anti-industry 

advertising and as creating an impression 

of responsible marketing practices. On the 

other hand, the public relations firm stated 

that “acknowledging health risks” is a key 

Figure 6.2 Philip Morris’s Annual Advertising Expenditures for its Corporate and Marlboro 

Brands

0

$150

$100

$50

$200

$250

$300

$350

Millions

1997 1998 1999 2000 2001

$114.5

$5.9

$134.6

$17.1

$94.7

$153.6

$94.5

$317.5

$178.6

$33.0

Think. Don’t Smoke. Work to Make a Difference.

Marlboro Cigarettes

Philip Morris Corporate

Note. Expenditure data for measured and unmeasured media were estimated (by Advertising Age) but did not include cigarette 

marketing expenditures such as price discounts or promotional allowances (which comprise more than one-half of the annual 

marketing budget). Also note that these data are considerably lower than FTC expenditure data for the same years because the 

figure estimates expenditures for a single brand from only one of the five tobacco companies summarized in the annual FTC report. 

Advertising Age ceased reporting annual expenditures for Marlboro in 2002. The numbers in the figure do not include marketing 

expenditures at the point of sale.

Adapted from Advertising Age. 1999. The 100 leaders. Advertising Age, September 27; Advertising Age. 2000. The 100 leaders. 

Advertising Age, September 24; Advertising Age. 2002. Advertising Age’s 100 leaders national advertisers report: Advertiser 

profile edition. Advertising Age, June 24.
195

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

driver of corporate reputation and still must 

be addressed before other messages can 

improve reputation.92(Bates no. 3000176517)

McDaniel and colleagues93 analyzed 

industry documents and reported that 

overall favorability ratings of Philip Morris 

increased from 23% in 1997 to 39% 

in 2000, mostly due to changes in the 

18–34-year age group (an increase from 

19% to 45%). In January 2004, 58% agreed 

that the tobacco industry was acting more 

responsibly than in the past. Philip Morris 

fared better than others; 41% said that 

Philip Morris was more responsible than 

other companies. It is difficult to discern 

which particular campaign may have led 

to the increases. The authors chose to 

discuss the changes in connection with a 

long-term Philip Morris program, called 

“Project Sunrise.” This project aimed 

at countering threats to the company’s 

public credibility and financial success 

by distinguishing the company from 

competitors and forging alliances with 

certain tobacco control organizations. 

Finally, in April 1998, four of the five largest 

tobacco companies began a $40 million 

advertising campaign (including print, 

radio, and television advertisements) “to 

inform the American people about both the 

proposed national tobacco resolution and 

proposed legislation before Congress.”94(p.135)

A survey conducted in August 1998 by 

Princeton Survey Research Associates, 

working under the direction of the 

University of Pennsylvania’s Annenberg 

Public Policy Center led by Communication 

Professor Kathleen Hall Jamieson,94

analyzed public opinion in response to the 

industry’s campaign as a function of whether 

media markets received light exposure 

(an average of 9 exposures), moderate 

exposure (an average of 25), heavy exposure 

(57 exposures), or no exposures, during 

Health-Risk Promotion: A New Tobacco Industry Strategy

In a more radical step for the tobacco industry, particularly relative to older internal documents,a,b

self-imposed health warnings have begun to appear. A Philip Morris cigarette pack insert explicitly 

stated that “Smoking causes many serious and fatal diseases including lung cancer, heart 

disease, and emphysema. Your risk of getting a disease from smoking is very high. Do not think 

that smoking won’t affect your health.”c An accompanying advertisement argues that “it also 

requires education about the serious health effects of smoking, including addiction.”d Another 

advertisement explicitly states that low tar is not a safer option and quotes the World Health 

Organization in support.

Marc Fritsch, Philip Morris head of corporate communications, spelled out the strategy behind 

this latest campaign: “We are providing information to respond to consumer concerns which is 

good for long-term business. We’re not telling them something they don’t already know. They 

simply want us to be more transparent. Yes, it’s frank, but why should we say anything different?”e

a

Nicoli, D. P. Memorandum. 14 Feb 2000. Philip Morris. Bates No. 2073073375. http://legacy.library.ucsf.edu/

tid/ssf60c00.

b

Philip Morris. “Steve” PM21 research overall objective. Dec 1999. Philip Morris. Bates No. 2073074117. 

http://legacy.library.ucsf.edu/tid/yiv27d00.

c

Philip Morris. 2000. Pack “Onsert.” http://www.philipmorrisinternational.com/global/downloads/SH/Feature

_30_Swiss_onsert.pdf.

d

Philip Morris. 2003. Press ads. http://www.philipmorrisinternational.com/global/downloads/SF/Feature_30

_press_comms.pdf.

e

Jones, M. C. 2003. What doesn’t kill you might even make you stronger. Brand Strategy 177:10–11.
196

6 . To b a c c o C o m p a n i e s ’ P u b l i c R e l a t i o n s E f f o r t s

a period of three and one-half months. 

The survey found that individuals exposed 

to heavy advertising judged three of the five 

message claims as more accurate than did 

those with less or no advertising exposure, 

even after controlling for behavioral, 

attitudinal, and demographic factors. For 

example, 43% of those exposed to heavy 

advertising, as compared with 31% exposed 

to no advertising, agreed that “the tobacco 

plan Congress considered would create 

the largest consumer tax in history.”94(p.138)

It appears that exposure to protobacco 

advertisements changed the public’s 

perceptions about claims concerning the 

tobacco debate in 1998.94 Those changes 

may have enhanced the industry’s image 

and bargaining power as it negotiated the 

MSA (signed in November 1998) with state 

attorneys general.

In summary, the research on the tobacco 

industries’ youth smoking prevention and 

other corporate image campaigns finds 

that while public opinion of the industry 

has been very poor (as described earlier 

in this chapter), corporate advertisements 

garnered support for the industry, including 

rating the companies as less dishonest, 

less culpable for adolescent smoking, 

more responsible, and more favorable 

overall. Company data from Philip Morris 

also indicate that this advertising 

increased company credibility and gave 

the impression of responsible marketing. 

Corporate image advertising benefits from 

association with prosocial issues in much 

the same way that corporate sponsorship 

benefits from association with prosocial 

issues.45 Adolescents and young adults 

transfer favorable image associations 

from the prosocial issue to the tobacco 

companies. As discussed for corporate 

sponsorship, more research is needed to 

determine whether the increased support 

for the tobacco companies translates 

into increased sales of tobacco company 

products. However, research on youth 

smoking prevention programs, in particular, 

as discussed in chapter 12, has shown 

effects on smoking behavior. In a couple 

of studies, youth showed increased rates of 

smoking, increased intentions to smoke, 

and increased approval of smoking following 

exposure to the tobacco industry’s youth 

smoking prevention advertisements 

targeting parents.

Future research should investigate the 

possibility that corporate advertising 

reduces the effectiveness of ongoing 

antismoking campaigns by making 

audiences more resistant to criticism of 

the tobacco industry. Evidence for this 

inoculation effect has been demonstrated 

in other contexts.95,96 For example, 

attitudinal and corporate image effects 

were measured after varying young adults’ 

exposure to advocacy advertisements from 

a Mobil Oil campaign and antiadvocacy 

advertisements on behalf of an opposing 

position. Consistent with the inoculation 

theory,97,98 prior exposure to advocacy 

advertising yielded more favorable attitudes 

toward Mobil’s position and more favorable 

impressions of the company.95 In the context 

of antismoking campaigns, understanding 

inoculation effects may improve the design 

and placement of specialized counteradvertising.99 Finally, more research is 

needed on the tobacco industry’s outreach 

to tobacco control organizations—such as 

appearances at public health conferences, 

support for potential reduced exposure 

products (PREPs) as part of industry 

strategy, and links to tobacco control 

organizations on tobacco industry Web 

sites—and the effects these efforts have on 

the favorability of tobacco corporate images.

Tobacco Corporate Advertising 

Effects on Tobacco Control Policy

The evidence for the effects of corporate 

advertising on tobacco control policy is 

limited, but analysis of industry documents 

shows that influencing legislation is a goal 

of corporate advertisements. According to 
197

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

industry documents, tobacco companies 

conceived of youth smoking prevention 

programs as public relations campaigns 

aimed at generating positive news coverage, 

encouraging support from business and from 

parent and teacher groups, and discouraging 

legislation that would restrict or ban tobacco 

sales or marketing activities.77 In lawsuits 

filed by people who believed they were 

affected by problems caused by smoking, 

tobacco company executives testified about 

their youth smoking prevention programs 

to convince jurors that the companies 

should be viewed sympathetically and to 

reduce or eliminate punitive damages.100

Despite the myriad ways in which tobacco 

companies benefit from their prevention 

advertisements, participants of focus groups 

convened to gauge public opinion of the 

advertisements perceived them to contradict 

the industry’s interests.77 As such, the public 

response to these advertisements, in some 

cases, may be suspicion. Alternatively, since 

audiences perceive statements against 

self-interest to be particularly persuasive,101

the advertisements could potentially 

enhance the company’s ability to garner 

public sympathy.

Future research is needed to measure the 

relationship between corporate advertising 

exposure and public support for tobaccocontrol policies and to more directly 

assess the role of corporate advertising in 

gaining opposition to more restrictive laws 

and regulations. Studies of the tobacco 

companies’ prevention advertisements have 

focused primarily on adolescents’ reactions 

to television advertisements aimed at youth. 

However, since the tobacco industry has 

shifted its resources for youth smoking 

prevention messages from targeting 

adolescents to targeting parents, the 

effects of the messages on adults becomes 

important. Research with adult respondents 

should address whether this shift represents 

a more effective strategy to forestall 

legislation that would restrict industry sales 

and marketing activities.

Corporate Advertising on 

Tobacco Company Web Sites

The corporate Web sites of the major 

tobacco companies, such as Philip Morris, 

provide a wealth of information about the 

companies’ social-responsibility policies and 

actions. Information includes positions on 

the health consequences of smoking, youth 

smoking prevention initiatives, rationales for 

support or nonsupport for advertising bans, 

and other social-responsibility positions. 

One of the message elements appearing in 

corporate advertisements by Philip Morris 

in their “www.philipmorrisusa.com” 

campaign has been an invitation to visit 

its corporate Web site. Also advertised on 

prime-time television, in magazines, in 

newspapers, and on inserts tucked in its 

cigarette packs, the corporate Web site has 

attracted approximately 250,000 visits per 

month.38 To the extent that consumers are 

persuaded by corporate advertising to visit a 

tobacco company Web site address, they will 

be exposed to further corporate advertising 

information. As reported by Szczypka and 

colleagues,11 a company memo in 2001, 

written by a public relations company 

hired to review the Philip Morris Web site, 

suggested that Internet information is 

more credible than paid media. In 2003, 

Philip Morris created a search engine plan 

to increase traffic flow to their Web site, 

and include a range of information on health 

issues, addiction, and Philip Morris products, 

but to do so in “a more user friendly, 

transparent, credible voice.”102(Bates no. 3001113881)

This redesigned Web site targeted opinion 

leaders and adults 18 years of age and older.11

Philip Morris characterizes, on the Web 

site, the company’s positions on the risks of 

smoking, without compromising its legal 

defenses.71 It seems reasonable to speculate 

that, in addition to targeted opinion leaders, 

consumers likely to visit the corporate 

Web site would be smokers seeking help 

in quitting smoking. As such, the Web site 
198

6 . To b a c c o C o m p a n i e s ’ P u b l i c R e l a t i o n s E f f o r t s

provides the tobacco company with a means 

for targeting specific audiences.

Media Literacy and Corporate 

Advertising

One means of countering the effects of 

corporate advertising is media literacy, an 

“ability to access, analyze, evaluate, and 

create messages in a variety of forms.”103(p.7)

Unfortunately, little research has been 

identified that examines media literacy 

in the context of corporate advertising. 

However, research sponsored by Legacy104

suggests that youth who were exposed to 

more Legacy advertisements (critical of the 

tobacco industry) had more skeptical views 

about tobacco companies. Furthermore, 

path analytic data among adolescents 

aged 12–17 showed that mistrust of 

individual tobacco companies was linked 

to mistrust of the tobacco industry overall, 

that mistrust of the tobacco industry was 

linked to more negative attitudes toward 

the tobacco industry, and that negative 

industry attitudes were linked to a lower 

likelihood of smoking.104 Research is needed 

to determine whether these effects also 

are found for adults. Teaching audiences 

about the advertiser’s identity and motives 

may encourage more skeptical responses 

to the tobacco companies’ advocacy 

advertisements.22 However, advertisements 

that have been designed to discredit the 

tobacco industry do not typically name 

a specific company or specific brand. 

For example, advertisements from the 

California Department of Health Services 

refer to “Big Tobacco.” These advertisements 

mock what a tobacco company might say: 

“We don’t say anything about cigarettes 

on the tube. We talk about beer, we talk 

about cheese, and we talk about community 

service.” Research is needed to determine 

whether these types of oblique references 

to a particular cigarette company, such 

as Philip Morris, are understood and are 

sufficient to engender skepticism about a 

company’s television advertising.

In the next section, the PM21 integrative 

marketing campaign is described as a 

case study of corporate public relations 

campaigns.

PM21: An Integrated 

Public Relations 

Campaign

Although typically regarded as distinct 

campaigns, Philip Morris advertisements 

about youth smoking prevention and 

community service were part of a 

coordinated public relations campaign called 

PM21 or “Philip Morris in the 21st Century.” 

This multifaceted campaign included paid 

media, a corporate Web site, a charitable 

giving program, a speakers’ bureau, and 

an internal toolkit to enhance employee 

morale.40 A 1999 company document 

summarizes the corporate image advertising 

and illustrates the central role of its youth 

smoking prevention advertisements in the 

company’s image “makeover”105 (figure 6.3).

Objectives of the PM21 

Advertising Campaign

A primary objective of PM21 was to move 

the public’s opinion of Philip Morris 

(its corporate image) closer to the 

company’s view of itself (its corporate 

identity), a process the company referred 

to as “societal alignment.”105(Bates no. 2081609499)

The public relations campaign had four 

target audiences: African Americans (aged 

25–54 years), Hispanics (aged 25–54 years), 

opinion leaders, and active mothers. Opinion 

leaders were defined as adults who voted in 

the past year; belonged to a club; and either 

led a company or worked for the federal, 

state, or local government. Active mothers 

had at least one child under age 18 in their 

households and either voted in the past year, 

entertained guests two to three times per 

month, held a position on a school/college 
199

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

board, took part in a civic issue, influenced 

others’ purchase decisions, or engaged in 

fundraising.

Targeted Advertisements 

Created for PM21

As shown in Figure 6.3, PM21 was 

designed to persuade target audiences 

that Philip Morris shares their social 

values; is an open, honest, responsible 

marketer/manufacturer of tobacco products; 

and is just like any other Fortune 500 

company. Four types of advertisements 

represented these key messages: (1) “Making 

a difference” refers to advertisements 

about Philip Morris’s community service; 

(2) “Strengthening efforts to protect 

kids” refers to advertisements about 

the company’s support of the MSA 

(“At Philip Morris, we’re changing the way 

we do business”) and restricting youth 

access at the point of sale (“We card”); 

(3) “Informed choices” refers to the youth 

smoking prevention advertisements; and 

(4) “More than a tobacco company” refers 

to advertisements that linked Philip Morris 

with its nontobacco subsidiaries and 

products. PM21 advertisements used 

different execution styles, slogans, and 

source attributions. Nonetheless, all 

portrayed reasons for audiences to “connect 

with Philip Morris on a positive emotional 

level.”106(Bates no. 2081613330) For example, a 

company document described its “desired 

mindset” for active mothers as follows:

I understand they make risky products, but 

I see in the past few years PM has gotten 

its act together. They aren’t so duplicitous 

and they’re being more responsible. 

They’re actually doing something to help 

kids and their futures. Working together 

we’re going to get there. There’s some 

common ground ... we want some of the 

same things.107(Bates no. 2081235877)

Company documents also quote several 

major Wall Street analysts as praising the 

Figure 6.3 Overview of PM21 Advertising Campaign

Societal Alignment

Image Building

PM Corporate Image Advertising Communications Architecture

Audience:

Corporate Image Advertising

Communication Objective:

Strengthening

Efforts to

Protect Kids

Making a

Difference

Informed

Choices

More Than a

Tobacco Company

Responsible

Marketer/Manufacturer

of Tobacco

(Open and Honest)

Shared Values

(...And acts on them)

Normalization

(Just Another Fortune 500

Company)

Primary

Campaign

Messages:

Strategy:

African Americans

Hispanics

Opinion Leaders

Active Mothers

Note. From Philip Morris. 1999. PM corporate image advertising audience groups. Bates No. 2081609502.

http://legacy.library.ucsf.edu/tid/clr65c00.
200

6 . To b a c c o C o m p a n i e s ’ P u b l i c R e l a t i o n s E f f o r t s

campaign, predicting that the corporate 

advertisements for “a kinder, gentler 

Philip Morris”108(Bates no. 2071041508) would move 

the company toward the mainstream of 

corporate America, improve its government 

lobbying efforts, and reduce the risk 

of large-scale punitive damage awards 

during trials.108

Evaluation of the PM21 

Advertising Campaign

As reported in tobacco industry documents, 

a market research firm evaluated 

the PM21 campaign by conducting 

random-digit-dial telephone surveys of a 

nationally representative sample of adults 

18 years and older almost quarterly from 

September 1999 to September 2001.23

The survey asked whether respondents had 

heard of “Philip Morris companies” and, 

if so, whether their opinion was favorable 

or unfavorable. It also measured agreement 

with specific positive statements about 

the company’s image and its defense in 

lawsuits. Data collection was suspended 

on September 11, 2001, before oversample 

interviews of the four target audiences 

had begun. Thus, the margin of error 

was ±2 percentage points for all adults 

(N = 2,078), but ±6 points for subsamples 

of active mothers, African Americans, 

Hispanics, and opinion leaders.

PM21 persuaded adults without pre-existing 

opinions of Philip Morris to think favorably 

about the company. However, the campaign 

failed to convince those with negative 

opinions to think otherwise. Between 

September 1999 and August 2001, the 

number of adults with favorable opinions of 

Philip Morris increased from 26% to 38%, 

but unfavorable opinions were unchanged 

(41% to 42%).23 Throughout the campaign, 

approximately 50% of respondents said the 

positions the company takes when defending 

itself in lawsuits were somewhat or very 

believable. Unaided recall of television 

advertisements for Philip Morris companies 

peaked at 45%, and advertisement awareness 

was associated with more favorable 

impressions of the sponsor. For example, 

compared with other adults, more adults 

who recalled PM21 advertisements agreed 

the company “is changing for the better,” 

“becoming a more responsible corporate 

citizen,” and “offering solutions to issues 

related to its products.”23(Bates no. 2085220389)

However, advertisement awareness also was 

associated with an increase in unfavorable 

opinions of Philip Morris (from 37% to 

44%), signaling a possible backlash against 

the campaign.

The campaign’s most dramatic impact 

was on African Americans, among whom 

favorable opinions of Philip Morris increased 

from 18% to 40%.23 Smaller increases in 

favorable impressions among active mothers 

(32% to 37%) and Hispanics (31% to 33%) 

and a decrease among opinion leaders (41% 

to 38%) did not exceed the poll’s margin of 

error (±6 points). In advertisements about 

food banks for the elderly and scholarship 

programs for youth, PM21 depicted tangible 

benefits to African Americans and used 

psychographic research about the lifestyles, 

activities, and passions of this audience to 

strengthen the emotional impact of these 

messages.106

PM21 culminated with the company’s 

decision to rename itself the Altria Group, 

which went into effect in January 2003.24

The name change represented the logical 

conclusion of the long-term efforts by 

Philip Morris to reposition its company in 

a more favorable light. 

Hostility toward Philip Morris and the 

industry it represents appears to be 

softening. In an annual survey of corporate 

reputations that evaluates products 

and services, financial performance, 

workplace environment, leadership, social 

responsibility, and emotional appeal of the 

60 most visible U.S. corporations, ratings 

for Philip Morris have improved. From 
201

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

PM21: Preparing for a Backlash

Philip Morris believed criticism of its PM21 public relations campaign was inevitable, and its 

strategic response plan offered vivid descriptions of what might happen.a So-called firestorm 

scenarios anticipated media events, such as the following:

n State attorney general convenes a press conference to “denounce PM21 advertisements 

as a PR scam, a back-door effort to advertise tobacco products, and a violation of the 

MSA [Master Settlement Agreement].”a He demands that television networks refuse 

to run the advertisements or provide equal, free time for antitobacco advertising, and 

prohibits sports facilities that receive public funding from selling any Philip Morris 

products (e.g., Miller, Kraft, and Oscar Mayer).

n Prominent political and public health figures convene a press conference to announce 

a lawsuit to ban the advertisements, subpoena all records related to the effort, and 

propose legislative efforts to increase tobacco excise taxes to pay for new antismoking 

advertisements.

n Popular daytime talk show host devotes an entire week of shows to ask the question, 

“who are the people of Philip Morris?” and sponsors a “give back dirty money” 

fundraiser to collect money for organizations that receive Philip Morris contributions.

n Popular nighttime talk show host attacks the advertising campaign by producing 

mock advertisements with the tagline, “The people of Philip Morris—Sick, fat, 

drunk & dead.”a

In fact, a Tonight Show spoof of Philip Morris advertising portrayed the demise of an American 

family brought about by corporate donations of Marlboro cigarettes, Miller beer, and Kraft cheese, 

but it preserved the original tagline (“Working to make a difference”).b In addition, the American 

Legacy Foundation produced a parody of the advertisement about Philip Morris’s support for the 

MSA, refuting the company’s claim to have significantly changed its business practices.c

Other media also criticized the hypocrisy of the corporate image advertising. A single television 

commercial, estimated to cost $1 million, dramatized the company’s food donation for Kosovar 

refugees—a five-ton food drop of Kraft macaroni and cheese that was valued at approximately 

$125,000.d Moreover, the company spent substantially less money on annual charitable 

contributions than it spent to advertise its largesse: $60 million versus $108 million, respectively, 

in 1999;e and $125 million versus $142 million, respectively, in 2000.f,g Ultimately, this type of 

negative publicity did not engender the boycotts, lawsuits, or tax increases that Philip Morris 

feared most.

a

Philip Morris. PM21 overview. 4 Sep 1999. Philip Morris. Bates No. 207823617/6287. http://legacy.library.ucsf

.edu/tid/gds75c00.

b

Tonight Show NBC. 2001. Request line/tobacco companies. Videocassette. San Francisco: Video Monitoring 

Services of America.

c

Healton, C. 2001. Big tobacco’s broken vows. Advertising Age, February 5.

d

Branch, S. 2001. Philip Morris’ ad on macaroni and peace: Kosovo tale narrows gap between philanthropy, 

publicity. Wall Street Journal, July 24.

e

Dorfman, L. 2001. Polishing its image or preventing domestic violence: What’s Philip Morris really doing? 

Off Our Backs, November.

f

Bruno, K. 2001. Philip Morris: Killing to make a difference. http://www.corpwatch.org/article.php?id=217.

g

Chronicle of Philanthropy. 2001. Gifts and grants: Charitable giving at 96 major corporations. http://

philanthropy.com/premium/corpgiving/2001corp_page.php?Corp_ID-1009.
202

6 . To b a c c o C o m p a n i e s ’ P u b l i c R e l a t i o n s E f f o r t s

its 1999 designation as having “the worst 

reputation in America,” the company rose 

to 48th place in 2004, surpassing companies 

such as AT&T and American Airlines.109

In previous years, Philip Morris never ranked 

above 52 out of 60. In 2003, its reputation 

surpassed only those tainted by the specter 

of bankruptcy or criminal indictment 

(e.g., Martha Stewart Living Omnimedia, 

Kmart, Global Crossing, WorldCom, and 

Enron, in descending order) and that of 

another tobacco company (R.J. Reynolds).110

Moreover, public opinion regards the 

tobacco industry as less culpable than it 

once did. The percentage of U.S. adults who 

describe tobacco companies as completely or 

mostly to blame for health problems caused 

by smoking decreased from a high of 30% in 

1999 to 22% in 2004, the lowest percentage 

yet reported.111 Fewer than one-half of 

U.S. adults surveyed think that tobacco 

companies require more government 

regulation—the percentage decreased 

from 44% in 2003 to 42% in 2004.110

In summary, the PM21 campaign is an 

integrated marketing campaign designed 

to improve public perceptions of the 

Philip Morris company. Key segments were 

targeted, including African Americans, 

Hispanics, opinion leaders, and active 

mothers. Public opinion research showed 

high overall awareness of the campaign 

(45% unaided recall). Among those 

with prior existing negative opinions 

of Philip Morris, opinions remained 

unchanged. However, adults without prior 

existing opinions of Philip Morris revealed 

an increase in positive associations with the 

company. African Americans, in particular, 

showed an increase in favorable opinions 

as a result of the integrated campaign. 

The combination of evidence from 

industry documents about PM21 and other 

research reviewed in this chapter indicate 

that U.S. tobacco companies have used 

corporate sponsorship and advertising to 

enhance their credibility. Tobacco industry 

documents should be examined to learn 

what strategies were used to accomplish 

these goals, to aid the design of effective 

tobacco control campaigns.

Summary

Compared with many consumer product 

manufacturers, the very nature of the 

tobacco industry’s product leaves it with 

substantial challenges in public image and 

perception. Studies have found that both 

adults and adolescents perceive the tobacco 

industry as dishonest and hold it in low 

esteem. In response to these concerns, 

tobacco companies have moved aggressively 

toward corporate public relations efforts 

aimed at building the public images and 

brand identities of their firms, spending 

hundreds of millions of dollars in the 

process. This chapter examines two such 

areas whose impact has been studied 

through research: corporate sponsorship 

and corporate advertising.

Research reviewed in this chapter suggests 

that corporate image campaigns have been 

successful in reducing negative perceptions 

of the tobacco industry. While research 

investigating the role of tobacco sponsorship 

in reducing negative perceptions has not 

been done, in other industries research 

shows that sponsorships build positive 

brand associations and reduce negative 

brand associations. Evidence for the effects 

of corporate advertising on perceptions 

does exist for the tobacco industry. Studies 

reviewed in this chapter have found that 

corporate advertising reduces perceptions 

among adolescents and young adults 

that the tobacco companies are dishonest 

and culpable for adolescent smoking, 

and, among adults, increases favorability 

ratings for the individual company, such as 

Philip Morris.

Also important are the effects of corporate 

sponsorship and corporate advertising 

on the sale and use of tobacco products, 
203

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

intentions to start smoking, intentions to 

quit smoking, and susceptibility of smokers 

to claims about “lower risk” cigarettes. 

In studies of youth smoking prevention 

programs (reported in more detail in 

chapter 12), those programs advertised 

by tobacco companies and targeted to 

parents were found to be ineffective, or in 

some cases, were found to increase older 

adolescents’ intentions to smoke, increase 

approval of smoking, and result in a higher 

likelihood of smoking behavior. More 

research is needed to determine the effects 

of other forms of corporate advertising and 

tobacco sponsorship on smoking intentions 

and behavior. In industries other than 

tobacco, increased consumer perceptions 

of corporate social responsibility and other 

favorable associations with a company have 

been linked to increased interest in and 

sales of products made by those companies. 

In the tobacco industry, the effect of public 

relations campaigns on adolescents’ and 

young adults’ intentions to start smoking, 

on smokers’ intentions to quit smoking, and 

on sales of tobacco products are important 

issues for future research.

Perhaps most important are the effects that 

softening negative attitudes and improving 

public image perceptions of cigarette 

companies may have on legislation, jury 

awards, public support, and consumer 

activism. Some evidence exists that 

patrons of corporate sponsors have felt an 

obligation, or even felt compelled, to voice 

support for the tobacco sponsor in opposing 

smoking bans. Industry documents show 

that the tobacco industry motives for youth 

smoking prevention programs include 

discouraging legislation that restricts or 

bans tobacco sales or marketing activities. 

Tobacco companies’ public relations efforts 

may be a key strategy for providing the legal 

and regulatory buffer against anti-industry 

legislation. These efforts could have tangible 

effects on tobacco companies’ ability to 

fight legislation and litigation affecting 

their sales and marketing activities, which, 

in turn, ultimately may affect the public’s 

exposure to tobacco. The effects of tobacco 

public relations efforts on public resistance 

to tobacco control policies also need 

further study. 

Discussions are needed about how to acquire 

accurate and topical data on corporate 

sponsorship and corporate advertising. 

Tobacco product advertising has been 

increasingly restricted over time. It remains 

subject to substantial monitoring by federal 

agencies (most notably the FTC) and some 

control through the MSA. A similar level 

of surveillance and oversight does not exist 

for corporate image advertising and public 

relations efforts, which, nonetheless, may 

affect public attitudes and behavior toward 

smoking through their effects on company 

credibility, social responsibility, or other 

favorable associations. 

Given its history of corporate image 

concerns and investment of significant 

resources to improve its image, the tobacco 

industry’s use of the media for public 

relations purposes warrants greater scrutiny. 

One possible direction is for the FTC or 

another agency to monitor the tobacco 

companies’ annual expenditures to advertise 

and promote their corporate brands as it 

does for their cigarette brands (see chapter 8 

for a discussion of government regulation). 

Future research should continue to measure 

public opinion of tobacco companies, public 

support for tobacco control policies, and 

their relationship to corporate advertising 

exposure. Combined with research on the 

impact of these corporate public relations 

efforts, here and abroad, it is possible to 

better understand the relationships among 

tobacco industry public relations efforts, 

smoking, and public health.

Finally, the global impact of these types 

of public relations activities represents 

another important area for future study. 

This chapter focuses on examples from the 

U.S. media, and these lessons may or may 
204

6 . To b a c c o C o m p a n i e s ’ P u b l i c R e l a t i o n s E f f o r t s

not be applicable worldwide. Similar work is 

needed in other countries and especially in 

Asia and Africa, where smoking prevalence is 

increasing and a dramatic rise in morbidity 

and mortality is anticipated.112 Future 

research should examine how multinational 

tobacco corporations use public relations 

advertising to manage corporate images in 

other markets and compare the reputation 

and performance of the tobacco industry in 

the United States and other countries.

Conclusions

1. Corporate sponsorship of events and 

social causes represents a key public 

relations strategy for major tobacco 

companies, which spent more than 

$360 million on these efforts in 2003. 

Key targets included sporting events, 

antihunger organizations, and arts and 

minority organizations. These efforts 

have been used, in certain cases, to 

influence opinion leaders who benefit 

from such sponsorship.

2. Corporate image campaigns by tobacco 

companies have highlighted their 

charitable work in the community and 

have promoted their youth smoking 

prevention programs; at times, 

corporate spending on these campaigns 

has vastly exceeded the amount 

actually given to the charities. These 

campaigns have reduced perceptions 

among adolescents and adults that 

tobacco companies are dishonest 

and culpable for adolescent smoking, 

and among adults, have increased 

perceptions of responsible marketing 

practices and favorable ratings for the 

individual companies.

3. Tobacco industry youth smoking 

prevention campaigns have been 

generally ineffective in reducing youth 

smoking. Moreover, they may even have 

increased smoking in some subgroups 

of youth. 

4. Tobacco industry public relations efforts 

such as corporate sponsorship and 

advertising may make audiences more 

resistant to criticism of the industry, 

may mitigate jurors’ negative views 

toward the industry, and may weaken 

public or legislative support for tobacco 

control policies. 

5. Systematic monitoring and descriptions 

of tobacco companies’ activities and 

expenditures for corporate sponsorship 

and advertising are needed to better 

understand the impact of these 

activities on the public image of tobacco 

companies, on consumers’ smoking 

intentions and behaviors, and on the 

image of sponsored events and causes.
205

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

References 

1. Lichtenstein, D. R., M. E. Drumwright, and 

B. M. Braig. 2004. The effect of corporate 

social responsibility on customer donations 

to corporate-supported nonprofits. Journal 

of Marketing 68:16–32. 

2. Berger, I. E., P. H. Cunningham, and 

M. E. Drumwright. 2004. Social alliances: 

Company/nonprofit collaboration. California 

Management Review 47 (1): 58–90. 

3. Hess, D., N. Rogovsky, and T. W. Dunfee. 

2002. The next wave of corporate 

community involvement: Corporate social 

initiatives. California Management Review

44 (2): 110–25. 

4. Andreason, A. 2003. Strategic marketing for 

nonprofit organizations. Upper Saddle River, 

NJ: Prentice Hall.

5. Ioannou, L. 2004. Corporate America’s social 

conscience. Fortune. http://www.timeinc.net/

fortune/services/sections/fortune/corp/2003

_05csr.html.

6. Cone, C. L., M. A. Feldman, and A. T. DaSilva. 

2003. Causes and effects. Harvard Business 

Review 81:95–101. 

7. Esrock, S. L., and G. B. Leichty. 1998. 

Social responsibility and corporate web 

pages: Self-presentation or agenda-setting? 

Public Relations Review 24 (3): 305–19. 

8. Murray, K. B., and C. M. Vogel. 1997. Using 

a hierarchy-of-effects approach to gauge the 

effectiveness of corporate social responsibility 

to generate goodwill toward the firm: 

Financial versus nonfinancial impacts. 

Journal of Business Research 38 (2): 141–59. 

9. Bhattacharya, C. B., and S. Sen. 2004. 

Doing better at doing good: When, why, 

and how consumers respond to corporate 

social initiatives. California Management 

Review 47 (1): 9–24. 

10. Grunig, L. A., and J. E. Grunig. 2003. 

Public relations in the United States: 

A generation of maturation. In The global 

public relations handbook: Theory, 

research, and practice, ed. K. Sriramesh 

and D. Vercic, 323–55. Mahwah, NJ: 

Lawrence Erlbaum.

11. Szczypka, G., M. A. Wakefield, S. Emery, 

Y. M. Terry-McElrath, B. R. Flay, and 

F. J. Chaloupka. 2007. Working to make an 

image: An analysis of three Philip Morris 

image media campaigns. Tobacco Control

16 (5): 344–59. 

12. Engle v. R. J. Reynolds Tobacco, No. 94-08273 

CA-22 (Fla. 11th Cir. Ct. Nov. 6, 2000), rev’d, 

853 So. 2d 434 (Fla. 3d DCA 2003).

13. Advertising Age. 2000. The 100 leaders. 

Advertising Age, September 24. 

14. Federal Trade Commission. 2007. Federal 

Trade Commission cigarette report for 

2004 and 2005. http://www.ftc.gov/reports/

tobacco/2007cigarette2004-2005.pdf.

15. Cruz, T. B. Forthcoming. Monitoring 

the tobacco industry: Data sources and 

recommendations for research and 

evaluation. 

16. Harris Interactive. 2004. Which industries 

should be more or less regulated? http://

www.harrisinteractive.com/harris_poll/

index.asp?PID=451.

17. Independent Evaluation Consortium. 2002. 

Final report. Independent evaluation of the 

California Tobacco Control Prevention and 

Education Program: Waves 1, 2, and 3 (1996–

2000). Rockville, MD: Gallup Organization.

18. American Legacy Foundation. 2004. Research 

and publications: Surveys and studies, Legacy 

Media Tracking Survey (LMTS). http://www

.americanlegacy.org/2141.aspx.

19. Wakefield, M., C. Miller, and S. Woodward. 

1999. Community perceptions about the 

tobacco industry and tobacco control 

funding. Australia New Zealand Journal of 

Public Health 23 (3): 240–44. 

20. Ashley, M. J., and J. E. Cohen. 2003. What 

the public thinks about the tobacco industry 

and its products. Tobacco Control 12 (4): 

396–400. 

21. Waller, B. J., J. E. Cohen, and M. J. Ashley. 

2004. Youth attitudes towards tobacco 

control: A preliminary assessment. Chronic 

Diseases in Canada 25 (3–4): 97–100. 

22. Henriksen, L., and S. P. Fortmann. 2002. 

Young adults’ opinions of Philip Morris and 

its television advertising. Tobacco Control

11 (3): 236–40. 

23. Roper Starch Worldwide. PM21 progress to 

date: A summary of survey findings from 

September 1999 to August 2001. Oct 2001. 

Philip Morris. Bates No. 2085220338/0414. 

http://legacy.library.ucsf.edu/tid/fav12c00.

24. Smith, E. A., and R. E. Malone. 2003. 

Thinking the “unthinkable”: Why Philip 

Morris considered quitting. Tobacco Control

12 (2): 208–13. 

25. United States v. Philip Morris USA, Civil 

Action No. 99-2496 (GK) (D.D.C.) (amended 

final opinion 2006).
206

6 . To b a c c o C o m p a n i e s ’ P u b l i c R e l a t i o n s E f f o r t s

26. Engle v. Liggett Group, No. SC03-1856 (Fla. 

Sup. Ct., Dec. 21, 2006, revised opinion).

27. Marden, R. Tobacco communication action 

group meeting. 4 May 2000. Philip Morris. 

Bates No. 2078240121. http://legacy.library

.ucsf.edu/tid/gnr75c00.

28. Baines, P., J. Egan, and F. Jefkins. 2004. 

Public relations: Contemporary issues and 

techniques. Oxford: Elsevier ButterworthHeinemann.

29. Keller, K. L. 2003. Strategic brand 

management: Building, measuring, and 

managing brand equity. 2nd ed. Upper 

Saddle River, NJ: Prentice Hall.

30. Kotler, P. 2003. Marketing management. 11th 

ed. Upper Saddle River, NJ: Prentice Hall.

31. Philip Morris. Facets of the index. Aug 1997. 

Bates No. 2073434651/4694. http://legacy

.library.ucsf.edu/tid/qiv84a00.

32. Dean, D. H. 2002. Associating the 

corporation with a charitable event through 

sponsorship: Measuring the effects on 

corporate community relations. Journal of 

Advertising 31 (4): 77–87. 

33. Creyer, E. H., and W. T. Ross Jr. 1996. The 

impact of corporate behavior on perceived 

product value. Marketing Letters 7 (2): 

173–85. 

34. Varadarajan, P. R., and A. Menon. 1988. 

Cause-related marketing: A coalignment 

of marketing strategy and corporate 

philanthropy. Journal of Marketing 52: 58–74. 

35. Independent Evaluation Consortium. 2003. 

Sponsorship spending to increase 8.7 

percent in 2004. IEG Sponsorship Report

22 (4): 1, 4–5. 

36. Rosenberg, N. J., and M. Siegel. 2001. 

Use of corporate sponsorship as a tobacco 

marketing tool: A review of tobacco industry 

sponsorship in the USA, 1995–99. Tobacco 

Control 10 (3): 239–46. 

37. U.S. Department of Health and Human 

Services. 1998. Tobacco use among 

U.S. racial/ethnic minority groups—

African Americans, American Indians 

and Alaska Natives, Asian Americans 

and Pacific Islanders, and Hispanics: 

A report of the Surgeon General. Atlanta: 

U.S. Department of Health and Human 

Services, Centers for Disease Control and 

Prevention, National Center for Chronic 

Disease Prevention and Health Promotion, 

Office on Smoking and Health. http://www

.cdc.gov/tobacco/data_statistics/sgr/sgr

_1998/index.htm. 

38. Altria Group. 2005. Contributions and 

communities—Who we fund. http://web

.archive.org/web/20051213203431/

http://www.altria.com/responsibility/4_9

_1_2_whowefund.asp.

39. Yerger, V. B., and R. E. Malone. 2002. African 

American leadership groups: Smoking with 

the enemy. Tobacco Control 11 (4): 336–45. 

40. Smith, E. A., and R. E. Malone. 2003. Altria 

means tobacco: Philip Morris’s identity 

crisis. American Journal of Public Health

93 (4): 553–56. 

41. Smith, K. C., and M. Wakefield. 2001. USA: 

The name of Philip Morris to sit on 28 million 

school desks. Tobacco Control 10 (1): 8. 

42. Wakefield, M., K. McLeod, and C. L. Perry. 

2006. “Stay away from them until you’re 

old enough to make a decision”: Tobacco 

company testimony about youth smoking 

initiation. Tobacco Control 15 Suppl. IV: 

iv44–iv53. 

43. Merlo, E. 2001. Trial testimony of Ellen 

Merlo, May 2, 2001, Boeken v. Philip Morris 

Inc. http://tobaccodocuments.org/datta/

MERLOE050201.html.

44. Meerabeau, E., R. Gillett, M. Kennedy, 

J. Adeoba, M. Byass, and K. Tabi. 1991. 

Sponsorship and the drinks industry in 

the 1990s. European Journal of Marketing

25 (11): 39–56. 

45. Javalgi, R. G., M. B. Traylor, A. C. Gross, 

and E. Lampman. 1994. Awareness 

of sponsorship and corporate image: 

An empirical investigation. Journal of 

Advertising 23 (4): 47–58. 

46. Stipp, H., and N. P. Schiavone. 1996. 

Modeling the impact of Olympic sponsorship 

on corporate image. Journal of Advertising 

Research 36 (4): 22–28. 

47. Dean, D. H. 1999. Brand endorsement, 

popularity, and event sponsorship as 

advertising cues affecting consumer prepurchase attitudes. Journal of Advertising

28 (3): 1–12. 

48. Menon, S., and B. E. Kahn. 2003. Corporate 

sponsorships of philanthropic activities: 

When do they impact perception of sponsor 

brand? Journal of Consumer Psychology

13 (3): 316–27. 

49. Gwinner, K. P., and J. Eaton. 1999. Building 

brand image through event sponsorship: 

The role of image transfer. Journal of 

Advertising 18 (4): 47–57. 

50. Brown, T. J., and P. A. Dacin. 1997. The 

company and the product: Corporate 
207

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

associations and consumer product 

responses. Journal of Marketing 61 (1): 

68–84. 

51. Ellen, P. S., L. A. Mohr, and D. J. Webb. 

2000. Charitable programs and the retailer: 

Do they mix? Journal of Retailing 76 (3): 

393–406. 

52. Pava, M. L., and J. Krausz. 1995. Corporate 

responsibility and financial performance: 

The paradox of social cost. Westport, CT: 

Quorum Books.

53. Webb, D. J., and L. A. Mohr. 1998. A typology 

of consumer responses to cause-related 

marketing: From skeptics to socially 

concerned. Journal of Public Policy and 

Marketing 17 (2): 226–28. 

54. Szykman, L. R., P. N. Bloom, and J. Blazing. 

2004. Does corporate sponsorship of a 

socially-oriented message make a difference? 

An investigation of the effects of sponsorship 

identity on responses to an anti-drinking 

and driving message. Journal of Consumer 

Psychology 14 (1–2): 13–20. 

55. Fein, S. 1996. Effects of suspicion 

on attributional thinking and the 

correspondence bias. Journal of Personality 

and Social Psychology 70 (6): 1164–84. 

56. Campbell, M. C., and A. Kirmani. 2000. 

Consumers’ use of persuasion knowledge: 

The effects of accessibility and cognitive 

capacity on perceptions of an influence 

agent. Journal of Consumer Research

27 (1): 69–83. 

57. Goldberg, M. E., and J. Hartwick. 1990. 

The effects of advertiser reputation and 

extremity of advertising claim on advertising 

effectiveness. Journal of Consumer Research

17 (2): 172–79. 

58. Stone, M., and M. B. Siegel. 2004. Tobacco 

industry sponsorship of community-based 

public health initiatives: Why AIDS and 

domestic violence organizations accept 

or refuse funds. Journal of Public Health 

Management and Practice 10 (6): 511–17. 

59. Goldberger, P. 1994. Philip Morris calls in 

its I.O.U.’s in the arts. New York Times,

October 4.

60. Porter, M. E., and M. R. Kramer. 2002. 

The competitive advantage of corporate 

philanthropy. Harvard Business Review,

December.

61. Rau, P. A., and J. F. Preble. 1988. Corporate 

public issue advertising: An analysis of the 

attitudes of chief executives. International 

Journal of Advertising 7 (4): 293–306. 

62. Wall Street Journal. 1996. An embattled 

Philip Morris launches advocacy advertising 

campaign. Wall Street Journal, April 17.

63. Wakefield, M., G. Szczypka, Y. TerryMcElrath, S. Emery, B. Flay, F. Chaloupka, 

and H. Saffer. 2005. Mixed messages 

on tobacco: Comparative exposure to 

public health, and tobacco company- and 

pharmaceutical company-sponsored 

tobacco-related television campaigns in 

the United States, 1999–2003. Addiction

100 (12): 1875–83. 

64. Sethi, S. P. 1979. The role of advocacy 

advertising in external communications. 

Journal of General Management 4 (3): 3–14. 

65. Waltzer, H. 1988. Corporate advocacy 

advertising and political influence. Public 

Relations Review 14 (1): 41–45. 

66. McLeod, D. M., and M. Kunita. 1994. A 

comparative analysis of the use of corporate 

advertising in the United States and Japan. 

International Journal of Advertising 13 (2): 

137–52. 

67. Fox, K. F. A. 1986. The measurement of 

issue/advocacy advertising effects. Current 

Issues and Research in Advertising 9 (1): 

61–92. 

68. Cutler, B. D., and D. D. Muehling. 1989. 

Advocacy advertising and the boundaries of 

commercial speech. Journal of Advertising

18 (3): 40–50. 

69. Haley, E. 1996. Exploring the construct 

of organization as source: Consumers’ 

understandings of organizational 

sponsorship of advocacy advertising. 

Journal of Advertising 25 (2): 19–35. 

70. Tobacco Industry Research Committee. 

1954. A frank statement to cigarette 

smokers. http://www.tobacco.org/resources/

history/540104frank.html.

71. Cummings, K. M., C. P. Morley, and 

A. Hyland. 2002. Failed promises of 

the cigarette industry and its effect on 

consumer misperceptions about the 

health risks of smoking. Tobacco Control

11 Suppl. 1: I110–I117. 

72. Philip Morris. 1994. Smokers and 

non-smokers: Facts you should know. 

Advertisement. New York Times, April 15.

73. Benoit, W. L. 1988. Merchants of death: 

Persuasive defense by the tobacco 

industry. In Argument in a time of change: 

Definitions, frameworks, and critiques,

ed. J. F. Klumpp, 220–25. Annandale, VA: 

National Communication Association.
208

6 . To b a c c o C o m p a n i e s ’ P u b l i c R e l a t i o n s E f f o r t s

74. Philip Morris. Kids should not smoke. 

Advertisement. 28 Mar 1996. Philip Morris. 

Bates No. 2042869041. http://legacy.library

.ucsf.edu/tid/bxe52e00.

75. DiFranza, J. R., and T. McAfee. 1992. The 

Tobacco Institute: Helping youth say “yes” 

to tobacco. Journal of Family Practice

34 (6): 694–96. 

76. DeBon, M., and R. C. Klesges. 1996. 

Adolescents’ perceptions about smoking 

prevention strategies: A comparison of 

the programmes of the American Lung 

Association and the Tobacco Institute. 

Tobacco Control 5 (1): 19–25. 

77. Landman, A., P. M. Ling, and S. A. Glantz. 

2002. Tobacco industry youth smoking 

prevention programs: Protecting the industry 

and hurting tobacco control. American 

Journal of Public Health 92 (6): 917–30. 

78. Sussman, S. 2002. Tobacco industry youth 

tobacco prevention programming: A review. 

Prevention Science 3 (1): 57–67. 

79. Szczypka, G. 2002. Working to make an 

image: Television exposure to Philip Morris’ 

youth smoking prevention and public 

relations campaigns. Paper presented at the 

National Conference on Tobacco or Health, 

San Francisco.

80. Farrelly, M. C., J. Niederdeppe, and 

J. Yarsevich. 2003. Youth tobacco 

prevention mass media campaigns: Past, 

present, and future directions. Tobacco 

Control 12 Suppl. 1: i35–i47. 

81. Farrelly, M. C., C. G. Healton, K. C. Davis, 

P. Messeri, J. C. Hersey, and M. L. Haviland. 

2002. Getting to the truth: Evaluating 

national tobacco countermarketing 

campaigns. American Journal of Public 

Health 92 (6): 901–7. 

82. Henriksen, L., A. L. Dauphinee, Y. Wang, 

and S. P. Fortmann. 2006. Industrysponsored anti-smoking ads and adolescent 

reactance: Test of a boomerang effect. 

Tobacco Control 15 (1): 13–18. 

83. Teenage Research Unlimited. 1999. Countertobacco advertising exploratory summary 

report. Northbrook, IL: Teenage Research 

Unlimited.

84. Healton, C. 2001. Who’s afraid of the truth? 

American Journal of Public Health 91 (4): 

554–58. 

85. Biener, L. 2002. Anti-tobacco advertisements 

by Massachusetts and Philip Morris: What 

teenagers think. Tobacco Control 11 Suppl. 

2: ii43–ii46. 

86. Wakefield, M., Y. Terry-McElrath, S. Emery, 

H. Saffer, F. Chaloupka, G. Szczypka, B. Flay, 

P. O. O’Malley, and L. Johnston. 2006. 

Effect of televised, tobacco company-funded 

smoking prevention advertising on youth 

smoking-related beliefs, intentions, and 

behavior. American Journal of Public Health

96 (12): 2154–60. 

87. Donovan, R. J., G. Jalleh, and O. B. J. Carter. 

2006. Tobacco industry smoking prevention 

advertisements’ impact on youth motivation 

for smoking in the future. Social Marketing 

Quarterly 12 (2): 3–13. 

88. Myers, M. L. 2002. Philip Morris changes 

its name, but not its harmful practices. 

Tobacco Control 11 (3): 169–70. 

89. Advertising Age. 1999. The 100 leaders. 

Advertising Age, September 27. 

90. Advertising Age. 2002. 47th annual leading 

national advertisers. Advertising Age, June 24. 

91. Henriksen, L., and S. P. Fortmann. 2003. 

Tests of the tobacco industry’s youth 

smoking prevention ads: Summary of 

scientific progress. Palo Alto, CA: Stanford 

Univ., Stanford Center for Research in 

Disease Prevention.

92. Apco Insight. Philip Morris USA advertising 

and reputation tracking research. ACQPRC ad tracking wave 2. 20 Jul 2003. 

Philip Morris. Bates No. 3000176309/6760. 

http://legacy.library.ucsf.edu/tid/teg95a00.

93. McDaniel, P. A., E. A. Smith, and 

R. E. Malone. 2006. Philip Morris’s Project 

Sunrise: Weakening tobacco control by 

working with it. Tobacco Control 15 (3): 

215–23. 

94. Beck, D., and K. H. Jamieson. 2000. Do issue 

ads work? If so, when? In Everything you 

think you know about politics ... and why 

you’re wrong, by Kathleen Hall Jamieson, 

pp. 125–140. New York: Basic Books.

95. Burgoon, M., M. Pfau, and T. S. Birk. 

1995. An inoculation theory explanation 

for the effects of corporate issue/advocacy 

advertising campaigns. Special issue: 

Communication and social influence. 

Communication Research 22 (4): 485–505. 

96. Pfau, M., K. J. Tusing, A. F. Koerner, W. Lee, 

L. C. Godbold, L. J. Penaloza, Y. S. Yang, and 

Y. Hong. 1997. Enriching the inoculation 

construct: The role of critical components 

in the process of resistance. Human 

Communication Research 24 (2): 187–215. 

97. McGuire, W. J., and D. Papageorgis. 1961. 

The relative efficacy of various types of 
209

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

prior belief-defense in producing immunity 

against persuasion. Journal of Abnormal & 

Social Psychology 62:327–37. 

98. McGuire, W. J. 1964. Inducing resistance to 

persuasion: Some contemporary approaches. 

In Advances in experimental social 

psychology, ed. L. Berkowitz, 191–229. 

New York: Academic Press.

99. Pfau, M., and S. Van Bockern. 1994. 

Persistence of inoculation in conferring 

resistance to smoking initiation among 

adolescents: The second year. Human 

Communication Research 20 (3): 413–30. 

100. Brown & Williamson. 2000. Deposition of 

Theresa Burch in Engle v. R.J. Reynolds 

Tobacco Co. http://tobaccodocuments.org./

datta/BURCHT062000AM.html.

101. Petty, R. E., M. A. Fleming, J. R. Priester, 

and A. H. Feinstein. 2001. Individual 

versus group interest violation: Surprise 

as a determinant of argument scrutiny and 

persuasion. Social Cognition 19 (4): 418–42. 

102. Philip Morris USA. WSA review. Feb 2003. 

Bates No. 3001113870/3001113882. http://

legacy.library.ucsf.edu/tid/zil07a00.

103. Christ, W. G., and W. J. Potter. 1998. Media 

literacy, media education, and the academy. 

Journal of Communication 48 (1): 5–15. 

104. Thrasher, J. F., and C. Jackson. 2006. 

Mistrusting companies, mistrusting the 

tobacco industry: clarifying the context of 

tobacco prevention efforts that focus on the 

tobacco industry. Journal of Health and 

Social Behavior 47 (4): 406–22. 

105. Philip Morris. 1999. PM corporate image 

advertising audience groups. http://www

.pmdocs.com/PDF/2081609499_9504.PDF.

106. Starcom. PM21 2001 communication 

plans. 6 Oct 2000. Philip Morris. Bates 

No. 2081613325/3395. http://legacy.library

.ucsf.edu/tid/jxr65c00.

107. Philip Morris. PM21 DV meeting. 

17 Apr 2000. Philip Morris. Bates No. 

2081235874/5881. http://legacy.library

.ucsf.edu/tid/pyx65c00.

108. Adelman, D. J., A. J. Cohen, A. H. Gurkin, 

B. Herzog, and W. Pecoriello. Philip Morris 

image campaign is part of long term 

solution, no quick fixes, outperform. 

13 Oct 1999. Philip Morris. Bates No. 

2071041507/1517. http://legacy.library.ucsf

.edu/tid/ynm32c00.

109. Harris Interactive. 2004. Reputation 

and management. http://web.archive

.org/web/20040824044714/

http://www.harrisinteractive.com/expertise/

reputation.asp.

110. Harris Interactive. 2004. Annual RQ 2003. 

http://www.harrisinteractive.com/services/

rqarchive.asp.

111. Arora, R. 2004. Tobacco industry not out yet. 

http://www.gallup.com/poll/12733/TobaccoIndustry-Yet.aspx

112. Chan-Yeung, M., N. Ait-Khaled, N. White, 

M. S. Ip, and W. C. Tan. 2004. The burden 

and impact of COPD in Asia and Africa. 

International Journal of Tubercular Lung 

Disease 8 (1): 2–14. 

211

7

Influence of Tobacco Marketing 

on Smoking Behavior

The relationship between tobacco marketing and smoking behavior, particularly among 

adolescents, has been extensively researched. This chapter examines the evidence base 

for how these marketing efforts affect initial uptake and continued use of tobacco by 

adolescents and by the general population. Data from a multitude of studies using a 

range of methodologies were examined along with tobacco industry source documents 

in assessing the role of marketing in tobacco use. Specific areas discussed include

n	 The relationship between cigarette marketing and identifiable adolescent needs, 

such as peer acceptance, rebelliousness, risk taking, and stress relief

n	 The impact of cigarette marketing on adolescents’ self-images and their 

perceptions of smokers

n	 The effects of exposure to cigarette marketing on adolescent smoking

n	 The relationship between tobacco marketing expenditures and tobacco 

consumption in the general population, including time-series and cross-sectional 

studies, as well as studies of the impact of advertising bans on consumption 

and use

Numerous studies find a strong connection among advertising exposure, adolescent 

initiation to tobacco use, and progression to regular tobacco use. Cross-sectional 

econometric studies also show a correlation between tobacco advertising and increased 

cigarette consumption. As a whole, the evidence base indicates a causal relationship 

between tobacco advertising and increased levels of tobacco initiation and continued 

consumption.
212

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

Introduction

Although the tobacco industry has asserted 

that its marketing efforts are not aimed 

at creating new demand but rather at 

increasing brand market share, internal 

industry documents contribute to the 

evidence refuting this claim. The ability of 

tobacco marketing to create new demand 

by encouraging smoking initiation among 

youth and adults is a critically important 

aspect of the role of the media in tobacco 

use. Researchers have studied whether the 

level of tobacco advertising is related to 

aggregate cigarette demand: When exposed 

to high levels of tobacco industry marketing, 

do more people start using tobacco, do 

smokers smoke more, and are they less 

likely to quit? Alternatively, would the 

absence of cigarette advertising have the 

opposite effect?

This chapter reviews evidence of the 

influence of cigarette marketing on 

adolescent smoking initiation—many start 

to smoke before the legal age for purchasing 

cigarettes1—and on cigarette consumption 

in the general population. Other chapters 

in this monograph review advertising 

theory (chapter 2), types and extent of 

tobacco advertising and promotions 

(chapter 4), themes and targets of tobacco 

advertising (chapter 5), and media 

influences in preventing and controlling 

tobacco use (chapter 12). For a discussion 

of the effects on adolescent behavior of 

the depiction of smoking in movies, see 

chapter 10. Below is a brief overview of 

the topics covered in the main sections of 

this chapter.

Three lines of evidence regarding adolescent 

smoking are considered. The first 

includes literature describing adolescent 

psychological needs and how tobacco 

marketing suggests that smoking can help 

satisfy these needs. Subsections under the 

main heading of adolescent needs show 

that adolescents have such needs, cigarette 

marketing communicates to them that 

smoking will help fulfill these needs, and 

that adolescents who smoke or who do not 

rule out smoking in the future are more 

likely to believe that smoking can fulfill 

these needs. Of course, marketing for 

many other products also aims to convince 

adolescents that product use can help 

satisfy these needs.

The second related line of evidence focuses 

on development of self-image during 

adolescence2 and involves many factors, 

such as popularity, masculinity/femininity, 

rebelliousness, acceptance by peers, 

confidence in interacting with others, and 

so forth. For example, a boy who feels he 

is masculine and rugged is a little more 

confident in interactions with others. If his 

peers see him in this way, he is more likely to 

gain admiration from others. If he perceives 

that smoking can bolster this image, he may 

more readily adopt this behavior. Further, 

there is evidence that those with personal 

images similar to the images they have of 

smokers will be more prone to smoke. 

The third line of evidence measures 

exposures of adolescents to tobacco 

advertising and promotions and any 

association between those exposures and 

smoking behavior, including the likelihood 

of future smoking. First, methodological 

issues including study design, measures 

of smoking behavior, and measures of 

exposures and receptivity to cigarette 

advertising and promotions are described. 

Then, this section reviews the evidence that 

these measures are associated with higher 

levels of both intentions to smoke and 

actual smoking in both cross-sectional and 

longitudinal studies.

A final section of this chapter addresses 

various types of time-series studies that 

relate the level of tobacco marketing 

expenditures to population-based cigarette 

consumption. It also discusses studies 
213

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

that correlate novel advertising and 

promotional campaigns with changes in the 

incidence of adolescent smoking initiation 

and brand preference.

For the review of research on the relationship 

between cigarette advertising and promotions 

and adolescent smoking behavior, the 

American Psychological Association’s 

PsycINFO database3 was searched for the 

period from index inception in 1809 to 

May 2007. Three search terms—marketing, 

tobacco, and teenagers—were combined for 

each search using as many forms of each 

word as possible, such as singular and plural, 

synonyms, shortened forms, and so on. After 

eliminating studies that clearly were not 

relevant (for instance, studies that mentioned 

the issue but addressed another topic), 

copies of the remaining 216 publications 

were reviewed, and more were eliminated as 

lacking actual data analysis for association 

between tobacco marketing and adolescent 

needs, self-image, smoking attitudes, or 

behavior. Ultimately, the list was pared down 

to 96 studies. This list then was checked 

against several published and unpublished 

bibliographies in this area, and another 

23 relevant articles were included. Of the 

articles directly relating cigarette marketing 

practices to smoking behavior, 52 were 

cross-sectional and 16 were longitudinal. 

Of these, 22 studied the relationship 

between tobacco marketing and smoking 

intention or susceptibility to smoking 

among never smokers.

This chapter also includes a review of 

tobacco companies’ documents related 

to marketing to adolescents, including 

research on the impact of brand advertising 

on images of the brand and the smoker 

of the brand. Many citations in this 

chapter were gathered as part of the 

U.S. Department of Justice lawsuit against 

the tobacco companies.4 The reference 

notations identified as Bates numbers 

refer to identifying numbers stamped on 

document pages that can be used to access 

the documents catalogued in various 

tobacco company depositories.

Adolescents’ 

Psychological Needs 

and the Influence of 

Cigarette Marketing

This section reviews important adolescent 

psychological needs, such as popularity; peer 

acceptance; gender identity; rebelliousness; 

sensation seeking; risk taking; having 

fun; and alleviating stress, anxiety, and 

depression. This review provides a basis for 

considering whether cigarette marketing 

suggests that smoking can help meet these 

needs, as some theorize, thus increasing the 

likelihood of their smoking. Studies that 

addressed more than one of these needs may 

be mentioned multiple times.

Psychological Needs of 

Adolescents

Changes during adolescence result in 

intertwined and powerful adolescent needs. 

Most adolescents want to be popular and gain 

peer approval.5 Boys commonly experience 

strong needs to feel and be seen as masculine, 

tough, and independent. On the other hand, 

girls may become concerned about being 

seen as attractive, thin, and feminine.6 Some 

adolescents become rebellious and may want 

to defy mainstream, adult-imposed norms.6

The need for new experiences and sensations 

increases in adolescence, especially among 

boys,7 and is closely associated with increased 

risk taking.8 Many adolescents experience 

stress and depression for the first time.9

Subsections address each important 

adolescent need. Where available, three 

sources of evidence are reviewed relevant 

to how each of these needs influences 

behavior: (1) whether adolescents perceive 

that smoking can fulfill the respective 
214

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

Attracting Young Smokers: A View from the Tobacco Industry

As a 1973 R.J. Reynolds planning memorandum stated, “If our Company is to survive and prosper, 

over the long term, we must get our share of the youth market.”a Comprehensive analyses of 

thousands of U.S. tobacco industry documents demonstrate that tobacco companies researched 

youth smoking initiation patterns, developed brand images to appeal specifically to youth, and 

used euphemisms such as “younger adult smokers” over the past 20 years to disguise the focus 

of these efforts.b,c,d,e,f Similarly, tobacco industry documents show that advertising for Camel 

cigarettes was revised in the late 1980s to communicate to young consumers that the brand 

had been reformulated to reduce harshness and deliver a smooth smoke.g Some documentary 

evidence suggests that the tobacco industry cooperated with manufacturers of candy cigarettes, 

which were designed and packaged to look like popular cigarette brands, to appeal to children.h

Tobacco industry documents in the United Kingdom reveal similar thinking.d,i The Health 

Select Committee inquiry into the U.K. tobacco industryj

 disclosed documents from the 

industry’s principal advertising agencies that show that the young are a key target and that 

discuss psychosocial drivers as the way to reach them. In many instances, the industry refers to 

“young adult smokers.” However, being “youthful and exciting,” attracting “new entrants,” and 

“gaining a disproportionately large share of new recruits to the market” are recognized as vital 

to commercial success.k Young people’s lifestyles, motivations, and aspirations are the subject of 

detailed and continuous market research. Everything possible is done to attract and retain their 

interest. Specifically, the conclusion is drawn repeatedly in these documents that young people 

smoke for emotional reasons and cigarettes can meet these needs by being aspirational and acting 

as “a badge” and a “sign of maturity, discernment and independence.”l The job of advertising, 

therefore, is to help build and reinforce these qualities in the product.

a

Teague, C. E. Research planning memorandum on some thoughts about new brands of cigarettes for the 

youth market. 2 Feb 1973. R.J. Reynolds. Bates No. 502987357/7368. http://legacy.library.ucsf.edu/tid/act68d00.

b

Cummings, K. M., C. P. Morley, J. K. Horan, C. Steger, and N. R. Leavell. 2002. Marketing to America’s youth: 

Evidence from corporate documents. Tobacco Control 11 Suppl. 1: I5–I17.

c

Perry, C. L. 1999. The tobacco industry and underage youth smoking: Tobacco industry documents from the 

Minnesota litigation. Archives of Pediatrics and Adolescent Medicine 153 (9): 935–41.

d

Hastings, G., and L. MacFadyen. 2000. A day in the life of an advertising man: Review of internal documents 

from the UK tobacco industry’s principal advertising agencies. British Medical Journal 321 (7257): 366–71.

e

Carter, S. M. 2003. Going below the line: Creating transportable brands for Australia’s dark market. Tobacco 

Control 12 Suppl. 3: iii87–iii94.

f

Pollay, R. W. 2000. Targeting youth and concerned smokers: Evidence from Canadian tobacco industry 

documents. Tobacco Control 9 (2): 136–47.

g

Wayne, G. F., and G. N. Connolly. 2002. How cigarette design can affect youth initiation into smoking: Camel 

cigarettes 1983–93. Tobacco Control 11 Suppl. 1: I32–I39.

h

Klein, J. D., and S. S. Clair. 2000. Do candy cigarettes encourage young people to smoke? British Medical 

Journal 321 (7257): 362–65.

i

Anderson, S., G. Hastings, and L. MacFadyen. 2002. Strategic marketing in the UK tobacco industry. Lancet 

Oncology 3 (8): 481–86.

j

United Kingdom. Parliament. House of Commons. 2000. The tobacco industry and the health risks of 

smoking. Health Select Committee, sess. 1999-00, 2nd report. Vol. 1. Report and proceedings, June 14, 2000. 

Vol. 2. Minutes of evidence and appendices, June 14, 2000. HC papers 1999-00 27-I and 1999-00 27-II. 

London: Stationery Office. http://www.parliament.the-stationery-office.co.uk/pa.

k

Collett Dickenson Pearce and Partners. 1995. Hamlet market share. http://www.tobaccopapers.com/PDFs/

0001-0099/0041.pdf.

l

Collett Dickenson Pearce and Partners. 1995. Benson & Hedges 1995 creative briefs. http://www.tobaccopapers

.com/PDFs/0001-0099/0052.pdf.
215

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

need, (2) whether adolescents who believe 

smoking will fulfill a need are more likely 

to smoke cigarettes, and (3) evidence from 

tobacco company documents about whether 

cigarette marketing for brands popular 

among youth conveys that smoking can 

help satisfy the need. 

Marlboro (manufactured by Philip Morris), 

Camel (R.J. Reynolds), and Newport 

(Lorillard) cigarettes have reigned as the top 

three brands smoked by adolescents since 

the 1980s, when many of the studies in this 

chapter were conducted. While Marlboro has 

remained by far the most popular, according 

to data from the national Teenage Attitudes 

and Practices Surveys, from 1989 to 1993 

Marlboro lost some youth smokers while 

Camel and Newport gained.10 A majority 

of African American adolescent smokers 

purchased Newports.10,11 Data from the 

2005 National Household Survey on Drug 

Abuse indicate that, among smokers aged 

12–17 years, 48.0% cited Marlboro, 23.2% 

The Dynamics of Adolescence

Adolescence is a period of change related to puberty, increasing independence from parents, 

educational environment (elementary to middle school to high school), and greater importance of 

peers. These changes contribute to the development of important psychological needs. The onset 

of the physical changes of puberty, such as rapid growth, development of primary and secondary 

sex characteristics, and physical changes that contribute to increased strength and endurance, 

varies by as much as five years.a However, puberty typically begins between the ages of 10 and 

15 years, so within a school grade, students can be at very different stages in this development. 

These changes affect body image,b particularly for girls.c Adolescent physical changes bring 

increasing interest in the opposite sex and a desire for independence, including autonomy in 

decision making.d In many families, these desires create conflict that can result in rebelliousness 

and defiance. This, in turn, can lead parents to give up attempts to monitor and set limits on 

their teenagers’ activities and behavior. 

At school, more is demanded of adolescents academically, with changing levels of support from 

teachers, the possibility of more competition among students, and increased importance of peer 

group relationships.e Such changes may contribute to lowered self-esteem and lead adolescents 

to become less interested in academics and more interested in social success.d,e,f Students, 

particularly those less competent academically, may become more focused on their abilities 

relative to their peers rather than on mastery of educational material. These adolescents will 

search for other ways to define themselves.

a

Steinberg, L. D. 1999. Adolescence. 5th ed. New York: McGraw-Hill.

b

Stice, E. 2003. Puberty and body image. In Gender differences at puberty, ed. C. Hayward, 61–76. New York: 

Cambridge Univ. Press.

c

Compian, L., L. K. Gowen, and C. Hayward. 2004. Peripubertal girls’ romantic and platonic involvement with 

boys: Associations with body image and depression symptoms. Journal of Research on Adolescence 14 (1): 23–47.

d

Eccles, J. S., C. W. A. Midgley, C. M. Buchanan, D. Reuman, C. Flanagan, and D. M. Iver. 1993. Development 

during adolescence. The impact of stage-environment fit on young adolescents’ experiences in schools and in 

families. American Psychologist 48 (2): 90–101.

e

Eccles, J. S., A. Wigfield, C. Midgley, D. Reuman, D. MacIver, and H. Feldlaufer. 1993. Negative effects of 

traditional middle school on student’s motivation. Elementary School Journal 93 (5): 553–74.

e

Wigfield, A., and J. S. Eccles. 1994. Children’s competence beliefs, achievement values, and general selfesteem. Journal of Early Adolescence 14 (2): 107–38.

f

Anderman, E. M., M. L. Maehr, and C. Midgley. 1999. Declining motivation after the transition to middle 

school: Schools can make a difference. Journal of Research and Development in Education 32 (3): 131–47.
216

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

cited Newport, and 10.1% cited Camel as the 

brand smoked most frequently in the month 

preceding the survey.12

A methodology subsection of the main 

section below relating exposure to tobacco 

advertising and promotions to adolescent 

smoking defines the smoking status variables 

mentioned throughout the chapter.

Need for Popularity and Peer 

Acceptance and Smoking

Do teenagers think smoking helps make them 

popular with their peers? Do social needs such 

as popularity and acceptance, for instance, 

play a role in encouraging smoking initiation 

and tobacco use among adolescents?

Perception That Smoking Contributes 

to Popularity

Evans and colleagues13 surveyed 3,536 

California never smokers aged 12 to 17 years 

regarding what tobacco advertisements 

convey to them about smoking. A majority 

of participants—60.5% of those aged 12 to 

13 years, 69.2% of those aged 14 to 15, and 

72.9% of those aged 16 to 17—perceived 

that cigarette advertisements claimed 

smoking would help them feel comfortable 

in social situations.

Romer and Jamieson14 conducted telephone 

surveys of 2,002 14- to 22-year-olds to 

assess exposure to cigarette advertisements 

and perceptions of smokers. Respondents 

rated smokers as popular, happy, and 

attractive. These ratings were higher 

for adolescents with greater exposure to 

cigarette advertisements.

Barton and colleagues15 asked students to 

rate pictures of youth that were identical 

except for the presence or absence of a 

cigarette. Youth pictured with a cigarette 

received higher ratings as having an interest 

in the opposite sex and being in a group—

traits considered desirable—than those 

pictured without a cigarette. 

Association of Social Needs with 

Smoking

Perry and colleagues16 found that 7th, 9th, 

and 10th graders who thought smoking 

would help them make friends were more 

likely to be smokers. Koval and colleagues17

examined whether 8th graders with high 

levels of social conformity (measure of 

compliance and susceptibility to social 

influence) were more likely to smoke. They 

found that high-conforming boys (but not 

girls) were more likely to be smokers.

In a longitudinal study among high school 

students, Chassin and colleagues18 found 

that a belief that smoking can have positive 

social outcomes was a predictor of whether 

an adolescent began smoking cigarettes in 

the following year.

Themes of Popularity and Peer 

Acceptance in Cigarette Advertising 

for Youth-Popular Brands

A review of tobacco company marketing 

research indicates that youth-popular brands 

Newport Pleasure advertisement 

associating smoking with popularity
217

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

convey an image of smokers of those brands 

as popular and admired. Documents also 

indicate that the companies believe that 

conveying that popular people smoke their 

brand motivates the choice of that brand. 

A 1981 memorandum by Philip Morris senior 

economist Myron Johnston emphasizes this 

advertising strategy with the statement, 

“At least a part of the success of Marlboro 

Red during its most rapid growth period was 

because it became the brand of choice among 

teenagers.”19(Bates no. 1000390808) Philip Morris 

also studied the need for peer acceptance 

as a factor in choosing Marlboro cigarettes. 

For example, a 1998 report concluded that 

“hollow followers”—those with a high desire 

for acceptance—were particularly likely 

to buy Marlboro products.20 Philip Morris 

research and marketing documents 

indicate that the company closely tracked 

whether the brand conveyed an aura of 

popularity. The company generally has been 

successful in conveying that (1) Marlboro 

is popular,21–25 (2) Marlboro is “growing in 

popularity,”21,22,26–28 (3) the Marlboro smoker 

is popular,29,30 and (4) Marlboro’s core 

brand personality includes “popular.”25,31–35

Adolescents who are concerned with being 

popular, therefore, might be likely to 

perceive that smoking Marlboro cigarettes 

could help them achieve this outcome.

R.J. Reynolds also understands the 

importance of popularity and peer 

acceptance in motivating adolescent 

smoking. For example, a July 3, 1974, 

memorandum on what causes smokers to 

select their first brand discussed the role of 

smoking in gaining peer acceptance.

Men, particularly, report that ... they 

took up smoking because they wanted to 

impress and be accepted by other young 

men who smoked. Often the motivation is 

to be less the target of group aggression. 

Smoking is often a way to gain entree 

to a group by effecting an appearance 

of being mature, sophisticated, sexy or 

manly.36(Bates no. 500574162)

With its Joe Camel campaign, R.J. Reynolds 

was highly successful in conveying that 

others would like and admire the Camel 

smoker. For example, in a series of focus 

groups conducted for the company in 

October 1991 with 18- to 24-year-old 

Camel cigarette smokers, respondents were 

unusually outspoken about their liking and 

admiration for the Joe Camel character:

He’s someone you can hang out with—

He makes you feel comfortable ... That’s 

a real knack ... I wish I could be so easy 

to talk to ... I guess it’s ’cause he’s done 

and seen everything ... He’s what guys 

really want to be—a man’s man but not 

super macho ... He’s a natural leader—

not pushy, but people just sort of follow 

his lead ...37(Bates no. 514340431)

Lorillard documents show that its marketing 

of the Newport brand conveys that the 

Newport cigarette smoker will be popular. 

A January 1994 Lorillard report described 

the results of eight focus groups of menthol 

cigarette smokers. The report stated that 

African Americans smoke Newport cigarettes 

“because they perceive Newport as an ‘in’ 

cigarette that is popular among their friends 

and peers.”38(Bates no. 91950199)

Boys and Masculinity, Girls and 

Femininity

Smoking and sex appeal: what role do they 

play in the adolescent psyche? This section 

addresses the multifaceted relationship 

between tobacco advertisements and 

smoking and adolescents’ perceptions of 

and needs associated with their masculinity 

or femininity.

Perception That Smoking Contributes 

to Masculinity or Femininity

Many adolescents value success with the 

opposite sex, often perceived as tied to an 

adolescent’s masculinity or femininity. 
218

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

Enhancing these attributes is appealing 

to teenagers. Barton and colleagues15

found that, on average, adolescents viewed 

smokers as tougher, an attribute they viewed 

positively. Evans and colleagues13 reported 

that 43.9% of 12- to 17-year-old female 

never smokers perceived that cigarette 

advertisements conveyed that smoking 

would help them stay thin.

In two samples of adolescent never smokers 

11–17 years old, Shadel and colleagues39

Did Joe Camel Attract the Attention of Children and Youth?

While a marked increase in youth smoking became apparent during the height of the Joe Camel 

advertising and promotions campaign in the early 1990s,a a necessary but not sufficient condition 

to link this upswing to the Joe Camel campaign was to demonstrate that children and adolescents 

were aware of it. Three studies published concurrently in a 1991 issue of JAMA: The Journal of 

the American Medical Association demonstrated that Joe Camel was well recognized among 

young people.b,c,d

Fischer and colleaguesb had young children aged 3–6 years match logos to product categories. 

Among 3-year-olds, 30.4% successfully matched an image of Old Joe to the cigarette category, and 

among 6-year-olds, 91.3% did, not significantly different from the percentage of 6-year-olds who 

matched a silhouette of Mickey Mouse (logo for the Disney Channel) to the Disney Channel. The 

study by DiFranza and colleaguesc showed Camel advertisements featuring Old Joe, but with all 

product and brand information removed, to youth aged 12–19 years and adults age 21 years or 

older. The youth were more likely to say they had ever seen the Joe Camel character than were the 

adults (97.5% vs. 67.0%), and among those who had seen it, youth were more able to associate the 

image with the Camel cigarette brand (98.0% vs. 70.1%). Youth were also significantly more likely 

than were adults to rate the Joe Camel character as “cool” or “interesting,” or wanted “to be friends” 

with him. Finally, Pierce and colleaguesd computed the percentage of respondents to the 1990 

California Tobacco Survey that named Camel or Marlboro as the brand most advertised. Camel was 

named about as frequently as Marlboro by those aged 12–13 years (34%–35%), with the percentage 

citing Camel declining steadily with age, so that less than 10% of those age 65 years or older cited 

Camel as the most advertised brand. Marlboro was cited by increasing percentages by age, peaking 

among those aged 16–17 years (48%), and then declining to about 20% among those age 65 years 

or older. Youth, then, seemed to be more attuned to advertising than were adults.

More information regarding the Joe Camel saga is presented in chapters 3, 5, and 8. Also, two 

articles explore in detail the rise and fall of Old Joe Camel,e,f with numerous additional citations 

from tobacco industry documents and news media.

a

Johnston, L. D., P. M. O’Malley, and J. G. Bachman. 2002. Monitoring the Future: National survey results on 

drug use, 1975–2001. Vol. 1: Secondary school students (NIH publication no. 02-5106). Bethesda, MD: U.S. 

Department of Health and Human Services, National Institutes of Health, National Institute on Drug Abuse.

b

Fischer, P. M., M. P. Schwartz, J. W. Richards Jr., A. O. Goldstein, and T. H. Rojas. 1991. Brand logo 

recognition by children aged 3 to 6 years. Mickey Mouse and Old Joe the Camel. JAMA: The Journal of the 

American Medical Association 266 (22): 3145–48.

c

DiFranza, J. R., J. W. Richards, P. M. Paulman, N. Wolf-Gillespie, C. Fletcher, R. D. Jaffe, and D. Murray. 1991. 

RJR Nabisco’s cartoon camel promotes camel cigarettes to children. JAMA: The Journal of the American 

Medical Association 266 (22): 3149–53.

d

Pierce, J. P., E. Gilpin, D. M. Burns, E. Whalen, B. Rosbrook, D. Shopland, and M. Johnson. 1991. Does 

tobacco advertising target young people to start smoking? Evidence from California. JAMA: The Journal of the 

American Medical Association 266 (22): 3154–58.

e

Cohen, J. B. 2000. Playing to win: Marketing and public policy at odds over Joe Camel. Journal of Public 

Policy and Marketing 19 (2): 155–67.

f

Calfee, J. E. 2000. The historical significance of Joe Camel. Journal of Public Policy & Marketing 19 (2): 168–82. 
219

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

assessed positive advertisement effect 

(n = 29) and personal relevance (n = 101), 

respectively. In the smaller study, 

adolescents viewed a balanced random 

sample of 24 protobacco advertisements, 

24 antitobacco advertisements, and 

24 neutral advertisements for other 

products. The researchers previously had 

categorized the advertisements’ valence as 

masculine, feminine, or gender neutral. 

In the larger study, participants were asked 

whether 11 tobacco advertisements did or 

did not remind them of themselves. Girls 

were more likely to show a positive affect 

toward the cigarette advertisements (smaller 

study) and judge them as self-relevant 

(larger study) if the advertisements were 

female valenced. No such relationship was 

found for boys in either study. The authors 

concluded, “Female-valenced cigarette 

advertising imagery may have specific effects 

on never smoking female adolescents by 

enhancing positive affect and suggesting 

that women who smoke hold the same 

characteristics as do the young women 

themselves.”39(p.1735)

Association of Masculinity and 

Femininity with Smoking

Chassin and colleagues40 found that 

adolescents who rated their ideal selves 

similarly to smokers as “tough,” “foolish,” 

“acts big,” “disobedient,” and “interested 

in the opposite sex” were more likely 

to report an intent to smoke. Boys who 

believe these characteristics will make 

them more attractive to the opposite sex 

may see smoking as a way of acquiring or 

strengthening them.

A number of similar studies have been 

conducted with adolescent girls, focusing on 

attractiveness and weight control. French 

and Perry41 identified several influences 

toward smoking that young women focus 

on, including being attractive and well 

dressed, having sex appeal, and experiencing 

weight concerns. Koval and colleagues17

found that 8th grade girls were more likely 

to smoke cigarettes if they believed smoking 

would improve their appearance. French 

and colleagues42 found that girls who smoke 

were significantly more likely than were 

nonsmokers to try to lose weight, fear 

gaining weight, want to be thin, and have 

eating disorders. They found that girls with 

substantial concerns about their weights 

were about twice as likely (compared 

with girls without weight concerns) to 

begin smoking during the following year. 

Charlton43 surveyed 16,000 9- to 19-yearolds in northern England. This researcher 

found that smokers were more likely, and 

never smokers were less likely, to agree 

Advertisements associating femininity and masculinity 

with cigarettes
220

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

that smoking controls weight. More girls 

than boys among 13- to 16-year-olds agreed 

with this statement. Finally, a survey of 

14- to 22-year-olds found that girls who 

smoked were significantly more likely than 

nonsmokers to believe that smoking would 

reduce weight.14

Themes Relevant to Masculinity and 

Femininity in Cigarette Advertising

Krupka and colleagues44 found that cigarette 

advertisements targeting women were 

significantly more likely than those not 

targeting them to show lean, attractive 

smokers. King and others45 found images 

of young women as attractive, sexy, 

independent, and sociable to be common in 

cigarette advertising. A third study found 

that billboard advertisements for tobacco 

depicted models as having sex appeal more 

often than did those for other products 

except alcohol.46

Much cigarette advertising, especially 

for Marlboro and Camel, has focused on 

conveying that smokers of those brands 

are masculine, tough, and rugged. 

Marketing research by Philip Morris 

consistently has shown that its audience 

perceives the Marlboro man as masculine, 

independent, and rugged. Since 1992, 

a marketing research organization has 

conducted biennial research to monitor 

the appeal of the Marlboro campaign. For its 

1999 report, that organization interviewed 

76 young adult male smokers between 

June and August 1999. It found that “core 

brand values of freedom, independence/

self-sufficiency, and ruggedness clearly 

come through.”47(Bates no. 2072468465) A 1999 

Philip Morris marketing report lists 

features of the Marlboro image to 

include “individualism, adventurousness, 

freedom, confidence, excitement and 

mastery”;48(Bates no. 2080930013) “the masculine 

ideal”; and “masculinity, freedom, adventure, 

limitless opportunities, self-sufficiency, 

mastery of destiny, harmony with 

nature.”48(Bates 2080930017) Other Philip Morris 

documents point to the success of the 

Marlboro campaign in representing the 

masculine ideal.49–51

An October 1991 report to R.J. Reynolds 

regarding focus groups conducted on Camel 

advertising indicated the strong impact of 

the Joe Camel campaign. A footnote in the 

report commented on the extraordinary 

power of the Joe Camel campaign:

The details recalled and the strength 

of the favorable CAMEL advertising 

commentary were considerably beyond 

what is typically heard in focused groups—

be it for cigarettes or other packaged 

goods—when awareness of/attitudes 

toward advertising—in the absence of 

stimuli—are explored.52(Bates no. 509045392)

Additional quotes from the report already 

mentioned earlier illustrate the impact 

of the campaign on perceptions of Camel 

smokers as attractive to members of the 

opposite sex.53 In contrast, a review of 

Lorillard documents regarding its marketing 

of Newport cigarettes does not show that 

the company uses a theme of masculinity 

in marketing this brand.

Rebelliousness

This section addresses the dynamic mix of 

adolescent rebelliousness, smoking, and 

tobacco advertisements.

Perception That Smokers Are More 

Rebellious

Chassin and colleagues54 studied high 

school student ratings of photographs of 

boys holding chewing tobacco, a pack of 

cigarettes, or a bag of corn chips. Compared 

with the boy with corn chips, the students 

rated the boy with the cigarettes as 

significantly more rebellious.
221

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Relationship between Rebelliousness 

and Smoking

A study of 6th graders found that 

rebelliousness was correlated with smoking 

behavior for both boys and girls, even 

when investigators controlled for parental 

smoking.55 A study of 8th-grade students 

revealed that rebelliousness was associated 

with student smoking. Here, too, variables 

controlled for parental and peer smoking. 

Thus, it can be inferred that rebelliousness 

is associated with smoking over and above 

any influence of parents or peers.17 In a 

longitudinal study of 3,130 5th graders, 

those high in rebelliousness at baseline 

were significantly more likely to have 

smoked by the 12th grade.56

Rebelliousness in Cigarette Marketing 

Images

Camel advertising (and perhaps Marlboro 

with its emphasis on independence 

and masculinity), but not Newport, 

has relied on the rebelliousness theme. 

In March 1986, R.J. Reynolds issued a 

report, Camel New Advertising Campaign 

Development. The report stated that the 

objective of the advertising is to “leverage 

the non-conformist, self-confident mindset 

historically attributed to the CAMEL user ... 

so that the brand becomes a relevant, 

appealing choice for today’s younger 

adult smokers.”57(Bates no. 503969239) The report 

outlined R.J. Reynolds’s plan for achieving 

this objective: “The advertising will create 

Cigarettes and Sex Appeal

R.J. Reynolds documents indicate that the intent of the Joe Camel campaign was to convey that 

the Camel smoker was a successful ladies’ man. For example, a June 21, 1988, document proposed 

ways to use promotions to communicate that the Camel smoker would “get the girls.”

Nothing quite captures the imagination for our target as the opposite 

sex. The CAMEL CONNECTION takes ... “Connection” between 

Camel and one of the main focuses of our target’s life.

The program features an endless variety of premiums, give-aways, 

etc. that play our “Camel Guy” as a real ladies’ man, the Camel 

equivalent of the Playboy bunny, all relatable and done with a very 

light, funny, fantasy orientation to our target.

Of course, there will be infinite attention paid to the focus of our 

target’s fascination: women. Beautiful, desirable, the kind of females 

who you wouldn’t care if they’d never read Julia Childs.

Yes, this is disgustingly chauvinistic. And yes, it is a very dead-end 

bullseye with our target.

He’s a blond beach god. Well, blond leaning camel.a

A 1989 document indicated that in a “consumer ad test,” 61% of male smokers aged 18–24 found 

Joe Camel to be “attractive to opposite sex.”b

Several Joe Camel ads—some of which were described by the U.S. Department of Justice as part of 

a racketeering act—featured “smooth moves” and “dating advice.”c(p.33)

a

KNT Plusmark. Camel project big idea concept development. 21 Jun 1988. R.J. Reynolds. Bates No. 515686724/

6729. http://legacy.library.ucsf.edu/tid/yln92d00.

b

R.J. Reynolds. “Smooth character” campaign. 1989. R.J. Reynolds. Bates No. 507244164/4184. http://legacy

.library.ucsf.edu/tid/lpi54d00.

c

United States vs. Philip Morris, et al. Appendix to complaint. U.S. District Court for the District of Columbia. 

1999. http://www.justice.gov/civil/cases/tobacco2/appendix.pdf.
222

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

the perception that CAMEL smokers are 

non-conforming, self-confident ... younger 

smokers who project a cool attitude which is 

admired by peers.”57(Bates no. 503969241)

A December 1988 report, Current/Projected 

Perceptions of Camel among Target 

Smokers, states, “the most important user 

image attributes to target 18–24 year old 

male smokers are to be perceived as having 

an independent/individualistic personality, 

followed by being masculine, admired/

accepted by friends. ...”58(Bates no. 506864590)

In a January 1991 evaluation of a later 

version of Joe Camel, R.J. Reynolds reported, 

“The Evolved Smooth Character campaign 

is particularly effective among smokers who 

reject traditional values.”59(Bates no. 509042746)

In 1994, R.J. Reynolds continued its pursuit of 

the rebellious audience. A document, CAMEL 

DBM [database marketing] Programs: 

Learning Perspective, notes that one 

development objective is to “provide readers 

with provocative articles that have an attitude 

of rebellion, adventure, individualism, humor 

and a lust for living.”60(Bates no. 525511595)

Sensation Seeking, Risk Taking, 

and Having Fun

The following discussion considers the 

appeal to adolescents of having fun, seeking 

excitement, and taking risks. These themes 

are prevalent in tobacco advertising and 

there is evidence that they likely encourage 

adolescent smoking.

Perception That Smoking Is Associated 

with Excitement, Danger, or Fun

The literature review did not reveal any 

studies that specifically evaluate adolescent 

perceptions related to sensation-seeking and 

risk-taking behavior as cigarette advertising 

themes. Evans and colleagues13 found that 

68% to 76% of nonsmoking California 

teenagers perceived cigarette advertisements 

as conveying that smoking is enjoyable.

Relationships between Smoking and 

Sensation Seeking, Risk Taking, or 

Having Fun

In a study of 1,841 17- to 19-year-olds, Kraft 

and Rise61 found sensation seeking to be 

significantly related to smoking. In a study 

of 8th- and 11th-grade students, Kopstein 

and colleagues62 found that cigarette 

smoking prevalence was significantly higher 

among students with a high rating on 

sensation seeking, even when controlled for 

measures of peer and parental influences 

on smoking.

A study of 1,051 10th graders found that 

those high in novelty seeking were more 

likely to smoke cigarettes.63 In a longitudinal 

study,56 5th grade students who rated high 

in risk taking were found to be more likely 

Joe Camel rebelliously riding a motorcycle
223

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

to be daily smokers by 12th grade. This is 

noteworthy because of the length of time 

between the measurement of risk taking 

and the smoking assessment. Skara and 

colleagues64 found that males in extended 

high school were more likely to smoke 

regularly if they were high in sensation 

seeking and violence. A study of 1,071 high 

school freshmen found that higher levels 

of novelty seeking were associated with 

greater receptivity to tobacco advertising.65

Sensation or novelty seekers appeared 

particularly likely to encounter and like 

cigarette advertising.

Perry and colleagues16 found that adolescent 

smokers were more likely than nonsmokers 

to say smoking will help them have fun.

Themes of Risk, Sensation, or Fun in 

Cigarette Marketing

Tobacco companies conduct extensive 

research to ensure that their advertisements 

communicate that smoking cigarettes can 

provide excitement, fun, and adventure. 

Public health research finds that adolescents 

get the message. There is evidence that 

billboard cigarette advertisements—when 

they still were permitted—associated 

smoking with fun or exciting activities, 

including vacationing, recreation, sports, 

an active lifestyle, and adventure or risk.66

A study of magazine cigarette advertisements 

in both male- and female-oriented magazines 

found recreation and adventure to be 

common themes.45

Philip Morris’s marketing of Marlboro 

has long conveyed that the Marlboro 

smoker leads an exciting and adventurous 

life. A June 18, 1999, Philip Morris 

memorandum concerning its direct mail 

marketing magazine, Unlimited, stated, 

“the magazine has an action/adventure 

format and tries to represent the core 

equities of the brand.”67 A 1998 marketing 

research study found that 67% of “prime 

prospects” rated themselves as “exciting,” 

implying that themes of excitement would 

be appealing to them.29 A November 1999 

Philip Morris study, Marlboro Direct 

Mail Equity Study, discusses direct mail 

marketing efforts, including Unlimited; 

young adult smoker (YAS) equity; and YAS 

promotional, savings/coupons/mainline 

mailing, and gear.68 The report stated that 

these programs contribute to higher ratings 

on “active, likes action/excitement, lives life 

to the fullest.”68(Bates no. 2073318229)

R.J. Reynolds documents indicate that the 

company often designed its marketing of 

the Camel brand to associate the brand with 

having fun and excitement. In February 

1985, R.J. Reynolds conducted focus groups 

among “Camel younger adult smokers.” 

It learned that, “the executions [of the 

advertisements] were too ‘tame’ in that 

they did not elicit enough excitement or 

enthusiasm.”69(Bates no. 504585738/5739) Three years 

later, in a November 1988 Winston/Camel 

Pack Action Study, R.J. Reynolds noted, 

“Younger adults center their lives on having 

fun in every way possible and at every time 

possible.”70(Bates no. 512544536) By 1990, an April 

review of Camel’s performance noted, 

“the CAMEL ‘Smooth Character’ campaign 

seems to deliver that sense of excitement 

and appeal to its target.”71(Bates no. 507302638)

Marlboro advertisement with the theme of 

risk taking
224

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

Two months later, a Perception Tracking 

Study targeting 18- to 24-year-old males 

added, “ads in emphasis markets were 

successful in getting targets to see Camel 

as ‘for people who lead exciting life 

styles.’”72(Bates no. 509042491) By November 1990, 

R.J. Reynolds seemed to have achieved 

the strategy designed five years earlier. A 

report, Summary of Findings on Reactions 

to Camel Advertising and Pack Exchange 

Program among Competitive Exchange 

Initiative Smokers, indicates that Joe is 

“constantly on an adventure which contains 

the element of danger.”53(Bates no. 509043739)

Lorillard’s marketing of Newport cigarettes 

also employs themes of fun and excitement. 

A November 11, 1993, presentation to 

Lorillard, titled Newport Promotional 

Concepts, outlined a number of advertising 

and marketing strategies that involved 

communicating fun and excitement:

n Build excitement around Newport as an 

integral part of the urban center lifestyle

n Develop exciting innovative program 

concepts and overlays with involving and 

dynamic features that pull the consumer 

to the brand

n Reinforce brand image and equity 

in the “pleasure” positioning as 

developed through previous advertising 

campaigns73(Bates no. 91949808)

A January 1994 Lorillard report addressed 

the results of eight focus groups with 

menthol cigarette smokers. It presented a 

number of findings showing that the Alive 

with Pleasure campaign communicates that 

Newport smokers have fun:

Black Salem/Kool Smokers relate Newport 

to fun and excitement.... Black Newport 

Smokers believe that Newport ads send 

strong, positive messages because they 

incorporate happiness, togetherness, 

and people taking part in fun things.... 

The strength of “Alive with Pleasure 

[AWP]” is that it depicts settings where 

fun situations that could include smoking 

Cigarette Marketing Strategy: Going to the Races

Philip Morris assessed respondents’ reactions 

to communication materials related to 

marketing activities such as advertising at 

racing events or promotional give-aways of 

attractive gear. The aim was to determine what 

each added to the core image of Marlboro. 

Philip Morris found that, after being exposed 

to racing marketing communications (mostly 

auto racing, but horse and human racing as 

well), respondents rated the following items 

higher than they had rated the Marlboro 

core personality: active, adventurous, likes 

action/excitement, aggressive, a leader, macho, 

energetic, driven to succeed, masculine, 

mechanically oriented, upscale, and discriminating/demanding. The report concluded, “Racing is 

a rich source of excitement, energy and competitive spirit for Marlboro.”a This study shows how 

Philip Morris expands Marlboro’s core image through its racing programs, which allow it to add 

the dimensions of excitement and adventure to the brand.a

a

Philip Morris. Marlboro marketing mix study. Feb 1996. Philip Morris. Bates No. 2062311535/1551. 

http://legacy.library.ucsf.edu/tid/nsl27a00.
225

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

are presented.... The strength of “Newport 

Pleasure” is that the theme centers on the 

benefits [fun] of a specific brand [bracketed 

“fun” appears in the original].... AWP ... 

communicates: life, energy, activities, 

happy times, couples, togetherness, 

wholesomeness, and fun.... AWP seems to 

set more of a mood of being upbeat, happy, 

full of life and energy.38(Bates no. 91950196/0200)

Stress, Anxiety, and Depression

The following considers themes among 

cigarette advertisements that communicate 

to adolescents that smoking can help solve 

some personal and emotional problems by 

relieving stress and promoting relaxation. 

In reality, addicted smokers can experience 

stress, anxiety, irritability, and depression 

when deprived of nicotine.74 Thus, 

adolescents may observe that smokers in 

their social environment self-medicate 

these symptoms by smoking cigarettes. 

As discussed below, cigarette marketing 

conveys themes suggesting that smoking 

has a positive emotional benefit.

Perception That Smoking Reduces 

Anxiety or Depression

When Evans and colleagues13 studied 

nonsmoking California teenagers, they 

found that 60% to 73% (depending on age) 

felt cigarette advertisements communicated 

that smoking would help them relax. 

Of the participants, 58% to 67% said these 

advertisements indicated smoking could 

help reduce stress. In addition, 45% to 51% 

said the advertisements communicated that 

smoking would reduce boredom.

In another study, among those 14 to 

22 years old, Romer and Jamieson14 found 

that the perception or image of smokers 

as relaxed rose during adolescence, 

significantly for those citing exposure 

to cigarette advertisements. Those with 

an image of smoking cigarettes as being 

relaxing also saw it as less risky and had 

more favorable feelings toward smoking.

Relationship between Smoking and 

Distress Reduction

Perry and colleagues16 found that middle 

and high school students were more likely 

to smoke if they thought smoking would 

alleviate boredom or loneliness or would be 

of benefit when they had to solve personal 

problems or needed personal energy.

Several researchers examined the link 

between high levels of distressing emotions 

and smoking. Two studies of the same 

sample (one among 6th graders55 and one 

among 8th graders17) found that young 

people under stress were more likely to 

smoke cigarettes. In a longitudinal study of 

students in extended high school, Skara and 

colleagues64 found that adolescents facing 

higher levels of stress were more likely to 

become regular smokers.

Some studies report that depressed 

adolescents are more likely to smoke 

cigarettes. A study in a nationally 

representative sample of 4,023 12- to 

17-year-olds found depressed girls more 

likely than nondepressed girls to smoke.75

Newport “Alive with Pleasure” advertisement 

associating smoking with fun
226

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

Another found a relationship between 

depression and smoking for boys, but not 

for girls.17,55 A third study found that high 

school freshmen with depression were more 

likely to smoke.76 This was especially true 

for those receptive to cigarette advertising. 

Researchers measured teenagers’ receptivity 

to advertising on the basis of whether they 

had a favorite advertisement or owned a 

cigarette promotional item. The study found 

depressed adolescents to be particularly 

receptive to cigarette advertising. In 

contrast, two longitudinal studies failed 

to establish a link between depression and 

future smoking;77,78 they found instead that 

adolescent smokers at baseline were more 

likely to report depression in the future 

than were nonsmokers.

Cigarette Marketing Conveying Themes 

of Relaxation or Stress Reduction

In the past, Philip Morris used television 

advertising to associate Marlboro with 

relaxation. Some television advertisements 

for Marlboro featured Julie London singing 

the Marlboro Song. The lyrics included “why 

don’t you settle back and have a full flavored 

smoke. Settle back with a Marlboro. Make 

yourself comfortable, whenever you smoke, 

have a Marlboro cigarette. You get a lot to like 

with a Marlboro, filter, flavor, pack, or box.”79

Philip Morris continues to associate the 

Marlboro brand image with relaxation 

through its print advertisements. A 

December 1999 report assessing Marlboro 

advertising among young adult male 

smokers (YAMSs) stated, “Commonly, YAMS 

are thought to crave excitement and novelty. 

But, based on their reaction to ‘relaxing’ 

imagery, they also seem to be looking for 

escape from daily stress.”47(Bates no. 2072468453)

Philip Morris also used advertisements 

conveying relaxation for its line extension 

Marlboro Milds. A Philip Morris document 

that summarizes research on Marlboro Milds 

stated, “The laid back tone of the advertising 

is clearly recognized.”80(Bates no. 2073178944)

The study obtained ratings on “relaxed/laid 

back” and “tranquil.”80 A September 15, 

1998, internal Philip Morris memorandum 

titled Marlboro Milds Research Findings

described research on Marlboro Milds 

advertising involving six focus groups with 

African American smokers aged 21 to 29 years 

old. The memorandum stated that “the ads 

strongly communicated that Marlboro Milds 

would leave them with a ‘mellow feeling’ and 

a sense of ‘relaxation.’”81(Bates no. 2061701079)

A May 12, 1999, marketing research study 

for Philip Morris reported that a point-ofsale Marlboro advertisement called Boots

clearly communicated relaxation and 

kicking back, while another advertisement 

called Windmill “seemed to convey a strong 

sense of relaxation.”82(Bates no. 2073373193)

In 1993, Philip Morris promoted Benson & 

Hedges cigarettes with a slogan—“Take the 

edge off”—that promised relief from anxiety.83

The slogan appeared on all of the items in a 

Benson & Hedges clothing line.84

R.J. Reynolds’s Joe Camel campaign 

communicated that the Camel smoker 

was able to relax and handle stressful 

situations with ease. The focus group 

research conducted for R.J. Reynolds 

elicited numerous statements from Camel 

smokers indicating their perceptions that 

the Camel smoker was cool and laid back. 

A focus group member described Joe Camel 

as follows: “Never gets stressed out ... 

He can deal with whatever comes his way.... 

If something doesn’t work out ... he just 

does something else ... goes with the flow.... 

No big deal to someone real flexible like 

he is.”37(Bates no. 514340432)

Lorillard also associates relaxation—a theme 

closely related to the theme of having 

fun—with Newport cigarettes. Documents 

indicate that Lorillard marketing effectively 

associates the Newport brand and Newport 

smokers with relaxation. For example, the 
227

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

September 1988 Newport Image Study 

reported that 48% of respondents said that 

Newport smokers were relaxed.85 A January 

1994 Lorillard document reported on the 

results of eight focus groups with 18- to 

29-year-old menthol smokers. It stated, 

“Black Newport Smokers relate Newport to 

relaxing situations or ‘chillin’ in pleasant 

surroundings.”38(Bates no. 91950195)

Role of Image 

Enhancement from 

Cigarette Marketing

This section presents empirical evidence 

regarding the role of adolescents’ selfimages and their images of smokers in 

their motivation to smoke or in actual 

smoking. Four types of images are relevant: 

adolescents’ self-image, image of smokers in 

general, particular brand image, and image 

of smokers of particular brands. Attributes 

such as “tough,” “cool,” “masculine,” or 

“adventurous” could apply to each of these 

image types. The idea is that when the 

image of the smoker of a specific brand 

embodies traits adolescents seek, they will 

want to smoke that brand. For example, 

a youth who wants to be manly and rugged 

and believes Marlboro smokers are rugged 

will smoke Marlboro cigarettes to be manly. 

The following section addresses adolescents’ 

self-image and image of smokers, describes 

evidence that the tobacco industry is aware of 

the issue, and presents experimental evidence 

from nonrandomized and randomized studies 

that measured the influence of tobacco 

marketing on images of smokers.

Self-Image and the Image of 

Smokers

Table 7.1 summarizes information about 

eight studies that examined the role of 

self-image and the image of smokers in 

influencing adolescents to smoke. Barton 

and colleagues15 first examined differences 

in adolescents’ perceptions of smoking 

and nonsmoking youth by systematically 

comparing adolescents’ ratings of pictures 

of youth that were identical except for 

the presence of a cigarette. Sixth graders 

saw the images of youth with cigarettes 

as tougher, wanting to be with the group, 

drinking more, more interested in the 

opposite sex, less obedient, less good, trying 

to act older, less likely to do well at school, 

less wise, less desirable as a friend, and less 

healthy. Tenth graders viewed the images 

of the presumed youth smokers as more 

tough, more likely to drink, more likely to 

act big, liking to be with the group more, 

older, less good, less healthy, and less wise. 

The majority of youth at each age saw some 

of these characteristics—being tough, 

having an interest in the opposite sex, 

and being in a group—as desirable.

The study also examined whether 

adolescents were more likely to state an 

intent to smoke if they had an ideal selfimage that more closely resembled that 

of a smoker than that of a nonsmoker 

(on certain attributes). No such relationship 

existed for 6th grade boys. However, for 

6th grade girls, intent to smoke was higher 

if a girl’s self-image was closer to her 

image of a smoker on five attributes: wise, 

relaxed, is good, drinks, and obeys. Among 

10th graders, both genders were more likely 

to intend to smoke if they saw smokers as 

closer to their ideal as having an interest in 

the opposite sex.

Chassin and colleagues54 conducted a 

similar study, mentioned briefly in an earlier 

section, examining high school student 

ratings of photographs of boys holding 

chewing tobacco, a pack of cigarettes, or 

a bag of corn chips. Compared with the 

boy with corn chips, the boy holding the 

cigarette seemed more rebellious, brave, 

rough/rugged, likely to use drugs and 

alcohol, phony, unhappy, lazy, unhealthy, 

less good at school, and getting along less 

well with family. Girls who admired the 
228

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r Table 7.1 Studies of the Relationships among Self-Image, Smoker Image, and Adolescent Smoking Study Setting/ sample size Measure of advertisement exposure (IV) Outcome measures (DV) Findings Aloise-Young et al. 199686 1,222 nonsmokers assessed in grades 5–8 and again in the next academic year Composite score ratings of self- image and smoker image on three traits: cool, sociable, and smart Any smoking by follow-up (longitudinal study) Looking at individual traits, young people whose self-image was consistent with the way they had rated smokers on the traits involving “cool” and “smart” were significantly more likely to initiate smoking. Amos et al. 1997;87 Amos et al. 199888 897 adolescents aged 12–19 years Pictures of youth from youth and style magazines, altered to create one version in which the person held a cigarette and the other in which the young person did not have a cigarette Ratings of the pictures on a set of attributes The presence of a cigarette affected how youth rated the photographs. Smoking images were rated as being more druggy, wild, and depressed. In contrast, nonsmoking images were rated as more healthy, rich, nice, fashionable, slim, and attractive. Smokers and nonsmokers differentially rated themselves in the same way they differentiated between smokers and nonsmokers in the photographs. “It is argued that these magazine images of smoking may be acting to reinforce smoking among young people.”88(p.491) The authors suggest some adolescents use smoking as a strategy for gaining entry to certain groups, e.g., wild, rebellious, not interested in school, or into taking risks. Barton et al. 198215 286 6th graders and 248 10th graders Rated pictures of adolescents in which the presence of a cigarette was systematically manipulated Ratings of the pictures on 12 adjective rating scales (e.g., tough/timid) A majority at each age saw some attributes— being tough, having an interest in the opposite sex, and being in a group—as good things to want. For 6th-grade girls, intentions to smoke were higher if their self-image was closer to the image of a smoker on each of 5 attributes: wise, relaxed, good, drinks, and obeys. Both male and female 10th graders were more 

likely to intend to smoke if they saw smokers as closer to their ideal than nonsmokers were on being interested in the opposite sex.
229

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 7.1 Studies of the Relationships among Self-Image, Smoker Image, and Adolescent Smoking (continued)

Study

Setting/

sample size

Measure of advertisement 

exposure (IV) Outcome measures (DV) Findings

Burton et al. 198989 122 7th graders Ratings of self-image, ideal selfimage, smoker image, and images 

in cigarette advertisement. Rated on healthy, wise, tough, and interested in the opposite sex

Rated intention to smoke Intention to smoke was highest for those with 

the least difference between self-image and image of smokers. Results indicate these youth had less positive self-images and more positive images of smokers than other students did. The authors argue,“...youth with relatively lower self-concepts, who do not perceive themselves as distinctive in terms of being especially healthy, wise, tough, or interested in the opposite sex, may be drawn toward smoking as a way of ‘adding something’ to their identity.”(p.661)

Chassin et al. 198140 175 9th and 

10th graders

Rated attributes of actual self, ideal self, ideal date, smokers, and nonsmokers

Monthly smoking and intentions to smoke

Smokers were more likely than nonsmokers to have a self-concept like that for the image of smoking adolescents (than like that for the image of the nonsmoking adolescent). Nonsmokers whose ideal date was closer to that of the smoker than nonsmoker were more likely to intend to smoke. Those who rated their self-image as closer to the smoking than nonsmoking image in terms of toughness, foolishness, acts big, disobedient, and interested in the opposite sex were significantly more likely to report an intention to smoke.

Note. IV = independent variable; DV = dependent variable.
230

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r Table 7.1 Studies of the Relationships among Self-Image, Smoker Image, and Adolescent Smoking (continued) Study Setting/ sample size Measure of advertisement exposure (IV) Outcome measures (DV) Findings Chassin et al. (1988)54 429 high school students Pictures of a boy holding (1) a can of chew, (2) a pack of cigarettes, or (3) a bag of corn chips Ratings of the pictured boy on adjective rating scales (e.g., timid/ brave; rough, rugged, vs. gentle, delicate); compared monthly smokers to never smokers The smoker was seen as more rebellious, more brave, more rough/rugged, more likely to use drugs and alcohol, as well as more phony, less good at school, more unhappy, more lazy, more unhealthy, and getting along less well with family. Girls who admired the smoker image most were more likely to smoke, and boys who admired the nonsmoker image most were less likely to smoke compared to never smokers. Perry et al. 198716 1,286 7th graders, and 2,587 9th and 10th graders Ratings of the functional meanings of smoking (e.g., how much you could get over feeling bored or lonely by smoking) Ever smoked Participants were more likely to have ever smoked if they felt that smoking made them feel older. Shadel et al. 200490 101 never smokers aged 11–17 years Rated ads with brand information removed: whether the ad did or did not remind them of themselves Self-conflict scale score Younger (aged 11–13 years) but not older (aged 14–17 years) adolescents associated the self-conflict scale with ratings that the ads reminded them of themselves, thus suggesting that they looked to the ad imagery for help in defining themselves Note. IV = independent variable; DV = dependent variable.
231

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

smoker image more than the nonsmoker 

image were more likely to smoke cigarettes 

(p < .001). Boys who admired the 

nonsmoker more than the smoker image 

were less likely to smoke (p < .05).

Shadel and colleagues86 assessed the level 

of self-conflict (i.e., conflicts between 

personality attributes experienced as 

part of self-concept development) related 

to the personal relevance of cigarette 

advertisements among 101 never-smoking 

volunteers aged 11–17 years. Brand 

identification was removed from 11 cigarette 

advertisements, and volunteers were 

asked if the advertisements did or did not 

remind them of themselves. The level 

of self-conflict was significantly related 

to advertisement relevance for younger 

(11–13 years) but not older (14–17 years) 

adolescents. The findings suggested that 

younger adolescents appeared “more likely 

to look to the powerful images displayed 

in cigarette advertising for help”86(p.463) in 

defining themselves.

Amos and colleagues87 compared adolescents’ 

ratings of photographs of youth differing 

only in whether the young person held a 

cigarette. Adolescents rated those holding 

cigarettes as higher on tough/hard, tart/tarty, 

druggy, wild, and depressed. They rated 

those without a cigarette higher on healthy, 

rich, nice, fashionable, slim, and attractive. 

Smokers and nonsmokers differentially 

rated themselves in the same way they 

ranked smokers and nonsmokers. The selfimages of adolescent smokers were more 

like adolescents’ images of pictured smokers 

than like their images of the pictured 

nonsmokers.

In the 1981 study by Chassin and 

colleagues,40 9th and 10th graders rated 

their real and ideal selves, images of 

smokers and nonsmokers, and an ideal 

date. Those rating self-images as closer to 

smoking than nonsmoking images in terms 

of tough, foolish, acting big, disobedient, 

and interested in the opposite sex were 

significantly more likely to report an intent 

to smoke. Nonsmokers whose ideal dates 

more closely resembled smokers than 

nonsmokers were more likely to intend 

to smoke. Finally, smokers differed from 

nonsmokers in having self-images and 

ideal dates closer to images of smokers 

than to nonsmokers.

In a longitudinal study, Aloise-Young 

and colleagues87 examined a sample of 

1,222 5th through 8th graders who rated 

themselves and an image of a smoker on 

the attributes cool, sociable, and smart. 

Those with a self-image consistent with 

their image of a smoker on any two of these 

traits were significantly more likely to start 

smoking cigarettes in the next school year. 

For individual traits, when a self-image was 

in line with the way they rated smokers 

on cool and smart, adolescents were 

significantly more likely to initiate smoking.

In another study, Burton and colleagues89

examined 7th graders’ ratings of self-image, 

ideal image, smoker image, and smoker 

image depicted in advertising. Intent to 

smoke was highest for those with the least 

disparity between self-image and smoker 

image. Analyses indicated that these youth 

had less-positive self-images and morepositive smoker images than did other 

students. The authors state, “Youth with 

relatively lower self-concepts, who do 

not perceive themselves as distinctive in 

terms of being especially healthy, wise, 

tough, or interested in the opposite sex, 

may be drawn toward smoking as a way of 

‘adding something’ to their identity.”89(p.661)

Perry and colleagues16 studied how 7th, 

9th, and 10th graders felt about smoking. 

Participants were more likely to smoke if 

they felt smoking made them feel older.

These studies indicate that many adolescents 

have certain positive images of smokers 

(e.g., tough, sociable). They are more apt 

to start smoking if they see smokers having 
232

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

traits they desire or that are in line with 

their self-views. Some traits that smokers 

are perceived to have would be seen by many 

people as negative (e.g., druggy, rebellious). 

However, for a subset of adolescents, these 

are desirable traits. Thus, adolescents see 

smokers in terms of traits that some typically 

consider negative. This finding is consistent 

with the thesis that adolescents are 

motivated to smoke, in part, by the images 

they feel they can achieve or reinforce. 

Impact of Marketing on 

Adolescents’ Images of Smokers

Many studies show that adolescents are 

motivated to smoke cigarettes to achieve 

the images they have of smokers. Yet, these 

studies do not demonstrate that cigarette 

marketing influences adolescents to 

have these favorable images of smokers. 

However, a number of nonrandomized 

and randomized experimental studies in 

the empirical literature indicate a role 

for marketing in influencing adolescents’ 

images of smokers. While these experimental 

studies can establish such a link in the 

laboratory, it is possible that in a natural 

setting, not specifically cued to advertising 

imagery, subjects might have different 

perceptions of and reactions to smokers and 

tobacco advertising and promotions.

Nonrandomized Studies

Aitken and colleagues91 examined whether 

6- to 17-year-olds could identify cigarette 

brands after viewing advertisements with no 

brand showing. Across three brands, 38% to 

83% of those age 12 and 13 years and 52% 

to 95% of older teenagers could identify 

the brands. They matched advertisements 

to thumbnail sketches of the type of person 

who smoked a brand. By age 10 years, 

students could match brands to thumbnail 

sketches of the brand’s smoker at betterthan-chance levels, showing that they had 

formed an image of each brand’s smoker.

Arnett and Terhanian92 presented 

advertisements for five brands of cigarettes 

(Camel, Marlboro, Kool, Benson & Hedges, 

Targeting the Young Smoker’s Self-Image

Cigarette companies understand the need of adolescents to adopt and enhance their chosen 

image. In a 1973 document from R.J. Reynolds, executive Claude Teague wrote:

The fragile, developing self-image of the young person needs all the support and enhancement 

it can get. Smoking may appear to enhance that self-image in a variety of ways. If one values ... 

an adventurous, sophisticated adult image, smoking may enhance one’s self-image.a

The Philip Morris Marlboro Marketing Mix Study from February 1996 notes that “young adult 

male Marlboro Red smokers” are the “most image-conscious segment.” The study involved 

2,203 personal interviews in 40 geographically dispersed markets. The sample consisted of 18- 

to 34-year-olds who smoked Marlboro Red or Marlboro Lights. Without seeing any marketing 

materials, participants answered the question, “What comes to mind when you think of Marlboro?” 

After answering, they reviewed a list of statements people use to describe cigarette brands and were 

asked to rate how well each statement applied to Marlboro. Finally, participants viewed a list of 

descriptions of different types of people, and researchers asked them “to rate each item on how well 

it describes Marlboro, the person.” Philip Morris used these data to define the Marlboro core image.b

a

Teague, C. E. Research planning memorandum on some thoughts about new brands of cigarettes for the youth 

market. 2 Feb 1973. R.J. Reynolds. Bates No. 502987357/7368. http://legacy.library.ucsf.edu/tid/act68d00.

b

Philip Morris. Marlboro marketing mix study. Feb 1996. Philip Morris. Bates No. 2062311535/1551. 

http://legacy.library.ucsf.edu/tid/nsl27a00.
233

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

and Lucky Strike) to 534 adolescents in 

grades 6 through 12 from seven schools in 

four U.S. states. They obtained ratings for 

each advertisement of how frequently the 

adolescents had seen the advertisement, 

how well they liked it, and the degree to 

which the advertisement made smoking 

appealing. These adolescents saw Marlboro 

and Camel advertisements more frequently 

than they saw advertisements for other 

brands. A larger proportion of these students 

liked these advertisements (44% Marlboro 

and 64% Camel) more than the other 

advertisements and found them more 

appealing than advertisements for other 

cigarettes. The findings suggest that brands 

whose advertising is seen more favorably 

by youth are more popular with youth. 

However, none of these comparisons 

included a statistical analysis.

Arnett93 conducted a study indicating 

that the more youth-popular cigarette 

brands were perceived more positively by 

adolescents than was advertising for a brand 

not popular with youth. He presented two 

advertisements for each of five youth-popular 

brands (Marlboro, Newport, Camel, Kool, 

and Winston) and one for a non-youthpopular brand (Merit) to 400 12- to 17-yearold American adolescents. They rated how 

much they liked the advertisements and how 

much they thought the advertisements made 

smoking appealing. The adolescents liked all 

but two of the advertisements for the youthtargeting brands significantly more than they 

liked the Merit advertisements. They rated 

one Marlboro advertisement, two Camel 

advertisements, and a Kool advertisement 

as making smoking significantly more 

appealing than did the Merit advertisement. 

They liked the Marlboro advertisements 

significantly more than they liked 

advertisements for Newport cigarettes.

Unger and colleagues94 assessed brand 

recognition among 386 8th-grade 

students for cigarette, alcohol, and other 

advertisements that had brand information 

removed. Students were able to identify the 

brands for Camel (71.7%), Marlboro (62.5%), 

and Newport (31.4%) more than for Capri, 

Kool, Misty, and Virginia Slims. Like the 

Arnett study cited above, this study suggests 

that adolescents more readily recognize the 

advertisements for the cigarette brands that 

are more popular with youth.

Randomized Experimental Studies

Table 7.2 summarizes information in five 

studies that experimentally manipulated 

adolescent exposure to cigarette marketing 

by randomly assigning adolescents to 

different study groups. These evaluations of 

cigarette advertising’s impact on adolescents 

control for other possible influences by 

randomly assigning adolescents to receive or 

not receive exposure. This makes it highly 

likely that adolescents in each condition 

are equal at the outset. By experimentally 

manipulating marketing exposure, 

researchers eliminate the possibility that 

differences arise from the adolescents’ 

prior experiences. If one group has a more 

positive attitude or image of smokers, it is 

due to the exposure (intervention).

Two of the studies evaluated the impact 

of cigarette advertisements in magazines. 

Turco95 experimentally evaluated the impact 

of cigarette magazine advertisements on 

adolescents’ attitudes toward smoking. 

She randomly assigned 178 5th, 7th, and 

9th graders to look at a magazine with 

four cigarette advertisements or at the 

same magazine without any cigarette 

advertisements. The students had 

only five minutes to review the entire 

magazine, but researchers asked them to 

look at all advertisements. Adolescents 

who saw the magazines containing 

cigarette advertisements rated a woman 

shown smoking more positively than 

did adolescents who were not exposed 

to cigarette advertisements. Adolescents 

who had ever tried smoking and who 

saw the magazine containing cigarette 
234

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

Promotion of Smokeless Tobacco Use

Smokeless tobacco is marketed extensively (chapter 4) and is visible at the point of sale in many 

stores.a CDC data for 2005b indicate that among U.S. adults, 6.0% of men and only 0.4% of women 

used smokeless products. Among high school students in 2005, 13.5% of boys and 2.2% of girls 

reported current use, and among middle school students in 2004, 4.0% of boys and 2.0% of girls 

currently used smokeless products. Use of smokeless products carries significant health risks,c,d

and evidence from the national Teenage Attitudes and Practices longitudinal survey suggests that 

adolescent boys who use smokeless products become cigarette smokers at more than three times 

the rate compared with nonusers.e

Smokeless tobacco products have been heavily promoted among professional athletes, especially 

baseball players, who provide important role models for children and adolescents.f,g Advertising 

imagery for smokeless products features rugged, good looking, athletic models,h,i which are 

relevant to adolescent image needs. Some advertisements for these products suggested that 

they could be used without parental awareness, one indication, among others,j of specific 

targeting to youth. Adolescent boys’ images of a smokeless tobacco user and self-image were 

significantly more alike for users than for nonusers.k One cross-sectional study related receptivity 

to smokeless tobacco advertising (being able to name a smokeless brand as most advertised) to 

product use among adolescent boys, adjusting for smokeless tobacco use by family and friends.l

This analysis also found a positive association between participation in athletics and smokeless 

tobacco use. While the data are limited, there is no reason to believe that the effect of advertising 

and promotions for smokeless products on product use by adolescents is different than that 

for cigarettes.

a

DiFranza, J. R., M. Coleman, and D. St Cyr. 1999. A comparison of the advertising and accessibility of cigars, 

cigarettes, chewing tobacco, and loose tobacco. Preventive Medicine 29 (5): 321–26.

b

Centers for Disease Control and Prevention. 2007. Smoking & tobacco use fact sheet: Smokeless tobacco 

(updated April 2007). http://www.cdc.gov/tobacco/data_statistics/Factsheets/smokeless_tobacco.htm.

c

National Cancer Institute. 1989. Smokeless tobacco use in the United States (Monograph no. 8, NIH 

publication no. 89-3055). Bethesda, MD: National Cancer Institute.

d

National Cancer Institute. 1992. Smokeless tobacco or health: An international perspective (Smoking 

and tobacco control monograph no. 2, NIH publication no. 92-3461). Bethesda, MD: National Cancer 

Institute.

e

Tomar, S. L. 2003. Is use of smokeless tobacco a risk factor for cigarette smoking? The U.S. experience. 

Nicotine & Tobacco Research 5 (4): 561–69.

f

Blum, A. 1983. Using athletes to push tobacco to children: Snuff-dippin’ cancer-lipped man. New York State 

Journal of Medicine 83: 1365–67.

g

Connolly, G. N., C. T. Orleans, and A. Blum. 1992. Snuffing tobacco out of sport. American Journal of Public 

Health 82 (3): 351–53.

h

Chassin, L., C. C. Presson, S. J. Sherman, and S. Margolis. 1988. The social image of smokeless tobacco use 

in three different types of teenagers. Addictive Behaviors 13 (1): 107–12.

i

Ernster, V. L. 1989. Advertising and promotion of smokeless tobacco products. In Smokeless tobacco use in 

the United States (Monograph no. 8, NIH publication no. 89-3055), 87–94. Bethesda, MD: National Cancer 

Institute. 

j

U.S. Department of Health and Human Services. 1992. Spit tobacco and youth (OEI publication no. 

OEI 06-92-0050). Washington, DC: U.S. Department of Health and Human Services, Office of Inspector 

General.

k

Chassin, L., C. Presson, S. J. Sherman, L. McLaughlin, and D. Gioia. 1985. Psychosocial correlates of 

adolescent smokeless tobacco use. Addictive Behaviors 10 (4): 431–35.

l

Choi, W. S., A. J. Farkas, B. Rosbrook, J. P. Elder, and J. P. Pierce. 1995. Does advertising promote smokeless 

tobacco use among adolescent boys? Evidence from California. Tobacco Control 4 Suppl. 1: S57–S63. 
235

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 7.2 Studies Involving Randomized Experimental Manipulation of Exposure to Cigarette Marketing

Study

Setting/

sample size Experimental design Findings

Donovan et al. 200297 100 10- through 

12-year-olds

Subjects were randomly assigned to either (1) exposure to a photograph of a pack of Benson & Hedges and a point-of-sale advertisement for Marlboro or (2) exposure to a photograph of a pack of Marlboro and a point-of-sale advertisement for Benson & Hedges.

Compared with seeing the pack, looking at the poster increased positive perceptions of the brand user. In the case of Benson & Hedges, the students who saw the advertisement rather than just the pack were more likely to describe the users as relaxed, interesting, cool, rich, adventurous, and classy. Those who saw the Marlboro point-of-sale advertisement rated Marlboro smokers as more adventurous than did students who saw only the picture of the pack.

Henriksen et al. 200298 385 8th and 9th 

graders from 5 ethnically diverse schools

Classrooms assigned to 1 of 4 cells of a 2 × 2 design. The first 2-level factor was (1) exposure to photographs of a convenience store containing tobacco advertisements and displays or (2) exposure to pictures of a convenience store without tobacco advertising. The second 2-level factor was (1) newspaper clipping about a tobacco policy issue, or (2) newspaper clipping about youth food purchases.

Those exposed to cigarette advertising: (1) perceived that it would be easier to purchase cigarettes in the pictured stores, (2) perceived that it would be easier to purchase cigarettes in other stores, (3) perceived a higher prevalence of adolescent smoking, and (4) expressed less support for policies to control tobacco use. The type of story students read had no effect on these variables.

Pechmann and Knight 200299 718 9th graders 

from 4 ethnically diverse California high schools

Students were individually assigned at random to 1 of 8 12-minute videotapes about teenagers, using a 4 × 2 design. The tapes differed in advertisements they contained. There were four levels of the advertisement condition: (1) 4 cigarette advertisements, (2) 4 antismoking advertisements, (3) 4 cigarette advertisements and 1 antismoking advertisement, and (4) 4 control advertisements not involving smoking. The tapes also varied in that they either (1) showed a smoking teenager or (2) showed a nonsmoking teenager. According to the authors, the videotapes did not make the advertisements conspicuous.

Students exposed to cigarette advertisements had significantly more positive beliefs about smokers. Those who saw both cigarette advertisements and adolescents smoking had significantly more positive beliefs about smokers and more positive intentions to smoke in the future. The impact of exposure to cigarette advertisements and to smoking adolescents on intentions to smoke was mediated by its effect on their beliefs about smokers. Those who saw the advertisements with the teenage smokers remembered the advertisements significantly more than those who did not see the smokers. The impact of exposure to advertisements and to smoking adolescents on beliefs and intentions was significant even when students did not recall seeing advertisements. There were no differences found depending on whether or not the student was susceptible to smoking.
236

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

advertisements expressed more positive 

attitudes toward smoking than did such 

adolescents who were not exposed to 

the advertisements. Pechmann and 

Ratneshwar96 compared the impact of 

magazine advertisements for Newport, 

Virginia Slims, and Camel cigarettes 

with the effect of three advertisements 

unrelated to smoking in randomized groups 

of 304 7th-grade students. The authors 

prepared a magazine especially for the 

study by inserting advertisements into 

the magazine. Exposure to the cigarette 

advertisements influenced participants to 

have more positive thoughts about smokers 

(e.g., “has lots of friends,” “likes to do 

exciting things”) than was true for students 

who saw the unrelated advertisements.

Point-of-sale advertisements also have 

been studied. Donovan and colleagues97

randomly assigned 100 10- to 12-year-olds 

to see either a photograph of a Benson & 

Hedges cigarette pack and point-of-sale 

advertisements for Marlboro or a photograph 

of a Marlboro pack and Benson & Hedges 

point-of-sale advertisement. Seeing a 

point-of-sale advertisement instead of just 

a picture of a cigarette pack led to more 

positive descriptions of the brand user. 

With Benson & Hedges, 10- to 12-year-olds 

seeing the advertisement rather than just 

the photograph of the pack were more likely 

to describe users as relaxed, interesting, 

rich, and adventurous. Ten- to 12-yearolds who saw the Marlboro point-of-sale 

advertisement rated Marlboro smokers as 

more adventurous than students who saw 

only the pack picture. Thus, in both cases, 

compared with seeing a pack, looking at a 

single point-of-sale advertisement increased 

positive perceptions of a cigarette brand’s 

user. This provides evidence that cigarette 

advertising influences adolescents to view 

smokers more positively and fosters peer 

acceptance for those influenced to smoke.

Whether adolescents misattribute the 

Table 7.2influence of advertisements as an influence 

Studies Involving Randomized Experimental Manipulation of Exposure to Cigarette Marketing (continued)

Study

Setting/

sample size Experimental design Findings

Pechmann and Ratneshwar 199496

304 7th graders Students were assigned at random to 1 of 6 cells of a 

3 × 2 design. Three levels of advertisement type (cigarette, antismoking, or unrelated to smoking) were used. Students were asked to rate a pictured student who was described as either a smoker or nonsmoker. Students were exposed to (1) magazine advertisements for Newport, Virginia Slims, and Camel or (2) three advertisements unrelated to smoking.

Students who saw cigarettes advertisements had a greater proportion of positive thoughts about smokers (e.g., “has lots of friends,” “likes to do exciting things”) than did students who saw the unrelated advertisements.

Turco 199795 178 5th, 7th, and 9th 

graders

Participants were randomly assigned to review for 5 minutes either (1) a magazine with 4 cigarette advertisements or (2) a magazine without 4 cigarette advertisements.

Adolescents who had ever tried smoking and were exposed to cigarette advertisements expressed more positive attitudes toward smoking than those not exposed to advertisements. Adolescents exposed to advertisements also rated a woman shown smoking more positively than did adolescents not exposed to advertisements.
237

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

of smokers in the social environment also 

has been studied.99

A positive smoker stereotype that is 

activated by cigarette ads may cause 

youth inadvertently to seek out favorable 

evidence about smokers. Seemingly due 

to this favorable evidence, but in actuality 

because the cigarette ads drove perceptions 

to be favorable, youth may gradually come 

to believe that smokers have desirable 

traits.... Accordingly, they may become 

interested in smoking themselves.... Since 

this process is nonconscious, youngsters 

may be unable to protect themselves.99(p.6)

These researchers randomly assigned 

718 9th-grade students from four ethnically 

diverse California schools to view one of 

eight videotapes depicting a “slice of life” of 

people their age. Each videotape described 

students studying advertising and with 

assignments to videotape advertisements. 

Videotapes varied in terms of advertisements 

shown, with four possibilities: (1) four 

cigarette advertisements, (2) four 

antismoking advertisements, (3) four 

cigarette advertisements and one 

antismoking advertisement, and (4) four 

control advertisements not involving 

smoking. The videotapes varied in terms 

of whether they showed teenagers as 

smokers or nonsmokers. In a 4 × 2 design, 

one-half in each condition saw teenagers 

depicted as smokers and the other onehalf as nonsmokers. These researchers 

created a scale of stereotypical beliefs about 

adolescent smokers. The scale included 

12 items to consider: fun/boring, well-liked/

disliked, sexy/not sexy, desirable/undesirable 

to date, successful/unsuccessful, smart/

dumb, intelligent/stupid, healthy/unhealthy, 

well/sickly, natural smelling/stinky, cool/

uncool, and winner/loser. Those exposed to 

cigarette advertisements and nonsmoking 

teenagers in the videotapes rated adolescent 

smokers significantly more positively on 

this scale of beliefs. This finding shows 

that advertisements alone can influence 

a favorable view of smokers. As predicted, 

those who saw both cigarette advertisements 

and adolescents smoking had significantly 

more positive beliefs about smokers and 

had a more likely intent to smoke. These 

findings indicate that, in addition to its 

direct impact on adolescents’ views of 

smokers, cigarette advertising primes 

adolescents’ reactions to smokers in ways 

that improve their attitudes toward smokers 

and increase their own intent to smoke. 

This is consistent with the Romer and 

Jamieson14 study of cigarette advertising 

influencing adolescents to view smoking 

more favorably, making it more likely peers 

will accept them if they smoke cigarettes.

Pechmann and Knight99 also found that 

students’ beliefs about smokers and 

intentions about smoking changed. They 

found a significant effect of exposure to 

advertisements and to smokers on beliefs 

and intentions, even when a student did 

not recall seeing the advertisements. 

They write

Cigarette advertising can augment the 

impact of peer smokers by enhancing 

perceptions of individuals. Youth may 

mistakenly assume that they have been 

swayed by smokers, not by ads, because 

smokers are the more obvious influence 

agent. Hence, self-reported reasons for 

smoking may be misleading.99(pp.14–15)

Another experimental study shows that 

marketing affects adolescents’ perceptions 

of the availability of cigarettes and the 

prevalence of adolescent smoking. Henriksen 

and colleagues98 showed a random onehalf sample of 9th graders photographs 

of a convenience store with no cigarette 

advertisements and the other one-half a 

store with several cigarette advertisements. 

Those who saw the store with advertisements 

perceived that they could more easily 

buy cigarettes there, thought they could 

more easily purchase cigarettes in general, 

perceived a higher prevalence of adolescent 
238

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

smoking, and expressed less support for 

policies to control tobacco use.

Together, these experimental studies provide 

strong support for the inference that 

cigarette marketing influences adolescents 

to have images of smoking and smokers that 

are more positive, and affects adolescents’ 

perceptions of how many of their peers 

smoke—factors shown to predict smoking 

initiation.100 Under these experimental 

conditions, just one exposure to cigarette 

advertising influences the images adolescents 

have of smokers. Typically, adolescents 

are exposed to a multitude of cigarette 

advertisements. Key motivating images 

adolescents have of smokers are exactly 

the ones conveyed in advertisements for 

youth-popular brands. Thus, to the extent 

that tobacco companies shape adolescents’ 

images of smokers through advertising, they 

influence adolescents to smoke.

Evidence of Effects 

of Exposure to 

Cigarette Marketing on 

Adolescent Smoking

This section reviews the considerable body 

of empirical evidence accumulated over the 

past 30 years about the influence of exposure 

to cigarette marketing on adolescent 

smoking behavior. The first section 

addresses methodological issues including 

study design and the measurement of 

both smoking behavior and exposure to 

advertising. Subsequent sections describe 

the findings from cross-sectional and 

longitudinal study designs.

Methodological Issues

Study Design

From a methodological perspective, 

three types of studies may be applied to 

examine the relationship between cigarette 

advertising and smoking behavior: 

(1) cross-sectional, (2) longitudinal, and 

(3) experimental (discussed earlier in 

“Randomized Experimental Studies”). 

In contrast to experimental studies, surveys 

capture information about exposure to 

tobacco advertising and promotions in a 

more natural setting. Also, if conducted 

on a population sample and appropriately 

weighted, survey findings can be generalized 

to the population. Cross-sectional studies 

examine the relationship between one or 

more measures of exposure to cigarette 

marketing and a measure of smoking 

behavior obtained at the same time. These 

studies provide relatively weak support 

for a causal inference. This is because the 

observed relationship can be due to the fact 

that those who smoke or have a greater 

inclination to smoke pay more attention to 

cigarette marketing after the development 

of their interest in smoking. Longitudinal 

studies provide stronger evidence regarding 

the influence of cigarette marketing on 

adolescent smoking. They can demonstrate 

that exposure occurred before the changes 

in smoking behavior. The main limitation in 

longitudinal studies is that typically not all 

people in the original sample are successfully 

followed, and generally, those most likely to 

smoke are lost from the sample. Although 

appropriate sample weighting can ameliorate 

this bias, the statistical power to identify an 

association is reduced. Also, a longitudinal 

relationship could be due to some other 

variable that influenced both exposure at the 

first assessment and later smoking behavior. 

A number of the cross-sectional and 

longitudinal studies that examined an 

association between cigarette advertising 

and smoking behavior included other 

variables suggested by existing theory or 

evidence to influence smoking. For example, 

social influences such as family or peer 

smokers may both model smoking behavior 

and lead adolescents to encounter cigarette 

marketing. An older sibling may give an 
239

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

adolescent a cigarette promotional item 

that influences the teenager to experiment 

with smoking. This would not necessarily 

mean that marketing had no influence, 

since without exposures to marketing, 

social influences could be less effective. 

Controlling statistically for social influences 

and finding that tobacco marketing exposure 

is related to or predicts future smoking 

provide greater confidence that the social 

influences do not account entirely for the 

exposure-smoking relationship.

The most definitive evidence of the influence 

of cigarette marketing on youth smoking 

would involve experimental manipulation of 

adolescents’ long-term exposure to cigarette 

marketing and assessment of its impact on 

adolescents’ initiation of smoking. With 

appropriate randomization, such a study 

would control for preexisting differences 

among adolescents in prior exposure to 

marketing as well as social influences to 

smoke. In that way, one could be confident 

that the exposure led to the smoking. 

However, such a study would be unethical or 

infeasible. One way to conduct this type of 

experiment would be to randomly assign a 

group of young people to receive high levels 

of cigarette marketing while others would 

experience the environment as it normally 

exists. Given existing evidence of the impact 

of cigarette marketing on adolescents, a 

study of this nature would risk addicting 

adolescents to cigarettes and would thus be 

unethical. Alternatively, one group could 

be assigned to experience the prevailing 

advertising environment, and the other 

could receive no advertising at all. However, 

attaining a control group with no exposure 

to cigarette marketing would not be feasible, 

since it would require the cooperation of 

tobacco companies.

Measures of Smoking Behavior

The smoking initiation process consists of a 

continuum of stages or phases.1,101–103 Many 

young children unexposed to smoking in 

their immediate social environment are 

not even aware of it. As they become older, 

inevitably it will enter their consciousness, 

and they may or may not be curious about 

it. Because of education about the dangers 

or social undesirability of smoking, some 

will adamantly deny that they would ever 

try a cigarette. However, their curiosity 

may lead them to pay attention to tobacco 

advertising and promotions, and both 

factors may play a role in their developing 

a susceptibility to smoking and/or 

experimenting in the future. For some, 

a few puffs or a single cigarette may be 

the extent of their smoking experience 

because their curiosity is satisfied. 

However, for others, experimentation 

will continue, perhaps intermittently, for 

months or even years. Eventually many of 

these experimenters develop a regular or 

established pattern of smoking. Regular 

smokers can smoke daily or occasionally.

Some researchers examine forward 

movement along this continuum as an 

outcome. When adolescents no longer 

adamantly deny that they would try a 

cigarette (even if offered by a friend), 

researchers consider them susceptible to 

smoking.104 Other studies reviewed below 

have further validated the susceptibility 

measure as highly predictive of future 

smoking.103,105 Some researchers consider 

ever smoking (even a few puffs) as smoking 

initiation. Others focus on current smoking, 

usually defined as smoking on any day in 

the past month.1 A common measure of 

established smoking is a report of having 

smoked at least 100 cigarettes in one’s 

lifetime.106

Measures of Exposure to Marketing

As background, this section describes 

various constructs used to measure different 

facets of exposure to tobacco marketing. 

It gives the conceptual name to each one as 

typically applied by investigators. Different 

researchers sometimes use the same 
240

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

constructs but different terms to designate 

them. Many studies use more than one of 

these measures.

n External estimates of exposure. Exposure 

to marketing stimuli is estimated on 

the basis of external (to the adolescent) 

measures of potential adolescent exposure 

to a source of advertising, such as what 

magazines they read or what types of 

advertising appear in stores they are 

likely to frequent.107 Knowing the level 

of advertising in these external sources 

allows an indirect and external measure 

of likely adolescent exposure to tobacco 

advertising.

n Self-reported exposure to marketing.

These are adolescent reports of exposure to 

various types of marketing (e.g., billboards, 

point-of-sale advertisements). Respondents 

do not indicate if they recall specific 

advertisements or brand advertising.108

The frequency of such exposure may 

or may not be assessed. This category 

includes measures of awareness of 

advertising (e.g., can you name a cigarette 

brand).109

n Self-reported recall. Reports of 

advertisements or other marketing 

stimuli that respondents specifically 

recall seeing.110

n Brand recognition. The ability to name a 

brand when such information is missing 

or deleted from sample advertisements.94

n Attitudes toward, liking for, or opinions 

or beliefs about advertising. Respondents 

rate their favorability or unfavorability 

toward tobacco advertising in general.111

n Beliefs about the impact of cigarette 

advertising. Respondents rate how much 

they believe that cigarette advertisements 

affect them or others.112

n Receptivity to tobacco marketing.

This is a multicomponent index of 

adolescents’ disposition toward tobacco 

marketing. Evans and colleagues13

included five components in their 

index of receptivity: (1) the number of 

positive messages that they indicated 

advertising conveyed, (2) naming a brand 

of a favorite advertisement, (3) naming 

a brand they would buy if they bought 

cigarettes, (4) ownership of a cigarette 

promotional item, and (5) willingness 

to use a cigarette promotional item. 

Levels beyond the first are more than just 

exposure; they reflect a positive attitude 

toward cigarette marketing. Feighery and 

colleagues113 defined receptivity in terms 

of “see” (recall of reported exposure to 

magazines, billboards, or convenience 

stores), “want” (desire for promotional 

items or saved coupons), and “own” 

(ownership of a promotional item).

On the basis of the theoretical concepts 

regarding media effects presented in 

chapter 2 of this monograph, measures 

that capture attitudes, liking, beliefs, or 

receptivity are more likely to be related to 

present or future smoking behavior than are 

measures of external exposure, self-reported 

exposure, or recall or brand recognition.

One study explored the relationships 

among some of these various measures. 

Unger and colleagues114 factor analyzed 

relationships among various measures of 

protobacco and antitobacco advertising. 

They identified four factors: (1) perceived 

pervasiveness of protobacco advertising, 

(2) perceived pervasiveness of antitobacco 

marketing, (3) recognition of specific 

antitobacco marketing, and (4) receptivity 

to protobacco marketing.

The variety of measures of exposure is 

not necessarily a weakness in this body 

of research. To the extent that diverse 

measures of exposure have a relationship 

with diverse measures of smoking behavior 

or susceptibility to smoking, there is greater 

confidence that the findings are not simply 

due to artifacts of a particular method of 

measurement.
241

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Cross-Sectional Studies

Table 7.3 presents summary information 

about cross-sectional studies of the 

relationship between various measures 

of exposure to cigarette marketing and 

adolescent smoking behavior measures. 

Altogether, 52 such studies were located 

using the search procedures described 

earlier. The summary of the findings of 

these studies is organized according to the 

measures of exposure the investigators 

used. Some studies are mentioned more 

than once, because they analyzed multiple 

exposure measures in different categories.

External Estimates of Exposure

Four studies estimated adolescents’ 

exposure to cigarette marketing on the 

basis of exposure to settings known to 

contain marketing stimuli. Wakefield 

and colleagues107 derived estimates of 

adolescents’ exposure to marketing of 

Marlboro and Camel cigarettes from direct 

observation measures of the amount of 

advertising and promotions these brands had 

in a population-based sample of convenience 

stores. They then related the share of voice 

for these brands (share of total cigarette 

advertising) in the convenience stores with 

the brand choice of high school students 

attending schools near each convenience 

store. Adolescents were more likely to smoke 

Marlboro cigarettes when their schools 

were near convenience stores with a greater 

share of the interior and exterior cigarette 

advertising for that brand and when the 

stores had more Marlboro advertising for a 

“gift with purchase.” Adolescents were more 

likely to be Camel cigarette smokers if the 

stores near their schools had a greater share 

of interior advertising devoted to Camel. 

However, share of exterior advertising 

for Camel had a negative relationship to 

smoking Camel cigarettes.

Henriksen and colleagues134 estimated 

adolescents’ exposure to marketing 

stimuli in convenience stores by obtaining 

student reports of the frequency of their 

visits to these stores. They found that 

weekly exposure to convenience stores was 

associated with a 50% increase in the odds 

of ever smoking. The study controlled for 

social influences on smoking. Ledwith137

reported that adolescents’ exposure to 

televised snooker (a game similar to pool) 

competitions sponsored by cigarette brands 

was associated with greater knowledge of 

cigarette brands. However, Sin147 found 

that adolescent-reported exposure to print 

media that contained cigarette advertising 

was not associated with smoking status. 

Smokers and nonsmokers reported similar 

levels of exposure.

Finally, Carson and colleagues123 asked 

967 12th graders how many hours per week 

they read magazines and watched television 

or videotapes. Four types of magazines 

were queried: fashion, entertainment/

gossip, health/fitness, and sports/activities. 

In a path analysis, exposure to fashion 

and entertainment/gossip magazines had 

an indirect effect on smoking behavior 

through a drive for thinness and tobacco 

advertisement receptivity.

Self-Reported Exposure, Awareness, 

or Recall of Specific Advertising

Of 23 studies that measured adolescents’ 

self-reported exposure to advertising, 

awareness of cigarette advertising, or recall 

of advertisements,46,91,93,108,114,116–119,121,122,124,130,

132,134,136,138–140,147–150 8 studies reported on nine 

samples in which there was a significant 

positive relationship between exposure, 

awareness, or recall and susceptibility 

to smoking or positive intention to 

smoke.114,117,119,121,122,130,132,150 Further, 

these 23 articles reported 17 significant 

positive relationships between measures of 

exposure, recall, or awareness and smoking 

status. One replicated the relationship 

between exposure and smoking status at 

two different times.122 As an example of a 
242

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r Table 7.3 Cross-Sectional Studies of the Association of Tobacco Marketing with Adolescent Smoking Study Setting/sample size Measure of advertisement exposure (IV) Outcome measures (DV) Findings Ahsan et al. 1998115 667 males (555 in 

2 metropolitan high schools and 112 from urban slums) in Dhaka, Bangladesh

Recognition of brand for cigarette advertisements that lacked brand information

Current smoker: smoked at least 1 cigarette or bidi per week 

Middle-class student smokers could better recognize tobacco advertisements than could nonsmokers (by the authors’ definition of smoker, this would include experimenters or occasional users). Among slum youth, a higher proportion of nonsmokers than smokers recognized all three advertisements. Half of students said cigarette advertisements influence young people to start smoking.

Aitken and Eadie 1990116 848 11- to 14-year-olds in 

Glasgow, Scotland

Recall (number of brands seen advertised) and attitudes toward, recognition of cigarette advertising

3 levels of smoking experience: (1) nonsmokers—never tried; (2) triers—at least 1 cigarette, 

but do not smoke now; and (3) smokers—smoke now

Smokers were better at recalling and recognizing cigarette advertisements than were nonsmokers. A discriminant analysis showed that smokers differed significantly from nonsmokers on ability to recognize cigarette advertisements and in attitudes toward advertisements. Triers were intermediate, between smokers and nonsmokers. The analysis also included social influences on smoking.

Aitken et al. 198791 726 6- to 17-year-olds in 

Glasgow, Scotland

Recall (whether they had seen an advertisement before—labeled recognition in this study) and recognition of cigarette brand (labeled identification in this study)

3 levels of smoking experience: (1) nonsmokers—never tried; (2) triers—at least 1 cigarette, but do not smoke now; and (3) smokers—smoke now

Proportionally more smokers or triers than nonsmokers said they had seen the cigarette advertisements. Proportionally more smokers or triers than nonsmokers could name the brand for advertisements without brand information. At age 10 years, children could match a smoker image description to brands at greater-thanchance levels. This ability was not related to smoking status.

Altman et al. 1996117 1,047 12- to 17-year-olds 

contacted via random-digit dialing in CA

Awareness of tobacco promotions, knowledge of friend owning promotional item or taking part in a promotion, and receipt of free samples or direct mail from tobacco companies

3-level smoking status: (1) never smoker, not susceptible; (2) noncurrent smoker, susceptible; and (3) current user, also considered susceptible

A strong association was found between awareness of and involvement with tobacco promotions and being susceptible to tobacco use or already using tobacco products. Evidence was found of a dose-response relationship between susceptibility index and subsequent tobacco use.
243

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 7.3 Cross-Sectional Studies of the Association of Tobacco Marketing with Adolescent Smoking (continued)

Study Setting/sample size

Measure of advertisement 

exposure (IV) Outcome measures (DV) Findings

Aloise-Young et al. 2006118 242 middle and high school 

students surveyed in health class in one school district in CO

Index of exposure to magazines containing (and extent of) tobacco advertising; self-report of level of attention paid to the tobacco advertising; recognition of advertisements with brand information removed

Multilevel composite measure of smoking status, frequency, and consumption level

Attention to advertising and advertisement recognition was significantly related to smoking after adjusting for passive peer pressure index. Magazine advertising exposure index was significantly related to smoking index only among 7th graders. Significant interaction exists between exposure and passive peer pressure and smoking as well as a similar significant interaction for attention paid and for advertisement recognition and passive peer pressure.

Arnett 200193 400 12- to 17-year-olds 

(100 smokers; 300 nonsmokers) surveyed in shopping malls in AZ and WA (200 in each state)

Awareness of and response to advertisements for several youth and 1 adult brands of cigarettes. Questions included how often seen (recall), how much liked; and does it make smoking appealing.

Any smoking in the last 30 days 

All adolescents were more likely to like and find the youth brands (but not the adult brand) appealing. Smokers (in past 30 days) were more likely to like, and find the advertisements for most of the youth brands more appealing, than were the other adolescents.

Arnett and Terhanian 199892 534 11- to 18-year-olds in 

a convenience sample of 7 schools in 4 states: NY, PA, OH, and TX

Print advertisements for 5 brands shown; ratings of how often seen (recall), liking, whether it made smoking appealing, and whether it made them want to smoke 

Ever smoking Ever smokers reported seeing Marlboro 

cigarette advertisements more than nonsmokers. Smokers liked advertisements for all 5 brands significantly more than did nonsmokers. Smokers rated Marlboro and Camel advertisements more appealing than did nonsmokers. Smokers rated all brands higher than did nonsmokers on making them want to smoke.

Audrain-McGovern et al. 

200365

1,071 high school freshmen from 5 public high schools in northern VA

Receptivity to tobacco advertising and marketing

Ever smoking and noveltyseeking personality Having ever smoked was positively associated with receptivity to tobacco advertising as 

was a novelty-seeking personality. The study controlled for social influences.

Note. IV = independent variable; DV = dependent variable.
244

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r Table 7.3 Cross-Sectional Studies of the Association of Tobacco Marketing with Adolescent Smoking (continued) Study Setting/sample size Measure of advertisement exposure (IV) Outcome measures (DV) Findings Borzekowski et al. 1999119 571 7th graders from 5 middle schools in San Jose, CA Self-reported exposure to prosmoking messages, including family, friends, acquaintances, and strangers who seem to condone smoking, and media messages (e.g., billboards, magazines, in stores, promotional materials)

4 categories of smoking susceptibility, based on both smoking experience and intent—“lack of firm resolve not to smoke in the future”: (1) no smoking experience, no intent; (2) experience, but no intent; (3) experience and intent; and (4) current smokers; also perceived influence of advertising 

Those with high exposure to cigarette marketing had higher ratings of perceived influence of advertising. Exposure to cigarette marketing was associated with smoking susceptibility (according to the four categories as shown), even when controlling for social influences to smoke.

Botvin et al. 1991120 375 students (146 7th graders, 

121 8th graders, and 108 9th graders) from 2 junior high schools in a suburban NY community

Recognition of brands for advertisements that had the brand information removed 

3-level status: (1) nonsmokers—never and not in past 12 months; (2) experimenters—1 or 2 cigarettes in past year or a few times per month; and (3) smokers—a few times each week to >1 pack/day

Adolescents with higher advertisement recognition were more likely to be smokers.

Botvin et al. 1993121 602 adolescents (28% in 

7th grade; 72% in 8th grade; 48% male; 82% white) in middle-class, suburban schools

Self-reported exposure to cigarette advertising

7-level scale of smoking experience, from never to current smoking and amount of current smoking. Also, intent to smoke in next 2 years

Exposure to cigarette advertisements was associated with current level of smoking experience and intentions to smoke, even when controlling for friends smoking. 

Braverman and Aaro 2004122 Two samples of Norwegian 

youth aged 13–15 years. In 1990, n = 4,282; in 1995, n = 4,065

Self-reported exposure to any advertisements for tobacco products

Current smoking status (daily, occasionally, and never) and expectation that would smoke at age 20 years (definitely yes, probably yes, probably no, and definitely no) 

In both samples, smokers (both daily and occasional) and those who expected to smoke were significantly more likely to report exposure to tobacco advertising, even when exposure to social influences was controlled. 
245

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 7.3 Cross-Sectional Studies of the Association of Tobacco Marketing with Adolescent Smoking (continued)

Study Setting/sample size

Measure of advertisement 

exposure (IV) Outcome measures (DV) Findings

Carson et al. 2005123 967 12th graders in 5 northern 

VA public high schools

Hours/week reading various types of magazines, receptivity to tobacco advertising and promotions, and drive for thinness

5-level scale of smoking experience: (0) never, (1) puffer, 

(2) whole cigarette, (3) current 

but <100 cigarettes in lifetime, and (4) current established, ≥100 cigarettes in lifetime

A path analysis showed that fashion/entertainment magazines had an indirect affect on smoking level through tobacco receptivity and drive for thinness, with a dose-response relationship through this link, while controlling for social influences to smoke.

Chang 2005124 1,490 Taiwanese high school 

students

Attention paid to cigarette advertising in magazines and at point of sale, and attitudes toward cigarette advertising

Smoking in the past 30 days Both attention paid and attitudes toward 

cigarette advertising were significantly related to smoking. A “hedonistic” factor derived from a factor analysis of values-based questionnaire items was positively associated with both smoking status and the advertising variables.

Chapman and Fitzgerald 1982125

1,195 7th and 8th graders in Sydney, Australia

Recognition of tobacco brands and slogans through use of blinded advertisements 

Smoking: any smoking in the past 4 weeks

In every case but one, nearly twice the proportion of smokers than nonsmokers could correctly recognize tobacco advertisements and slogans. 

Chen et al. 2002126 20,332 randomly sampled 

12- to 17-year-old boys and girls in CA

Receptivity to protobacco media (having favorite brand advertisements, having ever received a promotional item, willingness to use a promotional item, and having formed a preference to buy particular cigarette brand)

Smoking: any smoking in past 30 days

A consistent dose-response relationship was found between receptivity to protobacco media and 30-day cigarette smoking, even when controlling for social influences to smoke. Having a cigarette brand preference also was associated with smoking.

Diaz et al. 1998127 1,003 Spanish schoolchildren 

(aged 11–13 years)

Were asked: “Do you believe that it is [all right] that there is tobacco advertising?” 

Smoking status: never, experimenter, regular (weekly or daily)

A significant association was found between affirmative response to questions about advertisements and ever smoking (experimenters and regular smokers) and regular smoking. However, in a multivariate logistic regression adjusting for other attitudes and beliefs about smoking as well as smokers in the social environment, opinions about tobacco advertising were not related to smoking.

Note. IV = independent variable; DV = dependent variable.
246

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r Table 7.3 Cross-Sectional Studies of the Association of Tobacco Marketing with Adolescent Smoking (continued) Study Setting/sample size Measure of advertisement exposure (IV) Outcome measures (DV) Findings Emri et al. 1998128 1,093 children aged 7–13 years, from grades 2–5 in Ankara, Turkey Recognition—matched logos and brand names to product type Ever smoking Camel logo and Samsun (Turkish cigarette) and Marlboro brand names were most highly recognized of all products tested. Rates of recognition for cigarette brands were not related to ever smoking. Evans et al. 199513 3,536 adolescent never smokers contacted via random-digit dialing in the California Tobacco Survey Receptivity to tobacco advertising and exposure to smokers Susceptibility to smoking: never smokers who do not rule out trying a cigarette or taking one from a friend, if offered Receptivity to tobacco advertising and exposure to smokers were independently associated with susceptibility to smoking among never smokers, but the relationship appeared stronger for receptivity to advertising. Feighery et al. 1998113 571 7th graders from 25 randomly selected classrooms in 5 middle schools in San Jose, CA Receptivity to tobacco marketing strategies 3-level status: (1) never smoker resolved not to smoke; (2) has smoked, but resolved not to smoke again; and (3) has smoked but no clear resolve not to smoke again/susceptible Receptivity to tobacco marketing materials was found to be strongly associated with susceptibility, even when controlling for social influences. Gilpin et al. 1997129 5,531 youth (aged 12–17 years) surveyed in 1993; 1,735 youth (aged 12–17 years) and 4,170 adults surveyed in 1994 Possession of and willingness to use cigarette promotional items Current smokers (in past 30 days) vs. nonsmokers. Never smokers not susceptible vs. susceptible to smoking (does not rule out trying a cigarette soon, in the next year, or accepting one if offered by best friend) Among adolescents, current smokers were significantly more likely than nonsmokers to report possession of cigarette promotional items. Among adolescent nonsmokers, having cigarette promotional items appeared to be associated with smoking susceptibility. Thirty percent of susceptible adolescent never smokers were prepared to use a cigarette promotional item. Overall, a strong relationship was found between smoking status and willingness to use a promotional item.
247

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 7.3 Cross-Sectional Studies of the Association of Tobacco Marketing with Adolescent Smoking (continued)

Study Setting/sample size

Measure of advertisement 

exposure (IV) Outcome measures (DV) Findings

Goldberg 2003130 Over 1,700 14- to 17-year-old 

Hong Kong students

Recall of cigarette advertising, brands, promotional products, and American movies 

3-level smoking behavior: (1) never smokers’ smoking intentions in next year (definitely not, probably not, probably yes, or definitely yes); (2) exploratory puffing; and (3) current smoking (in last 7 days) 

All levels of smoking behavior (including intention) were significantly higher for those who recalled cigarette advertising.

Goldstein et al. 1987131 306 students in 9th 

through 12th grades in the United States

Cigarette advertising recognition of missing brands and missing slogans

4-level status: (1) nonsmoker—

never experimented or tried; (2) experimenter—tried but smokes less than 1 cigarette/week; (3) light smoker—1 cigarette to 1 pack/week; and (4) regular smoker—1 pack or more/week

A positive relationship was found between smoking level and cigarette advertising recognition.

Gunther et al. 2006132 818 6th graders in 2 WI middle 

schools

Scale combining perception of peer exposure and tobacco attention to protobacco and antitobacco advertising in the past 30 days

4-level status: (1) nonsusceptible never smoker; (2) susceptible never smoker; (3) experimenter; and (4) established smoker

Path analysis indicated that both protobacco and antitobacco media may have a significant indirect effect on adolescent smoking through their effects on peer norms. Peer norms and other social influences were included in the model. The positive effect for protobacco advertising was greater than the negative effect for antitobacco advertising.

Note. IV = independent variable; DV = dependent variable.
248

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r Table 7.3 Cross-Sectional Studies of the Association of Tobacco Marketing with Adolescent Smoking (continued) Study Setting/sample size Measure of advertisement exposure (IV) Outcome measures (DV) Findings Hawkins and Hane 2000133 843 middle/junior high-school- age students from a large midwestern metropolitan area Ratings of opinions about what cigarette advertising conveyed (e.g., “Cigarette advertisements make it look like smoking cigarettes will help you to get a girl/ boyfriend.” This was labeled as recall, but the authors of this chapter define it as a measure of opinions about advertising. Also assessed beliefs about smoking/smokers. 3-level status: (1) never tried, (2) tried, and (3) occasional and regular smokers Smoking status was not associated with respondents’ opinions about the content of print cigarette advertisements. However, those who smoke at least occasionally were more likely to rate smoking as having a variety of positive benefits. Henriksen et al. 2004134 2,125 middle-school students in Tracy (a midsized town in central CA); surveys completed in spring 2003 Exposure to tobacco marketing in stores (based on students’ report of visits to convenience, liquor, or small grocery stores), owning a promotional item, seeing tobacco advertisements in magazines, or seeing someone smoke on television/ film in past week Ever smoking (even a puff) Weekly exposure to retail tobacco marketing was associated with a 50% increase in the odds of ever smoking, even when controlling for parent and peer smoking. Retail marketing exposure was second only to owning a cigarette promotional item in increasing the odds of ever smoking. These results held, even when social influences on smoking were controlled. Kaufman et al. 2002135 A nationally representative sample of 17,287 13- to 19- year-old students, conducted in 1996 Receptivity to advertising (no favorite advertisement and does not own a cigarette promotional item; has favorite advertisement only, owns/would use a cigarette promotional item only, and has a favorite advertisement and owns/would use cigarette 

promotional item)

4-level status: (1) never smoker, not susceptible; (2) never smoker, susceptible; (3) experimenter; and (4) regular smoker. Susceptibility was based on answers to 3 questions: If one of your best friends were to offer you a cigarette, would you smoke it? At any time during the next year do you think you will smoke a cigarette? Do you think you will ever smoke a cigarette in the future?

All levels of receptivity to advertising were significantly associated with being a susceptible never smoker and with being an experimenter (ever tried or experimented, even a few puffs) or a regular smoker. These analyses controlled for social influences. Being an experimenter was not significantly associated with owning an item, and being a regular smoker was not associated with having a favorite advertisement.
249

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 7.3 Cross-Sectional Studies of the Association of Tobacco Marketing with Adolescent Smoking (continued)

Study Setting/sample size

Measure of advertisement 

exposure (IV) Outcome measures (DV) Findings

Klitzner et al. 1991136 295 subjects in 3 grade 

groups: 5th to 6th (35%); 7th to 9th (35%); and 10th to 12th (31%) in 3 separate school districts in an east coast urban/suburban area of the United States

Samples of advertisements (with brand information removed) from 42 magazines and 2 newspapers for measuring (1) recall (proportion of cigarette, perfume, or alcohol advertisements previously seen by students), (2) proportion of cigarette advertisements for which product was recognized, and (3) proportion of advertisements for which the brand was recognized

Ever smoking Ever smoking was associated with cigarette 

product recognition. Further, those who recalled more advertisements were more likely to be smokers.

Lam et al. 1998108 6,304 students aged 

12–15 years from 61 randomly 

selected secondary schools in Hong Kong

Self-reported exposure to various cigarette-marketing stimuli; attitude toward cigarette advertisements as attractive (liking)

5-level status: (1) never smoked; (2) tried; (3) used to smoke but not now; (4) sometimes, but less than once/week; and (5) 6+ cigarettes/week

Exposure and liking for advertisements were associated with current smoking (even less than once per week), even when controlling for parent and peer influences. 

Ledwith 1984137 Two representative surveys, 

each with 880 students from secondary schools in Greater Manchester, UK. The first survey included 5 secondary schools; the second survey included only 3 of the original 5 schools but surveyed 880 students from the same number of classes selected at random

Self-reported exposure to snooker championships on British television, the first sponsored by Benson & Hedges and the second sponsored by Embassy brand

Knowledge of sport sponsorship. Naming of cigarette brands. Children also listed the amount of their viewing time of recent snooker championship on British television

At the time of the first survey, Benson & Hedges sponsored the snooker championship. The majority of children surveyed had watched the coverage. The cigarette brands best known to the children and most associated by them with sports were the ones most heavily promoted by television sponsorship, including brands other than Benson & Hedges. The second study took place 2 months later, right after the British television showing of the Embassy brand’s sponsorship of snooker on television. It found an increase in adolescents’ knowledge of that brand and the brand’s association with sports. The authors contend that sports sponsorship serves as cigarette advertising to children.

Note. IV = independent variable; DV = dependent variable.
250

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r Table 7.3 Cross-Sectional Studies of the Association of Tobacco Marketing with Adolescent Smoking (continued) Study Setting/sample size Measure of advertisement exposure (IV) Outcome measures (DV) Findings Maassen et al. 2004138 282 students aged 14–18 years in school-based survey in Gambia Whether have seen cigarette brand names on television, billboards, in newspapers or magazines, or at community events; ever offered a free cigarette by a tobacco company representative 4-level status: (1) never, (2) less than monthly, (3) monthly, and (4) weekly A linear regression of the smoking status scale found an offer of a cigarette by a tobacco company to be the strongest associate with smoking level for any of the multitude of factors (including social influences) examined. With this variable in the model, none of the individual exposure variables was significant. Maziak et al. 2003109 School-based surveys of 12- to 15-year-olds (3,934 in 1994–95 and 4,028 in 1999–2000) in Muenster, Germany Tobacco advertising awareness (can you name a cigarette or tobacco brand?) and appreciation (do you think that cigarette advertisements are well made?) 4-level smoking status: (1) never; (2) occasional; (3) daily ≤10 cigarettes/ day; and (4) daily >10 cigarettes/day In 1994–95, appreciation of advertising was significantly greater among those who were smokers (including occasional). Awareness of advertising was high, but authors did not report a relationship between awareness and smoking status. Appreciation was not measured in 1999–2000. MacFadyen et al. 2001139 629 15- and 16-year-old students in northeast England Awareness of and involvement with tobacco marketing (e.g., advertisements, coupons, point-of-sale advertisements, sponsorship, direct mail, brand extension, or merchandising) 3-level smoking status: (1) never, (2) trier, and (3) current (not defined) Awareness of and involvement with tobacco marketing were both significantly associated with being a current smoker, even when controlling for social influences. Further, the higher the level of awareness and involvement with tobacco marketing, the higher was the smoking status level, indicating a dose- response relationship. Meier 1991140 School-based surveys of 1,085 7th- and 11th-grade students in Middletown, NJ Awareness of cigarette sponsorship of sporting events and opinion about whether cigarette advertising should be allowed 3-level status: (1) never smokers, (2) triers, and (3) smokers; attitudes toward smoking; Likert scale of 16 questionnaire items about 

attitudes toward smoking

There were significantly less negative attitudes toward smoking among those who thought cigarette advertising should be allowed. Greater awareness of sporting event sponsorship and agreement that advertising should be allowed were reported among smokers and triers than among nonsmokers (latter 2 associations not tested statistically).
251

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 7.3 Cross-Sectional Studies of the Association of Tobacco Marketing with Adolescent Smoking (continued)

Study Setting/sample size

Measure of advertisement 

exposure (IV) Outcome measures (DV) Findings

Mowery et al. 2004141 1999 (

N = 15,056) and 2002 

(N = 35,828) U.S. National Youth Tobacco Surveys. These school-based surveys interviewed students from 11 to 18 years old

Ownership or willingness to use a cigarette promotional item, analyzed as separate variables

Susceptibility to smoking among never smokers and any smoking among all respondents

For both outcomes, both ownership and willingness to use a cigarette promotional item were significant, after controlling for social influences to smoke.

O’Connell et al. 1981111 6,000 10- to 12-year-old 

primary schoolchildren in Hunter Health Region, New South Wales, Australia

Attitude toward tobacco advertising

4-level status: (1) never, (2) triers, (3) recent, and (4) regular

In order of strength of association, smoking (both recent and regular) was positively associated with friends’ smoking, approval of advertising, siblings’ smoking, money to spend per week, gender, age, and parents’ smoking.

Otake and Shimai 2002142 409 7th graders and 348 8th 

graders in an urban area of Japan

Attitude (liking) toward advertising

Stages of smoking acquisition (precontemplation, contemplation, preparation, and action) based on 4 smoking questions: (1) interested in smoking? (2) think you might smoke in future? (3) smoked in past year? and (4) smoked in past month? Not specified how questions were used to classify students into stages.

Liking for cigarette advertising increased from the precontemplation to the action stage. Social influences and access to cigarettes were controlled.

Peters et al. 1995143 Primary school students 

(8–13 years) in Hong Kong

Being able to give a brand name for logos presented in a survey instrument. Cigarette and other product logos were presented.

Ever smoked Ever smokers were significantly more 

successful at providing brand names for the cigarette logos than were never smokers.

Pinilla et al. 2002144 1,877 students from 

30 secondary schools on the Island of Gran Canaria, Spain

Attitudes toward cigarette advertising and awareness of cigarette prices 

4-level smoking status: (1) never; (2) less than once/ week; (3) weekends only; and (4) daily

Attitudes toward cigarette advertising were not significantly related to smoking status.

Note. IV = independent variable; DV = dependent variable.
252

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r Table 7.3 Cross-Sectional Studies of the Association of Tobacco Marketing with Adolescent Smoking (continued) Study Setting/sample size Measure of advertisement exposure (IV) Outcome measures (DV) Findings Potts et al. 1986145 258 5th-form pupils (aged 15–16; 137 boys, 121 girls) in city of Nottingham, UK Attitude—opinions of cigarette advertisements as exciting, interesting, eye- catching, glamorous, or witty 5-level status: (1) never, (2) tried once, (3) used to smoke, (4) infrequent smoker/ less than once/week, and (5) regular smoker/more than once/week) Significantly more regular smokers than nonsmokers rated advertising as exciting, interesting, and eye-catching. Sargent et al. 2000146 1,265 6th- to 12th-grade students in NH and VT public schools Receptivity—ownership of cigarette promotional items, specification of favorite brand 5-level smoking uptake continuum: (1) nonsusceptible never smoker, (2) susceptible never smoker, (3) nonsusceptible experimenter, (4) susceptible experimenter, and (5) smoker— ≥100 cigarettes in lifetime Being a smoker or being further along the smoking uptake continuum was more likely if a participant owned a cigarette promotional item, even when controlling for social influences to smoke. The more cigarette promotional items owned, the further along the initiation continuum the students were. Schooler et al. 199646 571 ethnically diverse 7th graders in San Jose, CA Self-reported exposure to cigarette advertisements in magazines, on billboards, in stores, or at sports or community events, and of receiving advertisements or promotions through the mail; also ownership of promotional items Any experimenting with smoking Even when controlling for social influences to smoke, experimentation was significantly greater for those with more exposure to magazine advertisements or in-store advertisements, receipt of mailings from a cigarette company, or ownership of promotional items. Sin 1997147 588 11- to 16-year-old students (grades 7 through 9) in 4 secondary schools in Hong Kong Levels of exposure to printed media and attitude toward cigarette advertising 2-level status: (1) smokers— at least 1 cigarette/day and (2) nonsmokers—never smokers or <1 cigarette/day Although smokers and nonsmokers had the same level of exposure to media, in each case smokers had more favorable evaluations of the cigarette advertisements than did nonsmokers. Attitude toward cigarette 

advertisements was significantly related to smoking status, even when controlling for friend and family smoking. 
253

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 7.3 Cross-Sectional Studies of the Association of Tobacco Marketing with Adolescent Smoking (continued)

Study Setting/sample size

Measure of advertisement 

exposure (IV) Outcome measures (DV) Findings

Smith and Stutts 1999148 246 junior/middle school, high 

school, and college students in a medium-sized metropolitan area in the southwest U.S.

Exposure to cigarette advertisements, attention paid to cigarette advertisements, and familiarity with cigarette characters and brand names

Smoking level: regular smokers vs. at-risk smokers (experimenters and social smokers) 

The hypothesis that adolescents who smoke are more likely to have been exposed to cigarette advertisements was not supported for any grade level nor for all students combined. However, for junior high/middle school students and for all students combined, those who smoke (regular and at-risk) were more likely than were nonsmokers to pay attention to cigarette advertisements. Regular smokers were significantly more familiar than were nonsmokers with cigarette characters and brands. 

Sovinova and Csemy 2004149 4,149 7th–9th graders in 

Czech Republic participating schools

Exposure to protobacco messages in newspapers and magazines, possession of a cigarette promotional item, and offer of a cigarette by a tobacco company representative

Never vs. current (in past 30 days)

No difference shown between never and current smokers’ exposure to protobacco messages (~80%). Significantly more current smokers owned a tobacco promotional item and had been offered a cigarette by a tobacco company representative compared with never smokers.

Straub et al. 2003150 1,229 nonsmoking 9th graders 

at 7 public schools in the San Francisco Bay Area, CA

Exposure to, recognition of, and receptivity and attitudes toward tobacco advertising

Intention to smoke Brand recognition/favorite tobacco 

advertisements and willingness to wear or use tobacco-branded products were found to be associated with intention to smoke. These associations remained significant in a multivariate analysis that included social influences. Self-reported exposure to advertisements was not related to intention when other measures of exposure to advertising (e.g., receptivity) were included in the model. 

Sun et al. 1998112 100 public junior high school 

students (48 females and 52 males) in Sunset Park, Brooklyn, NY

Beliefs about cigarette advertising

3-level smoking status: (1) never smokers, (2) former smokers, and (3) current smokers; classified both former and current smokers as smokers

Most smokers (8 of 12) preferred a brand that advertised heavily near the school. Twentyseven percent believed the advertisements influenced them, and 66% supported banning cigarette advertisements. Beliefs about whether advertising influenced them to smoke did not differ between smokers and nonsmokers.

Note. IV = independent variable; DV = dependent variable.
254

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r Table 7.3 Cross-Sectional Studies of the Association of Tobacco Marketing with Adolescent Smoking (continued) Study Setting/sample size Measure of advertisement exposure (IV) Outcome measures (DV) Findings Tercyak et al. 200276 1,123 high school freshmen from 5 public schools in northern VA Receptivity to tobacco advertising 2-level status: (1) never, even a few puffs; and (2) ever, at least a partial or whole cigarette; within ever, current smokers defined as any smoking in last 30 days Exposure to other smokers, high receptivity to tobacco advertisements, and clinically significant depressive symptoms were independently associated with ever smoking. Adolescents with high levels of depressive symptoms and high receptivity to tobacco advertisements were more likely to smoke currently than were their counterparts without elevated symptoms. Unger and Chen 1999151 10,030 adolescents contacted via random-digit dialing in the California Tobacco Survey Receptivity to protobacco media: having a favorite advertisement, having received a promotional item, and willingness to use promotional items Self-reported age at which respondent smoked first cigarette Younger age of smoking initiation was associated with all three measures of receptivity, even when sibling, parent, and friend smoking were controlled. Unger et al. 199594 386 8th graders (54% female; 46% male) in Southern CA (never smokers) Advertisement rating and liking: recognition of tobacco and alcohol brands, liking of these advertisements; liking of advertising, assessed with 3-point-scale answer to “How much do you like the advertisement (not the product)?” and a 4-point- scale answer to “Does this advertisement make you want to buy and try this product?” 3-level status: (1) nonsusceptible nonusers— have never used and do not intend to do so, (2) susceptible nonusers—have not used but have not made a firm commitment not to experiment in the future, and (3) users— have tried the substance Smoking susceptibility was a significant correlate of brand recognition across all cigarette brands. Susceptible nonsmokers liked the tobacco advertisements at a significantly greater level than did nonsusceptible nonsmokers and at a level comparable to that of smokers. Smoking susceptibility was significantly associated with liking for Marlboro cigarette advertising.
255

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 7.3 Cross-Sectional Studies of the Association of Tobacco Marketing with Adolescent Smoking (continued)

Study Setting/sample size

Measure of advertisement 

exposure (IV) Outcome measures (DV) Findings

Unger et al. 2001114 5,870 8th graders contacted 

via random-digit dialing in the California Tobacco Survey

Factor analysis of exposure measures identified 4 factors: perceived pervasiveness of both protobacco and antitobacco marketing, recognition of specific antitobacco marketing, and receptivity to protobacco marketing.

4-level status: (1) never, (2) susceptible—might accept from friend or try in next year, (3) experimenter, and (4) established smokers—100 or more cigarettes in lifetime

Factor analysis of measures of protobacco and antitobacco media identified two factors involving protobacco media: perceived pervasiveness of protobacco marketing and receptivity to cigarette marketing. Higher levels of receptivity were associated with higher levels of smoking. Perceived pervasiveness of protobacco marketing was significantly higher among established smokers than among susceptibles, and the susceptibles were significantly lower in this measure than never smokers, experimenters, and established smokers. 

Wakefield et al. 2002107 3,890 U.S. high school 

smokers, matched to 196 convenience stores that they frequented

Estimated exposure to advertising: brand-specific advertising and promotions in convenience stores for Marlboro and Camel cigarettes; examined share of voice in stores

Choice of usual brand among high school student smokers

The choice of Marlboro cigarettes was associated with the presence of a gift with the purchase and greater brand share of interior and exterior advertising voice. The choice of Camel cigarettes was associated with a greater share of interior advertisement voice but unrelated to a gift with purchase and negatively associated with a greater share of exterior advertising voice.

Note. IV = independent variable; DV = dependent variable.
256

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

positive study, Schooler and colleagues46

obtained data from an ethnically diverse 

sample of 571 7th-grade students in 

San Jose, California. Participants rated 

how often they saw advertisements in 

magazines, on billboards, in stores, or at 

sporting or community events. They also 

reported whether they had received mailings 

from cigarette companies and whether 

they owned cigarette promotional items. 

Even when controlling for social influences 

to smoke, experimentation with cigarettes 

was significantly greater for those with 

more exposure to magazine or in-store 

advertisements, receipt of mailings from a 

cigarette company, or ownership of cigarette 

promotional items.

In addition to the study by Schooler and 

colleagues,46 10 other studies of this 

type controlled for social influences to 

smoke. Like that study, they found that 

exposure to cigarette advertising was 

associated with smoking even when 

the influence of peers and/or family 

members on smoking was controlled 

statistically.91,108,116,118,119,121,122,132,134,139 Gunther 

and colleagues132 tested the hypothesis that 

advertising will influence many people 

regarding what is fashionable or attractive 

and that, as a result, people may adopt these 

new fashions themselves. In a sample of 

818 6th and 8th graders in two Wisconsin 

middle schools, these researchers used 

a path analysis and showed that both 

protobacco and antitobacco advertisements 

had a significant indirect effect on 

adolescent smoking through their effects 

on peer norms.

Five papers reported finding no significant 

relationship.138,147–150 No paper reported 

a negative relationship. One did not 

perform a statistical test, although the 

trend was for a positive relationship.140

One “negative” study of 282 adolescents 

aged 14–18 years included a four-level 

smoking status measure as the dependent 

variable in a linear regression analysis. 

The study involved a total of 72 independent 

variables (7 regarding social influences) 

and found that none of the exposure 

variables (television, billboard, newspapers 

and magazines, community events) was 

related to smoking level.138 However, the 

variable—an offer of a cigarette by a tobacco 

industry representative—was the most 

related to smoking level. The invasiveness of 

this marketing practice may have eclipsed 

the exposure variables. This study should 

have employed extensive data reduction and 

chosen a more appropriate analytic method.

Identifying a Dose-Response Relationship between Marketing Exposure and Youth Smoking

One of the studies profiled herea examined young people’s awareness of, and involvement in, all 

existing forms of tobacco marketing communications. The investigators conducted regression 

analyses to examine whether any association existed between these measures and smoking status. 

Young people were very aware of all forms of tobacco marketing communications; more than onehalf of all of the smokers studied had participated in some form of promotion. The first regression 

analysis showed that some individual marketing communication techniques (coupon loyalty 

offers and brand stretching) were associated with being a smoker. Perhaps more important, from 

an integrated marketing communications perspective, a second analysis found that the greater 

the number of tobacco marketing techniques a young person was aware of, the more likely he or 

she was to be a smoker. In other words, the investigators identified a dose-response relationship 

for marketing communications exposure and smoking behavior.

a

MacFadyen, L., G. Hastings, and A. M. MacKintosh. 2001. Cross sectional study of young people’s awareness 

of and involvement with tobacco marketing. British Medical Journal 322 (7285):513–17.
257

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Bivariate analyses from a study from the 

Czech Republic149 indicated that both current 

smokers and never smokers had similar high 

levels of exposure to protobacco messages 

in magazines and newspapers. However, 

smokers were significantly more likely to 

possess a cigarette promotional item and to 

have been offered a cigarette by a tobacco 

company representative. Another study that 

included multiple exposure measures did not 

find recall significantly related to smoking, 

but found other measures (e.g., attitudes 

and receptivity) to be significant.150 Smith 

and Stutts148 found exposure to cigarette 

advertisements unrelated to smoking, but 

smokers were more likely to pay attention to 

the advertisements and were more familiar 

with cigarette characters and brand names. 

Finally, a study of Hong Kong students also 

showed no difference in smoking behavior 

for those exposed and not exposed to 

cigarette advertising, but found that smokers 

viewed the advertisements more favorably 

than did nonsmokers.147

Recognition of Brands or Products

During the review period, 12 studies 

assessed how well adolescents could 

name the product or specific brand in 

an advertisement even when researchers 

had obscured the brand name from the 

advertisements.91,92,94,115,116,118,120,125,128,131,136,143

Only one study128 did not find that brand 

recognition was associated with smoking 

status, in a sample of 1,093 Turkish children 

aged 7–13 years.

As an example of a “positive” study, Unger 

and colleagues94 had 386 8th-grade students 

from Southern California attempt to 

identify the brand advertised in six cigarette 

advertisements, five alcohol advertisements, 

and nine other product advertisements. 

The researchers found smoking status 

to be significantly related to cigarette 

brand recognition for the brands depicted 

(Marlboro, Kool, Newport, Virginia Slims, 

Camel, and Capri).

While 10 of the studies found a positive 

relationship between brand recognition and 

smoking or smoking susceptibility, only 

one of these controlled for social influences 

on smoking. This study116 found that, 

among 11- to 14-year-old Scottish youth, 

smokers were better than nonsmokers at 

recognizing the brand of cigarette shown 

in advertisements that had identifying 

characteristics removed, when controlling 

for friend, sibling, and parent smoking.

Attitudes toward Advertising

In 15 studies, investigators assessed 

relationships between various smoking 

measures and adolescents’ attitudes or 

opinions about cigarette advertising.92–94,108,

109,111,112,116,124,127,133,142,144,145,147

Twelve of these studies found that attitudes 

toward advertising were significantly more 

positive among those who smoked or were 

susceptible to smoking. One “positive” 

study found a significant association when 

variables were assessed bivariately, but the 

relationship was not significant when a 

multivariate analysis controlled for social 

influences.127 This study of 1,003 Spanish 

schoolchildren 11 to 13 years of age 

analyzed cross-sectional baseline data with 

a fairly weak attitudinal measure: “Do you 

believe that it is [all right] that there is 

tobacco advertising?”

Of the remaining “positive” studies, 

another five controlled for social 

influences.108,111,116,142,147 Research by O’Connell 

and colleagues111 provides an example of this 

type of study. These researchers obtained 

data from 6,000 Australian children, aged 

10–12 years. They found that students’ 

ratings (low/unfavorable to high/favorable) 

of their attitudes toward cigarette advertising 

were significantly higher among smokers 

compared with nonsmokers.

Three additional studies found no 

significant relationship between attitudes 
258

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

toward cigarette advertisements and 

smoking.112,133,144 No study reported a 

negative relationship. One study that did 

not find a relationship between attitudes 

toward cigarette advertising and smoking 

asked adolescents whether they believed 

that advertising influenced young people to 

smoke.112 Results did not differ significantly 

by smoking status. This measure is 

conceptually distinct from measures of 

the degree to which adolescents like or 

find cigarette advertisements appealing. 

An adolescent who himself or herself does 

not find advertising appealing could still 

believe that it influences other adolescents 

to smoke.

Receptivity to Cigarette Marketing

Eighteen studies used indices of receptivity 

to cigarette marketing including owning 

or willingness to use cigarette promotional 

items.13,46,65,76,113,114,117,123,124,126,129,134,135,139,141,

146,150,151 Each of these studies found that 

receptivity to cigarette marketing was 

significantly related to smoking status 

or susceptibility. Four of these studies 

did not control for social influences to 

smoke.114,117,124,129

Evans and colleagues13 assessed receptivity 

in a sample of 3,536 adolescents who had 

never smoked but who varied in their 

susceptibility to smoking. Results show 

that adolescents’ susceptibility to smoking 

was significantly greater the more receptive 

they were to marketing. This relationship 

held even when researchers controlled for 

exposure to social influences to smoke.

The study by Tercyak and colleagues76 is 

of particular interest. These researchers 

obtained data from 1,123 high school 

freshmen in Northern Virginia. In addition 

to assessing receptivity, they evaluated 

depression and found that exposure to 

other smokers, high receptivity to tobacco 

advertisements, and clinically significant 

depressive symptoms independently were 

associated with whether the students had 

ever smoked. These findings suggest that 

depressed adolescents may be especially 

vulnerable to cigarette advertising. Tercyak 

and colleagues found that adolescents 

experiencing high levels of depressive 

symptoms and who were high in receptivity 

to tobacco advertisements were more likely 

to smoke cigarettes than were those who 

were receptive but not depressed.

A study by Sargent and colleagues146 of 

1,265 students (grades 6 through 12) in 

New Hampshire and Vermont assessed 

only whether they owned a cigarette 

promotional item. One of every three 

students did. Investigators found a doseresponse relationship between the number 

of promotional items owned and both 

being a smoker and being further along 

the continuum of the smoking initiation 

process.

Longitudinal Studies

Table 7.4 presents summary information 

about 16 longitudinal studies* of the 

relationship between various measures 

of exposure to cigarette marketing and 

adolescents’ smoking or susceptibility to 

smoking. With relatively large samples 

of subjects in four countries (and three 

U.S. states), researchers found that 

receptivity to, exposure to, or awareness of 

tobacco advertising significantly predicted 

smoking at follow-up. After controlling for 

other variables including social influences, 

a significant link was present in all but two 

studies.127,152 In these two studies, the link 

just missed statistical significance at the 

p < .05 level. Because of the importance of 

*

Twelve of the studies published before 2003 were reviewed previously in Lovato, C., G. Linn, L. F. Stead, 

and A. Best. 2003. Impact of tobacco advertising and promotion on increasing adolescent smoking 

behaviours. Cochrane Database of Systematic Reviews (3):CD003439.
259

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 7.4 Longitudinal Studies Predicting Later Smoking Behavior from Measures of Exposure to Tobacco Marketing at Baseline

Document

Setting/

sample size

Measure of advertisement 

exposure (IV) Outcome measures (DV) Findings

Aitken et al. 1991110 Glasgow, Scotland, in-home 

interviews of 640 children initially between 11 and 14 years old. They were reassessed about 1 year later. Few had smoking experience.

Recall of advertising for specific brands of cigarettes, recognition of brands in advertisements with brand information removed, appreciation of cigarette advertisements (ratings of liking for cigarette advertisements in general, recall of liked advertisements, and opinion about banning cigarette advertisements) 

Intentions to smoke (“Do you think you will smoke cigarettes when you are older?”) asked of all respondents, including those with smoking experience

The number of cigarette advertisements correctly identified significantly predicted the development of more positive intentions to smoke 1 year later, even when friends, parents, and sibling influences were controlled. Children with less appreciation of cigarette advertisements were significantly more likely to become more negative in their intention to smoke, even when friends, parents, and sibling influences were controlled.

Alexander et al. 1983153 5,686 10- to 12-year-old Australian 

children assessed at 2 points, 12 months apart

Approval of cigarette advertising 4-level status: (1) adopters—

did not smoke at first survey, but did at second, (2) nonsmokers at both surveys, (3) quitters—

smoked at first but not second survey, and (4) smoked at both surveys

Approval of cigarette advertising predicted smoking status (adopters and smoker at both times) 1 year later, even when friends’ and siblings’ smoking was controlled. 

Armstrong et al. 1990154 Australia, 2,366 year 7 students 

(modal age 12 years); reassessed 1 and 2 years later

Perceived influence of cigarette advertising on the student 

Initiation of smoking (ever smoked) 1 or 2 years later 

Children who were initially nonsmokers were more likely to have smoked 2 years later if they initially perceived that cigarette advertising influenced them. This was true even when parental, sibling, and friends’ smoking was controlled. 

Note. IV = independent variable; DV = dependent variable.
260

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r Table 7.4 Longitudinal Studies Predicting Later Smoking Behavior from Measures of Exposure to Tobacco Marketing at Baseline (continued) Document Setting/ sample size Measure of advertisement exposure (IV) Outcome measures (DV) Findings Biener and Siegel 2000155 Massachusetts Tobacco Survey (1993). 1997–98 follow-up on 529 adolescents, who were 12 to 15 years old and nonsmokers (never or experimenter) in 1993 Receptivity to tobacco marketing: (1) owned a promotional item and (2) could name a brand of cigarettes whose advertisements attracted them Whether or not had become an established smoker (had smoked 100 or more cigarettes) at 4-year follow-up Adolescents who owned a tobacco promotional item and named a brand whose advertisements attracted them were more than twice as likely to be established smokers 4 years later. This was true even when prior experimentation, rebelliousness, and smoking by adults and friends were controlled. Charlton and Blair 1989156 29 secondary schools in Northern England; 1,390 self- identified never smokers aged 12–13 years; assessed twice, 

4 months apart

Cigarette brand awareness, favorite advertisements for cigarettes, viewing of cigarette brand–sponsored sports on television

3-level status: (1) never smoker, (2) sometime smoker, and (3) regular smoker

For girls, awareness of at least one cigarette brand significantly predicted the uptake of smoking (sometimes or regularly) even when smoking by parents and friends was controlled. There were no significant findings for boys.

Choi et al. 2002157 Baseline data derived from the 

California Tobacco Survey, 1993; follow-up in 1996; 965 adolescents classified as experimenters (had smoked, but fewer than 100 cigarettes) at baseline

Receptivity to advertising (having a favorite tobacco advertisement, and being willing to use a promotional item)

Established smoking by 1996 (smoked 100 or more cigarettes in lifetime) 

Receptivity to tobacco advertising and promotions was a significant predictor of established smoking. Those who were highly receptive to tobacco marketing were 70% more likely to become established smokers at follow-up compared with those who were minimally receptive. This was true even when relationships with family members and family and friends who smoked were controlled. 
261

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 7.4 Longitudinal Studies Predicting Later Smoking Behavior from Measures of Exposure to Tobacco Marketing at Baseline (continued)

Document

Setting/

sample size

Measure of advertisement 

exposure (IV) Outcome measures (DV) Findings

Diaz et al. 1998127 1,003 Spanish schoolchildren 

(aged 11 to 13 years)

Were asked: “Do you believe that it is [all right] that there is tobacco advertising?” 

Never vs. any smoking at follow-up Never smokers at baseline 

(n = 906) were followed up 

1 year later, and agreement with 

the statement about tobacco advertising was marginally predictive of any smoking at follow-up. 

Gilpin et al. 2007158 2 cohorts of young adolescents 

(12–15 years) followed up 6 years later (1993–99, n = 1,734 and 1996–2002, n = 1,983); baseline cohorts identified from 1993 and 1996 California Tobacco Surveys

Receptivity to tobacco advertising and promotions: high—own or would be willing to use a tobacco promotional item and moderate—have a favorite cigarette advertisement

Being a current established smoker as a young adult 6 years later

Despite lower rates of current established smoking in the second cohort, the effects of high and moderate receptivity on the outcome variable were similar and significant in both cohorts after controlling for social influences to smoke.

Lopez et al. 2004159 Spanish students (13 and 14 years) 

participating in 3-country study (N = 2,356) in Spain completing 18-month follow-up

Awareness at baseline of 3 advertisements (with brand identification removed) that were exhibited near participating schools

New and at least weekly smoker at follow-up

Awareness level (provided brand for none, 1, 2, or 3 advertisements) predicted new weekly smokers at follow-up, after controlling for social influences to smoke.

Pierce et al. 1998160 Population-based, random-digitdialed telephone survey in CA; 

1,752 adolescent never smokers who were not susceptible to smoking in 1993 reinterviewed in 1996

Exposure to tobacco promotions and advertising

Progression to smoking: becoming susceptible to smoking (do not rule out trying a cigarette or accepting one if offered by a friend) or any experimenting by 1996

Having a favorite advertisement in 1993 predicted which nonsusceptible never smokers would progress by 1996, even when controlling for family and peer smoking. Possession of or willingness to use a tobacco promotional item was even more strongly associated with future progression, even when family and peer smoking was controlled. 

Note. IV = independent variable; DV = dependent variable.
262

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r Table 7.4 Longitudinal Studies Predicting Later Smoking Behavior from Measures of Exposure to Tobacco Marketing at Baseline (continued) Document Setting/ sample size Measure of advertisement exposure (IV) Outcome measures (DV) Findings Pierce et al. 2002161 Population-based, random-digit- dialed telephone survey in CA; sample of 1,641 adolescent never smokers aged 12–14 years in 1996 who had never smoked and were assessed again in 1999. Analysis in this paper focused on 894 adolescents whose parents were classed as authoritative. Receptivity to tobacco advertising and promotions Any smoking by follow-up Among adolescents whose parents were authoritative (an index of parents’ positive responsiveness and monitoring), high receptivity predicted smoking onset even when family and peer smoking was controlled. Pierce et al. 2005152 2,119 12- to 15-year-old never smokers from 1996 California Tobacco Survey followed 

3 years later

Advertising receptivity, curiosity about smoking, and susceptibility to smoking

Any smoking by follow-up in full sample, and susceptibility or any smoking among nonsusceptible never smokers

For the full sample, both curiosity about smoking and being susceptible to smoking predicted smoking by follow-up. High receptivity was of marginal significance. In the nonsusceptible never smokers, only curiosity predicted progression toward smoking. A further cross-sectional analysis showed receptivity and friends who smoked to be related to curiosity (dependent variable), suggesting that these factors may induce curiosity. All analyses controlled for social influences to smoke.

Pucci and Siegel 1999162 627 12- to 15-year-old never 

smokers in MA

External measure of brand-specific exposure to cigarette advertising in magazines the youth read

Brand first smoked by new ever smokers at follow-up, brand smoked by current smokers at follow-up, and brand whose advertisements attracted attention the most.

Brand of exposure in magazines at baseline was significantly correlated with brand of initiation 4 years later, brand smoked by current smokers at follow-up, and naming of the brand that attracted attention the most at follow-up.
263

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 7.4 Longitudinal Studies Predicting Later Smoking Behavior from Measures of Exposure to Tobacco Marketing at Baseline (continued)

Document

Setting/

sample size

Measure of advertisement 

exposure (IV) Outcome measures (DV) Findings

Sargent et al. 2000163 480 4th- to 11th-grade students 

in 3 rural VT kindergarten–12thgrade schools, surveyed at baseline, 12 months, and 21 months

Receptivity to cigarette promotions measured by ownership or willingness to use a cigarette promotional item

6-level uptake process: (1) never smoker/not susceptible, (2) never smoker/susceptible, (3) puffer, (4) noncurrent experimenter, (5) current experimenter, and (6) smoker/≥100 cigarettes in 

lifetime

Receptivity significantly predicted progression along the smoking initiation process 21 months later even when controlling for family and peer smoking. Increases in receptivity to cigarette promotions between the first and second or second and third assessments also significantly predicted progression to smoking (higher status level).

Weiss et al. 2006164 2,822 of 4,427 California 

6th graders who completed 3 waves (6th, 7th, 8th grade) of school survey; main analysis confined to 2,026 nonsusceptible never smokers at baseline

Self-reported exposure to smoking on TV or to point-of-sale tobacco advertising; self-reported exposure to anti-tobacco media advertising on television.

Reporting susceptibility to smoking and/or ever smoking (progression) at either follow-up (7th or 8th grade)

Report of exposure to either or both protobacco settings was significantly related to progression by follow-up. Report of exposure to antitobacco media was significantly protective of future progression. Analyses were adjusted for demographics and whether or not the school had an antitobacco program but not for social influence variables.

While et al. 1996165 1,450 English 11- and 12-year-olds 

assessed twice, 1 year apart

Awareness of brands and having a favorite cigarette advertisement 

Smoking status (precise measure not reported)

Girls who named Benson

& Hedges 

as a brand they were aware of were significantly more likely to be smoking 1 year later. The same was true for girls who named Benson

& Hedges and Silk Cut 

(the two most advertised cigarette brands). No effects were found for boys.

Note. IV = independent variable; DV = dependent variable.
264

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

this methodological approach, each of these 

studies is described in detail below.

Alexander and colleagues153 assessed 

5,686 Australian schoolchildren, aged 

10–12 years, at two occasions over 12 months 

(the follow-up rates were not reported). In 

the first assessment, students rated their 

approval of cigarette advertising. A multiple 

regression analysis indicated that those 

who approved of cigarette advertising were 

significantly more likely to report smoking 

at the second assessment. The analysis took 

account of smoking by friends and siblings, 

which also were significant predictors of 

later smoking.

Aitken and colleagues110 obtained data 

from 640 11- to 14-year-olds in Glasgow, 

Scotland (75% of original sample). 

Their measures of exposure included 

recall of advertising for specific brands 

of cigarettes, recognition of brands in 

advertisements with brand information 

removed, and ratings of appreciation of 

cigarette advertisements (ratings of liking 

for cigarette advertisements in general, 

recall of liked advertisements, and opinion 

about banning cigarette advertisements). 

They found that the number of cigarette 

advertisements correctly identified 

significantly predicted the development 

of more-positive intentions to smoke one 

year later, even when controlling for friend, 

parent, and sibling influences. Children with 

less appreciation of cigarette advertisements 

were significantly more likely to become 

more negative in their intention to smoke, 

even when friend, parent, and sibling 

influences were controlled.

Armstrong and colleagues154 measured the 

perceived responses to cigarette advertising 

in a large sample (2,366) of 7th-grade 

students in Australia participating in an 

experimental evaluation of a smoking 

prevention curriculum. At baseline, students 

provided information about their own, their 

families’, and their friends’ smoking status, 

and their knowledge of and attitudes toward 

smoking. They also answered the question, 

“How much do cigarette advertisements 

make you think you would like to smoke 

a cigarette?” There were two follow-up 

assessments, one and two years after the 

end of the intervention, with a successful 

reassessment of 64% at two years. For girls, 

the researchers found consistent evidence of 

smoking initiation both one and two years 

later among students who said cigarette 

advertising had some influence. For boys, 

the relationship was significant only at 

the two-year follow-up. All of the analyses 

controlled for family and peer smoking.

Six studies used data from statewide 

tobacco surveys in Massachusetts (two) 

and California (four).152,155,157,158,160,162 All but 

one study152 found that adolescents in 

Massachusetts and California who responded 

positively to cigarette promotional items 

or tobacco advertisements were more likely 

to progress toward smoking three to four 

years after baseline. The California studies 

were the only longitudinal studies that 

weighted the data to be representative of 

the population and to account for attrition 

by follow-up. 

In one Massachusetts study, Biener and 

Siegel155 reinterviewed 529 adolescents 

(58%) four years after baseline regarding 

their smoking status. Adolescents who 

owned a cigarette promotional item and 

who could name a cigarette brand whose 

advertisements they liked were twice as 

likely as those who did neither to become 

smokers. The analysis controlled for prior 

experimentation, rebelliousness, and adult 

and friend smoking. Thus, the influence of 

exposure to advertisements and cigarette 

promotional items was over and above any 

influences of these factors.

In another Massachusetts study of the 

same data set, Pucci and Siegel162 examined 

adolescent exposure (external measure) 

to brand-specific advertising and its 
265

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

relationship to smoking four years later. 

The first assessment obtained data on the 

magazines each youth read. The authors 

created an estimate of each student’s 

exposure to advertising for each cigarette 

brand on the basis of the number of pages 

of cigarette advertising for those brands in 

the magazines the youth reported reading 

that year. The investigators also estimated 

the share of advertising reaching these 

youth that each brand achieved by totaling 

the number of pages of advertising for each 

brand in the magazines the students read 

and dividing that by the total number of 

pages for all brands. The top five brands on 

this measure of share of advertising were 

(in order) Marlboro, Camel, Kool, Newport, 

and Winston. They accounted for 81.8% of 

all cigarette advertising in these magazines. 

Brand-specific exposure to advertising 

among these youths was highly related to 

each brand of initiation among new smokers 

four years later (r = .93). Moreover, this 

exposure measure predicted the brand 

smoked by current smokers in the follow-up 

assessment (r = .86), as well as the brand 

whose advertisements attracted the most 

attention at follow-up (r = .87).

Using California data, Pierce and 

colleagues160 reported on the 1996 followup of 1,752 adolescents 12–17 years of age 

who were nonsusceptible never smokers in 

1993 (62% of original sample). They found 

that having a favorite advertisement in 1993 

predicted which adolescents would progress 

toward smoking by 1996. Possession of or 

willingness to use cigarette promotional 

items was even more strongly associated 

with future progression toward smoking 

Other Models of the Influence of Tobacco Advertising

The psychological needs of adolescents and their related need to project a desired image have 

received the most attention from researchers regarding how tobacco marketing works to 

influence adolescents to smoke. However, at least three other mechanisms have been suggested 

and investigated on a more limited basis:

n One proposes that a positive stereotype depicted in cigarette advertising may lead 

adolescents to seek favorable evidence about smokers and come to believe that 

they have desirable traits.a In turn, they become more inclined to smoke cigarettes 

themselves.

n Another suggests that adolescents perceive that tobacco advertising influences their 

peers to engage in an accepted or “in” behavior. To not be left out, they adopt smoking 

to be part of the crowd.b

n Finally, another line of research based on advertising theory suggests that advertising 

helps to create curiosity about smoking. If adolescents perceive that trying a cigarette 

is low cost (offered free by a peer) and low risk (just one is okay), they may act to 

satisfy their curiosity.c

It is likely that most of these mechanisms operate to a greater or lesser extent in a given 

individual.

a

Pechmann, C., and S. J. Knight. 2002. An experimental investigation of the joint effects of advertising and 

peers on adolescents’ beliefs and intentions about cigarette consumption. Journal of Consumer Research

29 (1): 5–19.

b

Gunther, A. C., D. Bolt, D. L. G. Borzekowski, J. L. Liebhart, and J. P. Dillar. 2006. Presumed influence on 

peer norms: How mass media indirectly affect adolescent smoking. Journal of Communication 56 (1): 52–68.

c

Pierce, J. P., J. M. Distefan, R. M. Kaplan, and E. A. Gilpin. 2005. The role of curiosity in smoking initiation. 

Addictive Behaviors 30 (4): 685–96.
266

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

cigarettes. All analyses controlled for 

demographics, school performance, and peer 

and family smoking.

In another analysis of the 1993–96 

California data, Choi and colleagues157

conducted separate analyses for another 

965 adolescents who at baseline were 

classified as experimenters (had smoked, 

but fewer than 100 cigarettes). Among the 

32% of experimenters who had become 

established smokers by 1996, the highest 

rate of progression (52%) occurred among 

those who, in 1993, were willing to use a 

cigarette promotional item and believed they 

could quit anytime. The authors found that 

experimenters who were highly receptive to 

marketing were 70% more likely to become 

established smokers by follow-up than were 

those minimally receptive to the marketing. 

This was true even when family and friend 

smoking was controlled.

Pierce and colleagues161 conducted another 

longitudinal study using data from a 

sample of adolescent never smokers aged 

12–14 years identified from the 1996 

California Tobacco Survey and recontacted 

in 1999. These researchers examined the 

level of authoritative behavior in parents 

and the students’ receptivity to tobacco 

advertising and promotions. Authoritative 

parents were those whose children rated 

them as warmly responsive to the child and 

high in their level of parental monitoring. 

When 1,641 of the adolescents completed 

a follow-up survey in 1999 (68% of the 

original sample), the authors found 

significantly higher rates of smoking 

among adolescents who were receptive to 

advertising and who had more authoritative 

parents. Apparently, in families in which 

parents are authoritative but noninterfering 

with respect to their children’s exposure to 

cigarette marketing, such marketing can 

influence smoking initiation.

Another analysis152 of the above 1996–99 

data set investigated the role of curiosity 

together with smoking susceptibility and 

advertising receptivity in never smokers 

aged 12–15 years (n = 2,119, or 67% 

successfully followed). The study also 

examined only the nonsusceptible never 

smokers (n = 970) and whether they 

became susceptible or smoked by followup. Advertising theory emphasizes the 

necessity for closing the knowledge gap 

about the benefits of a product to increase 

curiosity about the product.166,167 Further, 

those curious about a product may seek to 

satisfy their curiosity if they perceive that 

it is low cost (free from a peer) and low risk 

(just one is okay).168,169 In the analysis of all 

never smokers, both smoking susceptibility 

and curiosity were significantly related 

to any smoking by follow-up. However, 

high advertising receptivity just missed 

statistical significance, with an adjusted 

odds ratio (OR) of 1.88 (95% confidence 

interval [CI], 0.99–3.56). In the analysis of 

the nonsusceptible never smokers, curiosity 

predicted progression toward smoking but 

receptivity did not. A further cross-sectional 

analysis (1,451 nonsusceptible never 

smokers at baseline in 1996), with curiosity 

as the dependent variable, identified friends 

who smoke and advertising receptivity 

as significant correlates, again adjusting 

for other variables. The authors conclude 

that curiosity, perhaps stimulated by 

advertising, might be a critical precursor 

to smoking initiation.

In addition, a 2007 study by Gilpin and 

colleagues158 further examined additional 

follow-ups in both of the cohorts reported 

on previously. The 1993–96 adolescent 

never smokers aged 12–15 years were 

again contacted in 1999 (n = 1,734, 47% of 

the original sample). In addition, similar 

adolescents from the 1996–99 cohort 

were contacted again in 2002 (n = 1,983, 

48% of the original sample). High (own or 

would use a cigarette promotional item) 

and moderate (have a favorite cigarette 

advertisement) levels of advertising 

receptivity in the young adolescent never 
267

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

smokers at baseline were significantly 

associated with being a current established 

smoker as a young adult to the same extent 

in both cohorts. This was true despite the 

lower percentage of current established 

smokers in the second cohort, reflecting 

California’s decline in youth and adult 

smoking prevalence. Analyses were adjusted 

for demographics, school performance, 

smoking susceptibility, and family and peer 

smokers in the social environment.

Another study by Weiss and colleagues164

of a California cohort of 6th graders 

successfully followed in both the 7th 

and 8th grades (n = 2,822 or 64% of the 

original sample) related reports among 

nonsusceptible never smokers at baseline 

(n = 2,026) of seeing smoking on television 

and/or seeing advertisements for tobacco 

in stores (point of sale) to reports of 

becoming susceptible to or actually smoking 

at either of the later follow-ups (7th or 

8th grade). The study also examined reports 

of seeing antitobacco media advertising 

on TV. The protobacco media exposure 

was coded as exposure to neither, either, 

or both of the above protobacco messages. 

Exposure to one type predicted significantly 

greater progression toward smoking than 

exposure to neither, and exposure to both 

types predicted greater progression than 

exposure to just one type. The analyses were 

adjusted for demographics and whether the 

school had an antitobacco program, but 

not for social influence variables. Exposure 

to antitobacco media was protective of 

progression toward smoking. 

A longitudinal study was conducted with the 

Spanish adolescents surveyed in the crosssectional study by Diaz and colleagues127

described above. Of never smokers at 

baseline, 906 were followed one year later 

(90% of the original sample). Agreement 

with the statement about the legitimacy 

of tobacco advertising was bivariately 

predictive of smoking at follow-up but only 

marginally significant in a multivariate 

analysis that controlled for opinions about 

smoking and social influences to smoke 

(adjusted OR of 1.6; 95% CI, 0.9–2.7).

Another Spanish study159 analyzed 

advertising awareness at baseline among 

2,356 adolescents, in 69 schools, aged 13 

and 14 years who were successfully followed 

18 months later (64%). Three billboard 

advertisements (selected according to 

specified criteria) that had appeared near 

each school were shown to the students 

with the brand identification removed. 

Participants could correctly identify zero, 

one, two, or all three brands. Awareness 

level was positively and significantly 

associated with being a new regular smoker 

(at least weekly) by follow-up. The authors 

adjusted for demographics and social 

influences.

Sargent and colleagues163 studied 480 rural 

Vermont students in grades 4 through 11. 

They assessed receptivity to cigarette 

promotions in terms of ownership of or 

willingness to use a cigarette promotional 

item. The students (66% of the original 

sample) were contacted again 12 and 

21 months later. Receptivity predicted 

progression toward smoking 21 months 

later, even when controlling for parent 

and peer smoking. Moreover, changes in 

receptivity between the first and second 

assessments or between the second and 

third assessments predicted progression to 

smoking even when controlling for initial 

receptivity. Thus, over time, the likelihood 

of smoking increased when an adolescent 

received or was willing to use a cigarette 

promotional item.

University of Manchester researchers165

examined smoking onset among 

1,450 students in England surveyed twice, 

one year apart (the follow-up response rate 

was not reported). The two most heavily 

advertised cigarette brands in that year 

were Silk Cut and Benson & Hedges. Girls 

who indicated awareness of either brand 
268

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

were significantly more likely to be smoking 

one year later. The study found no effects 

for boys.

Another study with divergent results between 

genders was conducted in 29 secondary 

schools in Northern England.156 In this 

study, 1,390 students (aged 12 and 13 years) 

self-identified as never smokers answered 

questions pertaining to nine variables. 

The students completed questionnaires 

twice, four months apart (the follow-up 

response rate was not reported), concerning 

cigarette brand awareness, favorite cigarette 

advertisements, and viewing of cigarettesponsored sporting events. Awareness of 

cigarette brands (determined by answering 

the question, “Can you name a brand of 

cigarette?”) was a significant predictor of 

smoking among girls, even when parent 

and friend smoking was controlled. 

However, there were no significant findings 

among boys.

There was a potential reduction in statistical 

power to identify a link between tobacco 

marketing activities and later smoking 

behavior because of sample attrition and 

the resulting potential bias toward a null 

finding. However, all of the longitudinal 

studies described above found at least a 

marginal link, even after adjusting for 

multiple other variables, including social 

influences to smoke cigarettes. 

Effects of Tobacco 

Advertising on Tobacco 

Consumption

This section reviews another line of 

evidence from the empirical literature 

from econometric studies about the 

effects of tobacco advertising on tobacco 

consumption. Tobacco industry sources 

have claimed that tobacco advertising 

only affects market share among various 

competing brands rather than increasing 

total demand for tobacco. This section 

develops a framework for studying the 

relationship between advertising and 

tobacco consumption and reexamines 

prior studies of tobacco advertising in the 

context of this framework. 

Chapters 4 and 6 in this monograph provide 

information as background for this chapter. 

Besides traditional media-based advertising to 

create a favorable product image, the tobacco 

industry uses additional marketing options 

to increase sales, including price discounts 

and promotional activities (e.g., specialty 

item distribution) that reduce the full 

price paid by consumers or by retailers.*

As a result of the 1998 Master Settlement 

Agreement (MSA)—which bans tobacco 

advertising on billboards, in transit media, 

and in most other outdoor venues—the 

only remaining traditional media available 

to tobacco advertising are newspapers 

and magazines. However, a great deal of 

advertising and promotion now takes place 

at the point of purchase,170 and it has more 

than doubled since the MSA (chapter 4). 

The MSA restrictions have not reduced the 

total amount of money the industry spends 

on advertising and promotions ($15.1 billion 

in 2003),171 only the allocation. Most of the 

studies reviewed later in this section consider 

the time before the shift from advertising to 

promotional activities became well advanced, 

and for this reason, the expenditure measures 

were mostly for advertising.

Total advertising expenditures typically 

are analyzed as a percentage of sales, 

which is known as the advertising-to-sales 

ratio.† Schonfeld and Associates172 reported 

that typical industry-level advertisingto-sales ratios average less than 3%. 

The advertising-to-sales ratio for cigarettes 

*

In this case, the full price can be defined as the monetary price minus the value of coupons or merchandise.

†

The advertising-to-sales ratio does not include promotional expenditures.
269

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

in 1980 was reported at 6.3%, although by 

2000 this ratio was down to 2.9% (for later 

data, see chapter 4). However, the empirical 

studies of tobacco advertising reviewed 

below used historic data from the period 

when the ratio was relatively high.

Economic Issues in Tobacco 

Advertising

To interpret the findings of prior studies 

of tobacco advertising, it is important to 

understand how the extent of advertising 

is measured. In general, three methods of 

measuring advertising have been used:

1. National aggregate advertising 

expenditures from annual or quarterly 

time series 

2. Local-level, cross-sectional advertising 

expenditure measures

3. Advertising bans

Examining the advertising response 

function can provide some insight into the 

consequences of these alternative methods 

of measuring advertising. An advertising 

response function describes the functional 

relationship between consumption and 

advertising. The advertising response 

function is nonlinear because of diminishing 

marginal effect. That is, while advertising 

increases consumption, increments of 

advertising yield ever smaller increments 

in consumption.* Ultimately, consumption 

is completely unresponsive to additional 

advertising, because all those who can be 

*

The literature on advertising response functions includes a variety of specifications. Some specifications 

also include a range of increasing marginal product.

Economics of Tobacco Advertising

Industries with a fairly limited number of producers (oligopolistic), such as the tobacco industry, 

often prefer competition through advertising rather than price to increase their share of the 

market.a Schmalensee showed that oligopolistic firms are likely to advertise more than similar 

firms in monopoly situations. Each firm is reluctant to use price competition if it believes that 

rivals also will cut their prices. If all firms cut prices, they all move down along an inelastic 

demand function similar to the industry demand function. Market share will not increase and 

revenue will decline. Advertising research usually finds that the firm with the largest share of 

voice (the firm’s advertising as a percentage of total industry advertising) has the largest share 

of the market. Each firm attempts to advertise more than its rivals, which results in a high level 

of industry advertising. However, popular price promotions (e.g., two packs for the price of one, 

promotional sales with the price differential absorbed by the parent company rather than the 

retailer) are prevalent tactics that tobacco companies use.b

The high level of total advertising expenditures by the tobacco industry also is a function of the 

regulatory environment. Tobacco is an addictive substance with a high degree of brand loyalty. 

For such a product, in a period of increasing regulation, short-run sales maximization may be 

preferred to short-run profit maximization. Consumers lost now to a cheaper brand will not be 

likely to return. As a response to this, tobacco firms may take a multiperiod perspective on sales 

and profits. In a multiperiod framework, advertising and pricing decisions are guided by the goal 

of sales maximization, which is expected to maximize profit in the long run.

a

Schmalensee, R. L. 1972. On the economics of advertising. Amsterdam: North Holland.

b

Feighery, E. C., K. M. Ribisl, N. C. Schleicher, and P. I. Clark. 2004. Retailer participation in cigarette company 

incentive programs is related to increased levels of cigarette advertising and cheaper cigarette prices in stores. 

Preventive Medicine 38 (6): 876–84.
270

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

enticed to buy the product have already 

done so and they can consume only a 

certain amount.

Advertising response functions have been 

used for some time in brand-level research 

to illustrate the effect of advertising 

on consumption at various levels of 

advertising.173–175 However, the same theory 

that describes the brand-level advertising 

response function also might be applied to 

aggregations of brands.* An aggregation of 

all brands in an industry can be defined as 

the industry-level response function. For the 

tobacco industry, the industry-level response 

function would include all brands and 

variations of cigarettes, cigars, and other 

tobacco products. If advertising resulted 

only in brand switching, the industry-level 

response function would be horizontal.†

The assumption of a positively sloped 

industry-level response function provides 

a potential framework to analyze prior 

research. The prior research, in turn, either 

will validate or reject this assumption. 

The industry-level response functions are 

different from the brand-level response 

functions in that advertising-induced sales 

must come at the expense of sales of products 

from other industries or consumer savings.

An industry response function using 

national data and an industry response 

function using market-level data are defined. 

The reason for two response functions is 

that the likely outcome (the relationship 

between advertising and consumption) 

of measuring advertising at the national 

level could be different from measuring 

advertising at the market level (geographic 

area). Figure 7.1 illustrates the nationallevel response function. The vertical axis 

measures industry-level consumption 

at the national level, and the horizontal 

axis measures industry-level advertising 

expenditures at the national level. Figure 7.2 

charts a market-level function. The vertical 

Figure 7.1 Relationship between Levels of Advertising and Consumption Aggregated at the 

National Level Consumption

0

Advertising expenditures

N

ban 

partial ban

Note. N = point beyond which slope of function becomes near zero. A ban on certain media shifts the function downward.

Adapted from Saffer, H. 2000. Tobacco advertising and promotion. In Tobacco control in developing countries, ed. P. Jha and 

F. Chaloupka, 219. Oxford: Oxford Univ. Press. Reprinted with permission of Oxford University Press.

*

Specific media may be subject to diminishing marginal product, which would suggest that media 

diversification is necessary to maximize the effect of a given advertising budget.

†

The theory of an industry response function also applies to counteradvertising, where the industry response 

function slopes downward and is subject to diminishing marginal product. Counteradvertising expenditures

are relatively small, so a negative effect of these expenditures is likely to be observed in empirical studies.
271

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

axis measures industry-level consumption 

at the market level, and the horizontal 

axis measures industry-level advertising 

expenditures at the market level.

Another important aspect of advertising 

is that its effects linger over time. That 

is, advertising in one period will have a 

lingering, although smaller effect, in the next 

period. Although the rate of decline over time 

remains an arguable issue, research such 

as that of Boyd and Seldon176 indicates that 

cigarette advertising fully depreciates within 

a year. The lingering effect of advertising 

is the basis for a widely used advertising 

technique known as pulsing. A pulse is a 

burst of advertising, in a specific market, that 

lasts for a short time and then stops.* After 

a period with no (or minimal) advertising, 

the market will be exposed to another pulse. 

The length and intensity of a pulse will vary 

due to several factors, including the specific 

media, the specific advertisers, and the 

advertising costs in the specific market.

The response function represented in 

figure 7.1 helps to illustrate the likely 

outcome of measuring advertising at 

the national level. National advertising 

expenditures are the total of all tobacco 

advertising expenditures, for all advertisers, 

in all media, for all geographic market 

areas. This high level of aggregation 

reduces variation in the data. Since the 

advertising-to-sales ratio for tobacco was 

relatively large in the past, advertising may 

have been in a range of a very low or zero 

marginal effect. In figure 7.1, this situation 

is represented as measuring advertising in 

a range around N. The slope of the response 

function in the range around N is near zero.†

That is, increases in advertising around 

N will not produce incremental cigarette 

sales (consumption). Studies that use this 

type of data would be expected to show no, 

or very little, effect of advertising.

Studies that use cross-sectional data to 

measure tobacco advertising are less 

common. Cross-sectional data can differ 

but typically are at the level of a local 

market area and have greater variation 

than national-level data for several reasons. 

Local markets are exposed to different 

Figure 7.2 Relationship between Levels of Advertising and Consumption Aggregated at the 

Market Level Consumption

0

Advertising expenditures

M

Note. M = point around which changes in advertising expenditures produce observable changes in consumption.

Adapted from Saffer, H. 2000. Tobacco advertising and promotion. In Tobacco control in developing countries, ed. P. Jha and 

F. Chaloupka, 219. Oxford: Oxford Univ. Press. Reprinted with permission of Oxford University Press.

*

This practice also is known as flighting, and the advertising period is known as a flight.

†

In a regression, the advertising coefficient is equal to the slope of the response function.
272

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

levels of advertising because of pulsing 

and because of differences in local relative 

media costs. A media plan may call for a 

different schedule of pulses in different cities 

or regions and a different mix of media. 

This creates variation in advertising across 

local areas, which increases the probability 

that some areas are exposed to a range of 

nonzero marginal effect of advertising. 

Figure 7.2 illustrates this situation, with the 

advertising data occurring in a range around 

M. Studies using local-level advertising data 

are more likely to find a positive relationship 

between advertising and consumption.

The third category of studies is based on 

tobacco advertising bans. The potential effect 

of a partial advertising ban is a downward 

shift of the response function, as figure 7.1 

illustrates. A partial ban may not reduce 

the total level of advertising, but it will 

reduce the effectiveness of the remaining 

nonbanned media. The reason for this is that 

a ban on one or more media will result in a 

shift toward the remaining media. However, 

advertising in each medium is subject to a 

diminishing marginal effect. The increased 

use of nonbanned media will result in a lower 

average effect for these media. This shifts the 

overall media response function downward. 

When only a few media are banned (i.e., a 

weak ban or limited ban as defined by 

Saffer and Chaloupka 2000),177 the change 

is minimal or modest and may be difficult 

to detect. However, when more media are 

banned (i.e., a comprehensive ban, defined by 

Saffer and Chaloupka as a ban on 5–7 media 

channels),177 the magnitude of the change 

increases, the marginal impact of additional 

advertising in the remaining (nonbanned) 

media decreases, and the bans are more 

successful in suppressing consumption.

Firms may or may not respond to this 

decrease in effectiveness of their advertising 

expenditures. Some may try to compensate 

with more advertising in nonbanned media, 

which would be illustrated by moving to 

a higher level of advertising on a lower 

advertising response function.* Firms 

also might respond by increasing the use 

of other marketing techniques such as 

promotional allowances to retailers.

Two authors178,179 make the interesting 

and almost universally ignored point that 

a study of cigarette advertising should, 

therefore, control for changes in the level 

of advertising in all industries. The level 

of advertising in all industries is defined 

as external advertising. The effect of 

external advertising can be explained 

with a simple example. Holding savings 

constant, if all industries, including 

cigarette manufacturers, doubled 

advertising, cigarette sales would not 

increase.† This is because the increase 

in advertising in each industry would be 

mutually canceling. Cigarette advertising 

should, therefore, be measured relative 

to external advertising.

Econometric Studies

Econometric studies of the effect of 

cigarette advertising on cigarette 

consumption are grouped into studies that 

use (1) time-series national expenditure 

data; (2) local-level, cross-sectional data; 

and (3) advertising bans. Table 7.5 provides 

a list of econometric studies and prior 

reviews. Each type of study and the results 

from previous reviews are described.

Time-Series National Expenditure 

Studies

Table 7.5 lists 15 econometric studies 

of cigarette advertising expenditure 

*

In a simple model, the decrease in marginal product would reduce the use of the input. However, in an 

oligopoly model, with response to rivals, one reaction to reduced sales is to increase advertising.

†

This assumes that there is no change in the relative effectiveness of all advertising.
273

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

studies, which use national annual or 

quarterly time-series data. All of these 

studies found either no effect or a small 

effect of advertising on cigarette demand. 

As mentioned earlier, it would be difficult 

to find an effect since the level of cigarette 

advertising is relatively high and nationallevel data may not provide sufficient 

Table 7.5 Econometric Studies of Tobacco Advertising and Consumption

Study Data Major conclusionsa

Time-series studies

Hamilton 1972180 U.S. 1925–70 no effect of advertising

Schmalensee 1972179 U.S. 1955–67 no effect of advertising

McGuinness and Cowling 1975181 UK quarterly, 1957–68 small positive effect of advertising

Grabowski 1976182 U.S. 1956–72 no effect of advertising

Schneider et al. 1981183 US 1930–78 no effect of advertising 

Bishop and Yoo 1985184 U.S. 1954–80 small positive effect of advertising

Abernethy and Teel 1986185 U.S. 1949–81 small positive effect of advertising

Baltagi and Levin 1986186 U.S. 1963–80 no effect of advertising

Johnson 1986187 Australian 1961–86 no effect of advertising

Porter 1986188 U.S. 1947–82 no effect of advertising

Chetwynd et al. 1988189 New Zealand, quarterly, 1973–85 small positive effect of advertising

Seldon and Doroodian 1989190 U.S. 1952–84 small positive effect of advertising

Wilcox and Vacker 1992191 U.S. quarterly, 1961–90 no effect of advertising

Valdes 1993192 Spanish 1964–88 small positive effect of advertising

Duffy 1995193 UK, quarterly, 1963–88 no effect of advertising

Cross-sectional studies

Lewit et al. 1981194 7,000 youths 1966–70 positive effect of advertising

Roberts and Samuelson 1988195 1971–82 for 5 firms positive effect of advertising

Goel and Morey 1995196 U.S. states 1959–82 positive effect of advertising

Advertising ban studies

Hamilton 1975197 11 OECD countries no effect of a ban

Laugesen and Meads 1991198 22 OECD countries 1960–86 negative effect of a ban 

Stewart 1993199 22 OECD countries 1964–90 no effect of a broadcast ban

Saffer and Chaloupka 2000177 22 OECD countries 1970–92 negative effect of a ban

Saffer 2000200 102 countries 1970–95 negative effect of a ban

Prior reviews and other work

Boddewyn 1986201 descriptive data no effect of bans

Andrews and Franke 1991202 meta-analysis positive effect of advertising

Smee et al. 1992203 literature review and 2 countries 

analysis

positive effect of advertising 

Lancaster and Lancaster 2003204 literature review no effect of advertising

Keeler et al. 2004205 U.S. 1990–2000 effect of MSA positive effect of advertising 

Nelson 2006206 international, meta-analysis no effect of advertising

Note. UK = United Kingdom; OECD = Organisation for Economic Co-operation and Development; MSA = Master Settlement Agreement.

a

”Positive effect” means an increase in consumption, and “negative effect” means a decrease in consumption.
274

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

variance.* These studies typically use annual 

or quarterly data from one country, with 

20 to 90 observations. Advertising usually 

is measured by expenditures, with control 

variables such as price and income included.

Chetwynd and colleagues189 found a small 

effect with quarterly data that was lost when 

aggregation was increased to the annual 

level. This supports the theory that annual 

data have insufficient variance. Duffy178

reviewed these studies and a few more 

that also use national-level advertising 

data. Duffy also reported that these studies 

found either no effect or a small effect, and 

concluded on the basis of these findings 

that cigarette advertising has no effect 

on cigarette consumption. An alternative 

conclusion, however, is that studies that 

use a single time series of national-level 

data measure the effect of advertising on 

consumption at a level of advertising for 

which little or no effect can be found, as 

illustrated by the industry response function 

in the area at N or higher in figure 7.1.

Local-Level Cross-Sectional Studies

Only three studies use cross-sectional data 

(table 7.5). The reason for so few crosssectional studies is that the data are expensive 

and difficult to assemble. Cross-sectional data 

measure advertising over a range around M, 

as illustrated in the industry-level advertising 

response function at the market level shown 

in figure 7.2. Since external advertising 

primarily is national, it will have little crosssectional variation and can be safely ignored. 

The study by Roberts and Samuelson195 is 

somewhat different but still may be classified 

as cross-sectional. In their study, the crosssectional unit is the firm. These researchers 

found that advertising increases market 

size and that market share is related to 

the number of brands sold by a company. 

These studies show that when advertising 

is measured over a wide range, such as with 

cross-sectional data, a significant positive 

effect of advertising is observed.

Advertising Bans

The third category of studies examine 

the effect of advertising bans on various 

aggregate-use measures. Partial advertising 

bans shift the function in figure 7.1 

downward. Five studies of cigarette 

advertising bans using pooled international 

data sets have been published (table 7.5). 

Hamilton197 used data on 11 countries over 

the period from 1948 to 1973 and presented 

a set of regressions using pooled data of 

countries with bans and countries without 

bans. The regressions show no effect from a 

ban. Laugesen and Meads198 used data from 

22 Organisation for Economic Co-operation 

and Development (OECD) countries for 

the period 1960 to 1986. Like Hamilton, 

Laugesen and Meads also found that before 

1973, cigarette advertising bans had no 

effect on consumption. However, they found 

that after 1973, cigarette advertising bans 

have had a significant negative effect on 

consumption. Laugesen and Meads argued 

that, before 1973, manufacturers were able 

to increase alternative marketing efforts in 

response to broadcast advertising restrictions. 

This is unmeasured in the data set and 

offsets the effect of the broadcast bans. 

However, after 1973, more comprehensive 

antismoking legislation was enacted. These 

newer laws restricted advertising efforts to a 

greater degree and resulted in lower cigarette 

consumption. Stewart199 conducted the third 

study of cigarette advertising bans. Stewart 

analyzed data from 22 OECD countries for 

the period 1964 to 1990 and found that a 

television advertising ban had no effect. 

This study did not control for other offsetting 

increases in advertising in other media 

and did not separately examine the more 

restrictive period after 1973. 

*

A flat portion of the function has a zero slope, which means a zero regression coefficient and no 

relationship between consumption and advertising.
275

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

One reason that the empirical results from 

these three studies are mixed is that the bans 

must be sufficiently inclusive to reduce the 

average effect of the nonbanned media so the 

industry does not compensate by increasing 

advertising or other marketing efforts. 

For example, a ban on television cigarette 

advertising alone may not be enough to 

affect total advertising, since other media 

and other marketing techniques can be used 

to compensate for the loss. Chapter 3, in 

the section titled “Ineffectiveness of partial 

advertising bans,” reviews studies and 

examples of how tobacco companies have 

circumvented partial advertising bans.

The International Advertising Association 

(IAA) published another ban study as a 

report edited by Boddewyn.201 According to 

tobacco industry and litigation documents, 

a British American Tobacco official 

was the report’s ghostwriter.207 The IAA 

report presented data on consumption in 

16 nations (8 centrally planned economies 

and 8 free-market economies), all but one of 

which had adopted tobacco advertising bans 

or had no advertising. The study included 

no other controls on tobacco demand such 

as tobacco price or income. Price changes 

and income changes can have a larger effect 

on tobacco demand than advertising bans. 

Thus, the failure to control these effects 

makes it impossible to determine the effect 

of bans from this study.

Saffer and Chaloupka177 estimated the effect 

of tobacco advertising bans by using an 

international aggregate data set consisting of 

22 countries for the years 1970 through 1992. 

The advertising bans considered included 

seven media: television, radio, print, outdoor, 

point of purchase, movie, and sponsorship. 

Three ban variables were constructed. The 

first, a weak ban, equaled one if zero, one, or 

two bans were in effect. The second, a limited 

ban, equaled one if three or four media were 

banned. The third, a comprehensive ban, 

equaled one if five, six, or seven media were 

banned. A set of regressions limited to the 

period 1984 to 1992 showed that limited bans 

were not effective but that comprehensive 

bans were effective. The results suggest 

that moving from a limited ban to a 

comprehensive ban has a compounding effect 

that is consistent with the theory that limited 

bans allow substitution to other media. The 

results show that limited sets of bans are 

minimally effective in reducing the impact 

of advertising. However, comprehensive bans 

have a clear effect in reducing tobacco use.

Saffer200 provided empirical research using 

data from 102 countries on the effect of 

tobacco advertising. The primary conclusion 

of this research was that a comprehensive 

set of tobacco advertising bans can reduce 

tobacco consumption and that a limited 

set of advertising bans will have little or 

no effect. The policy options that have 

been proposed for the control of tobacco 

advertising include limitations on the 

content of advertisements, restrictions on the 

placement of advertising, restrictions on the 

time that cigarette advertising can be placed 

on broadcast media, total advertising bans 

in one or more media, counteradvertising, 

and taxation of advertising. Saffer concluded 

that restrictions on content and placement 

of advertising and bans in only one or 

two media are not effective. However, 

comprehensive control programs, including 

comprehensive advertising bans, reduce 

cigarette consumption. Counteradvertising 

also can reduce tobacco use (see chapter 12). 

The taxation of advertising reduces total 

advertising and raises revenue that can be 

used to fund counteradvertising.

Prior Reviews and Other Work

Andrews and Franke202 presented the results 

from 24 time-series studies of advertising 

and cigarette demand, which include 

147 estimates of the advertising elasticity. 

They used these estimates to compute 

a mean elasticity and a variance for this 

mean. Meta-analysis assumes that all the 

data being analyzed come from randomized 
276

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

trials. In a regression context, this means 

that all unobserved heterogeneity in each 

study was random or controlled. This is 

an unlikely possibility, and how robust the 

method is to violations in this assumption 

is not known in this context. Nevertheless, 

Andrews and Franke found a small positive 

effect of tobacco advertising—a weighted 

mean advertising elasticity of 0.060, which is 

significantly different from zero (p < 0.039). 

This means that a 10% increase in cigarette 

advertising expenditures would result in a 

0.6% increase in cigarette sales. The authors 

also showed that the magnitude of the effect 

of advertising on sales (i.e., advertising 

elasticity estimates) declined over time in 

the United States and the United Kingdom—

“a result which is to be expected as a product 

moves through its life cycle.”202

Another meta-analysis by Nelson206

reanalyzed the studies from the Andrews and 

Franke meta-analysis and included several 

additional ones. One criticism Nelson made 

of the Andrews and Franke analysis was that 

it included more than one estimate from the 

studies considered; multiple estimates from 

the same study are not independent. Nelson 

selected one estimate from each study for 

his meta-analysis, but the selection criteria 

were not well explained. The aggregate 

estimate of advertising elasticity from this 

study was not statistically different from 

zero. A subsequent erratum to this study 

disclosed that Nelson consults for a law firm 

that represents the tobacco industry.208*

A report prepared by the Economics and 

Operational Research Division of the 

UK Department of Health203 provided an 

informative discussion of the econometric 

issues involved in estimation of the effects 

of advertising. The report pointed out 

that advertising is subject to diminishing 

marginal effectiveness and that studies 

using annual time-series data will measure 

the effects of advertising in a range in which 

marginal effects are likely to be small or 

zero. The report also indicated that studies 

of total or comprehensive bans examined 

across countries avoid many of the problems 

associated with time-series advertising 

studies because, in the case of ban studies, 

an advertising effect “will be on a larger 

scale and should show up more clearly.” 

The report reviewed a number of prior 

time-series studies and found that enough 

studies reported positive results to conclude 

that advertising has a positive effect on 

consumption. In addition, the report also 

concluded that in Norway, Finland, Canada, 

and New Zealand, the banning of advertising 

was followed by a fall in smoking on a 

scale that cannot reasonably be attributed 

to other factors. The report also provided 

empirical results for Norway and the 

United Kingdom. Unfortunately, the analysis 

included lagged values of consumption as 

an independent variable and estimated these 

equations with ordinary least squares, which 

is known to create biased results.

Keeler and colleagues205 estimated a 

demand function for cigarettes with the 

use of monthly data from 1990 to 2000. 

This was a period of significant advertising 

changes that resulted from the MSA. 

The MSA took effect in November 1998 

and eliminated tobacco advertising on 

billboards, in transit media, and in most 

other outdoor venues. The researchers 

reported that tobacco companies had been 

reducing traditional media advertising in 

favor of other marketing techniques since 

1980. They argued that the MSA resulted 

in a slowing of this trend, and as a result, 

a decrease in the reduction in cigarette 

sales. This was a time-series study, but since 

*

Erratum: “The author consults with a law firm that represents the tobacco industry. The paper was 

independently prepared by the author and was not reviewed by the law firm prior to submission for 

publication. I wish to thank two anonymous referees for helpful comments on an earlier draft. The usual 

caveats apply.”
277

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

the primary source of advertising variation 

was the exogenous shift in advertising due 

to the MSA, this study is not in the same 

category as the older time-series studies 

reviewed above, and is more credible than 

those older studies. Keeler and colleagues 

estimated an advertising elasticity of 0.27, 

which is large for this type of elasticity.

Lancaster and Lancaster204 reviewed 

35 single-country studies of tobacco 

advertising and found that overall 

advertising had little or no effect on 

consumption. These results are consistent 

with the industry-level advertising response 

function about the point N (figure 7.1). 

These researchers also reviewed 21 studies 

of tobacco advertising bans. Here, the 

evidence was mixed, but the authors 

concluded that bans had no effect. Some 

of these ban studies examined only limited 

bans, which are not likely to have any effect.

Time-Series Studies of Smoking 

Initiation and Brand Choice

Besides examination of time-series 

expenditure data and cigarette consumption, 

other investigators have studied measures 

of smoking initiation. Pierce and Gilpin209

examined annual age-specific rates of 

smoking initiation from the late 1800s 

through the 1970s. They note changes 

in these rates following the launching of 

novel and aggressive cigarette advertising 

campaigns. The early campaigns were 

targeted at males, and this group, but not 

females, showed increased initiation. In the 

1920s, when women became the target of 

advertising (e.g., “Reach for a Lucky Instead 

of a Sweet”), initiation incidence rates 

increased for both female adolescents and 

adults, but not for males. Advertisements 

for “women’s brands” (e.g., Virginia Slims) 

were heavily featured in the late 1960s. 

Girls, but not women or males of any age, 

showed increased rates of initiation.209,210

The increases in initiation observed 

appeared to be specific to the group being 

targeted by the advertising campaigns.

Another analysis of adolescent and young 

adult initiation rates showed that after a 

decline in the early 1980s, there was an 

increase in adolescent but not young adult 

initiation rates. This increase coincided with 

R.J. Reynolds’s Joe Camel campaign, perhaps 

reinforced by both the “Camel Cash” and 

“Marlboro Mile” promotions programs.211,212

Another study213 compared observed and 

expected rates of initiation of daily smoking 

among 9th graders (using Monitoringthe-Future data) with tobacco industry 

promotional expenditures. Using diffusion 

modeling, observed rates departed 

significantly from expected rates coincident 

with the increase in tobacco industry 

resources devoted to promotional activities.

A study published in 2006 examined the 

temporal relationship between health-theme 

magazine advertising for low-tar cigarette 

brands and sales of these brands.214 The 

authors reviewed cigarette advertisements 

published in 13 widely read magazines 

from 1960 to 1990 and noted the type of 

low-tar brand and whether the theme of the 

advertisement implied a health advantage. 

Two types of low-tar brands were considered: 

(1) those (14 in all) that represented a 

brand extension of a regular-tar brand 

(e.g., Marlboro Lights) and (2) those brands 

(6 in all) that had always been exclusively 

low tar (e.g., Carlton). Advertising that 

carried a health theme then was computed 

as a proportion of all advertising for these 

brands and plotted together with the 

proportion of sales of these brands among 

sales for all brands. 

For the brand extensions, the health theme 

began in 1965 and increased slowly until 

1975 (around 5% of all advertising for 

these brands), then increased markedly 

until 1977 (nearly 35% of all advertising of 

these brands). Sales for the low-tar brand 

extensions were low (<5% of total) until 
278

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

1976 but increased rapidly until 1982 (23%). 

By 1985, the health-theme advertising had 

returned to a low level (just over 5%), but 

sales remained high, reaching 25% in 1990. 

The pattern for exclusively low-tar brands 

was different. While sales also increased 

rapidly following a marked increase in 

health-theme advertising beginning in 1974, 

the health-theme advertising remained at 

nearly peak levels (30%–40%) through 1990. 

Sales peaked at about 15% in 1981 and 

declined slightly thereafter to 10% in 1990. 

For both brand types, marked increases in 

health-theme advertising were followed by 

increases in sales. It appeared, however, that 

once the brand extensions were established, 

further such advertising was not necessary 

to retain brand share, but advertising was 

needed for the exclusively low-tar brands.

Further information on advertising for lowtar cigarettes appears in chapters 4 and 5.

Summary

The most definitive evidence of the influence 

of cigarette marketing on youth smoking 

would involve experimental manipulation of 

adolescents’ long-term exposure to cigarette 

marketing and assessment of its impact on 

adolescents’ initiation of smoking. However, 

such a study would be either unethical 

or unfeasible. Nevertheless, a body of 

experimental evidence exists about the effect 

of brief exposure to cigarette marketing on 

images of smokers, perceptions about the 

prevalence of smoking among adolescents, 

and intentions to smoke.95–99 Further, an 

abundance of evidence from multiple lines 

of research using other study designs 

collectively establishes a causal link between 

tobacco marketing and smoking behavior.

Adolescent Psychological Needs

One type of evidence involves adolescent 

psychological needs. Many adolescents 

are motivated to smoke by the perception 

that doing so will help fulfill important 

psychological needs. Adolescents perceive 

that smoking will contribute to popularity 

and that advertising conveys this message. 

Those who believe the message are more 

likely to smoke. In addition, tobacco company 

documents show that marketing for cigarette 

brands popular with youth associates 

smoking those brands with popularity.

Many adolescents perceive that smoking will 

confer attributes associated with success 

with the opposite sex—toughness in the 

case of boys and slenderness in the case 

of girls. Girls are more likely to smoke if 

they think it will help them be thin and 

attractive. Cigarette marketing conveys 

that young women who smoke are high in 

sex appeal. Tobacco company documents 

show that several of the most youth-popular 

brands have been consistently and effectively 

associated with an image of rugged 

masculinity and sex appeal.

Many adolescents have a need to be 

rebellious and see smokers as having this 

characteristic. As a result, rebelliousness is a 

predictor of smoking initiation. At least one 

cigarette brand—Camel—is marketed for 

the rebellious.

Adolescents’ needs for sensation, risk 

taking, and fun also are associated with 

smoking. Adolescents high in sensation 

seeking are more likely to smoke. Cigarette 

marketing frequently associates smoking 

with themes of fun and excitement. Many 

adolescents feel that cigarette advertising 

conveys that smokers will derive pleasure 

from smoking.

Cigarette marketing also exploits 

adolescents’ needs to cope with depression 

and anxiety. Many adolescents perceive 

that smoking can help reduce distress. 

Adolescents high in stress or depression 

appear more likely to smoke. Those who 

are depressed and receptive to cigarette 
279

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

advertising are particularly vulnerable to 

initiating smoking. Numerous tobacco 

company documents indicate that cigarette 

marketing often conveys that smoking 

youth-popular brands will help a person to 

relax or better cope with stress.

Cigarette Marketing and Image 

Enhancement

Because of the importance of popularity 

and peer acceptance in adolescence, most 

teenagers have a strong need for a positive 

self-image. Many adolescents perceive 

smokers to have a number of desirable 

traits. The perception that smoking will 

reinforce a desired self-image motivates 

those adolescents to smoke.

Both correlational and experimental 

studies show that exposure to cigarette 

marketing influences adolescents to have 

a more favorable image of smokers, to 

perceive that smoking among adolescents is 

more prevalent, and to have more positive 

intentions to smoke. The experimental 

studies provide particularly strong evidence 

of the influence of marketing. They control 

for other possible influences on smoking 

and rule out the possibility that there is a 

relationship between smoking and exposure 

to advertising simply because both are 

due to some third variable, such as innate 

curiosity about smoking.

Exposure to Cigarette Marketing 

and Smoking Susceptibility and 

Behavior

This chapter reviewed a large number of 

cross-sectional and longitudinal studies 

dealing with the relationship between 

various measures of exposure to cigarette 

marketing and several different measures 

of susceptibility to smoking and actual 

smoking. The longitudinal studies provide 

strong evidence of such an effect, since 

exposure to tobacco marketing occurs 

before changes in smoking behavior occur. 

The findings are robust and consistent. 

In the overwhelming majority of studies, 

exposure to cigarette marketing was 

associated with smoking behavior. This was 

for diverse measures of exposure including 

self-reported exposure to advertisements, 

derived estimates of adolescents’ exposure, 

recall of specific advertisements, recognition 

of brands in advertisements in which brand 

information had been removed, a variety 

of attitudes toward the advertisements, 

beliefs about the impact of advertising, and 

multicomponent indices of adolescents’ 

receptivity to cigarette advertising. Measures 

of exposure predicted both increases in 

adolescents’ stated intentions to smoke as 

well as the actual initiation of smoking.

Tobacco companies have repeatedly asserted 

that peer and family influences—not their 

marketing practices—influence adolescents 

to smoke. However, many of these crosssectional and longitudinal studies of the 

influence of marketing exposure measured 

and analyzed social influences along 

with tobacco marketing exposure. They 

generally found that marketing practices 

influence adolescent smoking even after 

controlling for peer and parental influences. 

Indeed, a number of the studies that used 

advertising and influence of peers and 

parents to predict later smoking or intent 

to smoke found that advertising exposure 

is a stronger predictor than peer or parental 

smoking.150,154,155,160

Yet, these studies probably underestimate 

the influence of marketing practices, 

since some marketing influence develops 

through peers and parents. For example, 

tobacco companies design marketing to 

influence the perception that popular people 

smoke specific brands. These practices 

influence not just one person, but entire 

peer groups. Because of exposure to these 

advertisements, some adolescent peer groups 

may view smoking as the “in” thing. Theses 

groups are then more likely to approve and 
280

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

admire someone who smokes a brand that 

marketing tells them “in” people smoke.

Thus, evidence that an adolescent is more 

likely to smoke if his or her friends smoke, 

is, in part, due to the influence cigarette 

marketing has on the entire peer group. 

Advertising that associates a cigarette brand 

with popularity prepares an entire peer group 

to approve of those who smoke it. When 

adolescents correctly perceive Marlboro as a 

popular brand, they perceive that their peers 

will accept them if they smoke it.

Effects of Tobacco Advertising 

on Tobacco Consumption

The issues and studies relative to this line 

of evidence indicate, at a minimum, that 

empirical estimation of the effects of tobacco 

advertising on tobacco consumption is a 

complex challenge. The most potentially 

valid econometric strategies are either crosssectional data with advertising measured 

by independent sources at a local level 

or international data on comprehensive 

advertising bans. Many econometric studies 

use small samples of highly aggregated 

national time-series data and find little or 

no effect of advertising. This is because 

the advertising data employed have little 

variance and are measured at a level of 

expenditure at which advertising has little 

or no marginal effect. However, a metaanalysis that pooled the results of 24 such 

studies did find a small, but statistically 

significant, positive effect of advertising on 

cigarette consumption. The evidence from 

cross-sectional studies using disaggregated 

local-level data does indicate an effect of 

advertising on consumption. These timeseries and cross-sectional studies support 

the theory that the industry response 

function slopes upward and is subject to 

diminishing marginal effects.

The studies of advertising bans suggest 

that bans can reduce consumption under 

certain circumstances. Banning advertising 

in a limited number of media has little 

or no effect. Limited advertising bans do 

not reduce the total level of advertising 

expenditure but simply result in substitution 

to the remaining nonbanned media or 

to other marketing activities. Banning 

advertising in most or all available media 

can reduce tobacco consumption, because, 

in these circumstances, the possibilities for 

substitution to other media are limited.

Conclusions

1. Much tobacco advertising targets the 

psychological needs of adolescents, 

such as popularity, peer acceptance, and 

positive self-image. Advertising creates 

the perception that smoking will satisfy 

these needs.

2. Adolescents who believe that smoking 

can satisfy their psychological needs or 

whose desired image of themselves is 

similar to their image of smokers are 

more likely to smoke cigarettes.

3. Experimental studies show that even 

brief exposure to tobacco advertising 

influences adolescents’ attitudes and 

perceptions about smoking and smokers, 

and adolescents’ intentions to smoke.

4. The vast majority of cross-sectional 

studies find an association between 

exposure to cigarette advertising, 

measured in numerous ways, and 

adolescent smoking behavior, measured 

in numerous ways, indicating a robust 

association.

5. Strong and consistent evidence from 

longitudinal studies indicates that 

exposure to cigarette advertising 

influences nonsmoking adolescents to 

initiate smoking and to move toward 

regular smoking.

6. Many econometric studies have 

used national time-series data to 
281

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

examine the association between 

tobacco advertising expenditures and 

tobacco consumption. Some of these 

studies found a small positive effect 

of advertising on consumption. Other 

studies failed to find a positive effect, 

probably because the data used had little 

variance and were measured at a high 

level of advertising expenditure at which 

changes in the volume of advertising 

have little or no marginal effect.

7. The evidence from three cross-sectional 

econometric studies using disaggregated 

local-level data indicates a positive effect 

of advertising on tobacco consumption.

8. The studies of tobacco advertising 

bans in various countries show that 

comprehensive bans reduce tobacco 

consumption. Noncomprehensive 

restrictions generally induce an 

increase in expenditures for advertising 

in “nonbanned” media and for other 

marketing activities, which offset 

the effect of the partial ban so that 

any net change in consumption 

is minimal or undetectable. 

9. The total weight of evidence from 

multiple types of studies, conducted by 

investigators from different disciplines, 

using data from many countries, 

demonstrates a causal relationship 

between tobacco advertising and 

promotion and increased tobacco use, 

as manifested by increased smoking 

initiation and increased per capita 

tobacco consumption in the population.
282

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

References

1. U.S. Department of Health and Human 

Services. 1994. Preventing tobacco use 

among young people. A report of the 

Surgeon General. Atlanta: U.S. Department 

of Health and Human Services, Public 

Health Service, Centers for Disease Control 

and Prevention, National Center for Chronic 

Disease Prevention and Health Promotion, 

Office on Smoking and Health. http://www

.cdc.gov/tobacco/data_statistics/sgr/sgr

_1994/index.htm.

2. Harter, S. 1998. The development of selfrepresentations. In Social, emotional, and 

personality development, vol. 3, handbook 

of child psychology, 5th ed., 553–617. 

New York: John Wiley and Sons.

3. PsychINFO. http://www.apa.org.psycinfo. 

4. United States v. Philip Morris Inc., Civil 

Action No. 99-CV-02496GK (D.D.C.) 

(memorandum opinion 2002).

5. Eccles, J. S., C. W. A. Midgley, 

C. M. Buchanan, D. Reuman, C. Flanagan, 

and D. M. Iver. 1993. Development 

during adolescence. The impact of stageenvironment fit on young adolescents’ 

experiences in schools and in families. 

American Psychologist 48 (2): 90–101. 

6. Steinberg, L. D. 1999. Adolescence. 5th ed. 

New York: McGraw-Hill.

7. Zuckerman, M. 1994. Behavioral expressions 

and biosocial bases of sensation seeking.

New York: Cambridge Press.

8. Bardo, M. T., R. L. Donohew, and N. G. 

Harrington. 1996. Psychobiology of 

novelty seeking and drug seeking behavior. 

Behavioural Brain Research 77 (1–2): 23–43. 

9. Lewinsohn, P. M., G. N. Clarke, J. R. Seeley, 

and P. Rohde. 1994. Major depression in 

community adolescents: Age at onset, 

episode duration, and time to recurrence. 

Journal of the American Academy of Child 

Adolescent Psychiatry 33 (6): 809–18. 

10. Centers for Disease Control and Prevention. 

1994. Changes in the cigarette brand 

preferences of adolescent smokers—

United States, 1989–1993. Morbidity and 

Mortality Weekly Report 43 (32): 577–81. 

11. Centers for Disease Control and Prevention. 

2000. Youth tobacco surveillance—

United States, 1998–1999. Morbidity and 

Mortality Weekly Report Surveillance 

Summaries 49 (10): 1–94. 

12. Substance Abuse and Mental Health 

Services Administration. 2007. Cigarette 

brand preferences in 2005. http://oas.samhsa

.gov/2k7/cigBrands/cigBrands.htm.

13. Evans, N., A. Farkas, E. Gilpin, C. Berry, 

and J. P. Pierce. 1995. Influence of tobacco 

marketing and exposure to smokers on 

adolescent susceptibility to smoking. 

Journal of the National Cancer Institute

87 (20): 1538–45. 

14. Romer, D., and P. Jamieson. 2001. Do 

adolescents appreciate the risks of smoking? 

Evidence from a national survey. Journal of 

Adolescent Health 29 (1): 12–21. 

15. Barton, J., L. Chassin, C. C. Presson, and 

S. J. Sherman. 1982. Social image factors 

as motivators of smoking initiation in early 

and middle adolescence. Child Development

53 (6): 1499–1511. 

16. Perry, C. L., D. M. Murray, and K. I. Klepp. 

1987. Predictors of adolescent smoking 

and implications for prevention. Morbidity 

and Mortality Weekly Report 36 Suppl. 4: 

41S–45S. 

17. Koval, J. J., L. L. Pederson, C. A. Mills, 

G. A. McGrady, and S. C. Carvajal. 2000. 

Models of the relationship of stress, 

depression, and other psychosocial factors 

to smoking behavior: A comparison of 

a cohort of students in grades 6 and 8. 

Preventive Medicine 30 (6): 463–77. 

18. Chassin, L., C. C. Presson, S. J. Sherman, 

and D. A. Edwards. 1991. Four pathways 

to young-adult smoking status: Adolescent 

social-psychological antecedents in a 

midwestern community sample. Health 

Psychology 10 (6): 409–18. 

19. Johnston, M. Young smokers: Prevalence, 

trends, implications, and related 

demographic trends. 31 Mar 1981. 

Philip Morris. Bates No. 1000390803/

0855. http://legacy.library.ucsf.edu/tid/

ftu74e00.

20. Ken Warwick and Associates. Young adult 

smoker lifestyle and attitude segmentation. 

Feb 1998. Philip Morris. Bates No. 

2077896880/6964. http://legacy.library.ucsf

.edu/tid/iqo36c00.

21. Ellis, N. Metro YAS+ tracking. 29 Jun 1998. 

Philip Morris. Bates No. 2073308392. 

http://legacy.library.ucsf.edu/tid/dkk27a00.

22. Philip Morris. Marlboro marketing mix 

monitor. Jan 1996. Philip Morris. Bates 

No. 2063515175/5197. http://legacy.library

.ucsf.edu/tid/asl27a00.
283

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

23. Philip Morris. Marlboro YAMScan a 

proposal. 25 Jul 1996. Philip Morris. Bates 

No. 2062311988/1994. http://legacy.library

.ucsf.edu/tid/gsl27a00.

24. Philip Morris. Profile of the young adult 

Marlboro smoker part I: Males, 18 to 24 

years old. Nov 1994. Philip Morris. Bates 

No. 2048735500/5604. http://legacy.library

.ucsf.edu/tid/mul27a00.

25. Philip Morris. YAS flavor 4m.ppt. PowerPoint 

presentation. 10 Oct 2001. Philip Morris. 

Bates No. 2703203702/3706. http://legacy

.library.ucsf.edu/tid/qti95a00.

26. Philip Morris. Marlboro metro YAS tracking 

study - post-wave 1 - final report. Aug 1998. 

Bates No. 2073308359/8378. http://legacy

.library.ucsf.edu/tid/fkk27a00.

27. Philip Morris. Marlboro YAMScan a 

proposal. Jul 1996. Philip Morris. Bates 

No. 2062311984/1987. http://legacy.library

.ucsf.edu/tid/hsl27a00.

28. Philip Morris. Metro YAS tracking study - 

post-wave 1 - final report. Sep 1998. 

Philip Morris. Bates No. 2073308307/8358. 

http://legacy.library.ucsf.edu/tid/hkk27a00.

29. Philip Morris. Prime prospect analysis. 

Sep 1998. Philip Morris. Bates No. 

2073308055/8056. http://legacy.library.ucsf

.edu/tid/pkk27a00.

30. Philip Morris. YAMS xtra. Philip Morris. 

Bates No. 2062310887/1016. http://legacy

.library.ucsf.edu/tid/osl27a00.

31. LeVan, S. POS awareness - II - final 

report. Jun 2001. Philip Morris. Bates No. 

2085231514/1535. http://www.usdoj.gov/civil/

cases/tobacco2/20050103%20Biglan_Written

_Direct_and_%20Demonstratives.pdf.

32. Philip Morris. Natalie_s 4M Deck.ppt 

[Marlboro marketing mix monitor]. 

PowerPoint presentation. 14 Apr 2000. 

Philip Morris. Bates No. 2703811701/1762. 

http://legacy.library.ucsf.edu/tid/jti95a00.

33. Market View Research Group. Marlboro 

marketing mix monitor. Nov 1999. 

Philip Morris. Bates No. 2073578509/8570. 

http://legacy.library.ucsf.edu/tid/wjk27a00.

34. Philip Morris. Philip Morris print leadership 

initiative overview. 1999. Philip Morris. 

Bates No. 2080499829/9896. http://legacy

.library.ucsf.edu/tid/puj27a00.

35. Philip Morris. 837798-Additional charts.

ppt. 11 Jul 2001. Philip Morris. Bates No. 

2703203355/2703203370. http://legacy

.library.ucsf.edu/tid/nfu07a00.

36. Tredennick, D. W. The purpose of this 

memorandum is to answer the question 

“what causes smokers to select their 

first brand of cigarette?” 3 Jul 1974. 

R.J. Reynolds. Bates No. 500574161/4170. 

http://legacy.library.ucsf.edu/tid/kwa79d00.

37. Ellison Qualitative Research. A qualitative 

assessment of Camel advertising equity. 

Oct 1991. R.J. Reynolds. Bates No. 

514340409/0453. http://legacy.library.ucsf

.edu/tid/lmd13d00.

38. Day, R. H., and N. R. Hendersen. Final 

report on eight focus groups with black 

and white users of Newport, Salem, 

and Kool cigarettes on issues related to 

Newport cigarettes and its advertising 

campaign. Jan 1994. Lorillard. Bates No. 

91950191/0242. http://legacy.library.ucsf

.edu/tid/dzn54a00.

39. Shadel, W. G., R. Niaura, and D. B. Abrams. 

2004. Adolescents’ responses to the gender 

valence of cigarette advertising imagery: 

The role of affect and the self-concept. 

Addictive Behaviors 29 (9): 1735–44. 

40. Chassin, L., C. C. Presson, S. J. Sherman, 

E. Corty, and R. W. Olshavsky. 1981. 

Self-images and cigarette smoking in 

adolescents. Personality and Social 

Psychology Bulletin 7 (4): 670–76. 

41. French, S. A., and C. L. Perry. 1996. Smoking 

among adolescent girls: Prevalence and 

etiology. Journal of the American Medical 

Women’s Association 51 (1–2): 25–28. 

42. French, S. A., C. L. Perry, G. R. Leon, and 

J. A. Fulkerson. 1994. Food preferences, 

eating patterns, and physical activity among 

adolescents: Correlates of eating disorders 

symptoms. Journal of Adolescent Health

15 (4): 286–94. 

43. Charlton, A. 1984. Smoking and weight 

control in teenagers. Public Health 98 (5): 

277–81. 

44. Krupka, L. R., A. M. Vener, and G. Richmond. 

1990. Tobacco advertising in genderoriented popular magazines. Journal of 

Drug Education 20 (1): 15–29. 

45. King, K. W., L. N. Reid, Y. S. Moon, and 

D. J. Ringold. 1991. Changes in the visual 

imagery of cigarette ads, 1954–1986. 

Journal of Public Policy and Marketing

10 (1): 63–80. 

46. Schooler, C., E. Feighery, and J. A. Flora. 

1996. Seventh graders’ self-reported 

exposure to cigarette marketing and its 

relationship to their smoking behavior. 
284

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

American Journal of Public Health 86 (9): 

1216–21. 

47. Philip Morris. Leo Burnett Agency. Marlboro 

mainline pool research among YAMS. 

Dec 1999. Bates No. 2072468442/8550. 

http://legacy.library.ucsf.edu/tid/mnk27a00.

48. Philip Morris. Marlboro marketing 

research. Jul 1999. Philip Morris. Bates 

No. 2080929995/0053A. http://legacy.library

.ucsf.edu/tid/wtj27a00.

49. Eckman, B., and S. Goldberg. The viability 

of the Marlboro man among the 18–24 

segment. Mar 1992. Philip Morris. Bates 

No. 2045060177/0203. http://legacy.library

.ucsf.edu/tid/ema84e00.

50. Kohli, U. Male Marlboro smokers review. 

21 Dec 1995. Philip Morris. Bates No. 

2047134293–6729. http://legacy.library.ucsf

.edu/tid/nvl27a00.

51. Philip Morris. Marlboro/Camel consumer 

research. 6 Feb 1991. Philip Morris. Bates 

No. 2071581345/1365. http://legacy.library

.ucsf.edu/tid/vio26c00.

52. Ellison Qualitative Research. A qualitative 

assessment of Camel advertising equity. 

Oct 1991. R.J. Reynolds. Bates No. 

509045372/5416. http://legacy.library.ucsf

.edu/tid/ryi83d00.

53. Paul A. Warner Associates. Camel 

advertising focus groups—Exchange 

initiative—Supplier’s report. Summary 

of findings on reactions to Camel 

advertising and pack exchange program 

among competitive exchange initiative 

smokers. Nov 1990. R.J. Reynolds. Bates 

No. 509043734/3776. http://legacy.library

.ucsf.edu/tid/ehj83d00.

54. Chassin, L., C. C. Presson, S. J. Sherman, 

and S. Margolis. 1988. The social image of 

smokeless tobacco use in three different 

types of teenagers. Addictive Behaviors

13 (1): 107–12. 

55. Koval, J. J., and L. L. Pederson. 1999. Stresscoping and other psychosocial risk factors: 

A model for smoking in grade 6 students. 

Addictive Behaviors 24 (2): 207–18. 

56. Burt, R. D., K. T. Dinh, A. V. Peterson, and 

I. G. Sarason. 2000. Predicting adolescent 

smoking: A prospective study of personality 

variables. Preventive Medicine 30 (2): 

115–25. 

57. Caufield, R. T. Camel new advertising 

campaign development. 12 Mar 1986. 

R.J. Reynolds. Bates No. 503969238/9242. 

http://legacy.library.ucsf.edu/tid/pil75d00.

58. Snyder, S. L. Current/projected perceptions 

of Camel among target smokers. Letter. 

8 Dec 1988. R.J. Reynolds. Bates No. 

506864590/4591. http://legacy.library.ucsf

.edu/tid/rzf44d00.

59. Murphy, D. H. Advertising research report. 

Camel evolved smooth character advertising 

evaluation study. 2 Jan 1991. R.J. Reynolds. 

Bates No. 509042745/2841. http://legacy

.library.ucsf.edu/tid/nfj83d00.

60. R.J. Reynolds. Camel DBM programs: 

Learning perspective. 1999. R.J. Reynolds. 

Bates No. 525511589/1595. http://legacy

.library.ucsf.edu/tid/zel56a00.

61. Kraft, P., and J. Rise. 1994. The relationship 

between sensation seeking and smoking, 

alcohol consumption and sexual behavior 

among Norwegian adolescents. Health 

Education Research 9 (2): 193–200. 

62. Kopstein, A. N., R. M. Crum, 

D. D. Celentano, and S. S. Martin. 2001. 

Sensation seeking needs among 8th and 

11th graders: Characteristics associated 

with cigarette and marijuana use. Drug and 

Alcohol Dependence 62 (3): 195–203. 

63. Tercyak, K. P., and J. Audrain-McGovern. 

2003. Personality differences associated 

with smoking experimentation among 

adolescents with and without comorbid 

symptoms of ADHD. Substance Use and 

Misuse 38 (14): 1953–70. 

64. Skara, S., S. Sussman, and C. W. Dent. 

2001. Predicting regular cigarette use 

among continuation high school students. 

American Journal of Health Behavior

25 (2): 147–56. 

65. Audrain-McGovern, J., K. P. Tercyak, 

A. E. Shields, A. Bush, C. F. Espinel, and 

C. Lerman. 2003. Which adolescents 

are most receptive to tobacco industry 

marketing? Implications for counteradvertising campaigns. Health 

Communication 15 (4): 499–513. 

66. Schooler, C., M. D. Basil, and D. G. Altman. 

1996. Alcohol and cigarette advertising 

on billboards: Targeting with social cues. 

Health Communication 8 (2): 109–29. 

67. McCole, D. Philip Morris USA. Unlimited 

magazine research. 18 Jun 1999. 

Philip Morris. Bates No. 2073578697/8699. 

http://legacy.library.ucsf.edu/tid/tjk27a00.

68. Philip Morris. Marlboro direct mail equity 

study. Nov 1999. Philip Morris. Bates 

No. 2073318205/8466. http://legacy.library

.ucsf.edu/tid/ckk27a00.
285

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

69. R.J. Reynolds, and A. N. Mitchell. 

Marketing research report. Camel younger 

adult smoker focus groups. 1 Feb 1985. 

R.J. Reynolds. Bates No. 504585737/5757. 

http://legacy.library.ucsf.edu/tid/sli65d00.

70. R.J. Reynolds, and B. W. Zabel. Promotion 

research report. Winston/Camel pack action 

study, April–August, 1988 results. Final 

report. 18 Nov 1988. R.J. Reynolds. Bates 

No. 512544519/4537. http://legacy.library

.ucsf.edu/tid/mll33d00.

71. R.J. Reynolds. Camel review. 2 Apr 1990. 

R.J. Reynolds. Bates No. 507302620/2687. 

http://legacy.library.ucsf.edu/tid/ief54d00.

72. Faggert, T. L., and R.J. Reynolds. Advertising 

research report. 1990(900000). Perception 

tracking study Camel: 18–24 males emphasis 

vs. opportunity markets. 19 Jul 1990. 

R.J. Reynolds. Bates No. 509042482/2493. 

http://legacy.library.ucsf.edu/tid/xej83d00.

73. McCracken Brooks Communication. 

Newport promotional concepts. 11 Nov 1993. 

Lorillard. Bates No. 91949806/9831. http://

legacy.library.ucsf.edu/tid/tyy98c00.

74. U.S. Department of Health and Human 

Services. 1988. The health consequences 

of smoking: Nicotine addiction. A 

report of the Surgeon General (DHHS 

publication no. [CDC] 88-8406). Atlanta: 

U.S. Department of Health and Human 

Services, Public Health Service, Centers 

for Disease Control, National Center for 

Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health. 

http://profiles.nlm.nih.gov/NN/B/B/Z/D/.

75. Acierno, R., D. G. Kilpatrick, H. Resnick, 

B. Saunders, M. De Arellano, and C. Best. 

2000. Assault, PTSD, family substance use, 

and depression as risk factors for cigarette 

use in youth: Findings from the National 

Survey of Adolescents. Journal of Traumatic 

Stress 13 (3): 381–96. 

76. Tercyak, K. P., P. Goldman, A. Smith, 

and J. Audrain. 2002. Interacting effects 

of depression and tobacco advertising 

receptivity on adolescent smoking. Journal 

of Pediatric Psychology 27 (2): 145–54. 

77. Choi, W. S., C. A. Patten, J. C. Gillin, 

R. M. Kaplan, and J. P. Pierce. 1997. 

Cigarette smoking predicts development 

of depressive symptoms among U.S. 

adolescents. Annals of Behavioral Medicine

19 (1): 42–50. 

78. Goodman, E., and J. Capitman. 2000. 

Depressive symptoms and cigarette smoking 

among teens. Pediatrics 106 (4): 748–55. 

79. Philip Morris USA. “Jingle.”1961. 

80. Philip Morris. Marlboro Milds research 

summary. Philip Morris. Bates No. 

2073178927A/8956. http://legacy.library.

ucsf.edu/tid/zkk27a00.

81. McCole, D. Marlboro Milds research 

findings. 15 Sep 1998. Philip Morris. Bates 

No. 2061701079/1089. http://legacy.library

.ucsf.edu/tid/vie37c00.

82. Dezso, M. Topline of project blue in-depth 

interviews in Chicago. 12 May 1999. 

Philip Morris. Bates No. 2073373190/3196. 

http://legacy.library.ucsf.edu/tid/zjk27a00.

83. Slade, J. 1993. Snakes, sin, and cigarettes. 

Tobacco Control 2 (4): 331. 

84. Philip Morris. 1992. Take the edge off 

order form. http://tobaccodocuments.org/

ads_pm/2061032679.html.

85. Lorillard. Newport image study. Sep 1988. 

Lorillard. Bates No. 89579737/9797. http://

legacy.library.ucsf.edu/tid/nyh44a00.

86. Aloise-Young, P. A., K. M. Hennigan, and 

J. W. Graham. 1996. Role of the self-image 

and smoker stereotype in smoking onset 

during early adolescence: A longitudinal 

study. Health Psychology 15 (6): 494–97.

87. Amos, A., D. Gray, C. Currie, and R. Elton. 

1997. Healthy or druggy? Self-image, ideal 

image and smoking behaviour among young 

people. Social Science and Medicine 45 (6): 

847–58. 

88. Amos, A., C. Currie, D. Gray, and R. Elton. 

1998. Perceptions of fashion images from 

youth magazines: Does a cigarette make 

a difference? Health Education Research

13 (4): 491–501. 

89. Burton, D., S. Sussman, W. B. Hansen, 

C. A. Johnson, and B. R. Flay. 1989. Image 

attributions and smoking intentions among 

seventh grade students. Journal of Applied 

Social Psychology 19 (8): 656–64. 

90. Shadel, W. G., R. Niaura, and D. B. Abrams. 

2004. Who am I? The role of self-conflict 

in adolescents’ responses to cigarette 

advertising. Journal of Behavioral Medicine

27 (5): 463–75. 

91. Aitken, P. P., D. S. Leathar, F. J. O’Hagan, and 

S. I. Squair. 1987. Children’s awareness of 

cigarette advertisements and brand imagery. 

British Journal of Addiction 82 (6): 615–22. 

92. Arnett, J. J., and G. Terhanian. 1998. 

Adolescents’ responses to cigarette 

advertisements: Links between exposure, 

liking, and the appeal of smoking. Tobacco 

Control 7 (2): 129–33. 
286

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

93. Arnett, J. J. 2001. Adolescents’ responses 

to cigarette advertisements for five “youth 

brands” and one “adult brand.” Journal of 

Research on Adolescence 11 (4): 425–43. 

94. Unger, J. B., C. A. Johnson, and 

L. A. Rohrbach. 1995. Recognition and 

liking of tobacco and alcohol advertisements 

among adolescents: Relationships with 

susceptibility to substance use. Preventive 

Medicine 24 (5): 461–66. 

95. Turco, R. M. 1997. Effects of exposure to 

cigarette advertisements on adolescents’ 

attitudes toward smoking. Journal of 

Applied Social Psychology 27 (13): 1115–30. 

96. Pechmann, C., and S. Ratneshwar. 1994. 

The effects of antismoking and cigarette 

advertising on young adolescents’ 

perceptions of peers who smoke. Journal of 

Consumer Research 21 (2): 236–51. 

97. Donovan, R. J., J. Jancey, and S. Jones. 2002. 

Tobacco point of sale advertising increases 

positive brand user imagery. Tobacco 

Control 11 (3): 191–94. 

98. Henriksen, L., J. A. Flora, E. Feighery, and 

S. P. Fortmann. 2002. Effects on youth 

exposure to retail tobacco advertising. 

Journal of Applied Social Psychology

32 (9): 1771–89. 

99. Pechmann, C., and S. J. Knight. 2002. 

An experimental investigation of the 

joint effects of advertising and peers 

on adolescents’ beliefs and intentions 

about cigarette consumption. Journal of 

Consumer Research 29 (1): 5–19. 

100. Hansen, W. B. 1983. Behavioral predictors 

of abstinence: Early indicators of a 

dependence on tobacco among adolescents. 

International Journal of Addiction 18 (7): 

913–20. 

101. Flay, B. R., J. R. D’Avernas, J. A. Best, 

M. W. Kersell, and K. B. Ryan. 1983. 

Cigarette smoking: Why young people do 

it and ways of preventing it. In Pediatric 

and adolescent behavioral medicine: Issues 

in treatment, Springer Series on Behavior 

Therapy and Behavioral Medicine 10, ed. 

P. J. McGrath and P. Firestone, 132–83. 

New York: Springer.

102. Palmer, R. F., J. H. Dwyer, and N. Semmer. 

1994. A measurement model of adolescent 

smoking. Addictive Behaviors 19 (5): 477–89. 

103. Choi, W. S., E. A. Gilpin, A. J. Farkas, 

and J. P. Pierce. 2001. Determining the 

probability of future smoking among 

adolescents. Addiction 96 (2): 313–23. 

104. Pierce, J. P., W. S. Choi, E. A. Gilpin, 

A. J. Farkas, and R. K. Merritt. 1996. 

Validation of susceptibility as a predictor of 

which adolescents take up smoking in the 

United States. Health Psychology 15 (5): 

355–61. 

105. Jackson, C. 1998. Cognitive susceptibility to 

smoking and initiation of smoking during 

childhood: A longitudinal study. Preventive 

Medicine 27 (1): 129–34. 

106. U.S. Department of Health and Human 

Services. 1989. Reducing the health 

consequences of smoking: 25 years of 

progress. A report of the Surgeon General

(DHHS publication no. [CDC] 89-8411). 

Rockville, MD: U.S. Department of Health 

and Human Services, Public Health Service, 

Centers for Disease Control, National Center 

for Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health. 

http://profiles.nlm.nih.gov/NN/B/B/X/S/.

107. Wakefield, M. A., E. E. Ruel, F. J. Chaloupka, 

S. J. Slater, and N. J. Kaufman. 2002. 

Association of point-of-purchase tobacco 

advertising and promotions with choice of 

usual brand among teenage smokers. Journal 

of Health Communication 7 (2): 113–21. 

108. Lam, T. H., S. F. Chung, C. L. Betson, 

C. M. Wong, and A. J. Hedley. 1998. Tobacco 

advertisements: One of the strongest risk 

factors for smoking in Hong Kong students. 

American Journal of Preventive Medicine

14 (3): 217–23. 

109. Maziak, W., P. Rzehak, U. Keil, and 

S. K. Weiland. 2003. Smoking among 

adolescents in Muenster, Germany: Increase 

in prevalence (1995–2000) and relation to 

tobacco advertising. Preventive Medicine

36 (2): 172–76. 

110. Aitken, P. P., D. R. Eadie, G. B. Hastings, 

and A. J. Haywood. 1991. Predisposing 

effects of cigarette advertising on children’s 

intentions to smoke when older. British 

Journal of Addiction 86 (4): 383–90. 

111. O’Connell, D. L., H. M. Alexander, 

A. J. Dobson, D. M. Lloyd, G. R. Hardes, 

H. J. Springthorpe, and S. R. Leeder. 

1981. Cigarette smoking and drug use 

in schoolchildren. 2. Factors associated 

with smoking. International Journal of 

Epidemiology 10 (3): 223–31. 

112. Sun, D., M. Anderson, A. Shah, and 

K. Julliard. 1998. Early adolescents’ 

perceptions of cigarette smoking: A crosssectional survey in a junior high school. 

Adolescence 33 (132): 805–10. 
287

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

113. Feighery, E., D. L. Borzekowski, C. Schooler, 

and J. Flora. 1998. Seeing, wanting, owning: 

The relationship between receptivity 

to tobacco marketing and smoking 

susceptibility in young people. Tobacco 

Control 7 (2): 123–28. 

114. Unger, J. B., T. B. Cruz, D. Schuster, 

J. A. Flora, and C. A. Johnson. 2001. 

Measuring exposure to pro- and antitobacco marketing among adolescents: 

Intercorrelations among measures and 

associations with smoking status. Journal 

of Health Communication 6 (1): 11–29. 

115. Ahsan, H., P. Underwood, and D. Atkinson. 

1998. Smoking among male teenagers in 

Dhaka, Bangladesh. Preventive Medicine

27 (1): 70–76. 

116. Aitken, P. P., and D. R. Eadie. 1990. 

Reinforcing effects of cigarette advertising 

on under-age smoking. British Journal of 

Addiction 85 (3): 399–412. 

117. Altman, D. G., D. W. Levine, R. Coeytaux, 

J. Slade, and R. Jaffe. 1996. Tobacco 

promotion and susceptibility to tobacco 

use among adolescents aged 12 through 

17 years in a nationally representative 

sample. American Journal of Public Health

86 (11): 1590–93. 

118. Aloise-Young, P. A., M. D. Slater, and 

C. C. Cruickshank. 2006. Mediators and 

moderators of magazine advertisement 

effects on adolescent cigarette smoking. 

Journal of Health Communication 11 (3): 

281–300. 

119. Borzekowski, D. L., J. A. Flora, E. Feighery, 

and C. Schooler. 1999. The perceived 

influence of cigarette advertisements and 

smoking susceptibility among seventh 

graders. Journal of Health Communication

4 (2): 105–18. 

120. Botvin, E. M., G. J. Botvin, J. L. Michela, 

E. Baker, and A. D. Filazzola. 1991. 

Adolescent smoking behavior and the 

recognition of cigarette advertisements. 

Journal of Applied Social Psychology

21 (11): 919–32. 

121. Botvin, G. J., C. J. Goldberg, E. M. Botvin, 

and L. Dusenbury. 1993. Smoking behavior of 

adolescents exposed to cigarette advertising. 

Public Health Reports 108 (2): 217–24. 

122. Braverman, M. T., and L. E. Aaro. 2004. 

Adolescent smoking and exposure to tobacco 

marketing under a tobacco advertising 

ban: Findings from 2 Norwegian national 

samples. American Journal of Public Health

94 (7): 1230–38. 

123. Carson, N. J., D. Rodriguez, and J. AudrainMcGovern. 2005. Investigation of 

mechanisms linking media exposure to 

smoking in high school students. Preventive 

Medicine 41 (2): 511–20. 

124. Chang, C. 2005. Personal values, 

advertising, and smoking motivation in 

Taiwanese adolescents. Journal of Health 

Communication 10 (7): 621–34. 

125. Chapman, S., and B. Fitzgerald. 1982. 

Brand preference and advertising recall in 

adolescent smokers: Some implications 

for health promotion. American Journal of 

Public Health 72 (5): 491–94. 

126. Chen, X., T. B. Cruz, D. V. Schuster, 

J. B. Unger, and C. A. Johnson. 2002. 

Receptivity to protobacco media and its 

impact on cigarette smoking among ethnic 

minority youth in California. Journal of 

Health Communication 7 (2): 95–111. 

127. Diaz, E., J. R. Villalbi, M. Nebot, J. Auba, 

and F. Sanz. 1998. [Smoking initiation in 

students: Cross-sectional and longitudinal 

study of predictive factors]. Medicina Clinica

110 (9): 334–39. 

128. Emri, S., T. Bagci, Y. Karakoca, and E. Baris. 

1998. Recognition of cigarette brand names 

and logos by primary schoolchildren in 

Ankara, Turkey. Tobacco Control 7 (4): 

386–92. 

129. Gilpin, E. A., J. P. Pierce, and B. Rosbrook. 

1997. Are adolescents receptive to current 

sales promotion practices of the tobacco 

industry? Preventive Medicine 26 (1): 14–21. 

130. Goldberg, M. E. 2003. American media and 

the smoking-related behaviors of Asian 

adolescents. Journal of Advertising Research

43 (1): 2–11. 

131. Goldstein, A. O., P. M. Fischer, J. W. Richards 

Jr., and D. Creten. 1987. Relationship 

between high school student smoking and 

recognition of cigarette advertisements. 

Journal of Pediatrics 110 (3): 488–91. 

132. Gunther, A. C., D. Bolt, D. L. G. Borzekowski, 

J. L. Liebhart, and J. P. Dillar. 2006. Presumed 

influence on peer norms: How mass media 

indirectly affect adolescent smoking. Journal 

of Communication 56 (1): 52–68. 

133. Hawkins, K., and A. C. Hane. 2000. 

Adolescents’ perceptions of print cigarette 

advertising: A case for counteradvertising. 

Journal of Health Communication 5 (1): 

83–96. 

134. Henriksen, L., E. C. Feighery, Y. Wang, and 

S. P. Fortmann. 2004. Association of retail 
288

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

tobacco marketing with adolescent smoking. 

American Journal of Public Health 94 (12): 

2081–83. 

135. Kaufman, N. J., B. C. Castrucci, P. D. Mowery, 

K. K. Gerlach, S. Emont, and C. T. Orleans. 

2002. Predictors of change on the smoking 

uptake continuum among adolescents. 

Archives of Pediatrics and Adolescent 

Medicine 156 (6): 581–87. 

136. Klitzner, M., P. J. Gruenewald, and 

E. Bamberger. 1991. Cigarette advertising 

and adolescent experimentation with 

smoking. British Journal of Addiction

86 (3): 287–98. 

137. Ledwith, F. 1984. Does tobacco sports 

sponsorship on television act as advertising 

to children? Health Education Journal

43 (4): 85–88. 

138. Maassen, I. T., S. P. Kremers, A. N. Mudde, 

and B. M. Joof. 2004. Smoking initiation 

among Gambian adolescents: Social 

cognitive influences and the effect of 

cigarette sampling. Health Education 

Research 19 (5): 551–60. 

139. MacFadyen, L., G. Hastings, and 

A. M. MacKintosh. 2001. Cross-sectional 

study of young people’s awareness of and 

involvement with tobacco marketing. 

British Medical Journal 322 (7285): 513–17. 

140. Meier, K. S. 1991. Tobacco truths: The impact 

of role models on children’s attitudes toward 

smoking. Health Education Quarterly 18 (2): 

173–82. 

141. Mowery, P. D., M. C. Farrelly, M. L. Haviland, 

J. M. Gable, and H. E. Wells. 2004. 

Progression to established smoking among 

US youths. American Journal of Public 

Health 94 (2): 331–37. 

142. Otake, K., and S. Shimai. 2002. Relationship 

between stages of smoking acquisition and 

environmental factors among junior high 

school students. Psychology Report 90 (1): 

257–61. 

143. Peters, J., C. L. Betson, A. J. Hedley, 

T. H. Lam, S. G. Ong, C. M. Wong, and 

R. Fielding. 1995. Recognition of cigarette 

brand names and logos by young children in 

Hong Kong. Tobacco Control 4 (2): 150–55. 

144. Pinilla, J., B. Gonzalez, P. Barber, and 

Y. Santana. 2002. Smoking in young 

adolescents: An approach with multilevel 

discrete choice models. Journal of 

Epidemiology and Community Health

56 (3): 227–32. 

145. Potts, H., P. Gillies, and M. Herbert. 1986. 

Adolescent smoking and opinion of cigarette 

advertisements. Health Education Research 

Theory and Practice 1 (3): 195–201. 

146. Sargent, J. D., M. Dalton, and M. Beach. 

2000. Exposure to cigarette promotions and 

smoking uptake in adolescents: Evidence of 

a dose-response relation. Tobacco Control

9 (2): 163–68. 

147. Sin, L. 1997. Cigarette advertising and 

juvenile smoking behaviour: A Hong Kong 

study. Singapore Management Review

19 (1): 47–60. 

148. Smith, K. H., and M. A. Stutts. 1999. Factors 

that influence adolescents to smoke. Journal 

of Consumer Affairs 33 (2): 321–57. 

149. Sovinova, H., and L. Csemy. 2004. Smoking 

behaviour of Czech adolescents: Results 

of the Global Youth Tobacco Survey in the 

Czech Republic, 2002. Central European 

Journal of Public Health 12 (1): 26–31. 

150. Straub, D. M., N. K. Hills, P. J. Thompson, 

and A. B. Moscicki. 2003. Effects of pro- and 

anti-tobacco advertising on nonsmoking 

adolescents’ intentions to smoke. Journal 

of Adolescent Health 32 (1): 36–43. 

151. Unger, J. B., and X. Chen. 1999. The role 

of social networks and media receptivity 

in predicting age of smoking initiation: 

A proportional hazards model of risk and 

protective factors. Addictive Behaviors

24 (3): 371–81. 

152. Pierce, J. P., J. M. Distefan, R. M. Kaplan, 

and E. A. Gilpin. 2005. The role of curiosity 

in smoking initiation. Addictive Behaviors

30 (4): 685–96. 

153. Alexander, H. M., R. Callcott, A. J. Dobson, 

G. R. Hardes, D. M. Lloyd, D. L. O’Connell, 

and S. R. Leeder. 1983. Cigarette smoking 

and drug use in schoolchildren: 4. Factors 

associated with changes in smoking 

behaviour. International Journal of 

Epidemiology 12 (1): 59–66. 

154. Armstrong, B. K., N. H. de Klerk, 

R. E. Shean, D. A. Dunn, and P. J. Dolin. 

1990. Influence of education and 

advertising on the uptake of smoking by 

children. Medical Journal of Australia

152 (3): 117–24. 

155. Biener, L., and M. Siegel. 2000. Tobacco 

marketing and adolescent smoking: More 

support for a causal inference. American 

Journal of Public Health 90 (3): 407–11. 

156. Charlton, A., and V. Blair. 1989. Predicting 

the onset of smoking in boys and girls. 

Social Science and Medicine 29 (7): 

813–18. 
289

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

157. Choi, W. S., J. S. Ahluwalia, K. J. Harris, 

and K. Okuyemi. 2002. Progression to 

established smoking: The influence of 

tobacco marketing. American Journal of 

Preventive Medicine 22 (4): 228–33. 

158. Gilpin, E. A., M. M. White, K. Messer, and 

J. P. Pierce. 2007. Receptivity to tobacco 

advertising and promotions among young 

adolescents as a predictor of established 

smoking in young adulthood. American 

Journal of Public Health 97 (8): 1489–95. 

159. Lopez, M. L., P. Herrero, A. Comas, I. Leijs, 

A. Cueto, A. Charlton, W. Markham, and 

H. de Vries. 2004. Impact of cigarette 

advertising on smoking behaviour in 

Spanish adolescents as measured using 

recognition of billboard advertising. 

European Journal of Public Health 14 (4): 

428–32. 

160. Pierce, J. P., W. S. Choi, E. A. Gilpin, 

A. J. Farkas, and C. C. Berry. 1998. Tobacco 

industry promotion of cigarettes and 

adolescent smoking. JAMA: The Journal of 

the American Medical Association 279 (7): 

511–15. 

161. Pierce, J. P., J. M. Distefan, C. Jackson, 

M. M. White, and E. A. Gilpin. 2002. Does 

tobacco marketing undermine the influence 

of recommended parenting in discouraging 

adolescents from smoking? American 

Journal of Preventive Medicine 23 (2): 

73–81. 

162. Pucci, L. G., and M. Siegel. 1999. Exposure 

to brand-specific cigarette advertising in 

magazines and its impact on youth smoking. 

Preventive Medicine 29 (5): 313–20. 

163. Sargent, J. D., M. Dalton, M. Beach, 

A. Bernhardt, T. Heatherton, and M. Stevens. 

2000. Effect of cigarette promotions on 

smoking uptake among adolescents. 

Preventive Medicine 30 (4): 320–27. 

164. Weiss, J. W., S. Cen, D. V. Schuster, 

J. B. Unger, C. A. Johnson, M. Mouttapa, 

W. S. Schreiner, and T. B. Cruz. 2006. 

Longitudinal effects of pro-tobacco and antitobacco messages on adolescent smoking 

susceptibility. Nicotine & Tobacco Research

8 (3): 455–65. 

165. While, D., S. Kelly, W. Huang, and 

A. Charlton. 1996. Cigarette advertising and 

onset of smoking in children: Questionnaire 

survey. British Medical Journal 313 (7054): 

398–99. 

166. Smith, R. E., and W. R. Swinyard. 1988. 

Cognitive response to advertising and 

trial: Belief strength, belief confidence and 

product curiosity. Journal of Advertising

17 (3): 3–14. 

167. Wells, W., J. Burnett, and S. Moriarty. 1999. 

Advertising: Principles and practice. 5th ed. 

Upper Saddle River, NJ: Prentice Hall.

168. Berlyne, D. E. 1954. A theory of human 

curiosity. British Journal of Psychology

45:180–91. 

169. Berlyne, D. E. 1960. Conflict, arousal and 

curiosity. New York: McGraw-Hill.

170. Feighery, E., K. Ribisl, N. Shleicher, and 

S. Halvorson. 2001. Cigarette advertising 

and promotional strategies in retail outlets: 

Results of a statewide survey in California. 

Tobacco Control 10 (1): 184–88. 

171. Federal Trade Commission. 2005. Federal 

Trade Commission report to Congress 

for 2003. Washington, DC: Federal Trade 

Commission. http://www.ftc.gov/reports/

index.shtm.

172. Schonfeld and Associates. 1998. Advertising 

ratios and budgets. Riverwood, IL: Schonfeld 

and Associates.

173. Sasieni, M. W. 1989. Optimal advertising 

strategy. Marketing Research 8 (4): 358–70. 

174. Tull, D. S., V. R. Wood, D. Duhan, 

T. Gillpatrick, K. R. Robertson, and 

J. G. Helgeson. 1986. “Leveraged” decision 

making in advertising: The flat maximum 

principle and its implications. Journal of 

Marketing Research 23 (1): 25–32. 

175. Lodish, L. M., M. Abraham, S. Kalmenson, 

J. Livelsberger, B. Lubetkin, B. Richardson, 

and M. E. Stevens. 1995. How T.V. 

advertising works: A meta-analysis of 

389 real world split cable T.V. advertising 

experiments. Journal of Marketing Research

32 (2): 125–39. 

176. Boyd, R. G., and B. Seldon. 1990. The 

fleeting effect of advertising: Empirical 

evidence from a case study. Economic 

Letters 31 (4): 375–79. 

177. Saffer, H., and F. Chaloupka. 2000. The effect 

of tobacco advertising bans on tobacco 

consumption. Journal of Health Economics

19 (6): 1117–37. 

178. Duffy, M. 1996. Econometric studies of 

advertising, advertising restrictions, and 

cigarette demand: A survey. International 

Journal of Advertising 15 (1): 1–23. 

179. Schmalensee, R. L. 1972. On the economics 

of advertising. Amsterdam: North Holland: 

180. Hamilton, J. L. 1972. The demand for 

cigarettes: Advertising, the health scare, 
290

7 . I n f l u e n c e o f To b a c c o M a r k e t i n g o n S m o k i n g B e h a v i o r

and the cigarette advertising ban. Review of 

Economics and Statistics 54 (4): 401–11. 

181. McGuinness, T., and K. Cowling. 1975. 

Advertising and the aggregate demand for 

cigarettes. European Economic Review

6 (3): 311–28. 

182. Grabowski, H. G. 1976. The effect of 

advertising on the interindustry distribution 

of demand. Explorations in Economic 

Research 3 (1): 21–75. 

183. Schneider, L., B. Klein, and K. M. Murphy. 

1981. Government regulation of cigarette 

health information. Journal of Law and 

Economics 24 (3): 575–612. 

184. Bishop, J. A., and J. H. Yoo. 1985. “Health 

scare,” excise taxes and advertising ban in 

the cigarette demand and supply. Southern 

Economic Journal 52 (2): 402–11. 

185. Abernethy, A. M., and J. E. Teel. 1986. 

Advertising regulation’s effect upon demand 

for cigarettes. Journal of Advertising 15 (4): 

51–55. 

186. Baltagi, B. H., and D. Levin. 1986. 

Estimating dynamic demand for cigarettes 

using panel data: The effects of bootlegging, 

taxation and advertising reconsidered. 

Review of Economics and Statistics 68 (1): 

148–55. 

187. Johnson, L. W. 1986. Advertising expenditure 

and aggregate demand for cigarettes 

in Australia. International Journal of 

Advertising 5 (1): 45–58. 

188. Porter, R. H. 1986. The impact of 

government policy on the U.S. cigarette 

industry. In Empirical approaches 

to consumer protection economics 

(conference volume), ed. P. M. Ippolito and 

D. T. Scheffman, 447–84. Washington, DC: 

U.S. Government Printing Office.

189. Chetwynd, J., P. Coope, R. J. Brodie, 

and E. Wells. 1988. Impact of cigarette 

advertising on aggregate demand for 

cigarettes in New Zealand. British Journal 

of Addiction 83 (4): 409–14. 

190. Seldon, B. J., and K. Doroodian. 1989. 

Simultaneous model of cigarette 

advertising: Effects on demand and industry 

response to public policy. Review of 

Economics and Statistics 71 (4): 673–77. 

191. Wilcox, G. B., and B. Vacker. 1992. Cigarette 

advertising and consumption in the 

United States: 1961–1990. International 

Journal of Advertising 11 (3): 269–78. 

192. Valdes, B. 1993. Cigarette consumption in 

Spain: Empirical evidence and implications 

for public health policy. Applied Economics

25 (2): 149–56. 

193. Duffy, M. 1995. Advertising in demand 

systems for alcoholic drinks and tobacco: 

A comparative study. Journal of Policy 

Modeling 17 (6): 557–67. 

194. Lewit, E. M., D. Coate, and M. Grossman. 

1981. Effects of government regulation 

on teenage smoking. Journal of Law and 

Economics 24:545–73. 

195. Roberts, M. J., and L. Samuelson. 1988. 

An empirical analysis of dynamic, nonprice 

competition in an oligopolistic industry. 

RAND Journal of Economics 19:200–220. 

196. Goel, R. K., and M. J. Morey. 1995. The 

interdependence of cigarette and liquor 

demand. Southern Economic Journal

62 (2): 451–59. 

197. Hamilton, J. L. 1975. The effect of cigarette 

advertising bans on cigarette consumption. 

In Health consequences, education, 

cessation activities, and governmental 

action, vol. 2. Proceedings of the Third 

World Conference on Smoking and Health

(DHEW [NIH] 77-1413), ed. J. Steinfeld, 

W. Griffiths, K. Ball, and R. M. Taylor, 

829–49. Washington, DC: U.S. Department 

of Health, Education, and Welfare.

198. Laugesen, M., and C. Meads. 1991. Tobacco 

advertising restrictions, price, income and 

tobacco consumption in OECD countries, 

1960–1986. British Journal of Addiction

86 (10): 1343–54. 

199. Stewart, M. J. 1993. The effect on tobacco 

consumption of advertising bans in 

OECD countries. International Journal of 

Advertising 12 (2): 155–80. 

200. Saffer, H. 2000. Tobacco advertising and 

promotion. In Tobacco control in developing 

countries, ed. P. Jha and F. J. Chaloupka, 

215–36. New York: Oxford Univ. Press.

201. Boddewyn, J., ed. 1986. Tobacco advertising 

bans and consumption in 16 countries.

New York: International Advertising 

Association.

202. Andrews, R. L., and G. R. Franke. 1991. 

Determinants of cigarette consumption: 

A meta-analysis. Journal of Public Policy 

and Marketing 10 (1): 81–100. 

203. Smee, C., M. Parsonage, R. Anderson, and 

S. Duckworth. 1992. Effect of tobacco 

advertising on tobacco consumption: A 

discussion document reviewing the evidence.

London: Department of Health, Economics 

and Operational Research Division.
291

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

204. Lancaster, K. M., and A. Lancaster. 2003. 

The economics of tobacco advertising: 

Spending, demand, and the effect of bans. 

International Journal of Advertising 22 (1): 

41–65. 

205. Keeler, T., T.-W. Hu, M. Ong, and H.-Y. Sung. 

2004. The U.S. national tobacco settlement: 

The effects of advertising and price 

changes on cigarette consumption. Applied 

Economics 36 (15): 1623–29. 

206. Nelson, J. P. 2006. Cigarette advertising 

regulation: a meta-analysis. International 

Review of Law and Economics 26(2): 

195–226.

207. Davis, R. M. 2008. British American Tobacco 

ghost-wrote reports on tobacco advertising 

bans by the International Advertising 

Association and JJ Boddewyn. Tobacco 

Control 17 (3): 211–14.

208. Erratum to “Cigarette advertising 

regulation: A meta-analysis” NEED 

Publication Data.

209. Pierce, J. P., and E. A. Gilpin. 1995. 

A historical analysis of tobacco marketing 

and the uptake of smoking by youth in 

the United States: 1890–1977. Health 

Psychology 14 (6): 500–508. 

210. Pierce, J. P., L. Lee, and E. A. Gilpin. 1994. 

Smoking initiation by adolescent girls, 

1944 through 1988: An association with 

targeted advertising. JAMA: The Journal of 

the American Medical Association 271 (8): 

608–11. 

211. Gilpin, E. A., and J. P. Pierce. 1997. Trends 

in adolescent smoking initiation in the 

United States: Is tobacco marketing an 

influence? Tobacco Control 6 (2): 122–27. 

212. Cummings, K. M., and D. Shah. 1995. Trends 

in smoking initiation among adolescents and 

young adults—United States, 1980–1989. 

Morbidity and Mortality Weekly Report 44 

(28): 521–25. 

213. Redmond, W. H. 1999. Effects of sales 

promotion on smoking among U.S. ninth 

graders. Preventive Medicine 28 (3): 243–50. 

214. Reed, M. B., C. M. Anderson, and 

D. M. Burns. 2006. The temporal 

relationship between advertising and sales 

of low-tar cigarettes. Tobacco Control 15 

(6): 436–41.

293

8

Legal and Constitutional 

Perspectives on Tobacco 

Marketing Restrictions

Policy interventions for tobacco control have moved increasingly toward strong limitations 

on tobacco marketing. Steps in this direction include legislative and regulatory efforts by 

governmental agencies in the United States and other countries and a comprehensive ban 

on tobacco advertising, promotion, and sponsorship incorporated into the World Health 

Organization’s Framework Convention on Tobacco Control (WHO FCTC). This chapter 

explores the legal and constitutional issues presented by such restrictions, highlighted by 

discussions of controls imposed by the U.S. Federal Cigarette Labeling and Advertising 

Act, regulatory efforts by agencies including the U.S. Food and Drug Administration and 

Federal Trade Commission, and attempts at widespread promotional bans in Canada and 

the European Union.

Constitutional protection of commercial speech in the United States has been a major 

impediment to enacting a complete ban on tobacco advertising and promotion, and 

implementation of the WHO FCTC is subject to the constitutional frameworks of 

countries that are parties to the treaty. Nonetheless, the scope of such restrictions has 

continued to grow and evolve, with future limits remaining a matter of continuing legal 

and policy debate.
294

8 . L e g a l a n d C o n s t i t u t i o n a l P e r s p e c t i v e s

Introduction

This chapter examines the legal and 

constitutional issues affecting regulatory 

efforts aimed at tobacco marketing and 

promotion. Such efforts have expanded 

over time in response to public health 

concerns about the content and outcomes 

of tobacco product marketing and have 

become an important component of tobacco 

control policy interventions. As the scope of 

marketing restrictions broadens, important 

questions arise about balancing the public’s 

interest with the right to free speech and 

about the allowable scope of regulatory and 

legislative efforts. This chapter explores 

these issues within the framework of existing 

protections for commercial speech, the efforts 

of regulatory agencies, and legal precedents 

in the United States and elsewhere.

Chapter 3 examines the arguments for 

increased regulation of tobacco marketing 

and promotion. These issues include 

the health consequences of tobacco use, 

deceptive or misleading promotional tactics, 

the failure of tobacco industry efforts to 

self-regulate its marketing practices, and 

the ineffectiveness of partial restrictions on 

tobacco advertising and promotion. Effective 

global policies that respond to these concerns 

must consider the legal and constitutional 

framework of each country involved.

In response to the global health impact 

of tobacco promotion, the World Health 

Organization (WHO) called on countries 

to undertake a comprehensive ban of all 

tobacco promotion, in accordance with each 

country’s respective constitution, as part 

of the Framework Convention on Tobacco 

Control (FCTC). This chapter focuses on 

the United States but also illustrates and 

summarizes relevant regulatory actions and 

legal rulings in Canada, due to its proximity 

to the United States, and in the European 

Union (EU) because of the importance of 

regional developments taking place there.

Constitutional, 

Statutory, and 

Regulatory 

Perspectives

In the United States, constitutional and 

statutory provisions have impeded efforts 

to restrict tobacco advertising. First, 

there is a strong tradition of protecting 

free speech. The First Amendment to the 

U.S. Constitution prohibits the government 

from “abridging the freedom of speech.”1

Since the mid-1970s, the U.S. Supreme 

Court has increasingly interpreted this 

provision to include “commercial” speech, 

meaning speech solely intended to sell 

products or services. Although the Supreme 

Court initially afforded commercial speech 

a low level of constitutional protection, in 

recent years it has imposed strict limits on 

governmental interference with advertising.

Other constitutional and statutory 

constraints have similarly impeded efforts 

to warn consumers about the health 

hazards of smoking and to limit advertising. 

The Federal Cigarette Labeling and 

Advertising Act (FCLAA),2 which requires 

cigarette packs to contain specific health 

warnings, also contains language preempting 

state and local governments from imposing 

additional warnings on cigarette packs. 

The enactment by Congress of the FCLAA 

was also one basis for the Supreme Court’s 

conclusion that the U.S. Food and Drug 

Administration (FDA) lacks jurisdiction 

to regulate tobacco products. Finally, 

even when the government has had some 

authority to regulate advertising, such as the 

Federal Trade Commission’s (FTC’s) mandate 

to prohibit false and misleading advertising, 

political and other pressures appear to have 

limited the exercise of that authority.3

This chapter describes legal constraints, 

both constitutional and statutory, on the 
295

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

regulation of tobacco advertising and 

promotion in the United States, compares 

them to constraints on advertising 

restrictions in selected other countries, and 

discusses approaches that would more likely 

be consistent with current legal doctrine.

The First Amendment Framework

Evolution of Commercial Speech 

Protection

The First Amendment to the U.S. 

Constitution provides that “Congress 

shall make no law ... abridging the 

freedom of speech, or of the press.”(n.1) 1

The First Amendment constrains the federal 

government from suppressing speech 

by private citizens, even if the subject 

matter is factually wrong or offensive.4

(The same constraints are placed on states 

through the Fourteenth Amendment.) 

While government may, consistent with 

the First Amendment, exert some control 

as to the physical and temporal attributes 

of speech—so-called time, place, and 

manner restrictions(n.2) 5—it generally may 

not prohibit communications on the basis 

of their content.6 The general prohibition 

on content-based restrictions of speech 

applies equally to speech concerning 

matters of public health. In other words, 

the potentially detrimental effect of a 

particular communication on the health of 

an individual or population in and of itself 

is not considered a legitimate basis for 

government suppression.7

Several rationales are offered for such 

broad protection of free speech. Freedom 

of expression is thought to advance the 

values of (1) individual self-fulfillment, 

(2) attainment of the truth, (3) societal 

participation in social and political decision 

making, and (4) maintaining a balance 

between stability and change within 

society.8 The second value, that of truth, 

has been encapsulated in the metaphor 

of a “marketplace of ideas.”5,9,10 In his 

1919 dissent in Abrams v. United States,

Justice Oliver Wendell Holmes, citing 

John Stuart Mill, states that

when men have realized that time has 

upset many fighting faiths, they may 

come to believe ... that the ultimate good 

desired is better reached by free trade in 

ideas—that the best test of truth is the 

power of the thought to get itself accepted 

in the competition of the market.10(p.630)

Under the marketplace rationale, permitting 

unfettered expression exposes false ideas to 

debate and rejection while permitting truth 

to be discovered. As Mill states, 

the peculiar evil of silencing the expression 

of an opinion is, that it is robbing the 

human race; posterity as well as the 

existing generation; those who dissent 

from the opinion, still more than those 

who hold it. If the opinion is right, they are 

deprived of the opportunity of exchanging 

error for truth: if wrong, they lose, what 

is almost as great a benefit, the clearer 

perception and livelier impression of truth, 

produced by its collision with error.11

Certain classes of speech have, however, been 

categorically excluded from First Amendment 

protection. The exclusions have come, not 

from the text of the First Amendment itself, 

but from Supreme Court interpretations 

thereof. In Chaplinsky v. New Hampshire,12

the Court opines, “There are certain welldefined and narrowly limited classes of 

speech, the prevention and punishment of 

which have never been thought to raise any 

Constitutional problem.”12(pp.571–72) The Court 

lists these categories as “the lewd and 

obscene, the profane, the libelous, and the 

insulting or ‘fighting’ words.”12(p.572) From this 

and other cases, the following categories of 

speech have been historically excluded from 

First Amendment protection: (1) obscenity, 

(2) fighting words, (3) incitement, and 

(4) defamation.13 In contrast to political, 
296

8 . L e g a l a n d C o n s t i t u t i o n a l P e r s p e c t i v e s

social, or artistic expressions, these excluded 

categories of speech are considered to 

constitute “no essential part of any exposition 

of ideas, and are of such slight social 

value as a step to truth that any benefit 

that may be derived from them is clearly 

outweighed by the social interest in order 

and morality.”12(p.572) In Texas v. Johnson,14

however, the Court struck down a law 

prohibiting flag desecration, holding that 

such conduct could not be construed as 

fighting words.

Until relatively recently, the Supreme Court 

found that speech relating to commercial 

transactions and activities—what has 

become known as “commercial speech”—

was also categorically excluded from 

First Amendment protection.(n.3) In the 1942 

case Valentine v. Chrestensen,15 which was 

decided shortly after Chaplinsky, the Court 

upheld an ordinance prohibiting the use of 

city streets for “commercial and business 

advertising matter.”15(p.53)

The Supreme Court did not revisit the 

issue again for more than 30 years. In the 

1975 case Bigelow v. Virginia,9 however, 

the Court struck down an ordinance that 

would have prohibited a newspaper from 

carrying an advertisement informing the 

public that abortions were legal in New York 

and offering assistance in obtaining 

abortion services. The Court held that 

“speech is not stripped of First Amendment 

protection merely because it appears”9(p.818)

in the form of a paid commercial 

advertisement. The Court limited the effect 

of Chrestensen, stating that the case did 

not provide “authority for the proposition 

that all statutes regulating commercial 

advertising are immune from constitutional 

challenge”9(p.820) and “does not support any 

sweeping proposition that advertising is 

unprotected per se.”9(p.820)

The Bigelow decision involved advertising 

solely for abortion services, which the 

Supreme Court viewed as speech that 

“conveyed information of potential interest 

and value to a diverse audience—not only 

to readers possibly in need of the services 

offered.”9(p.822) In the following year, however, 

the Court confronted head on the issue of 

“pure” commercial advertising. In Virginia 

Pharmacy Board v. Virginia Citizens 

Consumer Council,16 the Court struck down 

a Virginia law prohibiting pharmacists 

from advertising the prices of prescription 

drugs. The state argued that the restriction 

was necessary to protect consumers, 

since permitting price advertising 

would undermine the professionalism of 

pharmacists and jeopardize the customerpharmacist relationship. By allowing 

pharmacists to compete as to price in 

advertising, the state feared that the quality 

of pharmacists’ service to customers would 

decline, to the customers’ detriment. 

The Court, after acknowledging that its 

holding in Chrestensen had “all but passed 

from the scene,”16(p.759) formally recognized 

that commercial speech (i.e., speech that 

does “no more than propose a commercial 

transaction”)16(p.762) is protected by the 

First Amendment. The Court noted the 

important interests furthered by commercial 

speech. “As to the particular consumer’s 

interest in the free flow of commercial 

information, that interest may be as keen, 

if not keener by far, than his interest in the 

day’s most urgent political debate.”16(p.763)

With respect to pharmaceutical price 

advertising specifically, the Court noted that 

those whom the suppression of 

prescription drug price information hits 

the hardest are the poor, the sick, and 

particularly the aged. A disproportionate 

amount of their income tends to be spent 

on prescription drugs; yet they are the 

least able to learn, by shopping from 

pharmacist to pharmacist, where their 

scarce dollars are best spent.16(p.763)

Responding to the state’s concerns that 

consumers would choose low-cost, lowquality pharmacy services, the Court states
297

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

There is, of course, an alternative to 

this highly paternalistic approach. 

That alternative is to assume that this 

information is not in itself harmful, 

that people will perceive their own best 

interests if only they are well enough 

informed, and that the best means 

to that end is to open the channels 

of communication rather than to 

close them.16(p.770)

The Court concluded that the state could 

not suppress truthful information about a 

lawful activity solely because of its concerns 

about the effect of the information on the 

disseminators and the recipients of that 

information.

Notwithstanding its recognition of the 

value of commercial speech that warranted 

First Amendment protection, the Court 

nevertheless notes factors that distinguish 

commercial speech from other types of 

protected speech. First, whether commercial 

speech is truthful “may be more easily 

verifiable by its disseminator”16(p.772) than 

other types of speech, since the advertiser 

is in a position to know about the product. 

Second, commercial speech is less likely 

to be stifled by government regulation 

because the speaker is motivated to speak 

by the opportunity for commercial profit. 

Thus, “the greater objectivity and hardiness 

of commercial speech ... may make it less 

necessary to tolerate inaccurate statements 

for fear of silencing the speaker.”16(p.772)

Central Hudson Gas & Electric 

Corporation

Following the Virginia Pharmacy Board

case, the Supreme Court considered 

commercial speech in a variety of 

contexts,17,18 including lawyer and other 

professional advertising.19–22 Through these 

cases, the Court formalized its commercial 

speech doctrine, which was articulated 

in the 1980 case Central Hudson Gas & 

Electric Corporation v. Public Service 

Commission.23

In Central Hudson, the Court laid out a 

four-part balancing test for determining 

whether a particular government restriction 

of commercial speech comported with the 

First Amendment. Under this test, a court 

must first determine whether the speech 

being restricted is misleading or concerns 

an unlawful activity.23 Only speech that 

is truthful and relates to a lawful activity 

merits First Amendment protection. 

Assuming this first criterion is satisfied, 

the second prong of the test imposes a 

burden on the government to demonstrate 

that it has a substantial interest in 

restricting the speech at issue.23 Third, the 

restriction must directly advance the state 

interest involved. Restrictions that provide 

only “ineffective or remote support for 

the government’s purpose”23(p.564) will not 

be upheld. Finally, the restriction must 

not be more restrictive than necessary 

to achieve the governmental interest.23

This step examines the “fit” between the 

interest and the means chosen to achieve 

it.23 The government must show, not merely 

that its regulation directly advances an 

important objective, but also that the means 

used are not more extensive than necessary 

to achieve that goal.(n.4) 23

Although some Supreme Court justices 

have advocated eliminating any variation 

in the level of protection afforded truthful 

commercial speech and fully protected 

or “core speech,”(n.5) 7,24 the Court has 

reaffirmed the Central Hudson test. 

What has changed, however, is the rigor 

with which some justices have applied the 

test, particularly the test’s third and fourth 

prongs.(n.6) 25,26 In earlier cases the Court had 

accepted a variety of restrictions to directly 

advance the state’s interest in a manner that 

was not unduly restrictive.(n.7) 27 In recent 

years the Court, although often divided, has 

imposed a much higher burden of proof on 
298

8 . L e g a l a n d C o n s t i t u t i o n a l P e r s p e c t i v e s

the government to link the ends sought with 

the means used.(n.8) 24,28

In Lorillard v. Reilly,7 for example, the 

Supreme Court struck down a Massachusetts 

regulation that prohibited the advertising 

of cigarettes, cigars, and smokeless tobacco 

products within 1,000 feet of any school 

or playground. Six members of the Court 

were satisfied that the state’s interest 

was directly advanced by the restrictions 

on outdoor cigar and smokeless tobacco 

advertising,(n.9) 7 thus meeting the third 

standard in Central Hudson. However, 

five members of the Court held that the 

1,000-foot rule was more extensive than 

necessary to serve the state’s interests, 

thus failing to satisfy the fourth step of 

Central Hudson. Specifically, they found 

that the attorney general did not “carefully 

calculate the costs and benefits associated 

with the burden on speech imposed by the 

regulations”7(p.561) (internal punctuation 

omitted). For example, they stated that 

the attorney general did not consider the 

impact of the restriction in metropolitan 

areas, which would be greater than in rural 

areas: “The uniformly broad sweep of the 

geographical limitation demonstrates a 

lack of tailoring.”7(p.563) Although, in the 

Court’s opinion, “[a] careful calculation 

of the costs of a speech regulation does 

not mean that a State must demonstrate 

that there is no incursion on legitimate 

speech interests,” the state “cannot unduly 

impinge on the speaker’s ability to propose 

a commercial transaction and the adult 

listener’s opportunity to obtain information 

about products.”7(p.565) The state’s interest in 

protecting children was insufficient, in the 

Court’s opinion, to completely override the 

legitimate interests of tobacco retailers to 

convey to adults truthful information about 

their products and the choice of adults to 

receive such information.

In Thompson v. Western States Medical 

Center,29 a six-member majority of the 

Court struck down a provision of the Food 

and Drug Administration Modernization 

Act (FDAMA) of 199729 that would have 

prohibited pharmacists from advertising 

compounded drugs.(n.10) 29,30 The FDA 

argued that the restriction on advertising 

was necessary to balance the interest in 

providing compounded drugs to those 

patients who require them with the 

need to preserve the integrity of the new 

drug approval process by ensuring that 

compounding remains on a small scale. 

Although the Court agreed that the 

government’s objective was substantial 

and that the means chosen might directly 

achieve the objective, it concluded that the 

FDA had not shown its methods were no 

more extensive than necessary. The Court 

noted that several alternatives to restricting 

speech could have been used to draw a 

line between compounding and large-scale 

manufacturing, such as by limiting the 

number of compounded drugs sold by a 

particular pharmacist or pharmacy or by 

prohibiting the use of commercial-scale 

equipment to compound drugs. According 

to the Court,

The Government simply has not 

provided sufficient justification here. 

If the First Amendment means anything, 

it means that regulating speech must 

be a last—not first—resort. Yet here it 

seems to have been the first strategy the 

Government thought to try.29(p.373)

Compelled Commercial Speech 

Just as the First Amendment protects 

the right to speak, it protects the right to 

refrain from speaking. The Supreme Court 

has articulated two complementary 

rationales for affording First Amendment 

protection against compelled speech. 

First, to compel a person to enunciate 

a view in which he or she does not 

believe violates freedom of conscience 

or belief.31 This reasoning was used to 

invalidate state laws making flag salute 

and the pledge of allegiance compulsory32
299

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

or requiring automobile owners to 

display license plates carrying the state 

motto “Live Free or Die.”33 Second, 

government-compelled speech may deter 

the speaker from expressing his or her 

own views.31 The Court struck down state 

laws prohibiting anonymous handbills34 and 

campaign literature35 because these laws 

discouraged a person’s underlying right to 

publish and disseminate his or her work. 

The Supreme Court’s compelled-speech 

jurisprudence is concerned principally with 

political and social discourse as opposed to 

product health and safety.(n.11) 36 However, 

in United States v. United Foods, Inc.,37 the 

Court makes clear that its compelled speech 

doctrine applies to commercial speech.(n.12)

In that case, the Court held that a federal 

statute requiring mushroom producers and 

importers to pay for generic advertising 

promoting the mushroom industry is 

coerced speech: “First Amendment values 

are at serious risk if the government can 

compel ... [citizens to subsidize speech] 

on the side that it favors.”(n.13) 37(p.411)

Lower courts have also grappled with 

the circumstances under which the 

government may compel disclosures in 

the commercial context. In International 

Dairy Foods Association v. Amestoy,38

dairy manufacturers challenged a Vermont 

law that required labeling of products 

from cows treated with recombinant 

bovine somatotropin (rBST, a synthetic 

growth hormone that increases milk 

production). The federal court of appeals 

analyzed the regulation under Central 

Hudson, concluding that the asserted 

government interest (“consumer curiosity”) 

was insufficiently strong to justify the 

regulation. 

In other circumstances, lower courts 

have viewed compelled disclosure as 

preferable to an outright ban on speech. 

In Pearson v. Shalala, the D.C. Circuit Court 

struck down an FDA regulation requiring 

prior approval of “health claims” for 

dietary supplements (i.e., claims on 

labels linking the use of the supplement 

to prevention of a particular disease or 

condition).(n.14) 39 The FDA required that 

such claims be supported by “significant 

scientific agreement,” a standard defined 

and enforced by the agency.(n.15) 39 The court 

held that the significant scientific agreement 

standard was unconstitutional because it 

precluded manufacturers from making 

claims having less scientific support in 

conjunction with a disclaimer, stating, 

It is clear ... that when government 

chooses a policy of suppression over 

disclosure—at least where there is no 

showing that disclosure would not suffice 

to cure misleadingness—government 

disregards a “far less restrictive” 

means.39(p.658)

Misleading Speech

The first prong of the Central Hudson

test makes clear that First Amendment 

protection will be afforded only to truthful 

commercial speech about a lawful activity. 

Commercial speech that is misleading, 

deceptive, or untruthful or that concerns 

illegal activity is outside the protection of 

the First Amendment. As the Supreme Court 

explained in Rubin v. Coors Brewing Co.,

Not only does regulation of inaccurate 

commercial speech exclude little truthful 

speech from the market, but false or 

misleading speech in the commercial 

realm also lacks the value that sometimes 

inheres in false or misleading political 

speech. Transaction-driven speech usually 

does not touch on a subject of public 

debate, and thus misleading statements 

in that context are unlikely to engender 

the beneficial public discourse that flows 

from political controversy. Moreover, the 

consequences of false commercial speech 

can be particularly severe: Investors 

may lose their savings, and consumers 
300

8 . L e g a l a n d C o n s t i t u t i o n a l P e r s p e c t i v e s

may purchase products that are more 

dangerous than they believe or that do 

not work as advertised. Finally, because 

commercial speech often occurs in the 

place of sale, consumers may respond 

to the falsehood before there is time for 

more speech and considered reflection to 

minimize the risks of being misled.28(p.496)

However, the Supreme Court has provided 

little guidance to aid in a determination 

of what is misleading commercial 

speech. For the most part, cases decided 

by the Court have involved challenges 

to government restrictions of speech 

acknowledged by both sides to be truthful. 

In a few instances, mostly involving 

professional advertising, the Court has 

addressed contentions by the government 

that certain types of advertising will mislead 

consumers.(n.16) 40–42 These opinions have 

not, however, dealt in depth with what 

factors should be used to assess whether a 

particular communication is deceptive or 

misleading.31 The Court has indicated that 

even when speech is potentially misleading, 

the remedy is additional disclosure, such 

as mandated warning labels, and not a 

categorical ban.(n.17)

Impact of the Supreme Court on 

Tobacco Advertising Restrictions

The Supreme Court’s jurisprudence has 

created a difficult dilemma for public health 

authorities. Narrowly tailored restrictions on 

tobacco advertising, while more defensible 

under the fourth (“reasonable fit”) prong 

of Central Hudson, are at the same time 

less likely to generate the type of concrete 

evidence of effectiveness necessary for 

the third prong’s “direct advancement” 

requirement. More sweeping restrictions, on 

the other hand, while more likely to advance 

the government’s objective of deterring 

tobacco use (see chapter 7), are less likely to 

satisfy the narrowly tailored requirement. 

Thus, the Court’s rulings create a conundrum 

for public health authorities seeking to 

craft tobacco advertising restrictions that 

are both demonstrably effective and likely 

to be deemed constitutional by the current 

Supreme Court.43

Although some advocates believe that 

focused and tailored advertising bans clearly 

aimed at preventing youth tobacco use 

could still be implemented consistent with 

Supreme Court jurisprudence,44 achieving 

this would be an uphill battle, at the very 

least. The only area in which bans have been 

held constitutional has been in electronic 

media; this historical anomaly is viewed 

by some observers as both constitutionally 

suspect and unlikely to be repeated.(n.18)

One avenue that remains largely unexplored 

could theoretically enable public health 

advocates to effect consumer protection 

consistent with First Amendment 

constraints. The Court has consistently 

stated that speech must be truthful and 

nonmisleading to receive First Amendment 

protection, but, as stated above, the Court 

has not examined manufacturers’ obligations 

under this requirement. As might be inferred 

from the “Misleading Speech” section above, 

many cigarette advertisements could be 

considered deceptive or misleading because 

of implied health claims. In addition, it is 

arguable that tobacco advertisements, to the 

extent that they fail to disclose the serious 

health hazards associated with use of the 

products, are deceptive and misleading and 

therefore not entitled to First Amendment 

protection.43

In the Lorillard case discussed earlier, 

the Supreme Court had, but failed to use, 

an opportunity to further consider what 

constitutes deceptive speech. In a partial 

dissent, Justice David Souter noted that the 

attorney general for Massachusetts “remains 

free to proffer evidence that the advertising 

is in fact misleading.”7(p.590) Thus, the 

door was left open for a future case to 

argue that images associating tobacco 
301

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

products with a vibrant, athletic lifestyle, 

while failing to disclose the full scope of 

their health effects and addictiveness, 

are deceptive and misleading.31 On the 

basis of such an argument, courts could 

impose on manufacturers the obligation 

to add language sufficiently balanced and 

informative such that the advertisements 

are not misleading. 

As already noted, the courts have 

consistently shown a preference for more 

speech rather than less and have viewed 

compelled disclosure as preferable to speech 

restrictions. Thus, for example, a court 

would be more likely to deem constitutional 

the government-mandated requirements 

for health warnings on tobacco packages 

and advertisements (including photos or 

other images illustrating the health effects 

of tobacco use), the inclusion of package 

inserts detailing the dangers of tobacco 

use and available treatments and resources 

for quitting, and industry funding of 

“corrective” advertising compared with laws 

that ban or significantly restrict tobacco 

product advertising.43

Morrison45 argues that one of the premises 

behind the Supreme Court’s protection 

of commercial speech is that it conveys 

useful information, and therefore the 

Court might be persuaded by evidence 

of tobacco advertising’s lack of utility. 

Morrison suggests that criteria could be 

established to assess the content of cigarette 

advertising, including the percentage 

of an advertisement devoted to “useful” 

information (e.g., information on price or 

tar and nicotine content). However, this 

author acknowledges that such a study 

might not necessarily change votes in the 

Court. In light of the challenging prospects 

for favorable judicial review of statutory 

restrictions on tobacco advertisements, 

some have advocated for increased funds 

for counteradvertising and for changing 

the preemption provisions of the FCLAA, 

as discussed in the next section.

Preemption of Warnings under 

the FCLAA

The 1964 Surgeon General’s report on 

smoking and health46 spurred government 

interest in regulating tobacco advertising. 

The FTC sought to require disclosure on 

cigarette packages and in advertising that 

smoking is dangerous to health.47 Many 

states and cities also began to consider new 

tobacco regulations. Public health advocates 

sought the broadest possible regulation 

at all levels of government. The tobacco 

industry, however, became increasingly 

interested in federal preemptive regulation 

as a means of avoiding more far-reaching 

restrictions by states and municipalities.43

The FCLAA,48 originally enacted in 

1965, requires the inclusion of health 

warnings specified by the government on 

cigarette packaging for cigarettes sold or 

distributed in the United States and in print 

advertising.(n.19) As amended in 1969,49 the 

FCLAA also contains a provision stating,

No requirement or prohibition based on 

smoking and health shall be imposed under 

State law with respect to the advertising or 

promotion of any cigarettes the packages 

of which are labeled in conformity with the 

provisions of this chapter.50

State is defined in the FCLAA as including 

“any ... political subdivision of any State.” 

This type of language, which prevents states 

and localities from acting, is known as 

preemption. The federal government’s power 

to preempt, and thereby nullify, state and 

local laws is grounded in the Supremacy 

Clause of Article VI of the U.S. Constitution, 

which proclaims that the laws of the 

United States “shall be the supreme law of 

the land ... anything in the Constitution 

or Laws of any State to the contrary 

notwithstanding.”51 Thus, in general, 

state law that conflicts with federal law is 

considered to be without legal effect.(n.20)
302

8 . L e g a l a n d C o n s t i t u t i o n a l P e r s p e c t i v e s

The legislative history of the FCLAA indicates 

that Congress used preemption to protect 

“commerce and the national economy” from 

being “impeded by diverse, nonuniform, and 

confusing cigarette labeling and advertising 

regulations.”52,53 The FCLAA, though 

widely viewed as a public health regulatory 

initiative, also served certain tobacco 

industry goals: forestalling FTC regulation, 

preempting state and local requirements, 

and softening the warnings that had been 

proposed by public health advocates.43,47

The consequences of federal preemption 

for efforts to restrict cigarette advertising 

and promotion can be seen in the Lorillard

decision. In addition to its ruling based 

on First Amendment jurisprudence, the 

Supreme Court ruled five to four that the 

FCLAA preempted Massachusetts from 

regulating outdoor and retail point-of-sale 

cigarette advertising.7 Justice Sandra Day 

O’Connor, writing for the Court, rejected 

the Massachusetts attorney general’s 

argument that the advertising restrictions 

were not “based on smoking and health” 

because they did not address the content 

of the advertising but instead sought to 

reduce youth exposure to such advertising. 

According to Justice O’Connor, this was an 

unduly narrow reading of the statute:

The context in which Congress crafted 

the current pre-emption provision leads 

us to conclude that Congress prohibited 

state cigarette advertising regulations 

motivated by concerns about smoking 

and health. At bottom, the concern about 

youth exposure to cigarette advertising 

is intertwined with the concern about 

cigarette smoking and health.7(p.548)

Similarly, Justice O’Connor rejected the 

argument that the restrictions addressed 

only the location of the advertising and 

not its content, stating that the FCLAA 

preempted all requirements and prohibitions 

based on smoking and health.7 She added, 

however, that the Court’s ruling would not 

prohibit general billboard zoning regulations 

or laws that prohibited certain conduct, 

such as underage possession of cigarettes or 

unlawful sales of cigarettes to minors.7

However, the Supreme Court has also held 

that the preemptive effect of the FCLAA 

is limited in that it does not completely 

preclude lawsuits by those who claim 

they were injured by tobacco products. 

In Cipollone v. Liggett Group, Inc.,54

the executor of the estate of a lifetime 

smoker who died of lung cancer sued several 

tobacco companies, alleging that they did not 

provide adequate warnings about the health 

risks of smoking, expressly warranted that 

their products were not dangerous to the 

health of consumers, tried to neutralize the 

effects of statutory warnings, ignored medical 

evidence about the dangers of smoking, and 

conspired to prevent such medical evidence 

from reaching the general public.54,55 The 

trial court awarded the decedent’s husband 

$400,000, but the appellate court reversed 

this on the basis that the plaintiff’s claims 

were preempted under the FCLAA. The 

Supreme Court, however, found that 

although the FCLAA expressly preempted tort 

claims based on inadequate health warnings 

in tobacco advertising or promotion after 

1969, it did not preempt claims against 

cigarette manufacturers for breach of 

express warranty, misrepresentation, or 

conspiracy.(n.21) Thus, the Court distinguished 

between tort claims that implicitly 

challenged the uniform labeling scheme of 

the FCLAA and those that did not directly 

relate to that scheme. 

The Comprehensive Smokeless Tobacco 

Health Education Act56 requires placement 

of government-specified health warnings 

on smokeless tobacco packages and in 

advertisements and banned smokeless 

tobacco advertising on television and radio. 

Like the FCLAA, the Smokeless Tobacco 

Act preempts state and local requirements 

for health warnings on packaging and in 

advertising (except for outdoor billboard 
303

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

advertisements). However, it does not 

preempt state and local restrictions on 

smokeless tobacco advertising and promotion 

analogous to the FCLAA’s preemption of 

restrictions on cigarette advertising and 

promotion that are “based on smoking and 

health.” Furthermore, no federal legislation 

preempts state or local restrictions on the 

advertising and promotion of other tobacco 

products, namely, cigars, pipe tobacco, and 

roll-your-own cigarette tobacco.57

The FDA’s Unsuccessful Efforts 

to Regulate Tobacco Products

The Federal Food, Drug, and Cosmetic Act 

authorizes the Secretary of Health and 

Human Services to regulate drugs and 

medical devices. The statute defines a 

drug as an “article” that is “intended for 

use in the diagnosis, cure, mitigation, 

treatment, or prevention of disease”58 or 

that is “intended to affect the structure or 

any function of the body.”59 A medical device 

is similarly defined, except that it “does 

not achieve its primary intended purposes 

through chemical action within or on the 

body of man [and] ... is not dependent upon 

being metabolized for the achievement of 

its primary intended purposes.”60 Before 

marketing a drug or device, a manufacturer 

must submit sufficient data for the agency to 

ascertain that there is reasonable assurance 

that the product is safe and effective.61

For most of its history, the FDA did not 

assert its jurisdiction over tobacco products. 

In the late 1970s, the agency declined 

petitions to consider cigarettes containing 

nicotine as a drug or medical device,62 relying 

on its “consistent position that cigarettes will 

not be deemed a drug unless health claims 

are made by the vendors.”62(p.237) An appellate 

court subsequently upheld the FDA’s position 

as a reasonable interpretation of the agency’s 

statutory authority—indeed, one that was 

fully consistent with “administrative and 

judicial emphasis upon manufacturer and 

vendor intent as the cornerstone” of the 

Federal Food, Drug, and Cosmetic Act.62(p.243)

During the tenure of Commissioner 

David Kessler (1990–97), the FDA 

reconceived its jurisdiction over tobacco. 

According to Kessler, this change was 

prompted by the agency’s discovery of 

new information in internal documents 

from tobacco manufacturers evidencing 

their awareness of the addictive properties 

of nicotine and that tobacco products 

were essentially a vehicle for its delivery. 

Moreover, the agency learned of methods 

used by manufacturers to increase the 

nicotine content of tobacco products and 

to enhance the drug’s impact.63–65

In 1995, the FDA proposed a rule outlining 

a regulatory approach that would include 

restrictions on the sale, distribution, 

and advertisement of tobacco products.66

Consistent with Kessler’s view that tobacco 

use was principally a pediatric disease in that 

most smokers begin smoking before they 

are 18 years old, the proposed rule restricted 

its scope to reducing youth and adolescent 

access to tobacco products and exposure 

to tobacco advertising and promotion. 

Restricting the focus to youth also appears 

to have been an attempt to enhance 

the political attractiveness of the FDA’s 

approach.65 However, Kessler, in testimony 

before Congress, acknowledged “the 

possibility that regulation of the nicotine 

in cigarettes as drugs would result in the 

removal of nicotine-containing cigarettes 

from the market, limiting the amount of 

nicotine in cigarettes to levels that are not 

addictive, or otherwise restricting access 

to them, unless the industry could show 

that nicotine-containing products are safe 

and effective.”63(p.157)

The FDA received more than 700,000 

comments on the proposed rule, more 

than “at any other time in its history on 

any other subject.”67(p.44418) In 1996, the FDA 

issued a final rule, “Regulations Restricting 
304

8 . L e g a l a n d C o n s t i t u t i o n a l P e r s p e c t i v e s

the Sale and Distribution of Cigarettes and 

Smokeless Tobacco to Protect Children and 

Adolescents,”68 which classified nicotine as a 

drug and cigarettes and smokeless tobacco 

as “drug delivery devices.” The agency found 

that tobacco products “affect the structure 

or any function of the body” within the 

meaning of the statute because nicotine has 

“significant pharmacologic effects,” including 

“psychoactive, or mood-altering, effects 

on the brain,” that cause addiction.68(p.44631)

Further, the agency concluded that these 

effects were “intended,” as required by the 

statute, because (1) they “are so widely 

known and foreseeable that these effects 

may be deemed to have been intended by 

the manufacturers,”68(p.44687) (2) the products 

are designed by manufacturers to achieve 

these effects,68(p.44849) and (3) the products 

are used by consumers primarily to achieve 

these effects.68(p.44807) The agency coupled 

its jurisdictional assertion with evidence 

of the profound public health detriment 

caused by these products—namely, more 

than 400,000 deaths per year as a result of 

illnesses caused by smoking.68(p.44398)

The FDA construed tobacco products 

as “combination products” in that they 

combine a drug (nicotine) with a device 

(the cigarette or smokeless tobacco) to 

deliver it. Relying on its discretion to 

regulate combination products as drugs or 

devices, the FDA chose to regulate tobacco 

under the “restricted devices” provisions of 

the Federal Food, Drug, and Cosmetic Act.69

These provisions give the agency significant 

latitude to restrict the sale, distribution, and 

use of a device based on the “potentiality for 

harmful effect or the collateral measures 

necessary to its use.”69

On the basis of this classification, the FDA 

promulgated rules regarding the promotion, 

labeling, sale, and distribution of tobacco 

products. These rules prevented the sale of 

cigarettes and smokeless tobacco to persons 

younger than 18 years of age, required 

retailers to verify through photographic 

identification the age of all purchasers 

younger than 27 years of age, prohibited 

the sale of cigarettes in quantities of less 

than 20, prohibited the distribution of 

free samples, and prohibited sales through 

self-service displays and vending machines 

except in adult-only locations.68(pp.44616–17)

The promotion regulations required that 

any print advertising appear in a blackand-white, text-only format, unless the 

publication in which it appears was read 

almost exclusively by adults; prohibited 

outdoor advertising within 1,000 feet of any 

public playground or school; prohibited the 

distribution of any promotional items, such 

as T-shirts or hats, bearing a tobacco-product 

brand name; and prohibited sponsorship of 

any athletic, musical, artistic, or other social 

or cultural event using a tobacco-product 

brand name (allowing only corporate-name 

sponsorship provided that the corporate 

name was not similar or identical to the 

name of a tobacco product).68(pp.44617–18)

The labeling regulation required that the 

statement “A Nicotine-Delivery Device for 

Persons 18 or Older” appear on all tobacco 

product packages.68(p.44617)

Tobacco manufacturers, retailers, and 

advertisers challenged the final rule in federal 

district court, arguing that (1) the FDA lacked 

jurisdiction to regulate tobacco products 

and (2) the advertising restrictions violated 

the First Amendment. The district court 

upheld the FDA’s jurisdiction to regulate 

tobacco products and found its access and 

labeling regulations lawful but held that 

its advertising and promotion restrictions 

exceeded its authority.70 On appeal, the 

Fourth Circuit Court reversed, holding 

that the FDA lacked jurisdiction to regulate 

tobacco products and that the court did 

not address the advertising and promotion 

restrictions or the First Amendment 

challenge.71 The FDA appealed the ruling 

on its jurisdiction to the U.S. Supreme Court.

In a five to four vote, the Supreme Court 

ruled that the FDA’s governing statute did 
305

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

not confer jurisdiction to regulate tobacco 

because such an interpretation would be 

inconsistent with congressional intent.71

The Court reasoned that if the FDA were 

to correctly apply its statutory authority 

to regulate medical devices to tobacco 

products, the FDA would be obligated to 

find them unsafe and remove them from 

the market. However, such action would 

be inconsistent with several statutes 

(including the FCLAA) that show Congress’s 

intent to maintain, and even promote, 

tobacco products in the marketplace 

while at the same time informing 

consumers of the associated adverse 

health consequences.71(p.143) The majority 

opinion written by Justice O’Connor stated, 

“Congress has created a distinct regulatory 

scheme to address the problem of tobacco 

and health, and that scheme, as presently 

constructed, precludes any role for the 

FDA.”71(p.144) The Court was not persuaded 

by the FDA’s justification that its regulatory 

framework, under which tobacco products 

were restricted but not banned, was 

preferable to a ban, which would create a 

“black market.”71(p.140) The Court held that 

in considering product safety, the agency 

could not take account of factors external 

to the product’s intended use such as the 

potential for a black market.71(p.141)

The Court’s decision left no room for FDA 

regulation of tobacco products as currently 

marketed absent Congress’s amending the 

Food, Drug, and Cosmetic Act to explicitly 

confer such authority. The Court’s decision 

may also discourage other agencies 

from asserting jurisdiction over tobacco 

or interpreting existing jurisdiction 

expansively. The Court construed Congress 

as having made a policy decision to maintain 

and even promote a market for tobacco 

products and to narrowly circumscribe 

agency authority to warn of the dangers of 

tobacco use.

However, legislation to give the FDA 

authority to regulate tobacco products 

was passed by the U.S. Senate on 

July 15, 2004 (by a vote of 78–15), but 

companion legislation in the U.S. House 

of Representatives was not adopted.72,73

Similar legislation (S. 625 and H.R. 1108) 

was approved by the Senate Committee on 

Health, Education, Labor, and Pensions on 

August 1, 2007 (by a vote of 13–8) and the 

House Committee on Energy and Commerce 

on April 2, 2008 (by a vote of 38–12).

The Court’s ruling does not preclude FDA 

action against tobacco products making 

explicit claims about health benefits. 

For example, the FDA might assert 

jurisdiction to regulate tobacco products 

that manufacturers claim to be less harmful 

to health than are other brands. The agency 

could argue that such products are drugs 

because manufacturers’ claims show their 

intent to mitigate disease. 

The Court’s ruling also does not preclude 

state action to restrict minors’ access to 

tobacco products along the lines proposed 

by the FDA. For example, all 50 states and 

the District of Columbia (D.C.) prohibit 

the sale of tobacco products to minors, 

which in most cases is defined as 18 years 

of age. Further, 45 states and D.C. restrict 

the distribution of free samples of tobacco 

products, and 10 states restrict direct 

consumer access to tobacco products 

by, for example, prohibiting self-service 

displays or requiring direct contact between 

retailers and customers.74

The FTC’s Limited Efforts to 

Regulate Tobacco Advertising

The FTC is an independent federal 

agency established by Congress in 1914.75

The Federal Trade Commission Act 

(FTC Act) declares unlawful “unfair or 

deceptive acts or practices in or affecting 

commerce”76 and directs the FTC to prevent 

such activities. (n.22) False or misleading 

advertising is considered an unfair trade 
306

8 . L e g a l a n d C o n s t i t u t i o n a l P e r s p e c t i v e s

practice and therefore unlawful. Thus, the 

agency has clear authority to take action 

against false advertising that misleads the 

public, including advertising for tobacco 

products.

However, having statutory authority does 

not necessarily imply that it is broadly 

exercised. As summarized below, the FTC’s 

role has been largely limited to enforcing 

legislated tobacco labeling requirements 

and reporting to Congress concerning the 

effectiveness, or lack thereof, of these laws.

The FTC can take action against false 

or misleading advertising through its 

adjudicatory (quasi-judicial) authority, in 

which case judgments apply only to the 

parties to the case. Alternatively, the agency 

can use general rule-making procedures to 

promulgate industrywide guidelines as trade 

regulation rules.47(pp.510–11) Between 1938 

and 1968, the FTC invoked its adjudicatory 

authority 25 times in regard to health claims 

made in cigarette advertising.77 However, 

because adjudicatory judgments applied only 

to the parties to the case, “the Commission 

found itself putting out brush fires of 

deception while the inferno raged on.”77(p.70)

Following the issuance of the 1964 

Surgeon General’s report on smoking and 

health,46 the FTC determined that cigarette 

advertising that failed to disclose the 

health risks of smoking was “unfair and 

deceptive.”78 It proposed a trade regulation 

rule that would have made it a violation 

of the FTC Act “to fail to disclose, clearly, 

and prominently, in all advertising and on 

every pack, box, carton or other container 

[of cigarettes] ... that cigarette smoking is 

dangerous to health and may cause death 

from cancer and other diseases.”78(p.8325)

This regulatory effort was, however, 

rendered moot before it was implemented 

by the passage of the FCLAA in 1965. 

The FCLAA articulated two policy goals: 

(1) informing the public about the 

dangers of smoking and (2) protecting 

commerce and the national economy 

by preventing “diverse, nonuniform, 

and confusing cigarette labeling and 

advertising regulations with respect to 

any relationship between smoking and 

health.”48,79 In contrast to the FTC trade 

regulation rule, the FCLAA required the 

warning “Caution: Cigarette Smoking May 

Be Hazardous to Your Health” to be placed 

on cigarette packages but not in advertising. 

The language of the warning was much 

milder than the FTC would have required 

and its dissemination more limited. Some 

did not view the FCLAA as a public health 

victory but saw it instead as an “unashamed 

act to protect private industry from 

government regulation”(n.23) 43(p.2991)

The FCLAA in 1965 and the Comprehensive 

Smokeless Tobacco Health Education 

Act in 1986 directed the FTC to report 

to Congress concerning sales and 

advertising for cigarettes and smokeless 

tobacco, respectively. The FTC issued 

its first report to Congress in 1967, in 

which it recommended that the warning 

label be changed to “Warning: Cigarette 

Smoking Is Dangerous to Health and 

May Cause Death from Cancer and Other 

Diseases.”80(p.30) In 1969, Congress enacted 

the Public Health Cigarette Smoking 

Act,49 which amended the FCLAA. This act 

prohibited cigarette advertising on television 

and radio and required that each cigarette 

package contain the label “Warning: The 

Surgeon General Has Determined That 

Smoking Is Dangerous to Your Health.” 

In 1981, the FTC issued a staff report that 

concluded that the current health-warning 

labels had little effect on public knowledge 

and attitudes about smoking.81 In response, 

Congress enacted the Comprehensive 

Smoking Education Act of 1984,82 which 

required four specific health warnings on all 

cigarette packages and advertising: “Surgeon 

General’s Warning: Smoking Causes Lung 

Cancer, Heart Disease, Emphysema And 

May Complicate Pregnancy”; “Surgeon 
307

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

General’s Warning: Quitting Smoking Now 

Greatly Reduces Serious Risks to Your 

Health”; “Surgeon General’s Warning: 

Smoking By Pregnant Women May Result 

in Fetal Injury, Premature Birth, And Low 

Birth Weight”; and “Surgeon General’s 

Warning: Cigarette Smoke Contains Carbon 

Monoxide.” (The warnings mandated 

for cigarette advertisements on outdoor 

billboards are slightly shorter versions of 

the same messages.)83

Responding to evidence that smokeless 

tobacco use causes oral cancer, nicotine 

addiction, and other health problems, 

in 1986 Congress passed the Comprehensive 

Smokeless Tobacco Health Education 

Act.56 This law required rotating warning 

labels on smokeless tobacco packaging 

and advertisements, in a circle-and-arrow 

format:47 “Warning: This product may 

cause mouth cancer”; “Warning: This 

product may cause gum disease and tooth 

loss”; and “Warning: This product is not a 

safe alternative to cigarettes.”84,85 As with 

the labeling of other tobacco products, 

the FTC was charged with enforcing 

this requirement.

In 1999, the FTC issued a report to Congress 

in which it recommended warning labels 

for cigar packaging and advertising.86

The Commission noted that cigar sales 

had increased 43% in one year, from 

$613 million in 1996 to $876 million in 

1997, and stated, “The dramatic increase in 

cigar use in America has occurred in tandem 

with the increase in promotional activities 

surrounding cigar smoking.”86 The FTC 

recommended that three warnings for cigars 

be required on a rotating basis: “Warning: 

Regular cigar smoking can cause cancers 

of the mouth and throat, even if you do not 

inhale”; “Warning: Inhaling cigar smoke 

can cause lung cancer. The more deeply 

you inhale, the greater your risk”; and 

“Warning: Cigars are not a safe alternative to 

cigarettes.”86 The report also recommended 

that Congress enact legislation prohibiting 

the advertisement of cigars on television, 

radio, and any other electronic media 

regulated by the Federal Communications 

Commission. Although Congress did not 

enact legislation as recommended by the 

FTC, some of these recommendations were 

achieved through consent agreements 

entered into with cigar manufacturers.

The FCLAA explicitly exempted from 

preemption the FTC’s ability to take 

action against unfair or deceptive acts or 

practices in the advertising of cigarettes.87

The agency has used this authority to initiate 

proceedings in response to promotional 

efforts it considered unfair or deceptive. 

Some of the FTC’s earlier actions (between 

1938 and 1968) were mentioned above 

and reviewed by Fritschler.77 More recently 

(in May 1997), the FTC took on a long-time 

cigarette icon—Joe Camel. The agency filed 

a complaint against R.J. Reynolds Tobacco 

Company charging that the company’s use 

of the cartoon character was an unfair trade 

practice in that it was a deliberate attempt 

to target smokers younger than 18 years of 

age and calling on the company to “cease 

and desist from advertising to children 

through the Joe Camel character or others 

like it.”88–90 In filing this complaint, which 

was decided in a three to two vote by the 

FTC commissioners, the agency reversed 

a 1994 decision not to take action against 

the advertising campaign.91,92 R.J. Reynolds 

subsequently filed a challenge to the FTC 

complaint but then decided to remove 

Joe Camel from its domestic advertising. 

The FTC initially continued to pursue 

the complaint and to seek a court order 

barring the company from using Joe Camel 

or his fellow cartoon camels again in 

advertisements and requiring the company to 

pay for an antismoking campaign targeted to 

teenagers.93 The FTC dropped the complaint 

in 1999, relying instead on the Master 

Settlement Agreement (see chapter 3), 

a multibillion-dollar settlement between 

the tobacco industry and 46 states that 

achieved the goals the FTC was seeking.94
308

8 . L e g a l a n d C o n s t i t u t i o n a l P e r s p e c t i v e s

In 2000, the FTC entered into a consent 

agreement with seven cigar manufacturers 

representing 95% of the cigars sold in 

the United States. The agreement settled 

a complaint filed by the FTC against the 

manufacturers in which it charged that 

failure to disclose health risks of cigars is a 

deceptive and unfair business practice. Under 

the consent agreement, the manufacturers 

agreed to place one of five warnings on 

cigar packages and in advertising. These 

warnings are as follows: “Surgeon General 

Warning: Cigar Smoking Can Cause Cancers 

Of The Mouth And Throat, Even If You Do 

Not Inhale”; “Surgeon General Warning: 

Cigar Smoking Can Cause Lung Cancer 

And Heart Disease”; “Surgeon General 

Warning: Tobacco Use Increases The Risk Of 

Infertility, Stillbirth And Low Birth Weight”; 

“Surgeon General Warning: Cigars Are 

Not A Safe Alternative to Cigarettes”; and 

“Surgeon General Warning: Tobacco Smoke 

Increases The Risk Of Lung Cancer And 

Heart Disease, Even In Nonsmokers.” 

This FTC consent agreement superseded 

a 1988 settlement under California’s 

Proposition 65, which had required that 

cigars sold in the state of California 

include on their packaging (but not in 

advertisements) a warning label stating the 

following: “WARNING: This product contains 

chemicals known to the State of California 

to cause cancer, birth defects, and other 

reproductive harm.” Cigar manufacturers 

had printed the California warning on 

the packages of manufactured cigars sold 

nationally.47,95 The FTC consent agreement 

preempted a California law that was set to 

take effect on September 1, 2000, which 

would have required new rotating warnings 

on cigar packages sold in the state.96

The FTC’s methodology for measuring the 

tar and nicotine levels of cigarettes has come 

under scrutiny in recent years. Beginning 

in the 1960s, various branches of the 

government sought to encourage tobacco 

companies to produce low-tar cigarettes and 

to encourage smokers to reduce their risk 

by switching to low-tar brands.97 In 1967, 

pursuant to its authority to prohibit unfair 

or deceptive advertising claims, the FTC 

authorized establishment of a laboratory to 

analyze mainstream cigarette smoke (i.e., the 

smoke that is drawn through the cigarette 

rod during puffing).98 The purpose of the 

program was to provide smokers seeking to 

switch to lower-tar cigarettes with a single, 

standardized measurement with which to 

choose among existing brands. The FTC 

protocol used a machine to simulate 

smoking in a standardized way and measure 

tar and nicotine yields in mainstream 

smoke for each cigarette brand. In 1970, 

the FTC began to develop a trade regulation 

rule that would have required disclosure 

of tar and nicotine ratings in all cigarette 

advertising. In response, five major cigarette 

manufacturers and three small companies 

agreed voluntarily to disclose the FTC ratings 

in certain types of advertising. The FTC 

added carbon monoxide to the protocol in 

1980, but its disclosure in advertising is 

not required. Industry disclosure of tar and 

nicotine yields on some cigarette packages 

occurs voluntarily, but rarely for brands with 

8 mg or more of tar.47(p.489) In 1987 the FTC 

closed its laboratory and began to collect 

data on tar, nicotine, and carbon monoxide 

yields, through a compulsory process, from 

cigarette companies, which conduct the 

testing through the Tobacco Industry Testing 

Laboratory, using the FTC method.99

On the basis of the FTC protocol, 

manufacturers have for decades advertised 

certain brands as “light” or “low tar.” In the 

1990s, scientists began to question the 

FTC methodology, alleging that the protocol 

did not effectively predict the amount of 

tar and nicotine a smoker would receive 

during actual smoking.100 One report 

concluded that

measurements of tar and nicotine 

yields using the FTC method do not 

offer smokers meaningful information 
309

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

on the amount of tar and nicotine 

they will receive from a cigarette. 

The measurements also do not offer 

meaningful information on the relative 

amounts of tar and nicotine exposure 

likely to be received from smoking 

different brands of cigarettes.101

The Centers for Disease Control and 

Prevention believes that existing evidence 

(1) does not support recommending that 

smokers switch to low-yield cigarette brands 

and (2) does not support the conclusion that 

changes in cigarette design have appreciably 

reduced the incidence of diseases caused 

by smoking.102

In 1997, the FTC issued a notice in the 

Federal Register seeking comments on 

proposed changes to the FTC methodology. 

No final rule implementing these changes 

has been issued. In 2000, the FTC issued 

an alert in which it warned consumers that 

cigarette tar and nicotine ratings cannot 

predict the amount of tar and nicotine 

a smoker will receive from a particular 

cigarette. The alert states, “Smoking ‘low 

tar’ or ‘light’ cigarettes does not eliminate 

the health risks of smoking.”103

In 1994, the FTC announced a settlement 

with the American Tobacco Company, 

prohibiting the company from disseminating 

ads for Carlton or any other cigarettes that 

make certain misrepresentations about 

the relative amount of tar and nicotine 

consumers will receive by smoking certain 

cigarette brands.104 However, the agency 

has not undertaken any industrywide 

enforcement efforts against cigarette 

manufacturers advertising “low-tar,” “light,” 

or other low-yield cigarettes for making 

false or misleading claims. Legislation 

mentioned above (S. 625 and H.R. 1108 in 

the 110th Congress) that would give the 

FDA authority to regulate tobacco products 

would ban the use of terms such as “light,” 

“mild,” or “low” in advertising and on 

package labels.

Class action lawsuits have been filed 

in several states alleging that cigarette 

companies engaged in fraudulent claims by 

marketing “low-tar” and “light” cigarettes 

despite knowledge that such cigarettes 

were no less dangerous, and perhaps were 

more dangerous, than other cigarettes.105,106

One class action failed because of a 

longstanding FTC agreement with tobacco 

companies that they would voluntarily 

measure tar and nicotine levels. In a four to 

two decision reached in 2005, the Illinois 

Supreme Court overturned a lower court 

ruling in favor of a class of consumers who 

argued they were defrauded by Philip Morris’s 

marketing of “light” and “lowered tar and 

nicotine” cigarettes.107 The Supreme Court 

relied on section 10(b)(1) of the Illinois 

Consumer Fraud and Deceptive Practices 

Act, which exempts conduct “specifically 

authorized by laws administered by any 

regulatory body or officer acting under 

statutory authority of this State or the 

United States.” In determining that the 

claims at issue were “specifically authorized” 

by the FTC, the Illinois court relied heavily 

on a 1970 agreement between the FTC 

and U.S. cigarette companies, directing 

them to voluntarily measure their brands’ 

tar and nicotine yields. In 2006, the 

U.S. Supreme Court denied a petition for 

a writ of certiorari, allowing the state high 

court’s decision to stand.107

Preemption arguments did not, however, 

prevail in a challenge by R.J. Reynolds to a 

California law prohibiting the distribution 

of free cigarettes. The justices said that 

California, one of 16 states regulating free 

tobacco promotions, had the right to ban 

free cigarette sampling because tobacco is 

a health hazard and because Congress has 

not spoken against state laws regulating the 

time, place, and manner in which cigarettes 

are sold or distributed. Nevertheless, 

California’s highest court overturned the 

$14.8 million fine the state imposed on 

R.J. Reynolds Tobacco Co. for illegally doling 

out free cigarettes at a beer fest, a biker rally, 
310

8 . L e g a l a n d C o n s t i t u t i o n a l P e r s p e c t i v e s

and other public events, and sent the case 

back to a lower court to consider whether 

the fine was excessive and whether the 

tobacco maker had acted in bad faith.108

With low-yield claims under attack, some 

manufacturers have begun to market 

cigarettes with explicit claims of lowered 

risk. In 1996, for example, R.J. Reynolds 

began to test-market Eclipse, which used 

a design that was purported to present less 

risk of cancer and produce less inflammation 

in the respiratory system. Slade and 

colleagues concluded that there was not 

satisfactory evidence that this cigarette 

is less harmful than are conventional 

cigarettes.109,110 As noted above, another new 

R.J. Reynolds brand, Advance, is marketed 

with the slogan “Great Taste. Less Toxins.”111

The FTC has yet to consider whether such 

claims are false or misleading. 

The FTC has a long history of oversight 

of tobacco advertising and its statutory 

authority would appear quite broad in 

its direction to prohibit any “false or 

misleading” advertising claims. Nevertheless, 

some view the agency’s activities in this 

area as fairly limited,112 particularly when 

compared with its more aggressive stance 

with respect to advertising for other 

products (e.g., those promising weight 

loss).113,114 For example, one might argue 

that advertisements depicting healthy, 

vibrant smokers are inherently false and 

misleading because they imply that smoking 

is a healthful activity. However, the FTC 

has largely refrained from undertaking 

enforcement action against tobacco 

advertisements on these or similar grounds. 

Comparison of the United States 

with Other Countries’ Experience 

In 2000, the U.S. Surgeon General issued 

a report on reducing tobacco use in the 

United States. The report concludes that 

tobacco products are far less regulated 

in the United States than in many other 

developed countries.115 In particular, the 

report finds that warning labels on cigarette 

packages in the United States are weaker 

and less conspicuous than those of some 

other countries.115 In addition, the report 

states that current regulation of advertising 

and promotion of tobacco products in the 

United States is considerably less restrictive 

than in several other countries.115

The sections below review the oversight 

of tobacco advertising and promotions 

in Canada and the European Union as 

examples of marketing controls outside 

the United States and describe the WHO 

FCTC. Further, the American Cancer 

Society has published a comprehensive 

review of information on tobacco 

production, trade, consumption, disease 

burden, and legislation (including 

marketing controls) for 196 countries 

and territories.116

Canada

Although the United States and Canada 

share a continent, they are miles apart 

in the extent to which they have pursued 

many tobacco control policy interventions. 

For more than a decade, for example, the 

Canadian legislature has sought to protect 

public health and prevent youth smoking 

through a variety of substantial restrictions 

on tobacco advertising and promotion. 

Like the First Amendment to the 

U.S. Constitution, however, section 2(b) of 

Canada’s Charter of Rights and Freedoms117

protects freedom of expression,(n.24) and 

the Canadian Supreme Court, like its 

U.S. counterpart, has held that such 

protection includes commercial speech.118,119

The Canadian Supreme Court has based 

this view on the need to protect the 

receiver and the belief that a free-market 

economy relies on having fully informed 

consumers.(n.25) Unlike the First Amendment, 

however, section 2(b) may be overridden 
311

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

by section 1 of the charter, which permits 

the legislature to place limits on the 

freedoms protected in the charter if they 

are “demonstrably justified in a free and 

democratic society.”(n.26)

In recent years, the Canadian legislature 

and courts have struggled with the inherent 

conflict between the constitutional 

guarantee of free speech and laws 

intended to protect the public and foster 

public health.120 This struggle has been 

particularly apparent in the case of tobacco 

advertising and promotion. The 1988 

Tobacco Products Control Act (TPCA)121

largely banned tobacco advertising. 

The TPCA also prohibited retailers from 

displaying signs with tobacco brand names 

or trademarks, prohibited manufacturers 

from applying tobacco trademarks to 

other products or using tobacco-product 

brand names in sponsorship (weakened 

by an ambiguity in the law discussed in 

the section on “Ineffectiveness of Partial 

Advertising Bans,” chapter 3), and required 

the placement of “health indicators” on 

cigarette packages as imposed by regulation. 

After the TPCA was passed, tobacco 

manufacturers sued the Canadian 

government, arguing that the statute 

exceeded the federal government’s 

legislative authority and violated the 

constitutional protection of freedom of 

expression.122 The trial court rejected 

both arguments,123 but the Quebec 

Court of Appeal124 overturned the lower 

court’s decision. In RJR MacDonald Inc. v. 

Canada (Attorney General),125 the Canadian 

Supreme Court, in a 5–4 ruling, struck 

down certain provisions of the advertising 

restrictions and labeling requirements, 

holding that they violated section 2(b) of 

the Charter and were not justified under 

section 1.125(pp.10–12)

First, the court held that the government 

had not adequately justified a complete 

advertising ban. In particular, the 

government did not distinguish between 

“lifestyle” advertising (i.e., evocative or 

emotionally appealing advertising), which, 

the court found, “is designed to increase 

consumption,” and “informational” or 

“brand preference” advertising, which “has 

not been shown to have this effect.”125(p.15)

With respect to the prohibition on 

the use of logos on articles other than 

tobacco products, the court held that 

the government had not adequately 

demonstrated a link between the objective 

of decreasing tobacco consumption and 

the ban on logos.125 In regard to the health 

warning requirement, the government’s 

failure to permit manufacturers to attribute 

the health warnings violated section 2(b) of 

the charter because “freedom of expression 

necessarily entails the right to say nothing 

or the right not to say certain things.”125(p.9)

While the majority found the warning labels 

themselves to be a justifiable impairment 

on expression, the government failed to 

demonstrate the need for the warnings to 

be unattributed.120

The Canadian Supreme Court left open the 

possibility that “less intrusive alternative 

measures would be a reasonable impairment 

of the right to free expression, given the 

important objective and the legislative 

context.”125 In 1997, the Canadian legislature 

enacted the Tobacco Act.126 A response to 

the court’s objections, the Tobacco Act is 

more nuanced in its approach to advertising 

restrictions. The act prohibits lifestyle 

advertising,127 defined as “advertising 

that associates a product with, or evokes 

a positive or negative emotion about or 

image of, a way of life such as one that 

includes glamour, excitement, vitality, risk 

or daring,”128 and restricts advertising to 

media primarily targeted at adults.127,128

However, the act permits manufacturers 

to use informational and brand-preference 

advertising to promote their products to 

adult smokers.127,128 Also in response to the 

court’s ruling, the act permits attribution of 

mandated health warnings.126(p.13)
312

8 . L e g a l a n d C o n s t i t u t i o n a l P e r s p e c t i v e s

In 2000, the Canadian government 

mandated new health warnings to appear on 

cigarette packages. Under these regulations, 

manufacturers must dedicate at least 

50% of the “principal display surfaces” of 

each cigarette pack to 1 of 16 warnings that 

combine a textual warning with a visual 

image, such as a diseased mouth, a lung 

tumor, a brain after a stroke, a damaged 

heart, or a limp cigarette (coupled with a 

warning that smoking can cause impotence). 

Warnings inside each package offer tips on 

quitting.129 These warnings began to appear 

on cigarette packages in 2001.

Several manufacturers challenged the 

requirements imposed by the Tobacco Act 

as unconstitutional, but the trial court 

(the Quebec Superior Court) dismissed 

the claim.130 On August 22, 2005, the 

Quebec Court of Appeal upheld most of the 

stipulations of the act. However, because 

the court allowed event sponsorship using 

corporate names (as long as they are 

not also tobacco product brand names), 

the Canadian government appealed the 

decision to the Canadian Supreme Court.131

The tobacco manufacturers crossappealed in an attempt to defeat some of 

the provisions held to be constitutional. 

On June 28, 2007, the Supreme Court 

issued a unanimous (nine to zero) ruling 

in favor of the government’s appeal and 

against the cross-appeal, thereby upholding 

the order of the trial court and the 

provisions of the original statute.132

Perhaps because of Canada’s proximity 

to the United States and because the 

two countries share many cultural 

values,133 tobacco control advocates in 

the United States often look to Canada 

as a model for the United States to 

follow. In reality, there appears to be 

little diffusion of tobacco control policies 

from Canada to the United States.133

The reasons for this are many and varied 

and are largely beyond the scope of this 

chapter. With respect to prohibitions on 

advertising, however, it is worth noting 

that the Canadian Supreme Court and the 

U.S. Supreme Court, while having on paper 

similar constitutional parameters to work 

from, have come to different conclusions 

about where to place the fulcrum in 

balancing freedom of expression and public 

health protection. Although the Canadian 

Supreme Court struck down certain 

provisions of the TPCA, it left much room 

for more nuanced restrictions (and upheld 

the Tobacco Act), room that likely would 

not be available if the U.S. Supreme Court 

were to evaluate similar legislation. 

This may in part be due to the relative 

newness of the charter itself, which permits 

greater flexibility to address emergent 

health threats. In addition, unlike the 

U.S. Supreme Court, the Canadian 

Supreme Court is operating against a 

backdrop of broad political and social 

consensus at the provincial and national 

levels on the public health need to reduce 

tobacco use. This consensus may have led 

the Canadian Supreme Court to grant more 

latitude to the legislature in restricting 

tobacco advertising and promotion.

European Union

The European Union banned tobacco 

advertising on television and radio 

and tobacco company sponsorship of 

television programs in 1989.134 In 1998, 

the EU enacted a directive banning 

tobacco advertising and sponsorship in 

all EU Member States.135,136 The directive 

would have phased out all advertising and 

sponsorship by 2006. The directive was 

based on several provisions of the Treaty 

Establishing the European Community.136

In particular, Article 100a(1) permits 

the adoption of laws that have as their 

objective the establishment and functioning 

of the internal market, meaning the 

“abolition, as between Member States, of 

obstacles to the free movement of goods, 

persons, services, and capital .... ”136

The council argued that the directive 
313

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

was necessary to facilitate trade among 

member states,136 since conflicting national 

advertising laws could impede the free 

movement of media, such as newspapers 

and magazines,137 and create distortions in 

competition.136

The Federal Republic of Germany, which 

opposed the directive, and several British 

tobacco companies thereafter challenged 

its legality, arguing that the council 

and the parliament had exceeded their 

authority. In 2000, the Court of Justice 

of the European Community overturned 

the directive.138,139 The court held that the 

ban was too broad to be justified as an 

internal market measure. In particular, 

the court said it could not see how a 

ban on advertising tobacco on posters, 

parasols, ashtrays, or in theaters could help 

facilitate trade in those products between 

EU Member States.140 However, the court 

stated that a more limited ban that focused 

on eliminating foreseeable obstacles to 

the free movement of goods and services, 

and for which distortion of competition 

was appreciable, would be valid under 

the treaty.136

In 2002, the EU voted to outlaw tobacco 

advertising in newspapers and magazines, 

on the Internet, and at international sports 

events.141 The directive, issued in 2003, also 

includes a prohibition on tobacco company 

sponsorship of major international sporting 

events, such as Formula One racing.142

However, the ban does not include posters, 

billboards, cinema advertising, and indirect 

advertising (see chapter 4) such as cigarette 

logos on clothing. It also does not affect 

magazines published outside the EU but 

distributed within it. Most of the provisions 

were scheduled to take effect in 2005; the 

Formula One racing sponsorship ban took 

effect in 2006.141

All Member States should have transposed 

the directive into national law by July 2005. 

However, some countries—notably 

Germany, the Czech Republic, Hungary, 

and Spain—failed to do so, leading to legal 

action by the European Commission.143

In December 2006, the EU’s highest 

court upheld the directive and rejected 

Germany’s challenge that it was illegal.144

Germany, Europe’s biggest tobacco market, 

had argued that tobacco advertising in 

local newspapers should not be subject 

to blocwide legislation because it does 

not affect trade among nations in the 

25-member EU. However, the European 

Court of Justice in Luxembourg held 

that prohibitions met the conditions 

to be adopted for the purpose of the 

establishment and functioning of the 

internal market.145

World Health Organization

On May 21, 2003, the World Health 

Assembly, the governing body of WHO, 

unanimously adopted resolution WHA 56.1, 

which included adoption of the FCTC.146 This 

represents the first-ever global health treaty 

negotiated by WHO.147 The FCTC entered 

into force on February 27, 2005, 90 days after 

ratification of the treaty by 40 countries.148

By April 2008, 154 countries—not including 

the United States—had become parties to 

the treaty.149

Included in the FCTC are provisions 

aimed at reducing both the supply of 

and demand for tobacco.150 Among the 

provisions intended to reduce demand is a 

comprehensive ban on tobacco advertising, 

promotion, and sponsorship (Article 13).

However, the treaty also recognizes that 

compliance with such bans may not be 

feasible by some signatories because of 

constitutional constraints that exist within 

those countries. Thus, ratification does 

not necessarily require that a country 

impose a comprehensive ban. Rather, 

Article 13 of the treaty provides that 

“each Party shall, in accordance with its 

constitution or constitutional principles, 

undertake a comprehensive ban of all 
314

8 . L e g a l a n d C o n s t i t u t i o n a l P e r s p e c t i v e s

tobacco advertising, promotion and 

sponsorship.”151(p.10) It states that a country 

that is not in a “position to undertake a 

comprehensive ban due to its constitution 

or constitutional principles” should apply 

“restrictions” to these activities consistent 

with its legal environment.151(p.10)

The treaty provides minimum standards 

that parties must adopt, but again, in 

accordance with their constitutional 

principles. These minimum standards 

include (1) prohibition of advertising, 

promotion, or sponsorship for a tobacco 

product that is “false, misleading, or 

deceptive or likely to create an erroneous 

impression about its characteristics, 

health effects, hazards or emissions”;151(p.9)

(2) the inclusion of health warnings in 

all advertising and “as appropriate” in 

promotion and sponsorship; (3) restriction 

of 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 (4) restriction of tobacco sponsorship 

of international events, activities, and/or 

participants. Further, in Article 11, the 

FCTC requires that each party to the treaty 

“adopt and implement, in accordance with 

its national law, effective measures to ensure 

that: (a) tobacco product packaging and 

labelling do not promote a tobacco product 

by any means that are false, misleading, 

deceptive, or likely to create an erroneous 

impression about its characteristics, health 

effects, hazards or emissions, including any 

term, descriptor, trademark, figurative or 

any other sign that directly or indirectly 

creates the false impression that a particular 

Framework Convention on Tobacco Control

Article 13: Tobacco advertising, promotion and sponsorshipa

1. Parties recognize that a comprehensive ban on advertising, promotion and sponsorship 

would reduce the consumption of tobacco products. 

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, 

subject to the legal environment and technical means available to that Party, 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 legislative, executive, administrative and/or other measures and 

report accordingly in conformity with Article 21. 

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. This shall include, subject to the legal environment and technical means available 

to that Party, restrictions or a comprehensive ban on advertising, promotion and sponsorship 

originating from its territory with cross-border effects. In this respect, each Party shall undertake 

appropriate legislative, executive, administrative and/or other measures and report accordingly in 

conformity with Article 21. 

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; 

(b) require that health or other appropriate warnings or messages accompany all tobacco 

advertising and, as appropriate, promotion and sponsorship; 
315

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

tobacco product is less harmful than any 

other tobacco products.”151(p.9)

Article 13 includes several references to the 

need to eliminate cross-border advertising, 

specifically expressed to apply to “radio, 

television, print media and, as appropriate, 

other media, such as the internet.”151(p.11)

Article 13.7 states that, “Parties which have a 

ban on certain forms of tobacco advertising, 

promotion and sponsorship have the 

sovereign right to ban those forms of crossborder tobacco advertising, promotion and 

sponsorship entering their territory and to 

impose equal penalties as those applicable 

to domestic advertising, promotion 

and sponsorship originating from their 

territory in accordance with their national 

law.”151(p.11) These articles are directly 

intended to address tobacco advertising 

and promotion that may cross national 

borders through international print media 

(especially magazines), direct broadcast 

satellite linked to domestic receiving dishes, 

paid product placement in movies, and 

the World Wide Web and other Internetbased communication channels. To control 

cross-border advertising under the FCTC, 

Kenyon and Liberman have recommended 

a multilayered approach including formal 

law and regulation, monitoring and 

enforcement practices, education, and 

international cooperation.152

The United States signed the treaty in 

May 2004 but has not ratified it.149 Article II, 

section 2, of the U.S. Constitution states 

that the president “shall have power, by and 

with the advice and consent of the Senate, 

to make treaties, provided two-thirds of the 

(c) restrict the use of direct or indirect incentives that encourage the purchase of tobacco 

products by the public; 

(d) require, if it does not have a comprehensive ban, the disclosure to relevant 

governmental authorities of expenditures by the tobacco industry on advertising, promotion 

and sponsorship not yet prohibited. Those authorities may decide to make those figures 

available, subject to national law, to the public and to the Conference of the Parties, pursuant 

to Article 21; 

(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 

(f) 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. 

6. Parties shall cooperate in the development of technologies and other means necessary to 

facilitate the elimination of cross-border advertising. 

7. Parties which have a ban on certain forms of tobacco advertising, promotion and sponsorship 

have the sovereign right to ban those forms of cross-border tobacco advertising, promotion and 

sponsorship entering their territory and to impose equal penalties as those applicable to domestic 

advertising, promotion and sponsorship originating from their territory in accordance with their 

national law. This paragraph does not endorse or approve of any particular penalty. 

8. Parties shall consider the elaboration of a protocol setting out appropriate measures 

that require international collaboration for a comprehensive ban on cross-border advertising, 

promotion and sponsorship.

a

World Health Organization. 2003. World Health Assembly Resolution 56.1. Geneva: World Health Organization. 

http://www.who.int/tobacco/framework/final_text/en.
316

8 . L e g a l a n d C o n s t i t u t i o n a l P e r s p e c t i v e s

Senators present concur.”153 By April 2008, 

the president had not yet submitted the 

FCTC to the Senate for ratification. It is 

unclear to what extent ratification would 

require the United States to impose 

new restrictions on tobacco advertising, 

promotion, and sponsorship beyond those 

already in effect.154

Summary

The history of efforts to restrict tobacco 

advertising and promotion in the 

United States has been closely intertwined 

with legal and constitutional factors such as 

constraints established by prior legislation, 

the proper roles of regulatory agencies, and 

constitutional protections derived from 

free speech rights encompassed in the 

First Amendment. Such issues have taken 

on increasing prominence, at both domestic 

and global levels, with the increasing use of 

policy interventions toward such promotion 

as a strategy to reduce the disease burden 

related to tobacco use.

Numerous legislative and regulatory efforts 

have been launched to date to curb tobacco 

promotion, including a comprehensive ban 

on such promotion within the WHO FCTC. 

Implementation of such broad restrictions, 

however, has generally been limited by 

constitutional protections for commercial 

speech (for example, in the United States 

and Canada) or legal challenges (such as the 

EU’s eventual modification of its sweeping 

1998 ban of tobacco advertising and 

sponsorship). At the same time, policies 

on tobacco advertising and promotional 

activities have generally evolved to become 

progressively more restrictive over time. 

Moves toward broader prohibitions in this 

area are likely to continue and will probably 

stimulate further legal and policy debate 

and analysis.

Conclusions

1. The First Amendment to the 

U.S. Constitution, as the Supreme Court 

has interpreted it in recent years, 

grants broad protection for commercial 

speech, including speech about tobacco 

products. The Court has precluded 

regulation of tobacco products by the 

U.S. Food and Drug Administration 

(FDA) on the basis of the Court’s analysis 

of existing authorities under the FDA’s 

governing statute and the complex 

balance that Congress has struck 

between protecting and promoting 

trade in tobacco products and informing 

consumers of their dangers.

2. The Federal Trade Commission has 

authority to prevent “unfair or deceptive 

acts or practices in or affecting 

commerce.” However, the agency’s efforts 

to prevent tobacco advertisements that 

are false or misleading have been limited. 

3. Canada and the European Union 

have imposed limitations on tobacco 

advertising and promotion, but these 

policies were weakened as a result of 

legal challenges. Nevertheless, Canadian 

and European restrictions on tobacco 

marketing are stronger than those 

currently in place in the United States.

4. The Framework Convention on 

Tobacco Control (FCTC), the first treaty 

ever negotiated by the World Health 

Organization, calls on each party to the 

treaty to “undertake a comprehensive 

ban of all tobacco advertising, promotion 

and sponsorship ... in accordance with its 

constitution or constitutional principles.” 

As of April 2008, 154 countries were 

parties to the FCTC. The United States 

signed the treaty in May 2004 but has 

yet to ratify it.
317

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Notes

n.1 “Congress shall make no law respecting an 

establishment of religion, or prohibiting 

the free exercise thereof; or abridging the 

freedom of speech, or of the press; or the 

right of the people peaceably to assemble, 

and to petition the Government for a 

redress of grievances.”1

n.2 See, for example, Members of City Council 

v. Taxpayers for Vincent.5 The Supreme 

Court has stated that time, place, and 

manner restrictions do not violate the 

First Amendment “provided that they are 

justified without reference to the content 

of the regulated speech, that they are 

narrowly tailored to serve a significant 

governmental interest, and that they 

leave open ample alternative channels for 

communication of the information.”155

n.3 But see Troy.156 Troy argues that the Framers 

of the Constitution believed that the right 

to advertise was encompassed within the 

First Amendment’s protection of freedom 

of the press and that they did not intend 

to distinguish between commercial and 

noncommercial speech, but rather between 

truthful and false speech. 

n.4 In Bd. of Trustees v. Fox157 the Court 

ruled that the Court of Appeals had erred 

in requiring the application of a least 

restrictive means test to a university 

regulation; the Court instead interpreted 

the fourth prong of the Central Hudson

test as a reasonable fit standard. “What our 

[commercial speech regulation] decisions 

require is a ‘fit’ between the legislature’s 

ends and the means chosen to accomplish 

those ends” (quoting Posadas v. Tourism 

Co. of Puerto Rico [478 U.S. 328, 341 

(1986])27—“a fit that is not necessarily 

perfect, but reasonable ... that employs 

not necessarily the least restrictive means 

but ... a means narrowly tailored to achieve 

the desired objective.”157

n.5 See, for example, 44 Liquormart, Inc. v. 

Rhode Island 24 in which Justice Clarence 

Thomas argues that where “legal users of 

a product or service [are kept] ignorant in 

order to manipulate their choices in the 

marketplace, the balancing test adopted in 

Central Hudson ... should not be applied”). 

See also Lorillard Tobacco Co. v. Reilly7

(533 U.S. at 572) in which Justice Thomas 

states that “I continue to believe that when 

the government seeks to restrict truthful 

speech in order to suppress the ideas it 

conveys, strict scrutiny is appropriate, 

whether or not the speech in question may 

be characterized as ‘commercial.’”

n.6 See Gilhooley,25 which notes that “while 

the Justices use the same [Central Hudson] 

test, they differ on its meaning in practice.” 

See also Vladeck,26 which traces the history 

of the commercial speech doctrine.

n.7 See, for example, Posadas v. Tourism Co. of 

Puerto Rico,27 which upholds Puerto Rico 

law prohibiting casino advertising, finding 

that the government’s interest in reducing 

the demand for casino gambling by 

residents of Puerto Rico was substantial and 

that the regulations directly advanced the 

government’s interest, and the restrictions 

were no more extensive than necessary to 

serve the government’s interest. 

n.8 See, for example, Rubin v. Coors 

Brewing Co.,28 which finds that federal 

government prohibition on display of 

alcohol content on beer labels did not 

sufficiently advance the government’s 

interest in protecting the health, safety, 

and welfare of its citizens). See also 44 

Liquormart, Inc. v. Rhode Island,24 which 

unanimously overturned a state ban on 

liquor price advertising, while disagreeing 

on whether the state’s failure related to 

the direct advancement or reasonable fit 

prong of Central Hudson.

n.9 Because the Court concluded that the 

restrictions on cigarette advertising were 

preempted by the Federal Cigarette Labeling 

and Advertising Act, it did not render an 

opinion regarding whether the cigarette 

advertising restrictions violated the 

First Amendment.7

n.10 The appellate court ruled that the prohibition 

on advertising was not severable from the 

rest of the compounding provision.30 Because 

petitioners did not challenge the severability 

determination, the Court’s ruling had the 

effect of invalidating the entire pharmacy 

compounding section of FDAMA.29

n.11 For example, in Riley v. Nat’l Fed’n 

of Blind,36 the Court declined to use a 

commercial speech test in striking down a 

statute mandating professional fundraisers 

to disclose the percentage of charitable 

contributions actually turned over to 

the charity. “Even assuming ... that [the 

mandated] speech in the abstract is indeed 

merely ‘commercial,’ we do not believe 

that the speech retains its commercial 
318

8 . L e g a l a n d C o n s t i t u t i o n a l P e r s p e c t i v e s

character when it is inextricably intertwined 

with otherwise fully protected speech 

[involved in charitable solicitations].” 

n.12 The Court decided the case on the basis 

of its compelled speech jurisprudence and 

did not apply the Central Hudson test. 

Nevertheless, some legal commentators 

view the United Foods case as a victory for 

constitutional protections of commercial 

speech. See Hudson.

158

n.13 Four years earlier, in Glickman v. Wileman 

Bros. & Elliott,159 the Court had upheld 

similar federal marketing orders requiring 

California fruit producers to fund a generic 

advertising program, characterizing the 

orders as economic regulation that did not 

impinge on First Amendment rights.160

The Court in United States v. United Foods

distinguished its prior ruling by reasoning 

that the exaction in Glickman was ancillary 

to a comprehensive regulatory program that 

included several competition-displacing 

features. In contrast, the federal statute in 

United Foods had no regulatory objective 

other than the generic advertising.

n.14 In Pearson v. Shalala,39 the claims at issue 

in the case were that consumption of 

antioxidant vitamins may reduce the risk of 

certain kinds of cancer, that consumption of 

fiber may reduce the risk of colorectal cancer, 

that consumption of omega-3 fatty acids may 

reduce the risk of coronary heart disease, 

and that 0.8 mg of folic acid in a dietary 

supplement is more effective in reducing the 

risk of neural tube defects than is a lower 

amount in foods in common form.

n.15 In Pearson v. Shalala,39 the regulation at 

issue stated that the FDA would authorize 

a health claim only “when it determines, 

based on the totality of publicly available 

scientific evidence (including evidence 

from well-designed studies conducted in a 

manner which is consistent with generally 

recognized scientific procedures and 

principles), that there is significant scientific 

agreement, among experts qualified by 

scientific training and experience to evaluate 

such claims, that the claim is supported by 

such evidence.”161

n.16 See, for example, Zauderer v. Office of 

Disciplinary Counsel of Supreme Court.40

This case upholds disciplinary counsel 

finding that advertising contingent fee 

arrangement without disclosing the need to 

pay legal costs was deceptive and misleading, 

but rejecting prohibition of advertisements 

offering to represent previous users of 

a defective birth control device, where 

advertisements did not promise successful 

outcome on cases or suggest that the 

attorney had special expertise in such 

lawsuits and illustrations were accurate 

representation of device). See also Ibanez v. 

Florida Dep’t of Bus. & Prof’l Regulation,41

which finds that attorney’s use of Certified 

Public Accountant (CPA) and Certified 

Financial Planner (CFP) designations were 

not misleading provided that she held an 

active CPA license and CFP certification. 

See also Peel v. Atty. Registration & 

Disciplinary Comm’n,42 which holds that 

attorney’s letterhead stating that he was 

a “Certified Civil Trial Specialist By the 

National Board of Trial Advocacy” was not 

actually or inherently misleading where the 

information was true and verifiable, and the 

potential for the information to mislead was 

insufficient to warrant a categorical ban.

n.17 For example, in Thompson v. Western 

States Med. Ctr.29 the Court states that 

“[e]ven if the Government did argue that 

it had an interest in preventing misleading 

advertisements, this interest could be 

satisfied by the far-less-restrictive alternative 

of requiring each compounded drug to be 

labeled with a warning that the drug had 

not undergone FDA testing and that its 

risks were unknown.”

n.18 Although the FCLAA also banned 

cigarette advertising in electronic media 

subject to the jurisdiction of the Federal 

Communications Commission, at least one 

commentator has opined that this provision 

would likely be considered unconstitutional 

were it enacted today but that a court 

would be reluctant to overturn a ban that 

has become so entrenched. See Hoefges53

(quoting from Redish162).

n.19 Cigarette packages, outdoor billboards, 

and other forms of advertisements must 

bear one of the following labels: Surgeon 

General’s Warning: Smoking Causes Lung 

Cancer, Heart Disease, Emphysema, And May 

Complicate Pregnancy; Surgeon General’s 

Warning: Quitting Smoking Now Greatly 

Reduces Serious Risks to Your Health; 

Surgeon General’s Warning: Smoking By 

Pregnant Women May Result in Fetal Injury, 

Premature Birth, And Low Birth Weight; 

Surgeon General’s Warning: Cigarette 

Smoke Contains Carbon Monoxide.163

n.20 Preemption doctrine has its origins in the 

nineteenth-century Supreme Court case 

McCulloch v. Maryland.164 In that case, the 
319

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Court held unconstitutional the levying of 

a tax by the state of Maryland on a federal 

bank. The Court ruled that “the States 

have no power, by taxation or otherwise, to 

retard, impede, burden, or in any manner 

control the operations of the constitutional 

laws enacted by Congress.” Since then, 

“it has been settled that state law that 

conflicts with federal law is ‘without effect’.” 

See Cipollone v. Liggett Group,54 which 

quotes Maryland v. Louisiana (451 U.S. 725, 

746 [1981]). See also Garner and Whitney.165

n.21 In Cipollone, the Court concluded that 

section 5 of the 1965 act preempted only 

“state and federal rule making bodies 

from mandating particular cautionary 

statements and did not preempt state-law 

damages actions.”54 See also Ausness,55

which concluded, however, that the 1969 

amendment to the act did have a limited 

preemptive effect.

n.22 The 1914 statute prohibits only unfair 

methods of competition. The Wheeler Lea 

Amendment of 1938 expanded the agency’s 

jurisdiction to include unfair and deceptive 

trade practices and to prohibit false ads of 

drugs, devices, food, and cosmetics. See 

Wheeler-Lea Amendment of 1938166 and 

FTC v. Sperry & Hutchinson Co.167

n.23 Bayer and colleagues43 (quoting from 

Brenner168). 

n.24 Section 2(b) of the charter states, “Everyone 

has the following fundamental freedoms: 

Freedom of thought, belief, opinion and 

expression, including freedom of the press 

and other media of communication.”117

n.25 In Ford v. Quebec, the Canadian Supreme 

Court states, “Over and above its intrinsic 

value as expression, commercial expression 

which, as has been pointed out, protects 

listeners as well as speakers plays a significant 

role in enabling individuals to make 

informed economic choices, an important 

aspect of individual self-fulfillment and 

personal autonomy. The court accordingly 

rejects the view that commercial expression 

serves no individual or societal value in a 

free and democratic society and for this 

reason is undeserving of any constitutional 

protection.”118,120

n.26 Section 1 of the charter provides the 

following: “The Canadian Charter of Rights 

and Freedoms guarantees the rights and 

freedoms set out in it subject only to such 

reasonable limits prescribed by law as can 

be demonstrably justified in a free and 

democratic society.”117
320

8 . L e g a l a n d C o n s t i t u t i o n a l P e r s p e c t i v e s

References

1. U.S. Const., amend. I (1791).

2. Federal Cigarette Labeling and Advertising 

Act, Pub. L. 89-92, 79 Stat. 282 (1965), as 

amended by Pub. L. 98-474, 98 Stat. 2204 

(1984) and by Pub. L. 99-92, § 11, 99 

Stat. 393, 402-04 (1985), current version at 

15 U.S.C. § 1331 (1982 & Supp. IV 1986).

3. Pertschuk, M. 1982. Revolt against 

regulation: The rise and pause of the 

consumer movement. Berkeley, CA: Univ. 

of California Press.

4. Cohen v. California, 403 U.S. 15 (1971).

5. City Council v. Taxpayers for Vincent,

466 U.S. 789, 804, 808 (1984).

6. Boos v. Barry, 485 U.S. 312, 322 (1988).

7. Lorillard Tobacco Co. v. Reilly, 533 U.S. 525, 

540–53, 555, 561, 563, 566, 572, 590 (2001).

8. Emerson, T. I. 1963. Toward a general 

theory of the First Amendment. Yale Law 

Journal 72 (5): 877–956. 

9. Bigelow v. Virginia, 421 U.S. 809, 818–20, 

822, 926 (1975).

10. Abrams v. United States, 250 U.S. 616, 630 

(1919).

11. Mill, J. S. 1869. On liberty. http://

www.bartleby.com/25/2/2.html.

12. Chaplinsky v. New Hampshire, 315 U.S. 568, 

572 (1942).

13. Weaver, R. L., and A. D. Hellman. 2002 . 

First Amendment: Cases, materials and 

problems. Dayton, OH: LexisNexis.

14. Texas v. Johnson, 491 U.S. 397 (1989).

15. Valentine v. Chrestensen, 316 U.S. 52–55 

(1942).

16. Va. Pharmacy Bd. v. Va. Citizens Consumer 

Council, 425 U.S. 748, 759, 762–63, 770, 

772 n. 24 (1976).

17. Carey v. Pop. Serv. Int’l, 431 U.S. 678 

(1977).

18. Linmark Assocs., Inc. v. Willingboro,

431 U.S. 85 (1977).

19. Bates v. State Bar of Ariz., 433 U.S. 350 

(1977). http://www.bc.edu/bc_org/avp/cas/

comm/free_speech/bates.html.

20. Ohralik v. Ohio State Bar Ass’n, 436 U.S. 

447 (1978).

21. In re Primus, 436 U.S. 412 (1978).

22. Friedman v. Rogers, 440 U.S. 1 (1979).

23. Cent. Hudson Gas & Electric Corp. v. Pub. 

Serv. Comm’n of N.Y., 447 U.S. 557, 563–66 

(1980).

24. 44 Liquormart, Inc. v. Rhode Island, 517 

U.S. 484, 518 (1996).

25. Gilhooley, M. 2003. Drug regulation and 

the Constitution after Western States.

Richmond Law Review 37 (3): 901, 903. 

26. Vladeck, D. C. 2004. Lessons from a story 

untold: Nike v. Kasky reconsidered. Case 

Western Reserve Law Review 54 (4): 1049–90. 

27. Posadas de Puerto Rico Assoc. v. Tourism 

Co., 478 U.S. 328, 341 (1986).

28. Rubin v. Coors Brewing Co., 514 U.S. 476, 

486–91, 496 (1995).

29. Thompson v. W. States Med. Ctr., 535 U.S. 

357, 360, 373, 376 (2002) aff’d 238 F.3d 1090.

30. W. States Med. Ctr. v. Shalala, 238 F.3d 1090, 

1098 (9th Cir. 2001).

31. Gostin, L. O., and G. H. Javitt. 2001. Health 

promotion and the First Amendment: 

Government control of the informational 

environment. Milbank Quarterly 79 (4): 

547–78. 

32. W. Va. State Bd. of Educ. v. Barnette, 319 

U.S. 624 (1943).

33. Wooley v. Maynard, 430 U.S. 705 (1977).

34. Talley v. California, 362 U.S. 60 (1960).

35. McIntyre v. Ohio Elections Comm’n, 514 

U.S. 334 (1995). http://straylight.law.cornell

.edu/supct/html/93-986.ZO.html

36. Riley v. Nat’l Fed’n Blind, 487 U.S. 781, 796 

(1988).

37. United States v. United Foods, Inc., 533 

U.S. 405 (2001).

38. Int’l Dairy Foods Ass’n v. Amestoy, 92 F.3d 

67 (1996).

39. Pearson v. Shalala, 164 F.3d 650, 658 

(D.C. 1999).

40. Zauderer v. Office of Disciplinary Counsel 

of U.S., 471 U.S. 626 (1985).

41. Ibanez v. Fla. Dep’t of Bus. & Prof’l 

Regulation, 512 U.S. 136 (1994).

42. Peel v. Attorney Registration & Disciplinary 

Comm’n of Ill., 496 U.S. 91 (1990).

43. Bayer, R., L. O. Gostin, G. H. Javitt, and 

A. Brandt. 2002. Tobacco advertising 

in the United States: A proposal for 

a constitutionally acceptable form of 

regulation. JAMA: The Journal of the 

American Medical Association 287 (22): 

2990–95. 
321

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

44. Vladeck, D. C., and J. C. Sims. 1998. Why the 

Supreme Court will uphold strict controls 

on tobacco advertising. Southern Illinois 

University Law Journal 22 (3): 651–76. 

45. Morrison, A. B. 2002. Counteracting 

cigarette advertising. JAMA: The Journal 

of the American Medical Association 287 

(22): 3001–3. 

46. U.S. Department of Health, Education, and 

Welfare. 1964. Smoking and health: Report 

of the Advisory Committee to the Surgeon 

General of the Public Health Service

(PHS publication no. 1103). Washington, 

DC: U.S. Department of Health, Education, 

and Welfare, Public Health Service, Center 

for Disease Control. http://profiles.nlm.nih

.gov/NN/B/C/X/B/.

47. U.S. Department of Health and Human 

Services. 1989. Reducing the health 

consequences of smoking: 25 years of 

progress. A report of the Surgeon General

(DHHS publication no. [CDC] 89-8411). 

Rockville, MD: U.S. Department of Health 

and Human Services, Public Health Service, 

Centers for Disease Control, National Center 

for Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health. 

http://profiles.nlm.nih.gov/NN/B/B/X/S/.

48. Brown & Williamson v. FDA, 153 F.3d 155 

(1998).

49. Public Health Cigarette Smoking Act of 

1969, Pub. L. No. 91-222, 84 Stat. 87 (1970).

50. Federal Cigarette Labeling and Advertising 

Act, 15 U.S.C. § 1334(b).

51. U.S. Const., art. VI.

52. Federal Cigarette Labeling and Advertising 

Act, 15 U.S.C. § 1331(2) (1965).

53. Hoefges, M. 2003. Protecting tobacco 

advertising under the Commercial Speech 

Doctrine: The constitutional impact of 

Lorillard Tobacco Co. Communication Law 

and Policy 8 (3): 267–311. 

54. Cipollone v. Liggett Group, Inc., 505 U.S. 

504 (1992).

55. Ausness, R. C. 2004. Preemption of state 

tort law by federal safety statutes: Supreme 

Court preemption jurisprudence since 

Cipollone. Kentucky Law Journal 92 (4): 

913–78. 

56. Comprehensive Smokeless Tobacco Health 

Education Act of 1986, Feb. 27, 1986, 100 

Stat. 30 (15 U.S.C. 4401 et seq.).

57. Bierig, J. R., S. A. Weber, and 

T. R. Scarborough. 1994. Legal analysis of 

approaches to state and local regulation 

of tobacco advertising and sales in the US. 

Tobacco Control 3 (3): 257–62. 

58. Federal Food, Drug, and Cosmetic Act, 21 

U.S.C. § 321(g)(1)(B) (2005).

59. Federal Food, Drug, and Cosmetic Act, 21 

U.S.C. § 321(g)(1)(C) (2005).

60. Federal Food, Drug, and Cosmetic Act, 21 

U.S.C. § 321(h).

61. Federal Food, Drug, and Cosmetic Act, 21 

U.S.C. § 360(e) (2005).

62. Action on Smoking & Health v. Harris, 655 

F.2d 236, 237 (D.C. Cir. 1980).

63. Kessler, D. A. 1994. Statement on nicotinecontaining cigarettes. Tobacco Control 3 (2): 

148–58.

64. Kessler, D. A. 1994. The control and 

manipulation of nicotine in cigarettes. 

Tobacco Control 3 (4): 362–69. 

65. Kessler, D. 2001. A question of intent: 

A great American battle with a deadly 

industry. New York: Public Affairs.

66. Federal Register. 1995. U.S. Department of 

Health and Human Services, Food and Drug 

Administration. Regulations restricting 

the sale and distribution of cigarettes and 

smokeless tobacco products to protect 

children and adolescents; Proposed rule. 

(21 CFR Parts 801, 803, 804, and 897). 

Federal Register 60 (155): 41313–75. 

67. Federal Register. 1996. U.S. Department of 

Health and Human Services, Food and Drug 

Administration. Regulations restricting 

the sale and distribution of cigarettes and 

smokeless tobacco products to protect 

children and adolescents; Final rule. 

Federal Register 168 (61): 44395–445. 

68. Federal Register. 1996. U.S. Department of 

Health and Human Services, Food and Drug 

Administration. Regulations restricting 

the sale and distribution of cigarettes and 

smokeless tobacco to protect children 

and adolescents; Final rule. (21 CFR 

Parts 801, 803, 804, 807, 820, and 897). 

Federal Register 61 (168): 44395–849. 

69. Federal Food, Drug, and Cosmetic Act, 21 

U.S.C. § 360j(e) (2005).

70. Coyne Beahm, Inc. v. FDA, 966 F. Supp. 1374 

(M.D.N.C. 1997).

71. FDA v. Brown & Williamson, 529 U.S. 120, 

135, 140–41, 143–44 (2000), aff’d, 153 

F.3d 155.

72. Campaign for Tobacco-Free Kids. 2004. 

Public health groups applaud historic 

Senate vote to regulate tobacco products: 
322

8 . L e g a l a n d C o n s t i t u t i o n a l P e r s p e c t i v e s

Statement of American Cancer Society, 

American Heart Association, American 

Lung Association and Campaign for 

Tobacco-Free Kids. Press release. 

http://www.tobaccofreekids.org/Script/

DisplayPressRelease.php3?Display=776.

73. Givel, M. 2005. Philip Morris’ FDA gambit: 

Good for public health? Journal of Public 

Health Policy 26 (4): 450–68. 

74. American Cancer Society. 2004. State 

legislated action on tobacco issues: 

Restrictions on smoking in public places. 

http://www.cancer.org/docroot/home/

index.asp.

75. Federal Trade Commission Act, 15 U.S.C.

§ 41, ch. 311, § 1, 38 Stat. 717 (2005).

76. Federal Trade Commission Act, 15 U.S.C.

§ 45(a) (2005).

77. Fritschler, A. L. 1969. Smoking and politics: 

Policymaking and the federal bureaucracy.

New York: Appleton-Century-Crofts.

78. Federal Register. 1964. Unfair or deceptive 

advertising and labeling of cigarettes in 

relation to the health hazards of smoking. 

Federal Register 29:8324–75. 

79. Federal Cigarette Labeling and Advertising 

Act, 15 U.S.C. § 1331 (2005).

80. Federal Trade Commission. 1967. Report 

to Congress pursuant to the Public Health 

Cigarette Smoking Act. Washington, DC: 

Federal Trade Commission.

81. Myers, M. L., C. Iscoe, C. Jennings, 

W. Lenox, E. Minsky, and A. Sacks. 1981. 

Staff report on the cigarette advertising 

investigation. http://tobaccodocuments.org/

bw/11839935.html.

82. Comprehensive Smoking Education Act,

Pub. L. 98-474, 98 Stat. 2200 (1984).

83. Davis, R. M., and J. S. Kendrick. 1989. The 

surgeon general’s warnings in outdoor 

cigarette advertising: Are they readable? 

JAMA: The Journal of the American Medical 

Association 261 (1): 90–94. 

84. Cigarette.Com. 2007. Quit smoking—

Label fact sheet. http://www.cigarette.com/

quitsmokingtidbits.htm.

85. Noah, L., and B. A. Noah. 1996. Nicotine 

withdrawal: Assessing the FDA’s effort to 

regulate tobacco products. Alabama Law 

Review 48 (1): 1–63. 

86. Federal Trade Commission. 1999. Cigar sales 

and advertising and promotional expenditures 

for calendar years 1996 and 1997. http://www

.ftc.gov/os/1999/07/cigarreport1999.htm.

87. Federal Cigarette Labeling and Advertising 

Act, 15 U.S.C. § 1336 (2005).

88. Federal Trade Commission. 1997. In the 

matter of R.J. Reynolds Tobacco Company. 

Docket No. 9285. http://www.ftc.gov/os/

1997/05/d9258cmp.pdf.

89. Cohen, J. B. 2000. Playing to win: Marketing 

and public policy at odds over Joe Camel. 

Journal of Public Policy and Marketing

19 (2): 155–67. 

90. Etzioni, A. 2004. On protecting children 

from speech. Chicago-Kent Law Review

79 (1): 3–53. 

91. Reporters Committee for Freedom of the 

Press. 1997. New media update: FTC votes 

to send Joe Camel packing. Press release. 

Arlington, VA: The Reporters Committee for 

Freedom of the Press. http://www.rcfp.org/

news/1997/0616i.html.

92. Federal Trade Commission. 1997. Joe Camel 

advertising campaign violates federal law, 

FTC says. Press release. http://www.ftc.gov/

opa/1997/05/joecamel.shtm.

93. Associated Press. 1998. Battle over Joe Camel 

moves to federal court: Government aims 

to keep tobacco firm from using character 

in ads again. St. Louis Post-Dispatch,

November 10.

94. Wall Street Journal. 1999. FTC drops 

Joe Camel case in light of state settlement. 

Wall Street Journal, January 28.

95. Connolly, G. N. 1998. Policies regulating 

cigars. In Cigars: Health effects and trends

(Smoking and tobacco control monograph 

no. 9, NIH publication no. 98-4302), 

221–32. Bethesda, MD: National Cancer 

Institute. http://cancercontrol.cancer.gov/

tcrb/monographs/9/index.html.

96. California Department of Justice. 

2000. Attorney General Bill Lockyer, 

Assemblymember Carole Migden, Federal 

Trade Commission Chair Robert Pitofsky, 

and Surgeon General David Satcher 

announce new warning labels for cigars: 

Five rotating health warnings for cigar 

packaging and advertising established 

in a consent agreement announced 

today. Press release. Sacramento: 

California Department of Justice, Office 

of the Attorney General. http://ag.ca.gov/

newsalerts/release.php?id=691.

97. Parascandola, M. 2005. Lessons from the 

history of tobacco harm reduction: The 

National Cancer Institute’s Smoking and 

Health Program and the “less hazardous 
323

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

cigarette.” Nicotine & Tobacco Research

7 (5): 779–89. 

98. Federal Register. Federal Trade Commission. 

1997. Cigarette testing; Request for public 

comment. Notice. Federal Register 62 (177): 

48158–63. 

99. Federal Trade Commission. 2007. Prepared 

Statement of the Federal Trade Commission 

by William E. Kovacic, Commissioner, 

Before the Committee on Commerce, 

Science, and Transportation, United 

States Senate. Washington, DC: Federal 

Trade Commission. http://www.ftc.gov/os/

testimony/P064508tobacco.pdf.

100. National Cancer Institute. 1996. The FTC 

cigarette test method for determining 

tar, nicotine, and carbon monoxide yields 

of U.S. cigarettes: Report of the NCI 

Expert Committee (Smoking and tobacco 

control monograph no. 7, NIH publication 

no. 96-4028). Bethesda, MD: National 

Cancer Institute. http://cancercontrol

.cancer.gov/tcrb/monographs/7/index.html.

101. National Cancer Institute. 2001. Risks 

associated with smoking cigarettes with 

low machine-measured yields of tar and 

nicotine (Smoking and tobacco control 

monograph no. 13, NIH publication no. 

02-5074). Bethesda, MD: National Cancer 

Institute. http://cancercontrol.cancer.gov/

tcrb/monographs/13/index.html.

102. Centers for Disease Control and Prevention. 

2005. Low-yield cigarettes and cigarette-like 

products. http://www.cdc.gov/tobacco/data

_statistics/Factsheets/low_yield_cigarettes

.htm.

103. Federal Trade Commission. 2000. Up in 

smoke: The truth about tar and nicotine 

ratings. FTC consumer alert. http://www.ftc

.gov/bcp/conline/pubs/alerts/smokealrt.

shtm.

104. Federal Trade Commission. 1994. FTC 

obtains agreement from American Tobacco 

over allegedly-deceptive advertising of lowtar cigarette. Press release. http://legacy

.library.ucsf.edu/tid/afr18d00.

105. O’Hagan, M. 2004. Lawsuit attacks ‘light’ 

cigarettes as fraud. Seattle Times, April 9.

106. Tobacco Control Legal Consortium. 2004. 

Legal update. http://www.wmitchell.edu/

tobaccolaw/resources/LegalUpdate_Dec04.pdf.

107. Price v. Philip Morris Inc., 549 U.S. 465 

(2006).

108. Perry, A. 2002. Before the brand: Creating 

the unique DNA of an enduring brand 

identity. New York: McGraw-Hill.

109. Slade, J., G. N. Connolly, and D. Lymperis. 

2002. Eclipse: Does it live up to its health 

claims? Tobacco Control 11 Suppl. 2: 

ii64–ii70. 

110. R.J. Reynolds. Eclipse difference. http://

www.eclipse.rjrt.com/ECL/dtc_certify.jsp?

brand=ECL.

111. Wahlberg, D. 2004. Tobacco companies pitch 

safer cigarette. Is less bad good? Health 

officials wary of claims that new products 

lower smoking dangers. The Atlanta 

Journal-Constitution, October 4.

112. Bonnie, R. J., K. Stratton, and R. B. Wallace, 

ed. 2007. Ending the tobacco problem: 

A blueprint for the Nation. Washington, DC: 

The National Academies Press.

113. Federal Trade Commission. 2007. Red flag: 

A reference guide for media on bogus weight 

loss claim detection. http://www.ftc.gov/bcp/

conline/edcams/redflag/index.html.

114. Federal Trade Commission. 2004. FTC 

launches “Big Fat Lie” initiative targeting 

bogus weight-loss claims. http://www.ftc

.gov/opa/2004/11/bigfatliesweep.htm.

115. U.S. Department of Health and Human 

Services. 2000. Reducing tobacco use: 

A report of the Surgeon General. Atlanta: 

U.S. Department of Health and Human 

Services, Centers for Disease Control and 

Prevention, National Center for Chronic 

Disease Prevention and Health Promotion, 

Office on Smoking and Health. http://www

.cdc.gov/tobacco/data_statistics/sgr/sgr

_2000/index.htm.

116. American Cancer Society, World Health 

Organization, and International Union 

Against Cancer. 2003. Tobacco control 

country profiles. http://www.who.int/

tobacco/global_data/country_profiles/

Introduction.pdf.

117. Canadian Charter of Rights and Freedoms,

pt. I, Constitution Act, 1982, enacted 

as sched. B, Canada Act, 1982, ch. 11 

(U.K. 1982).

118. Ford v. Quebec (Attorney Gen.), 2 S.C.R. 

712 (1988).

119. Irwin Toy Ltd. v. Quebec (Attorney Gen.),

1 S.C.R. 927 (1989).

120. McNaughton, E. L., and C. M. Goodridge. 

2003. The Canadian approach to freedom 

of expression and the regulation of food 

and drug advertising. Food and Drug Law 

Journal 58 (3): 521–36. 

121. Tobacco Products Control Act, S.C. 1988, 

ch. 20 (Can. 1988).
324

8 . L e g a l a n d C o n s t i t u t i o n a l P e r s p e c t i v e s

122. Manfredi, C. P. 2002. Expressive freedom and 

tobacco advertising: A Canadian perspective. 

American Journal of Public Health 92 (3): 

360–62. 

123. RJR–MacDonald v. Canada (Attorney Gen.),

82 D.L.R. (4th) 449 (Can. 1991).

124. RJR–MacDonald Inc. v. Canada (Attorney 

Gen.), 102 D.L.R. (4th) 289 (Can. 1993).

125. RJR–MacDonald Inc. v. Canada (Attorney 

Gen.), 3 S.C.R. 199 (Can. 1995).

126. Tobacco Products Control Act, S.C. § 13 

(Can. 1997).

127. Hogg, P. W., and A. A. Bushell. 1997. 

The Charter dialogue between courts 

and legislatures: Or perhaps the Charter 

of Rights isn’t such a bad thing after all. 

Osgoode Hall Law Journal 35 (1): 75, 86–87. 

128. Tobacco Products Control Act, S.C., ch. 13 

§ 22(2, 3,4) (Can. 1997).

129. Tobacco Products Information Regulations, 

SOR/2000-272, (2000).

130. J.T.I. MacDonald Corp. v. Canada (Attorney 

Gen.), IIJCan 41702 (QC C.S. 2002).

131. Health Canada. 2005. Minister Dosanjh 

announces that the Government of Canada 

seeks leave to appeal in constitutional 

challenge of the Tobacco Act. News release. 

http://www.hc-sc.gc.ca/ahc-asc/media/

nr-cp/2005/2005_111_e.html.

132. Canadian Cancer Society. 2007. Canadian 

Cancer Society applauds Supreme Court 

decision. Press release. http://www.cancer

.ca/ccs/internet/mediareleaselist/0,,3172

_1613121606_2061648882_langId-en.html.

133. Studlar, D. T. 1999. Diffusion of tobacco 

control in North America. Annals of the 

American Academy of Political and Social 

Science 566:68–79. 

134. Council of the European Communities. 

1989. Council Directive 89/552/EEC 

of 3 October 1989 on the coordination 

of certain provisions laid down by law, 

regulation or administrative action in 

Member States concerning the pursuit of 

television broadcasting activities. Official 

Journal of the European Union L 298: 

23–30. http://eur-lex.europa.eu/en/dossier/

dossier_01.htm.

135. European Parliament, and Council of the 

European Union. 1998. Directive 98/43/EC 

of the European Parliament and of the 

Council of 6 July 1998 on the approximation 

of the laws, regulations and administrative 

provisions of the Member States relating to 

the advertising and sponsorship of tobacco 

products. Official Journal of the European 

Communities L 213:9–12.

136. Alegre, M. 2003. We’ve come a long way 

baby (or have we?): Banning tobacco 

advertising and sponsorship in the European 

Union. Boston College International and 

Comparative Law Review 26 (1): 157–70. 

137. Watson, R., and W. Tinning. 2000. Tobacco 

adverts to stay as ban vetoed: European 

Court rules in favour of trade giants and 

against health campaigners. The Herald - 

Glasgow, October 6.

138. Federal Republic of Germany v. European 

Parliament & Council of European Union,

Directive 98/43/EC, Case C-376/98 (2000). 

http://eur-lex.europa.eu/LexUriServ/

LexUriServ.do?uri=CELEX:62003J0380:

EN:html

139. The Queen v. Sec’y of State for Health 

ex parte Imperial Tobacco, Case C-74/99, 

E.C.R. I-08599 (2000).

140. Smyth, P. 2000. EU court rejects legislation 

to combat smoking. The Irish Times,

June 10.

141. BBC News. 2002. EU adopts tobacco ad 

ban. http://news.bbc.co.uk/1/hi/world/

europe/2535071.stm.

142. European Parliament, and Council of 

the European Union. 2003. Directive 

2003/33/EC of the European Parliament 

and of the Council of 26 May 2003 on the 

approximation of the laws, regulations and 

administrative provisions of the Member 

States relating to the advertising and 

sponsorship of tobacco products. Official 

Journal of the European Union L 152:16–19.

143. Action on Smoking and Health. 2006. 

Tobacco policy in the European Union. 

Factsheet 20. http://oldash.org.uk/html/

factsheets/html/fact20.html.

144. Germany v. Parliament & Council, C-380/03 

(2006).

145. Newman, M., and S. Bodani. 2006. EU-wide 

tobacco ad ban upheld by European Union’s 

highest court. Bloomberg News. http://www

.bloomberg.com/apps/news?pid=newsarchive

&sid=a3U5tTDARAPI.

146. World Health Organization. 2003. 

Framework Convention on Tobacco Control: 

Resolutions. http://www.who.int/gb/ebwha/

pdf_files/WHA56/ea56R1.pdf.

147. Hammond, R., and M. Assunta. 2003. The 

Framework Convention on Tobacco Control: 

Promising start, uncertain future. Tobacco 

Control 12 (3): 241–42. 
325

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

148. World Health Organization. 2005. 

Frequently asked questions about the WHO 

FCTC entry into force. http://www.who.int/

tobacco/framework/faq_entry_force/en.

149. Framework Convention Alliance for Tobacco 

Control. 2008. Current signatories and parties 

to the FCTC. http://www.who.int/tobacco/

framework/countrylist/en/index.html.

150. Shibuya, K., C. Ciecierski, E. Guindon, 

D. W. Bettcher, D. B. Evans, and C. J. Murray. 

2003. WHO Framework Convention on 

Tobacco Control: Development of an 

evidence based global public health treaty. 

British Medical Journal 327 (7407): 154–57. 

151. World Health Organization. 2003. World 

Health Assembly Resolution 56.1. Geneva: 

World Health Organization. http://www.who

.int/tobacco/framework/final_text/en.

152. Kenyon, A. T., and J. Liberman. 2006. 

Controlling cross-border tobacco: Advertising, 

promotion and sponsorship—Implementing 

the FCTC. Univ. of Melbourne Legal Studies 

Research Paper No. 161. http://papers.ssrn

.com/sol3/papers.cfm?abstract_id=927551.

153. U.S. Const., art. II., § 1.

154. Bump, C. P. 2003. Close but no cigar: 

The WHO Framework Convention on 

Tobacco Control’s futile ban on tobacco 

advertising. Emory International Law 

Review 17 (3): 1251–310. 

155. Clark v. Community for Creative NonViolence, 468 U.S. 288, 293 (1984).

156. Troy, D. E. 1999. Advertising: Not “low 

value” speech. Yale Journal on Regulation

16:85–144. 

157. Bd. Trs., State Univ. of N.Y. v. Fox, 492 U.S. 

469, 480 (1989).

158. Hudson Jr., D. L. 2007. Compelled 

advertising: Overview. http://www

.firstamendmentcenter.org/Speech/

advertising/topic.aspx?topic=compelled.

159. Glickman v. Wileman Bros. & Elliott, 521 

U.S. 457 (1997).

160. Casarez, N. B. 1998. Don’t tell me what to 

say: Compelled commercial speech and the 

First Amendment. Missouri Law Review

63: 929–77. 

161. 21 C.F.R. § 101.14(c) (2003).

162. Redish, M. H. 1996. Tobacco advertising 

and the first amendment. Iowa Law Review

81:589–639. 

163. Federal Cigarette Labeling and Advertising 

Act, 15 U.S.C. § 1333(a) (2005).

164. McCulloch v. Maryland, 17 U.S. 316 (1819).

165. Garner, D. W., and R. J. Whitney. 1997. 

Protecting children from Joe Camel and his 

friends: A new First Amendment and federal 

preemption analysis of tobacco billboard 

regulation. Emory Law Journal 46 (2): 

479–585. 

166. Wheeler-Lea Amendment of 1938, ch. 49, 

§ 3, 52 Stat. 111 (codified as amended at 

15 U.S.C. § 45 2000).

167. FTC v. Sperry & Hutchinson Co., 405 U.S. 

233 (1972).

168. Brenner, D. E. 1965. The quiet victory of 

the cigarette lobby: How it found the best 

filter yet—Congress. Atlantic Monthly,

September:76–80. 

327

Tobacco in News and 

Entertainment Media

Part

3

The average American is exposed to news and entertainment programming every day, 

yet the influence of these media on tobacco use remains an area open to future study. 

This part reviews the current evidence concerning tobacco use and exposure to mass 

media, together with the methodologies used to research these areas.

The first chapter looks at the influence of the news media on tobacco use and the 

broad range of metrics used to assess news coverage related to tobacco and whether it 

correlates with tobacco consumption, policy outcomes, and activities from both pro- and 

antitobacco stakeholders to influence news coverage. The following chapter then closes 

this part by examining the role of entertainment media in affecting attitudes and 

behavior toward smoking, particularly among children and adolescents. The research 

base in this area, much of which revolves around the relationship between movies and 

smoking, informs policy development and further research as newer entertainment 

media channels compete for the attention of today’s youth.

329

9

How the News Media Influence 

Tobacco Use

News media coverage is an important source of health information and can frame 

discussions of tobacco-related issues among both policymakers and the general public. 

As a result, media coverage has the potential to affect individual attitudes, behaviors, 

and outcomes regarding tobacco use. This chapter examines the impact of news coverage 

on tobacco control and presents the following information:

n	 Summaries of descriptive studies examining tobacco-related news coverage, 

including the volume and nature of news stories, content analysis of specific 

tobacco-related topics, and contextual issues

n	 Issues and early research into relationships between news coverage of tobacco 

issues and individual and policy outcomes

n	 Tobacco industry efforts to influence news coverage of tobacco issues

This research indicates that media advocacy is an important but underutilized area of 

tobacco control. The impact of such media coverage on tobacco use remains a critical 

area for further study.
330

9 . H o w t h e N e w s M e d i a I n f l u e n c e To b a c c o U s e

Introduction

This chapter examines the influence of the 

popular news media on issues surrounding 

tobacco use. It first looks at key concepts in 

the study of tobacco-related news coverage 

and corresponding audience reception. 

Next, it summarizes conclusions from 

literature examining the news media’s 

coverage of tobacco, smoking, and tobacco 

control, including studies that sought to 

assess the impact of such news coverage on 

behavioral, policy, and legislative outcomes. 

This chapter also reviews published 

accounts of tobacco control media advocacy 

efforts to increase and improve the quality 

of news media reporting on tobacco. Finally, 

evidence is reviewed from tobacco industry 

documents to illustrate the industry’s 

attempt to shape news coverage.

The news media are recognized as among 

the world’s most influential and powerful 

institutions. George D. Lundberg, M.D., 

editor of the Journal of the American Medical 

Association for 17 years, remarked, “In our 

society ... public media are irreplaceable 

as a mechanism for moving a problem to 

a solution.”1(p.113) Alan Otten, a long-time 

reporter for the Wall Street Journal, noted, 

“Well-done investigative reporting produces 

public outrage (or policymaker outrage) that 

forces new regulations and laws or tougher 

enforcement of existing ones.” Otten quotes a 

health consultant saying, “Ten-thousand-watt 

klieg lights turned on a situation focuses the 

minds of policymakers very fast.”1(p.112) Page 

and Shapiro’s seminal analysis of 50 years 

of trends in Americans’ policy preferences 

concluded, “Short-term movements in public 

opinion can largely be accounted for (and 

predicted) by quantitative analyses of what 

news, from what sources, appears in the mass 

media.”2(p.386) Authoritarian governments 

invariably control the news media, but in 

democracies with historically independent 

news media, those in government, politics, 

industry, popular culture, and special interest 

groups work to obtain positive and extensive 

news coverage.

In the wider field of public health, research 

has established that the news media serve as 

an important source of health information 

for members of the general public3–8 who 

rely on it particularly for information about 

issues lying outside of their immediate 

realm of experience.5 A 2001 survey by the 

Kaiser Family Foundation and the Harvard 

School of Public Health found that more 

than one-half of Americans name national, 

local, or cable news as their most important 

source of health information, rather than 

a health care provider or public health 

source.9 In addition, 42% of those polled 

reported that they closely follow health 

news stories.10

A Changing Media Mix

Today’s news media extend beyond newspapers, radio, and television bulletins. New technologies 

such as the Internet, handheld computers, and mobile telephones have revolutionized the ways 

people obtain their news, and news increasingly resembles entertainment. Industry groups, 

nongovernmental organizations, and community groups target audiences via direct mail and 

e-mail, selecting, synthesizing, and thereby selectively emphasizing a limited range of news 

that may be editorialized. These developments have attracted relatively little research attention 

of direct relevance to tobacco use or the use of these media tools by either tobacco control or 

tobacco industry interests, suggesting an important gap in knowledge. Regardless, in whatever 

form they take, news sources are an important and often unparalleled source of information for 

both the general public and influential decision makers.
331

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Tobacco issues have become increasingly 

newsworthy as organized public health 

efforts to reduce tobacco use have grown 

and tobacco issues have become more 

politicized. Reporting on links between 

smoking and adverse health outcomes 

increased after the release of the 1964 

Surgeon General’s report on smoking and 

health.11 Moreover, many other facets of 

tobacco control also have fallen under the 

news media spotlight. Over the last 40 years, 

the news media have paid significant 

attention to the tobacco-caused deaths 

of famous people; attempts to increase 

cigarette taxes, introduce and uphold 

smoke-free laws, and mount antismoking 

campaigns; criticism of tobacco industry 

advertising, promotions, and conduct in 

opposing effective tobacco controls; and 

private and state efforts to recover smokingrelated health care costs from the tobacco 

industry. Much of the increase in news 

coverage results from a rise in the number 

of newsworthy tobacco-related events in the 

United States and internationally. However, 

this increase also reflects explicit efforts to 

create newsworthy events and stories and 

to shape news coverage by those working 

to promote or to undermine tobacco 

control progress.

The newsworthiness of tobacco control 

should not, however, be measured 

solely by the volume of news coverage. 

Efforts to incorporate measures of audience 

engagement also are important. To this 

end, research conducted using the Kaiser 

Family Foundation/Harvard School of Public 

Health’s Health News Index10 listed tobacco 

use as one of the top three health issues to 

draw public attention between 1992 and 

2002, after bioterrorism and abortion clinic 

violence. In this study, health stories were 

broadly defined as being those relating 

to national health policy, health issues or 

specific diseases and treatments, or social 

policy issues indirectly related to health, 

including elections, economic policy, gun 

control, poverty, welfare, and Social Security. 

Overall, 55% of respondents reported that 

they closely follow news on tobacco.

The presence and prominence of 

tobacco control material in the news 

are indisputable. However, the tobacco 

control research community has largely 

neglected studying news coverage and the 

response to and influence of this coverage 

on smokers, on the broader community, 

and on policymakers. For instance, very 

few papers focused on news media at 

World Conferences on Tobacco OR Health 

held from 1983 to 2003 (table 9.1).

This low level of research effort, compared 

with the relatively high level of media 

coverage of tobacco issues and its potential 

impact, points to the need for a greater focus 

on media issues in tobacco control. This 

chapter examines concepts in news media 

coverage of tobacco, summarizes research 

on such coverage and its influence on 

tobacco use, and outlines a future research 

agenda based on trends found in existing 

data. By understanding the nature and 

potential impact of the news media, tobacco 

control stakeholders can gain a promising 

new area of knowledge in the fight to reduce 

the public disease burden due to smoking.

Perspectives on 

News Story Selection 

and Content

General news coverage can be viewed at a 

superficial level as a reflection of observable 

events happening in the world at a given 

time that are deemed newsworthy. Using this 

narrow definition, a change in the volume 

of coverage of an issue such as tobacco use 

could be considered to reflect a change in the 

occurrence of relevant, newsworthy events. 

In this vein, one research tradition focuses 

on the accuracy and comprehensiveness 

of news coverage12 and how they might be 

improved. One study specifically attempted 
332

9 . H o w t h e N e w s M e d i a I n f l u e n c e To b a c c o U s e

to compare news coverage of an issue or 

event with some a priori criteria, such as 

quality of the study designs or involvement 

of commercial sponsors.13

By contrast, the social problems 

perspective14–17 treats the news media as 

an institution of power, rejecting both the 

“just the facts” notion of journalism and the 

idea that media content can ever accurately 

represent the “real world out there.” Instead, 

proponents of a social constructionist or 

social problems perspective consider public 

attention a scarce resource for which 

advocates of various issues are in constant 

competition. The news media cannot 

simply reflect the external world because 

of its sheer vastness and complexity and 

because the media are a critical part of the 

mechanism through which that world is 

both assembled and understood.

Agenda Setting

From a social problems viewpoint, the 

news media constitute a vital institutional 

arena within which competition for public 

attention to a given problem can occur. 

However, only a limited number of problems 

or issues can be presented by the news 

media at any given time.15 All potential 

issues of interest must compete with 

hundreds if not thousands of events and 

issues that come before the news media each 

day. According to agenda-setting theory, 

the degree of emphasis the mass media 

place on an issue influences the priority the 

public affords to that issue.18 This theory 

essentially suggests that the influence of the 

news media is due to this capacity to set the 

public agenda—to determine, for example, 

which issues people discuss.

The relative scarcity of space for news 

highlights the importance of determining 

a topic’s newsworthiness. This designation 

suggests to the public that a topic is 

important or interesting enough to 

receive media attention, thereby implicitly 

contributing to public notions of the 

relative importance of issues and events.19,20

From this perspective, news does not 

merely mirror society or passively reflect 

preexisting concerns at a particular time, 

but helps shape both individual and 

community concerns about what is worthy 

of public attention. Further, the news 

media can choose, create, sustain, and 

Table 9.1 News Media Papers Presented at World Conferences on Tobacco OR Health, 1983–2003

Conference

Abstracts or 

proceedings

Total papers 

or abstracts 

published

Total papers or 

abstracts focusing 

on media campaign 

descriptions, planning, 

and evaluations

Total papers or abstracts 

focusing on tobacco 

coverage by news media

Total % Total %

Winnipeg 1983 Proceedings 178 4 2.2 1 0.6

Tokyo 1987 Proceedings 189 12 6.3 8 4.2

Perth 1990 Proceedings 280 23 8.2 3 1.1

Buenos Aires 1992 Abstracts 412 6 1.5 2 0.5

Paris 1994 Proceedings 233 5 2.1 4 1.7

Beijing 1997 Proceedings 428 15 3.5 10 2.3

Chicago 2000 Program 574 16 2.8 11 1.9

Helsinki 2003 Abstracts 1,911 75 3.9 18 0.9

Note. These numbers are approximations because of incompatibilities in conference publications’ inclusion of papers, seminars, 

workshops, and posters and because only one coder assessed each paper and abstract. The reliability of categorizations has not 

been determined.
333

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

shape an issue for public consumption by 

influencing how issues are presented or 

framed for consideration by the public and 

decision makers.21–23

Embedded in this power to introduce 

and reinforce issues to the public is 

the notion that news media treatments 

influence perceived solutions to a given 

problem.24 Iyengar25 also argues that news 

discourses can implicitly question who or 

what is responsible for problems and their 

solutions. The result is that audiences can 

be presented with an account of a problem 

as well as perspectives for thinking about 

it and potential avenues for its resolution. 

Indeed, Menashe and Siegel26 concluded 

that tobacco-related news coverage guides 

people’s thoughts about tobacco and plays 

an important role in determining how 

people address the issue of tobacco use 

as a social problem.

Some research has found that stakeholders 

who seek to shape media coverage in an 

effort to guide or oppose social change 

can instigate news coverage of an issue.27

Furthermore, allegations have been 

made that some journalists may tend to 

collaborate with rather than criticize the 

most influential societal elites. For example, 

one study found that medical science 

reporting is based on regular journalistic 

review of a very limited number of top 

science journals.4 This practice reinforces 

the established hierarchy of knowledge. 

Analyzing mainstream news coverage as a 

reflection of powerful societal institutions 

as well as an instigator of change may, 

therefore, be most appropriate.

Similarly, the identification of stakeholders 

in news media coverage of tobacco use issues 

is worthy of critical analysis. For example, 

Wakefield and colleagues28 analyzed 

Australian news coverage of a liability 

trial involving a nonsmoking worker with 

laryngeal cancer and her employer at a bar. 

They found debate shaped around worker 

inequity, smoking bans, and employer 

liability that made it difficult for the 

tobacco industry to publicly assert that the 

issue is one of personal responsibility or 

accommodation of smokers.

Framing

As part of the power of news resides in 

gaining attention for particular issues, 

understanding which issues are considered 

and how they are shaped for public 

consumption is important to analyzing 

news coverage. Researchers have long 

used the core concept of framing. At its 

most basic level, Goffman’s29 notion of 

framing emphasizes people’s reliance on 

a structure within which to understand 

their experiences. Goffman argues that 

this structure always is necessary to 

facilitate social interaction.30 To frame news 

discourse is to “select some aspects of a 

perceived reality and make them more 

salient ... in such a way as to promote 

a particular problem definition, causal 

interpretation, moral evaluation, and/or 

treatment recommendation....” 31(p.52)

News coverage necessarily frames an issue 

for consumers as the language used, the 

sources consulted, and the opinions cited 

(as well as those omitted) provide the 

context for a news story.32 This context tells 

the reader whether the issue is of local or 

national importance, for example, or may 

link the topic to salient ideological debates 

on larger issues such as human rights, 

industry responsibility, or the government’s 

role as protector or standard setter. A story 

may also define how the issue was instigated 

or interests that need to be considered in 

solving a problem.

One useful application of the framing 

concept is to distinguish between 

episodic and thematic contexts for news 

coverage.25,33 An episodic story isolates an 

event as newsworthy, such as an outbreak 

of a particular disease or the outcome of 

a court case or policy decision. Thematic 
334

9 . H o w t h e N e w s M e d i a I n f l u e n c e To b a c c o U s e

stories address a general issue or emerging 

pattern that may require broader public and 

political attention. Public health advocates 

often seek more thematic news coverage 

or provide thematic contexts for coverage 

of newsworthy events. Researchers need to 

distinguish between episodic and thematic 

news coverage in studying how consumers 

may develop different perceptions and 

understanding of health issues, the 

responsible parties, and potential solutions.

The notion of framing providing the 

interpretive schema for a particular news 

story is useful. However, framing can be 

considered an active process that seeks to 

move an issue in a particular direction. 

Social movements literature has developed 

an idea of framing as an action whereby 

advocates for issues seek to use widely 

accessible cultural ideologies to draw 

people’s attention to particular issues and 

to gain public support for specific courses 

of action.34,35 Pan and Kosicki30 argue 

that framing an issue in the news media 

essentially provides the parameters within 

which the public will debate the nature of 

a problem and what should be done about 

it. A frame implies the structure within 

which something is viewed, somewhat 

like a photograph or window frames. 

The importance of framing suggests that 

public health issues, which can lead to social 

developments such as the breast cancer 

movement Kolker35 studied, may benefit 

from reframing to encourage change in the 

dominant public perception of an issue. 

The success of the breast cancer movement 

is seen at least partly as the result of a 

change away from framing breast cancer 

as an individual, stigmatized condition 

toward prominent and powerful notions of 

survivorship and camaraderie. Such potent 

concepts, in turn, suggest the need for 

public and financial support for prevention 

and treatment.

The crucial role of reporters and editors in 

constructing news frames and the brevity 

of news reporting require those seeking 

media coverage to present their issues so 

they resonate for journalists. In highly 

competitive news environments, journalists 

come to learn which news frames are 

more likely to be deemed newsworthy 

and strive for optimal positioning for 

their news offerings within these frames. 

Those working in tobacco control also need 

to be acutely aware of how groups opposed 

to tobacco control can successfully frame 

their arguments to capture news attention.

Press articles and television bulletins are 

constructed to guide interpretation of the 

messages and make sense of events and how 

they relate to the social world. By referring 

to certain news discourses and narratives, 

news producers attempt to provide signposts 

to guide audiences in understanding a text. 

As Morley explains, “While the message 

is not an object with one real meaning, 

there are within it signifying mechanisms 

which promote certain meanings, even one 

privileged meaning, and suppress others: 

these are the directive closures encoded 

in the message.”36(p.21) Media analysts refer 

to this construction as the preferred or 

dominant meaning of a media text.

Descriptive analyses of the inclusion of 

tobacco issues within the news and the 

framing of tobacco within such coverage 

can improve the understanding of both 

the successes and limitations of public 

health efforts and campaigns in relation 

to tobacco use.26 An appreciation of which 

tobacco issues receive news media attention 

helps to provide context for understanding 

changes in public attitudes and behavior 

as well as the success or failure of policy 

initiatives. Furthermore, analyses of any 

temporal and geographic variations in the 

volume and focus of news media coverage of 

tobacco issues enhance the understanding 

of the evolution of tobacco control and its 

popular and political reception. Analyses 

of the news both inform and are informed 

by an understanding of societal values and 
335

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

concerns at a given time.16,37 Decisions about 

what is newsworthy entail a contemporary 

understanding of the significance of 

specific events as well as commonly held 

perspectives on institutional behavior and 

motives.24 Research in this area has focused 

on what the volume of tobacco coverage 

can reveal and what might be learned from 

the analogies, metaphors, and historical 

comparisons used in framing news stories.38

The total volume of unpaid news media 

coverage routinely outweighs even the 

most intensive antismoking advertising 

campaigns.39 Because of its mass-reach 

nature, news can have a sizable impact on 

both individual- and policy-level outcomes. 

News coverage related to tobacco control 

gains importance when government funding 

for mass media campaigns decreases and as 

the public’s exposure to explicitly formulated 

tobacco control messages declines.40

Media Advocacy for 

Tobacco Control

As discussed, numerous studies have 

established news coverage as a primary 

source of health information for the general 

public.41,42 Given the potential of the media 

as a channel of influence, media advocacy is 

an aspect of policy change that prioritizes 

strategic efforts to attract media attention 

toward a particular subject or specific 

aspects of a given topic. The intent is to 

shape consideration of the given issue in 

ways that are conducive to the interests of 

those advocating the policy in question. 

Advocacy has become an essential tool that 

stakeholders use to influence how the public 

and policymakers attend to and rank the 

importance of various issues.43–46

Media advocates work to reframe and shape 

public discussion of a policy objective 

through strategic use of the news media.47,48

They bring attention to problems that 

might otherwise be considered private 

(for instance, viewing lung cancer as the 

result of an individual’s smoking), and they 

focus on important social and public policy 

dimensions (such as the societal costs 

of smoking and the influence of tobacco 

industry practices in promoting smoking). 

Redefined as a social problem, an issue 

warrants societal response through policy 

rather than remaining the concern of an 

individual or friends and family.15

Effective tobacco control programs 

encompass individual, interpersonal, and 

societal factors and approaches to addressing 

the problem of tobacco use. Media advocacy 

has become an important component of 

these efforts.43,49,50 By working directly with 

news producers, advocates can influence 

the level of attention given to specific 

concerns and shape the consideration 

of potential solutions. Media advocacy 

includes publicizing data and study findings, 

planning events likely to attract coverage, 

and submitting letters to the editor and 

opinion articles (op-ed columns—named as 

such because they are generally opposite the 

editorial page) in support of tobacco control 

perspectives.51 There is a growing need for 

an active research and evaluation agenda to 

ensure that advocacy efforts have the desired 

effect to improve future campaigns and 

maximize impact. Chapman46(p.361) outlined 

10 key questions that should be considered 

in planning advocacy strategies to “build 

support for public policies and ultimately 

influence those who have the power to 

change or preserve laws, enact policies, and 

fund interventions that can influence whole 

populations.” These questions include the 

need for clear objectives for advocacy efforts, 

matching media advocacy objectives to meet 

these goals, and issue framing to promote 

outlined objectives.

News coverage that supports tobacco control 

sets the agenda for further change at the 

community, state, and national levels.52

However, policy analysts and researchers 

seeking to understand how policies, laws, 
336

9 . H o w t h e N e w s M e d i a I n f l u e n c e To b a c c o U s e

and community attitudes against smoking 

evolve often neglect to consider news 

reportage and commentary. At best, news 

coverage tends to be acknowledged as a 

mere background factor compared with 

more proximate, specific factors such as 

lobbying, petitions to government or paid 

media campaigns that are seen to influence 

policy, and behavioral change. For example, 

as suggested by table 9.1, researchers 

routinely evaluate the impact of limitedduration, health-promotion, antismoking 

campaigns sponsored by governments and 

nongovernmental organizations. However, 

they relatively seldom examine the influence 

and impact of ongoing antismoking news 

reportage that may dwarf the duration 

and number of exposures provided to 

audiences and readerships of health 

promotion campaigns. Accordingly, news 

coverage needs to be brought more into 

the foreground of explanations about how 

community and political attitudes influence 

support for tobacco control legislation 

and programs.21,22

The news media are a primary source for 

information dissemination.53,54 However, 

many working in tobacco control 

underuse this source. Individuals involved 

in public health research and practice 

should recognize that if decision makers 

are not made aware via mass media 

reportage of advances in knowledge and/or 

understanding, the potential impact of this 

new knowledge is greatly limited.53,55 People 

can react only to information to which they 

have access. Yet, much research relevant to 

tobacco control is never brought to public 

attention via the news media. It remains 

relatively unnoticed, uncited, and unreported 

except in research journals that often have 

very low circulations compared to news 

audiences and readerships.44

The next two sections review existing 

literature on the nature and volume of news 

coverage of tobacco and their relationship 

with behavioral and policy outcomes. 

Most of the studies reviewed focused on 

newspapers because of the ease and relative 

lack of expense involved in accessing 

archival material. Longitudinal studies of 

electronic media in tobacco control are rare 

because the 24-hour monitoring required 

is resource intensive and the costs of 

purchasing the necessary data are very high. 

Newspapers also serve as a major source of 

information for electronic media56 and are 

considered by most researchers to be the 

official record for news events.

Descriptive Studies 

of News Coverage of 

Tobacco Use

The literature on news coverage and 

tobacco consists primarily of descriptive 

studies. Researchers have focused either on 

analyzing variation in the volume and/or 

nature of news coverage of tobacco during 

specified periods, or examining coverage 

of one specific topic or type of coverage 

in isolation. As the literature has grown, 

an increasing number of studies have 

sought to go beyond simply examining 

the overall volume of coverage to consider 

more in-depth framing of tobacco issues 

in various news media. These descriptive 

studies can enhance the understanding of 

news coverage and are an important first 

step in informing efforts to improve future 

coverage.57 Furthermore, analyses of news 

coverage of a particular topic can provide 

insights into the public mood regarding 

that issue, making the news media a proxy 

source for public opinion. Indeed, research 

has established that public officials often 

use news data for exactly this purpose.30

However, few studies (see below) have 

linked an analysis of coverage of tobacco to 

individual, policy, or legislative outcomes.

Chapman’s58 study of 30 Australian 

newspapers over 12 months was one of the 

earliest descriptive studies of tobacco-related 
337

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

news coverage. This study considered 

the volume, content, and orientation of 

coverage. Chapman identified 1,601 articles 

on tobacco-and-health issues. Of those 

articles, 62% were positive, 17% were 

negative, and 21% were neutral in their 

orientations toward tobacco control 

objectives. Articles on secondhand smoke 

were found to be the most frequent of 

all subcategories.

Menashe and Siegel26 studied the frames 

used in front-page coverage of tobacco 

issues in the New York Times and the 

Washington Post from 1985 to 1996. In this 

more qualitative study of 179 front-page 

articles, the authors identified 11 protobacco 

frames and 10 tobacco control frames 

regularly used in press coverage. In contrast 

with the Australian study, Menashe and 

Siegel argued that the tobacco industry 

has been more successful than public 

health advocates in promoting a consistent, 

powerful, and clear message through the 

press. Over the 11-year period, tobacco 

control frames in these U.S. newspapers 

evolved from closely reflecting Surgeon 

General C. Everett Koop’s message 

that tobacco kills and we must work to 

achieve a smoke-free society to focusing 

predominantly on combating youth 

smoking and restricting the tobacco 

industry’s ability to target youth as potential 

smokers. By contrast, tobacco interest 

groups consistently emphasized the 

intrusion of tobacco control advocates into 

individual liberties and freedom of choice. 

The investigators argued that by having 

a tobacco control advocacy position that 

focused more on youth smoking—a frame 

that tobacco interest groups readily 

adopted—tobacco control advocates 

undermined the broader position that 

tobacco use is harmful to all.

Clegg Smith and Wakefield59 analyzed 

newspaper editorial coverage on tobaccorelated issues from 30 U.S. daily newspapers 

during 2001 as part of a comparative study of 

coverage in the United States and Australia. 

Their descriptive analysis of 1,317 articles 

indicated a considerable fluctuation in 

the volume of news coverage of tobacco 

throughout the year. More favorable than 

unfavorable news stories were reported 

from a tobacco control perspective. Opinion 

coverage, less than 20% of overall coverage, 

tended to support tobacco control. The most 

prominent tobacco issue in the news during 

2001 was secondhand smoke and smoking 

bans (17.6% of the coverage), followed by 

economic issues (such as cigarette taxation 

and price) and advertising and promotion 

issues. This analysis illustrated that 

U.S. print news coverage of tobacco issues 

was prominent in overall volume but fairly 

diffuse in its substantive focus. The analysis 

of the focus and tone of editorials, columns, 

and letters to the editor also allowed the 

authors to identify issues that elicited 

opinionated coverage.

Clegg Smith and colleagues60 used the same 

methods in a subsequent study59 to describe 

newspaper coverage of tobacco issues in 

the United States from 2001 to 2003. In a 

sample of 9,859 articles (approximately onethird of all articles published on tobacco) 

from the 100 leading daily newspapers, 

the majority of coverage reported on events 

that represented progress for tobacco 

control (55%), 23% reported on setbacks, 

and other coverage was mixed or neutral. 

Two-thirds of all articles were concerned 

with secondhand smoke and smoking bans 

(33%); economic issues (10%); education, 

prevention, and cessation efforts (10%); 

and the tobacco industry (9%). In opinion 

pieces such as editorials, columns, and 

letters to the editor, 56% expressed clear 

support for tobacco control objectives, while 

26% expressed overt opposition. 

Long and colleagues61 studied news 

coverage of tobacco by daily newspapers, 

local and national television newscasts, 

and three national news magazines in 

the United States during 2002 and 2003. 
338

9 . H o w t h e N e w s M e d i a I n f l u e n c e To b a c c o U s e

The nationally representative sample was 

drawn from 56 days of news coverage and 

was stratified by day of week and season 

of the year. Of 335 newspaper articles, 

stories about government policy, law, and 

regulation applying to tobacco dominated 

coverage (between 44% and 58% of 

articles each year), and the negative health 

consequences of tobacco were the next most 

common (between 13% and 27% of articles 

each year). However, government action 

and negative health effects usually were not 

covered in the same article. Tobacco news 

coverage was placed fairly prominently in 

newspapers, with nearly 62% in the front 

section of the newspaper. Among newspaper 

articles mentioning government tobacco 

control, news and feature stories evenly 

reported opinions that expressed support 

(16%) or opposition (17%), while opinion 

articles were more likely to favor control 

efforts (55%) than to oppose them (29%). 

Finally, Long and colleagues found that 

newspaper coverage in the southeast, 

the main U.S. tobacco-growing region, 

did not differ from that in the rest of the 

country. The sample of television coverage 

of tobacco issues found only 21 stories from 

550 television news programs, averaging 

0.38 stories per sampling day or one tobacco 

story every 25 news programs. The sampling 

period also identified 17 news magazine 

stories or about one story every four 

magazine issues. The allocation of television 

news coverage to tobacco-related topics was 

similar to that found in newspaper coverage. 

Magazines, however, tended to publish a 

relatively greater proportion of articles 

about health effects and were more likely to 

report about both government action and 

health effects in the same article.

In 2007 Nelson and colleagues62 published 

the findings of a news surveillance system 

for tracking tobacco news stories in 

the United States from January 2004 to 

June 2005. Tobacco news stories were coded 

from 10 newspapers selected according 

to circulation estimates and geographic 

diversity, 4 national news wire services, 

and 7 national broadcast or cable television 

networks. The number of newspaper and 

wire stories fluctuated over time, averaging 

71 per month, meaning that a tobacco story 

was present virtually every day in these 

newspapers and newswires. Television news 

stories were less common, with an average 

of 29 tobacco stories per month. Three 

main tobacco themes accounted for more 

than 70% of newspaper coverage: policy or 

regulation (31%), legal news or lawsuits 

(24%), and health effects or statistics (16%). 

By contrast, 49% of television news stories 

concerned health effects or statistics, with 

policy or regulation stories (19%) a distant 

second. This study suggests that television 

coverage is more common than observed 

by Long and colleagues.61 The difference is 

likely to be explained by the fact that Nelson 

and colleagues62 continuously sampled CNN 

television, which contained one-half of all 

televised news stories on tobacco, whereas 

Long and colleagues61 sampled only one 

hour of CNN per day. 

These studies sought to describe news 

coverage of tobacco in general, rather than 

focusing on any particular issue of interest 

to tobacco control. Other descriptive 

research has focused more specifically on 

the coverage of particular topics of interest, 

such as tobacco farming, secondhand 

smoke, or cigars. Altman and colleagues,63

for example, conducted a content analysis 

of news coverage of tobacco farming issues 

from 1995 to 1997. They concluded that 

diversification away from tobacco farming 

was underrepresented in news coverage 

of farming topics. These data indicate that 

there is a discrepancy in tobacco topics 

being covered by the media and suggest that 

public health practitioners need to track 

coverage of specific tobacco issues to ensure 

that media advocacy goals are achieved.

The resurgence in cigar smoking and cigar 

bars in the middle to late 1990s prompted 

Wenger and colleagues64 to analyze news 
339

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

coverage of cigars. The authors sought to 

characterize the role of the news media 

in the increasing consumption of cigars 

that accompanied a decline in the use 

of other forms of tobacco. Cigar-focused 

articles increased substantially over the 

study period, paralleling increased cigar 

consumption. Articles focused on cigar 

business (39%) and events (19%). Only 4% 

of articles focused on health effects. Sixtytwo percent portrayed cigars favorably. 

The tobacco industry was mentioned in 54% 

of articles and portrayed positively in 78%. 

Forty-two percent of the individuals quoted 

or described in articles were affiliated with 

the tobacco industry, whereas only 5% were 

government/public health figures. The study 

concluded that the news coverage failed 

to communicate health risk messages and 

contributed to positive images of cigars.

In focusing on news coverage of tobacco 

policy, Lima and Siegel’s38 analysis of 

coverage of the 1997–98 national policy 

debates found that 55% of articles relating 

to tobacco policy portrayed the problem 

of tobacco use as smoking by youth and 

identified a “kids” frame as the dominant 

position relating to tobacco policy. This 

frame publicly established tobacco use as 

a problem on the basis that minors should 

not smoke. Thus, the news coverage did 

not frame the problem in terms of issues 

such as the long-term health harms to adult 

smokers, the economic costs of smoking to 

either the individual or society, or tobacco 

industry strategies to promote cigarette use. 

The authors recommended that the public 

health community should work to frame 

tobacco use as also relevant to the general 

population rather than continuing to frame 

it as primarily a youth issue.

Clegg Smith and Wakefield’s65 textual 

analysis of press coverage revisited 

the subject of discourses about youth 

in news coverage about smoking. The 

researchers applied an agenda-setting 

approach to their analysis of more than 

600 youth-focused tobacco news stories from 

daily U.S. newspapers over a one-year period 

(2001). The presentation of smoking as a 

youth issue was a dominant component of 

tobacco control media advocacy efforts. News 

articles more often presented education as 

a solution to youth smoking, rather than 

calling on policy approaches to reduce the 

demand for tobacco among youth.

Three descriptive studies examined how 

secondhand smoke has been covered in 

the press. In a content analysis, Kennedy 

and Bero66 found that newspaper and 

magazine coverage of secondhand smoke 

issues generally increased from 1981 to 

1994. However, most of the articles (62%) 

suggested that research on secondhand 

smoke remained controversial, with the 

implication that decisive policy to restrict 

public smoking would move ahead of the 

supportive research evidence. As with the 

studies discussed above, tobacco industry 

spokespersons frequently were given voice 

in the articles and the industry perspective 

was often prominent, as evidenced by the 

tendency of stories to challenge the science 

of studies of secondhand smoke and to 

suggest continued controversy among 

experts over the issue. Magazines accepting 

tobacco advertising were significantly more 

likely than those refusing such advertising 

to publish stories suggesting that the 

harmful effects of secondhand smoke 

continued to be controversial.

Malone and colleagues23 examined 

journalistic accounts and rhetorical devices 

used in representations of secondhand 

smoke as a news issue. Their analysis 

revealed a tendency to present the 

secondhand smoke issue as a moral 

argument between the tobacco industry and 

tobacco control advocates. Furthermore, 

they concluded that news coverage tended 

to treat science indicating harm from 

secondhand smoke as an area of controversy. 

Magzamen and colleagues67 conducted 

a quantitative content analysis of press 
340

9 . H o w t h e N e w s M e d i a I n f l u e n c e To b a c c o U s e

coverage relating to California’s proposed 

smoke-free policy for bars. Their study 

focused on the topics and nature of the 

coverage. The extent to which space on the 

editorial and letters pages of newspapers was 

allocated to this topic led the researchers to 

believe that secondhand smoke remained 

controversial in the public’s mind. Nearly 

half of the press coverage of secondhand 

smoke was commentary. Tobacco industry 

representatives and public health advocates 

promoted their own perspectives by focusing 

on different aspects of the proposed policy. 

Moreover, tobacco industry representatives 

were more successful in gaining consistent 

coverage of their viewpoints.

Champion and Chapman68 analyzed media 

reportage of the final years of public debate 

before Australian state governments 

announced smoke-free bars. Those seeking 

to retain smoking in bars were quoted in the 

press more often than others. However, more 

articles cast ongoing smoking in bars as a 

problem that needed solving. Health advocates 

promoted the themes of occupational health 

inequity. Tobacco industry frames emphasized 

smoking in bars as an important cultural 

tradition and commercially important to 

bar owners.

The relationship between news coverage on 

tobacco and coverage of other public health 

issues is an important subject that largely 

has been ignored, particularly as it pertains 

to the potential impact on behavioral 

and policy change. The competition for 

space within the “news hole” is likely to 

be most fierce across topics that public 

health advocates would ideally treat as 

complementary (such as coverage of obesity 

and tobacco). Clegg Smith and colleagues69

analyzed how the daily press described the 

allocations of Master Settlement Agreement 

(MSA) funds to areas other than tobacco 

control. This is an example of a study 

examining news coverage of one public 

health issue (or perspective) in competition 

Tobacco Control Efforts and News Coverage: ASSIST Evaluation

Engaging in effective media advocacy is an established objective for many tobacco control 

programs. Therefore, monitoring the volume and nature of news coverage is an important part of 

evaluation efforts. The American Stop Smoking Intervention Study (ASSIST) was implemented 

to reduce tobacco use primarily by using policy-based approaches to change the socio-political 

environment. Seventeen ASSIST states formed coalitions to increase tobacco control media 

coverage, strengthen tobacco control policies and laws, and increase demand for smoking 

cessation services.a Stillman and colleaguesb analyzed the volume and slant of news coverage 

of tobacco policy issues as an outcome variable in studying the impact of ASSIST in relation to 

the first objective. The authors conducted a content analysis of newspaper coverage of tobacco 

policy issues from 1994 to 1998 and compared the volume and content of coverage between 

ASSIST and non-ASSIST states. While the overall rate of increase in the volume of articles did 

not differ between ASSIST and non-ASSIST states, the rate of local stories in ASSIST states was 

greater than in non-ASSIST states. In addition, a state’s ASSIST status did not predict the nature 

of editorial coverage. However, letters to the editor in ASSIST states, compared to non-ASSIST 

states, were more supportive of tobacco control.

a

National Cancer Institute. 2005. ASSIST: Shaping the future of tobacco prevention and control (Tobacco 

control monograph no. 16, NIH publication no. 05-5645). Bethesda, MD: National Cancer Institute. 

http://cancercontrol.cancer.gov/tcrb/monographs/16/index.html. 

b

Stillman, F. A., K. A. Cronin, W. D. Evans, and A. Ulasevich. 2001. Can media advocacy influence newspaper 

coverage of tobacco: Measuring the effectiveness of the American Stop Smoking Intervention Study’s 

(ASSIST) media advocacy strategies. Tobacco Control 10 (2): 137–44.
341

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

with others. The issue of “tobacco money” 

(a term that many news articles used to refer 

to MSA funds) is considered newsworthy 

without necessitating any discussion of 

tobacco control. Proponents of various 

causes (public health and others) use the 

news media effectively to illustrate the 

extent to which they deserve the MSA funds. 

However, others often conceptualized MSA 

funds as state property, requiring little or 

no justification for allocation outside of 

tobacco control.

Similarly, Caburnay and colleagues57

situated tobacco use as one element in 

an analysis of news coverage of health 

behavior in local newspapers. Their study 

compared the nature of newspaper coverage 

of diet, exercise, and tobacco over one 

year. Health behavior stories occurred 

infrequently, and few were prominent or had 

a local focus. The authors concluded that 

more concentrated efforts need to be made 

in translating health behavior research into 

media content for local journalists.

The studies summarized so far have 

described the nature of coverage given to 

specific events or considered variations in 

the volume of coverage during particular 

periods. There is, however, also a need 

for analyses to consider the relative 

value and/or role of certain types of press 

coverage around tobacco. Clegg Smith and 

Wakefield’s59 study of editorial coverage of 

tobacco topics in detail is one example of 

these types of investigations. This qualitative 

study treated editorials as evidence of 

engagement on the part of key media 

gatekeepers. It attempted to relate the 

salience of various tobacco-related frames to 

these opinion leaders. The authors examined 

162 newspaper editors’ perspectives on 

tobacco issues as a way of assessing the 

relative success of those involved in seeking 

to promote or curb tobacco interests in 

the news media. They concluded that 

editors largely promoted tobacco control 

efforts, particularly structural innovations. 

They also cautioned that there is little 

coverage of key issues such as health effects 

and addiction related to tobacco use and 

emphasized the need to reestablish these 

topics as newsworthy.

Relating News 

Coverage of Tobacco 

to Individual Attitudes, 

Behaviors, and Policy 

Outcomes

As outlined in the previous section, much 

can be learned from descriptive analyses 

of news coverage of tobacco use issues. 

However, if media advocacy is the powerful 

public health tool that it increasingly 

is assumed to be, research is needed to 

establish the relationship between coverage 

and key policy and behavioral outcomes. 

A large body of research literature spanning 

many different fields of public health 

indicates that news coverage informs 

the public about particular issues,10

and this information can influence behavior. 

Research has linked news coverage to 

behaviors such as using contraceptives,33

having mammograms,70 and using hormone 

replacement therapy in New Zealand71

and the United States.72

News coverage of the health effects of binge 

drinking has been associated with greater 

self-reported disapproval rates for these 

behaviors among adolescents.73 Likewise, 

Stryker74 drew on evidence relating to breast 

cancer, mammography, and colorectal 

cancer screening to argue that a compelling 

societal event (such as a celebrity diagnosis) 

can produce enough news coverage to bring 

about at least a temporary change in healthrelated behaviors. People are highly sensitive 

to the contextual cues they gain from 

sources such as television news when they 

make decisions and formulate judgments.25

In this light, news coverage of tobacco 
342

9 . H o w t h e N e w s M e d i a I n f l u e n c e To b a c c o U s e

issues could cue particular behavioral and 

attitudinal responses (such as attempts 

to quit smoking cigarettes and support 

for policy initiatives). Comprehending 

the interactions between the nature of 

news coverage and the progression of key 

individual decisions and policy outcomes 

may be instructive for tobacco control.

One challenge to studying the influence of 

news coverage on behavior is establishing 

causal relationships. It is difficult to separate 

the impact of the news coverage of a policy 

or intervention (on smoking behaviors) 

from the effects of the policy or intervention 

itself that has been subject to reportage.75

For example, in considering the effects of 

the passage of a municipal clean indoor 

air policy on smoking behavior, one might 

anticipate that the restrictions themselves 

will reduce smoking. To the extent that the 

policy receives widespread news coverage, 

however, the coverage would communicate 

additional normative information and would 

support future policy efforts, thus having its 

own impact. The difficulty for the researcher 

is how to tease apart these effects. At the 

most basic level, the news media may have 

a direct influence on individual behavior 

via increased individual-level knowledge. 

News coverage may also have indirect effects 

on health behavior. For example, the news 

offers opportunities to change the nature of 

interpersonal influence relating to behavior. 

Finally, the news can influence the attitudes 

and behaviors of people in positions of 

power, which in turn may affect policy 

decisions and lead to behavior change.

Understandably, this latter effect is rarely 

studied. This is because the relationship 

among media coverage, individual 

attitudes, and policy outcomes is difficult 

to distinguish from the effects of other 

environmental and contextual factors.76,77

Moreover, politicians and key decision 

makers in government are reluctant to 

act as research informants and to admit 

that news events influence their decisions. 

However, one innovative study examined the 

contribution of four factors in explaining 

the rate of adoption of smoke-free bylaws 

(ordinances) in Canadian municipalities 

between 1970 and 1995.78 These four 

factors were (1) the number of journal 

articles about secondhand smoke in major 

scientific journals, (2) the number of pages 

of parliamentary debate about secondhand 

smoke, (3) the release of the U.S. Surgeon 

General’s report on secondhand smoke, 

and (4) the number of newspaper articles 

about secondhand smoke. By using event 

history analysis, Asbridge78 determined 

that the amount of news coverage and 

the U.S. Surgeon General’s report both 

significantly increased the rate of smoke-free 

bylaw adoption. In fact, the size of the effect 

for news media was such that each additional 

news article increased the rate of bylaw 

adoption by 5%. Strong evidence from other 

areas of public health indicates that news 

coverage can spur policy change. However, 

few published studies have explicitly linked 

news coverage—either positive or negative—

to key tobacco use behaviors.

Nonetheless, the tobacco control 

community is beginning to make some 

advances in understanding the influence 

of the news media on key tobacco use 

behaviors. Warner’s11 analysis of the impact 

of publicity flowing from the release of the 

Surgeon General’s 1964 report on smoking 

and health is one study that explicitly links 

news coverage and behavior. The report’s 

release and subsequent news coverage 

caused immediate (though transitory) 

decreases (4%–5%) in annual per capita 

tobacco consumption. Unpaid media 

coverage of the health effects of tobacco use 

also has been credited for much of the 30% 

decline in smoking among British men in 

the 20 years after release of the first Royal 

College of Physicians’ report on smoking 

and health in 1962.79

Laugesen and Meads80 conducted a study 

in New Zealand that linked news coverage 
343

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

of tobacco with cigarette sales data as an 

objective measure of tobacco consumption. 

This study examined the relationship 

between the volume of news stories on 

tobacco issues in daily newspapers and 

aggregate weekly cigarette sales data, 

within a broader study of the impact of 

cigarette price, individual income, and 

level of cigarette advertising on weekly 

cigarette sales. Aggregate cigarette sales 

were inversely related to the number of 

press clippings on tobacco or smoking 

issues. By calculating the elasticity for 

news volume and cigarette sales, the 

authors estimated that a 10% increase in 

the weekly volume of news stories could 

decrease purchase levels in the same week 

in which the stories were published by 

0.4%. Doubling news coverage of tobacco 

use issues could be comparable to a 10% 

price increase. Similarly, a U.S. study by 

Cummings and colleagues81 found that a 

week-long newspaper series on smoking 

cessation had approximately the same effect 

on quit attempts (13% of smokers reported 

being prompted to attempt to quit, and 

4% reported quitting for at least one week) 

as would participation in 380 dedicated 

smoking cessation clinics.

Pierce and Gilpin82 explored the relationship 

between news coverage and key tobacco use 

behaviors by analyzing coverage of tobacco 

issues in the most popular U.S. magazines 

from 1950 to 1990. They related patterns 

of news coverage to tobacco use cessation 

and initiation data from the National 

Health Interview Surveys (1965–92). 

This study sought to uncover potential 

relationships between news media coverage 

on tobacco and rates of smoking initiation 

and cessation over the 40-year period. 

From observed trends over time, the authors 

concluded that, for approximately 30 years, 

“The annual incidence of cessation in the 

USA mirrored the pattern of news media 

coverage of smoking and health.”82(p.145)

suggesting that news coverage was related 

to cessation but not to smoking initiation. 

They further suggested that efforts to create 

newsworthy tobacco issues could be most 

effective in settings in which cessation 

rates have begun to lag.

Only two studies have statistically examined 

the relationship between news coverage 

and youth smoking behavior. Niederdeppe 

and colleagues83 assessed the relationship 

between exposure to tobacco-related 

News Coverage, Policy Change, and Adolescent Smoking

Niederdeppe and colleaguesa used data from the evaluation of the Florida Tobacco Control Program 

(FTCP) to relate news coverage of the FTCP to policy change (in the form of implementation of 

tobacco control policies at the county level) and then to investigate whether that policy change was 

related to adolescent smoking behavior within Florida. The authors conducted a content analysis 

of newspaper coverage between April 1998 and December 2001 and related the variation in tobacco 

news coverage to the enactment of tobacco product placement ordinances (specifically, policies to 

move cigarettes behind store counters) in 67 Florida counties by using event history analysis. 

Greater news coverage of Students Working Against Tobacco events was associated with an 

increase in the likelihood of tobacco product placement ordinances being passed. However, 

passage of tobacco product placement ordinances did not lead to reduced smoking, as measured 

by 30-day self-reports by students up to one year after adoption of the ordinances. The authors 

conclude that the findings support the use of media advocacy as a tool to change tobacco policies 

but suggest caution in choosing policy goals that may not themselves influence tobacco use.

a

Niederdeppe, J. D., M. C. Farrelly, and D. Wenter 2007. Media advocacy, tobacco control policy change and 

teen smoking in Florida. Tobacco Control 16 (1):47–52.
344

9 . H o w t h e N e w s M e d i a I n f l u e n c e To b a c c o U s e

newspaper coverage in Florida counties 

and youth smoking, as measured by Florida 

Youth Tobacco Surveys administered between 

1998 and 2002. Cumulative exposure to 

newspaper coverage on the Florida Tobacco 

Control Program (FTCP) with a one-year 

time lag (based on the assumption that news 

effects take time to diffuse) was associated 

with a lower likelihood of youth smoking 

(smoked in the past 30 days) among high 

school students. These results were found 

after adjusting for other FTCP policy and 

program efforts as well as individual variables 

associated with smoking participation. 

News coverage of youth advocacy efforts in 

particular contributed to lower rates of youth 

smoking in both middle and high school 

students. These findings provide persuasive 

evidence for the indirect effects of news 

coverage on smoking initiation. 

Smith and colleagues84 assessed the extent to 

which the volume and content of newspaper 

articles on tobacco were related to perceived 

smoking harm and smoking behavior among 

almost 100,000 American youth from 2001 

to 2003, after adjusting for other individual 

factors and tobacco policy variables. 

The study found that each 10-article increase 

in newspaper coverage per community over 

the five-month period preceding survey 

administration was associated with increased 

odds of perceiving great harm from smoking 

(odds ratio [OR] = 1.04, p < .01) and 

decreased odds of smoking in the past 

30 days (OR = 0.93, p < .001). However, no 

consistent association was found between 

the content or tone of coverage and youth 

smoking outcomes. The study suggests that 

gaining news coverage about tobacco issues 

may be an important tool by which to tackle 

youth smoking at the community level. 

Getting and keeping tobacco on the agenda 

is important, with volume of coverage, 

rather than detailed content, appearing to 

be the driving factor.

Another pathway through which news 

media affect attitudes and behavior is the 

idea that general news coverage of tobacco 

control supports health communication 

campaigns that prioritize other forms of 

communication, such as paid mass media 

messaging. In this pathway, the news 

media are a secondary source of influence 

to the extent that the campaigns can be 

established as newsworthy and generate 

subsequent free coverage. For example, 

if a community were to invest heavily in 

tobacco control programs that generated 

newsworthy education or policy promotion 

events, news coverage of these events 

might generate additional awareness of 

and support for the goals of the overall 

program on the part of the general public 

and policymakers.

As noted above, some studies have 

suggested that news coverage on tobacco 

can lead to behavioral and policy change, 

but no sufficiently detailed, large-scale 

systematic study of such relationships has 

been conducted to determine how such 

an influence is achieved.22 Little is known 

about the potential pathways between 

media advocacy efforts and changes in 

attitudes toward tobacco control policy. 

In addition, little is known about the role of 

news coverage in influencing key decision 

makers to support or oppose tobacco control 

policy and legislation. As illustrated in the 

previous sections, existing research offers 

valuable descriptive insights. However, 

further investigation is needed into the 

relationship between news coverage on 

tobacco and tobacco use behaviors and 

policy change. The challenge now is to apply 

the increased understanding of the nature 

of news coverage on tobacco to determining 

the mechanisms by which it influences 

individual-level attitudes and behavior 

and policy implementation. Qualitative 

methodologies will be important in this 

effort, as well as complex statistical methods 

such as multilevel analysis, time series, and 

event history analysis linking news coverage 

to change in tobacco policies and smoking 

attitudes and behavior.
345

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Tobacco Industry 

Influence on News 

Reporting

A key marketing tool, advertising requires a 

mutually beneficial commercial relationship 

between the advertiser and the media that 

carry the advertising. These relationships 

might afford the tobacco industry the ability 

to leverage editorial influence by favoring 

advertising in publications that downplay 

antismoking content or publish prosmoking 

articles. This effect is acknowledged in the 

Surgeon General’s 1989 report85(pp.502,508–10)

as one of the indirect mechanisms by which 

advertising and promotion might increase 

tobacco consumption. Evidence for this line 

of reasoning from industry documents is 

provided later in this section.

Tobacco advertising might influence a 

publication’s coverage of tobacco and 

health in several ways. An agent of the 

tobacco manufacturer might advise the 

publisher or editor (verbally if not in 

writing) to avoid certain types of news 

coverage, or a manufacturer might cancel 

its advertising contract with a publication 

or pull advertisements from one or more 

issues following publication of an article 

unfavorable to the company or industry. 

Some publications might self-censor 

their coverage of tobacco and health to 

avoid offending an advertiser and losing 

its business. A study of internal tobacco 

industry documents demonstrated previous 

instances when tobacco companies punished 

corporations that acted against its interests.86

The Surgeon General’s 1989 report85(pp.509,510)

provides several references for stating, 

“Writers, editors, and publishers have 

described numerous instances of purported 

censorship attributed directly to publications’ 

fears of alienating cigarette advertisers.”

While instances and impressions of the 

influence of advertising on editorial content 

exist, a number of caveats need to be borne 

in mind. First, the degree of influence may 

vary by type of medium (television, radio, 

magazines, newspapers, etc.). Second, 

the relationship may be influenced by 

the geographical scope (national versus 

local) of the medium. Third, as discussed 

in chapter 2, news media companies are 

typically organized so as to separate and 

insulate business operations from editorial 

activities. Advertisers are serviced by 

marketing departments of media companies; 

thus, reporters rarely come into direct 

contact with advertisers in their media, 

although this may be more likely to occur 

in local news media. Finally, the degree 

of influence is likely to vary by the degree 

of the medium’s reliance on advertising 

revenue. Controlled-circulation newspapers 

such as shoppers’ guides or neighborhood 

newspapers that rely exclusively on 

advertising may be more susceptible 

compared to larger newspapers that rely 

heavily on subscription fees. In the case of 

larger newspapers and other media, it is 

possible that news coverage is more likely to 

influence advertising, rather than the other 

way around. In other words, an editorial 

environment that is not hospitable to a 

product is unlikely to attract advertising 

for the product, thus limiting the revenue 

stream for the news medium. With these 

general principles in mind, the remainder 

of this section discusses the relationship 

between revenue from tobacco advertising 

and publication of tobacco-related content.

As reviewed in chapter 10, early studies of 

news coverage of tobacco posed questions 

about the possible correlations between a 

publication’s receipt of tobacco advertising 

revenue and tobacco-related content. 

For example, Whelan and colleagues87

surveyed coverage of smoking in women’s 

magazines with the objective of identifying 

magazines that published smoking-related 

articles, exploring a possible relationship 

between tobacco advertising and tobaccorelated news content. They found few 
346

9 . H o w t h e N e w s M e d i a I n f l u e n c e To b a c c o U s e

smoking-related stories compared with 

other health topics. The authors concluded 

that the paucity of antismoking articles 

was related to the importance of tobacco 

advertising as a source of revenue for 

the magazines. They also concluded that 

magazine news coverage would adequately 

address tobacco issues only by restricting 

tobacco advertising.

A study of 99 U.S. magazines published 

over 25 years (1959–69 and 1973–86) 

essentially confirmed the summation 

by Whelan and colleagues that cigarette 

advertising in magazines was associated 

with diminished coverage of the hazards of 

smoking, particularly in magazines directed 

toward women. In women’s magazines, the 

probability of publishing an article on the 

risks of smoking in a given year was 11.7% 

for magazines that did not carry cigarette 

advertisements compared with 5.0% for those 

that did publish these types of advertisements 

(adjusted OR = 0.13; 95% confidence interval 

[CI], 0.02–0.69).88 For all magazines, when 

the proportion of revenues derived from 

cigarette advertising was the independent 

variable, the probability of publishing an 

article on the risks of smoking in a given year 

was reduced by 38% (95% CI, 18%–55%). 

This relationship was particularly strong 

in the case of women’s magazines. Studies 

examining British,89 Irish,90 and European91

women’s magazines reached similar 

conclusions. Furthermore, DeJong’s92

analysis of the nature of tobacco coverage 

in student newspapers before and after 

acquisition by a tobacco company revealed 

a possible relationship between ownership 

and content. Similar studies have not yet 

been conducted to determine whether the 

presence of tobacco advertising influences 

editorial coverage in daily newspapers, 

radio, or television. However, anecdotal 

evidence about the influence of advertising 

over editorial coverage exists for newspapers 

and the broadcast media before the removal 

of cigarette commercials,85(p.520) and 

occasional examples of industry claims of 

influencing news coverage or plans to do 

so have surfaced within formerly private 

internal tobacco industry documents.

The internal tobacco industry documents 

made public through the MSA and 

other settlements and investigations 

provide insights into tobacco industry 

efforts to influence media coverage of 

tobacco matters. These insights often are 

fragmentary because documents made 

public represent an undefined sample 

of all documents ever produced within 

the industry. They also frequently raise 

questions that cannot be addressed because 

related documents are missing. However, 

many documents demonstrate the tobacco 

industry’s awareness of the importance 

of news coverage favorable to industry 

interests. For example, Philip Morris used 

the InfoFlow measure to “understand 

what the public is reading, hearing and 

seeing in the news related to tobacco 

and ... to determine the impact this has 

on the general public’s overall view of the 

tobacco industry.”93 A negative InfoFlow 

score indicates that members of the public 

listen to news that influences their opinion 

about the tobacco industry “in a negative 

direction.” To that end, by its own accounts, 

the industry fares less well than it would 

like in attempts to control the nature of 

coverage. In 2000, Philip Morris reported to 

its staff, “Despite some minor movement, 

InfoFlow has remained decidedly negative.”93

Thomas Lauria from the now-defunct 

U.S. Tobacco Institute lamented the 

nature of news coverage of the industry: 

“We are forever dogged with being at the 

bottom of the story in a chip shot quote 

that’s taken out of context. I’ve counted 

as many as 13 anti-smoking activists 

in one Los Angeles Times article, with 

one recycled comment of mine at the 

bottom.”94 The importance the industry 

places on news coverage also was illustrated 

when the New South Wales (Australia) 

government declined to support the 
347

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

national introduction of health warnings 

on cigarettes packages in the early 1970s. 

One local Philip Morris operative in Australia 

reported to his U.S. head office, “Our first 

task is now to protect the New South Wales 

Government from too much adverse 

publicity — by exerting pressure on media 

chieftains. This is being done presently, 

so far with some success.”95(Bates no. 2015047984)

Similarly, an anonymous speaker at a 1985 

meeting of Philip Morris’s “top management” 

suggests that the news media could be 

“exploited” to “write articles or editorials 

positive to the industry position on the 

various aspects of the smoking controversy.”96

It is not known whether Philip Morris or 

other tobacco companies adopted this 

strategy. However, the following comments 

illustrate that industry representatives were 

aware of the potential influence of messages 

delivered within the media arena.

The sixth point I want to make is that 

we are not using our very considerable 

clout with the media. [emphasis 

in original] A number of media proprietors 

that I have spoken to are sympathetic 

to our position - Rupert Murdoch and 

Malcolm Forbes are two good examples. 

The media like the money they make 

from our advertisements and they are an 

ally that we can and should exploit.

In most societies in the world today 

public opinion is formed, to a significant 

extent, by the news media and I believe 

we should make a concerted effort in our 

principal markets to influence the media 

to write articles or editorials positive to the 

industry position on the various aspects 

of the smoking controversy. I can’t speak 

for the U.S. but I can tell you all that 

we are not doing enough in this area in 

International.96(Bates no. 2023268336)

A 1985 unsigned document commenting 

on a memorandum written by Philip Morris 

senior official Hamish Maxwell stated:

Another area we intend to exploit more 

fully is the ad agencies and media 

proprietors. We have already been 

helped a great deal by the agencies in 

Hong Kong for example, in our efforts to 

resist advertising restrictions. As regards 

the media, we plan to build similar 

relationships to those we now have with 

Murdoch’s News Limited with other 

newspaper proprietors. Murdoch’s papers 

rarely publish anti-smoking articles 

these days.97(Bates no. 2023268390)

However, a 1989 Australian study somewhat 

contradicts this claim. The study found 

that newspapers owned by Rupert Murdoch 

published 55.7% of articles on tobacco 

control that were judged positive and 

23.7% that were negative to tobacco control 

objectives, compared with 68.0% positive 

and 13.7% negative articles in the other 

large chain of Australian newspapers.58

Despite the tobacco industry’s desire to 

influence media coverage, a growing 

number of studies (such as those 

reviewed above) have found that the 

news media often publish and broadcast 

news that is unfavorable to the industry’s 

interests. Indeed, internal tobacco 

industry documents demonstrate 

corporate officials’ frustration about 

negative news coverage. For example, 

in 1994, a Philip Morris official wrote of 

the news situation in Australia:

There is a vast amount of material 

published in the media which is 

predominantly negative. For example, 

in May 1993 1,659 national daily’s, 

metropolitan daily’s, suburban 

regional newspapers were published. 

These contained 450 unfavourable 

mentions concerning tobacco not 

including negative mentions in classified 

advertisements. In the same month, 

an examination of 460 magazines 

published during the month revealed 

181 unfavourable articles.98(Bates no. 2023248099)
348

9 . H o w t h e N e w s M e d i a I n f l u e n c e To b a c c o U s e

An undated Brown & Williamson document 

lamented the news media’s “lack of balance” 

in favoring antismoking coverage:

This case illustrated the problem we have 

in presenting to the public an alternative 

and balancing viewpoint to the antismokers [sic] strident claims. The media 

is biased and sensational, so that Industry 

responses do not get the headlines that the 

anti-smokers achieve.99(Bates no. 620215679)

Like other types of manufacturers, the 

tobacco industry generally seeks to 

maximize positive and minimize negative 

news coverage germane to its interests. 

Research shows that, on average, magazines 

that accept tobacco advertising tend to 

provide less coverage of smoking and 

health.87–91 However, this relationship has 

not been noted for newspapers. As more 

nations ban tobacco advertising after 

ratifying the World Health Organization’s 

Framework Convention on Tobacco Control, 

tobacco industry influence on magazine 

content pertaining to smoking and health 

is likely to diminish.

Future Directions

Research on the volume of coverage of 

tobacco issues, particularly compared with 

other health topics, firmly establishes 

tobacco control as a highly newsworthy issue. 

News media coverage of tobacco control 

could have a significant impact on tobacco 

policy and individual tobacco use. Milestones 

in the epidemiology of tobacco use and 

disease (such as U.S. Surgeon General’s 

reports) have attracted intensive news 

coverage during the past several decades, as 

have policy changes pertaining to curbing 

the tobacco epidemic and litigation aimed at 

tobacco industry activities. Over time, this 

has broadened to the extent that tobacco has 

long been one of the most covered issues in 

health reporting. Indeed, in June 2004 the 

Wall Street Journal deemed newsworthy a 

finding that obesity “had eclipsed coverage 

of passive smoking” in global reportage in a 

news-monitoring study.100

At the same time, the tobacco industry 

is no different from any institution 

in pursuing its strategic objectives in 

public communications and attempting 

to maximize the likelihood of news 

coverage favoring its economic interests. 

Some evidence suggests the industry may 

try to leverage its considerable advertising 

contributions to influence editorial 

coverage in magazines. However, a growing 

body of research focused on newspapers 

indicates that several decades of strong 

and continuing coverage of the negative 

aspects of tobacco issues is incompatible 

with any hypothesis that industry influence 

can seriously affect the ways in which the 

news media (except for magazine content) 

approach tobacco matters. As the tobacco 

control community continues to make 

strides in limiting the acceptable locales 

for print advertising, the influence of the 

tobacco industry even on magazine content 

is likely to diminish.

Further work needs to be done to elucidate 

the nature of tobacco-related news coverage 

and its broader impact on public health. 

The results of this work can, in turn, 

inform future efforts of the tobacco control 

community pertaining to the news media, 

including media advocacy, framing of 

key issues, and appropriate use of media 

channels in broader policymaking efforts. 

Five specific areas for future discussion are 

outlined here.

1. The tobacco control community has 

yet to give sufficient research attention 

to efforts to shape the nature of 

news coverage and understanding the 

impact of these efforts. The public 

health research community has given 

relatively little research attention to the 

news media in tobacco control studies. 

This is despite the prominence given 
349

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

in the news media to matters directly 

relevant to tobacco control and the 

acknowledgment of the importance of 

the news media in generating public and 

political interest in all aspects of public 

life. The tobacco control field could 

gain an important understanding of the 

role of news in advancing and retarding 

tobacco control objectives by studying 

three broad areas: the production of 

news accounts, the influence of news 

accounts on individual behaviors, and 

the impact of news coverage on policy 

outcomes.

2. Research is needed on the process 

for producing news coverage of 

tobacco issues. News is produced 

by the decisions of those working in 

news organizations who—on a daily 

basis—apply precepts of newsworthiness 

to their selection and treatment of what 

will be published or broadcast. Studies 

examining this selection process and 

how news media gatekeepers interpret 

information presented for their 

consideration could bring important 

insights to those working in tobacco 

control. This could help frame news 

in ways that are more likely to interest 

journalists in tobacco control stories 

and to avoid engagement in news events 

and actions likely to attract coverage 

that is negative to tobacco control.

3. Better and more systematic research is 

needed on the nature of news coverage 

of tobacco and the relationship between 

this coverage and key behavioral and 

policy objectives. More studies are 

needed to examine news texts that 

are published and broadcast about 

tobacco. This research ideally should 

move beyond content analysis studies 

that simply enumerate instances of 

categories of stories and into more 

text-based studies that examine matters 

such as the dominant frames used 

to convey tobacco news, differences 

in how reportage positive to the 

tobacco industry or tobacco control 

is constructed, and predictors of news 

coverage. There appear to be few 

longitudinal studies of the coverage of 

tobacco and tobacco-control-related 

material in the news. Those running 

health promotion media campaigns 

routinely evaluate them. However, 

detailed examinations of tobacco-asnews tend to occur only irregularly 

and opportunistically. Therefore, this 

widespread and ongoing source of 

public discourse about smoking remains 

relatively unexplored.

4. Researchers need to explore how 

smokers, potential smokers, the general 

public, and key policymakers decode 

and interpret news about smoking.

Several research areas might enhance 

knowledge of the ways that news on 

smoking influences contemporary 

public thinking about tobacco use and 

its control. They include qualitative 

research among these groups seeking to 

explore how different styles of news are 

interpreted, how audiences understand 

key concepts such as risk as they apply 

to smoking, what people think of the 

credibility of tobacco control advocates 

and spokespeople for the tobacco 

industry, and how people assess policy 

debates covered by the media.

5. Systematic study beyond the newspaper 

is needed to understand niche market 

news, the emerging news media, and the 

role of infotainment.* Again, largely due 

to pragmatic considerations, most studies 

of news coverage of tobacco issues have 

focused on print sources (primarily 

newspapers). While this provides valuable 

insights, there also is a growing need to 

include television, radio, and Internet 

*

A type of media broadcast program that provides a combination of current events news and feature 

news or feature stories.
350

9 . H o w t h e N e w s M e d i a I n f l u e n c e To b a c c o U s e

news sources within studies to more 

accurately reflect the myriad sources of 

coverage. Thus, studies are needed that 

focus on the nature of news coverage and 

the influence of this coverage from a wide 

variety of news sources and a range of 

settings. The studies summarized here 

were intentionally those conducted 

using mainstream daily newspapers 

published in the United States. However, 

a few seminal studies from other 

developed countries (such as Australia, 

the United Kingdom, and New Zealand) 

and studies using magazines also 

were included. The applicability of the 

findings to other news media sources 

is uncertain in terms of the framing 

of tobacco issues, the influence of 

various stakeholders, and the influence 

of coverage on behavioral and policy 

outcomes, particularly in developing 

countries, but this is clearly an 

important area for future investigation. 

Furthermore, in an increasingly global 

and postmodern environment, studies 

are needed that examine patterns of 

coverage across both national and media 

boundaries, as well as niche media, to 

fully understand the impact on attitudes, 

behavior, and policy progression.

Summary

The news media represent an important 

area of influence for both tobacco policy and 

individual smoking behavior, yet they have 

not been adequately investigated. The volume 

of coverage of tobacco issues in news media 

may outweigh that in other communication 

vehicles such as paid advertising and 

promotion. Advocacy contained within this 

news coverage can form a key component of 

an overall tobacco control strategy. 

Research shows that tobacco control 

interests often are favorably covered in the 

news media. Generally, the media focus on 

topical news stories such as secondhand 

smoke, policy interventions, or economic 

issues such as the use of MSA funds. 

Content analyses of specific issues show 

that protobacco interests can sometimes be 

successful in framing issues or expressing 

their views. The tobacco industry has enjoyed 

the leverage of paid advertising in areas 

such as print media, especially magazines. 

However, studies have shown that this 

influence has not affected editorial coverage 

in other media such as newspapers. Proposed 

advertising restrictions—stimulated in 

many cases by the Framework Convention 

on Tobacco Control—hold the promise 

to further limit such influence in other 

communication channels.

Challenges for the future include further 

research to better establish the relationship 

between news media coverage and tobacco 

use outcomes as well as the social attitudes 

and public policy issues surrounding 

tobacco consumption. More information is 

needed about the impact of the changing 

landscape of media channels on tobacco 

control issues and advocacy. The existing 

base of research points to a promising role 

for leveraging news media efforts to help 

reduce tobacco use and improve overall 

public health.

Conclusions

1. The news media represent a key source 

of health information for the general 

public. More important, they serve 

as a framing mechanism for issues 

surrounding tobacco control. As a result, 

news coverage is a frequent aim of 

stakeholder activity on both sides of 

tobacco-related issues. However, only 

a small proportion of tobacco control 

research has been devoted to news 

media issues to date.

2. News coverage that supports tobacco 

control has been shown to set the agenda 

for further change at the community, 

state, and national levels. Despite this, 
351

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

organized media advocacy efforts on 

behalf of tobacco control issues remain 

an underutilized area of activity within 

public health.

3. Key issues covered as news stories 

include secondhand smoke, tobacco 

policies, and the health effects of 

smoking. Studies of tobacco-related news 

coverage often show that the majority of 

stories favor tobacco control progress, 

including opinion pieces. Other studies 

have shown the tobacco industry to be 

successful in gaining consistent coverage 

for selected issues.

4. Content analyses of tobacco-related 

news articles have revealed some trends 

that remain favorable to protobacco 

interests. These trends include the 

underrepresentation of tobacco farming 

diversification in the farming press, 

a tendency of articles to challenge the 

science behind secondhand smoke 

issues, and positive coverage of the 

growth in cigar smoking.

5. Numerous factors can affect the 

volume and nature of tobacco news 

coverage. The American Stop Smoking 

Intervention Study found more support 

for tobacco control in letters to the 

editor in participating states, and 

editors largely support tobacco control 

efforts. However, news coverage often 

focuses on specific areas such as tobacco 

control policies, the outcomes of 

tobacco lawsuits, or the disbursement 

of Master Settlement Agreement funds.

6. Large-scale studies have yet to be 

undertaken investigating associations 

between tobacco-related news coverage 

and attitudes, behaviors, and outcomes 

related to tobacco use. These studies 

face challenges in separating the 

effects of news coverage from those 

of the interventions or policy changes 

they describe. Research shows 

potential evidence for such an impact, 

including a drop in per capita cigarette 

consumption after news coverage of 

the 1964 Surgeon General’s report on 

smoking and health, a relationship 

between tobacco-related news coverage 

and cessation, and a link between news 

coverage of specific tobacco control 

efforts and lower adolescent smoking 

prevalence and consumption.

7. Paid tobacco advertising tends to 

suppress or reduce news coverage of 

tobacco-related issues, particularly in 

magazines. However, bans on tobacco 

advertising that accompany ratification 

of the World Health Organization’s 

Framework Convention on Tobacco 

Control may impair the tobacco 

industry’s ability to exert editorial 

control over published content.
352

9 . H o w t h e N e w s M e d i a I n f l u e n c e To b a c c o U s e

References

1. Otten, A. L. 1992. The influence of the 

mass media on health policy. Health Affairs 

(Millwood) 11 (4): 111–18. 

2. Page, B. I., and R. Y. Shapiro. 1991. 

The rational public: Fifty years of trends 

in Americans’ policy preferences. American 

Politics and Political Economy series. 

Chicago: Univ. of Chicago Press.

3. Burns, R. B., M. A. Moskowitz, M. A. Osband, 

and L. E. Kazis. 1995. Newspaper reporting 

of the medical literature. Journal of General 

Internal Medicine 10 (1): 19–24. 

4. Entwistle, V. 1995. Reporting research in 

medical journals and newspapers. British 

Medical Journal 310 (6984): 920–23. 

5. Radford, T. 1996. Influence and power of the 

media. Lancet 347 (9014): 1533–35. 

6. Conrad, P. 1999. Uses of expertise: Sources, 

quotes, and voice in the reporting of 

genetics in the news. Public Understanding 

of Science 8: 285–302. 

7. Nelkin, D., and M. S. Lindee. 1995. The 

DNA mystique: The gene as a cultural icon.

New York: W. H. Freeman.

8. Mountcastle-Shah, E., E. Tambor, 

B. A. Bernhardt, G. Geller, R. Karaliukas, 

J. E. Rodgers, and N. A. Holtzman. 2003. 

Assessing mass media reporting of diseaserelated genetic discoveries: Development of 

an instrument and initial findings. Science 

Communication 24 (4): 458–78. 

9. Kaiser Family Foundation/Harvard School 

of Public Health. 2001. Kaiser/Harvard 

Health News Index 6: no. 5. http://www.kff

.org/kaiserpolls/3189-index.cfm.

10. Brodie, M., E. C. Hamel, D. E. Altman, 

R. J. Blendon, and J. M. Benson. 2003. 

Health news and the American public, 

1996–2002. Journal of Health Politics, 

Policy and Law 28 (5): 927–50. 

11. Warner, K. E. 1977. The effects of the 

anti-smoking campaign on cigarette 

consumption. American Journal of Public 

Health 67 (7): 645–50. 

12. Entwistle, V. A., and I. S. Watt. 1999. 

Judging journalism: How should the 

quality of news reporting about clinical 

interventions be assessed and improved? 

Quality Health Care 8 (3): 172–76. 

13. Moynihan, R., L. Bero, D. Ross-Degnan, 

D. Henry, K. Lee, J. Watkins, C. Mah, and 

S. B. Soumerai. 2000. Coverage by the 

news media of the benefits and risks of 

medications. New England Journal of 

Medicine 342 (22): 1645–50. 

14. Spector, M., and J. I. Kituse. 1997. 

Constructing social problems. Menlo Park, 

CA: Cummings.

15. Hilgartner, S., and C. L. Bosk. 1988. The rise 

and fall of social problems: A public arenas 

model. American Journal of Sociology

94 (1): 53–78. 

16. Best, J., ed. 1994. Troubling children: 

Studies of children and social problems.

New York: Aldine de Gruyter.

17. Linders, A. 1998. Abortion as a social 

problem: The construction of “opposite” 

solutions in Sweden and the United States. 

Social Problems 45 (4): 488–509. 

18. McCombs, M., and S. Ghanem. 2001. 

The convergence of agenda setting and 

framing. In Framing public life: Perspectives 

on media and our understanding of the 

social world, ed. S. D. Reese, O. Gandy Jr., 

and A. Grant, 67–81. Mahwah, NJ: 

Lawrence Erlbaum.

19. McCombs, M. E., and D. L. Shaw. 1972. 

The agenda-setting function of mass media. 

Public Opinion Quarterly 36 (2): 176–87. 

20. Lemmens, P. H., P. A. Vaeth, and 

T. K. Greenfield. 1999. Coverage of beverage 

alcohol issues in the print media in the 

United States, 1985–1991. American Journal 

of Public Health 89 (10): 1555–60. 

21. Wakefield, M. A., and F. J. Chaloupka. 1998. 

Improving the measurement and use of 

tobacco control “inputs.” Tobacco Control

7 (4): 333–35. 

22. Chapman, S. 1999. The news on tobacco 

control: Time to bring the background into 

the foreground. Tobacco Control 8 (3): 

237–39. 

23. Malone, R. E., E. Boyd, and L. A. Bero. 

2000. Science in the news: Journalists’ 

constructions of passive smoking as a social 

problem. Social Studies of Science 30 (5): 

713–35. 

24. Tuchman, G. 1978. Making news: A study 

in the construction of reality. New York: 

Free Press.

25. Iyengar, S. 1991. Is anyone responsible? 

How television frames political issues.

American Politics and Political Economy 

series. Chicago: Univ. of Chicago Press.

26. Menashe, C. L., and M. Siegel. 1998. 

The power of a frame: An analysis of 
353

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

newspaper coverage of tobacco issues—

United States, 1985–1996. Journal of Health 

Communication 3 (4): 307–25. 

27. Shoemaker, P., and S. Reese. 1991. Mediating 

the message: Theories of influence on mass 

media content. New York: Longman.

28. Wakefield, M., K. Clegg Smith, and 

S. Chapman. 2005. Framing of Australian 

newspaper coverage of a secondhand smoke 

injury claim: Lessons for media advocacy. 

Critical Public Health 15 (1): 53–63.

29. Goffman, E. 1974. Frame analysis: An 

essay on the organization of experience.

New York: Harper Univ. Press.

30. Pan, Z., and G. M. Kosicki. 2001. Framing 

as a strategic action in public deliberation. 

In Framing public life: Perspectives on 

media and our understanding of the world,

ed. S. D. Reese, O. Gandy Jr., and A. Grant, 

35–66. Mahwah, NJ: Lawrence Erlbaum.

31. Entman, R. M. 1993. Framing: Toward 

clarification of a fractured paradigm. 

Journal of Communication 43 (4): 51–58. 

32. Taylor, C. A., and S. B. Sorenson. 2002. 

The nature of newspaper coverage of 

homicide. Injury Prevention 8 (2): 121–27. 

33. Jones, E. F., J. R. Beniger, and C. F. Westoff. 

1980. Pill and IUD discontinuation in the 

United States, 1970–1975: The influence of 

the media. Family Planning Perspectives

12 (6): 293–300. 

34. Williams, R. H. 1995. Constructing the 

public good: Cultural resources and social 

movements. Social Problems 42 (1): 124–44. 

35. Kolker, E. S. 2004. Framing as a cultural 

resource in health social movements: 

Funding activism and the breast cancer 

movement in the US 1990-1993. Sociology 

of Health and Illness 26 (6): 820–44. 

36. Morley, D. 1992. Television, audiences and 

cultural studies. London: Routledge.

37. Altheide, D. L. 1997. The news media, the 

problem frame, and the production of fear. 

Sociological Quarterly 38 (4): 647–68. 

38. Lima, J. C., and M. Siegel. 1999. The 

tobacco settlement: An analysis of 

newspaper coverage of a national policy 

debate, 1997–98. Tobacco Control 8 (3): 

247–53. 

39. Stevens, C. 1998. Designing an effective 

counteradvertising campaign—California. 

Cancer 83 Suppl. 12: S2736–S2741. 

40. Chapman, S., and A. Dominello. 2001. 

A strategy for increasing news media 

coverage of tobacco and health in Australia. 

Health Promotion International 16 (2): 

137–43. 

41. Meissner, H. I., A. L. Potosky, and 

R. Convissor. 1992. How sources of health 

information relate to knowledge and use 

of cancer screening exams. Journal of 

Community Health 17 (3): 153–65. 

42. James, C., N. James, D. Davies, P. Harvey, and 

S. Tweddle. 1999. Preferences for different 

sources of information about cancer. Patient 

Education and Counseling 37 (3): 273–82. 

43. Jernigan, D. H., and P. A. Wright. 1996. 

Media advocacy: Lessons from community 

experiences. Journal of Public Health Policy

17 (3): 306–30. 

44. Chapman, S. 2001. Advocacy in public 

health: Roles and challenges. International 

Journal of Epidemiology 30 (6): 1226–32. 

45. Chapman, S., and M. Wakefield. 2001. 

Tobacco control advocacy in Australia: 

Reflections on 30 years of progress. Health 

Education Behavior 28 (3): 274–89. 

46. Chapman, S. 2004. Advocacy for public 

health: A primer. Journal of Epidemiology 

and Community Health 58 (5): 361–65. 

47. Wallack, L. 1994. Media advocacy: A strategy 

for empowering people and communities. 

Journal of Public Health Policy 15 (4): 

420–36. 

48. Wallack, L., K. Woodruff, L. E. Dorfman, 

and I. Diaz. 1999. News for a change: 

An advocate’s guide to working with the 

media. Thousand Oaks, CA: Sage.

49. Russell, A., R. B. Voas, W. Dejong, and 

M. Chaloupka. 1995. MADD rates the states: 

A media advocacy event to advance the 

agenda against alcohol-impaired driving. 

Public Health Reports 110 (3): 240–45. 

50. U.S. Department of Health and Human 

Services. 2000. Reducing tobacco use: 

A report of the Surgeon General. Atlanta: 

U.S. Department of Health and Human 

Services, Centers for Disease Control and 

Prevention, National Center for Chronic 

Disease Prevention and Health Promotion, 

Office on Smoking and Health. http://www

.cdc.gov/tobacco/data_statistics/sgr/sgr

_2000/index.htm.

51. Holder, H. D., and A. J. Treno. 1997. Media 

advocacy in community prevention: News as 

a means to advance policy change. Addiction

92 Suppl. 2: S189–S199. 

52. Wakefield, M., B. Flay, M. Nichter, and 

G. Giovino. 2003. Role of the media in 
354

9 . H o w t h e N e w s M e d i a I n f l u e n c e To b a c c o U s e

influencing trajectories of youth smoking. 

Addiction 98 Suppl. 1: 79–103. 

53. Carpenter, D. O. 1995. Communicating with 

the public on issues of science and public 

health. Environmental Health Perspectives

103 Suppl. 6: 127–30. 

54. Nelkin, D. 1995. Selling science: How the 

press covers science and technology.

New York: W. H. Freeman.

55. Houston, T. P., P. M. Fischer, and 

J. W. Richards. 1992. The public, the press 

and tobacco research. Tobacco Control

1 (2): 118–22. 

56. Winsten, J. A. 1985. Science and the media: 

The boundaries of truth. Health Affairs 

(Project Hope) (Millwood) 4 (1): 5–23. 

57. Caburnay, C. A., M. W. Kreuter, D. A. Luke, 

R. A. Logan, H. A. Jacobsen, V. C. Reddy, 

A. R. Vempaty, and H. R. Zayed. 2003. 

The news on health behavior: Coverage 

of diet, activity, and tobacco in local 

newspapers. Health Education and 

Behavior 30 (6): 709–22. 

58. Chapman, S. 1989. The news on smoking: 

Newspaper coverage of smoking and health 

in Australia, 1987–88. American Journal of 

Public Health 79 (10): 1419–21. 

59. Clegg Smith, K., and M. A. Wakefield. 

2004. Textual analysis of tobacco editorials: 

How are key media gatekeepers framing 

the issues? American Journal of Health 

Promotion 19 (5): 361–68. 

60. Clegg Smith, K., M. Wakefield, and 

E. Edsall. 2006. The good news about 

smoking: How do U.S. newspapers cover 

tobacco issues? Journal of Public Health 

Policy 27 (2): 166–81. 

61. Long, M., M. D. Slater, and L. Lysengen. 

2006. US news media coverage of tobacco 

control issues. Tobacco Control 15 (5): 

367–72. 

62. Nelson, D. E., W. D. Evans, L. L. Pederson, 

S. Babb, J. London, and J. McKenna. 2007. 

A national surveillance system for tracking 

tobacco news stories. American Journal of 

Preventive Medicine 32 (1): 79–85. 

63. Altman, D. G., B. Strunk, and M. H. Smith. 

1999. Newspaper and wire service coverage 

of tobacco farmers. Health Education 

Research 14 (1): 131–37. 

64. Wenger, L., R. Malone, and L. Bero. 2001. 

The cigar revival and the popular press: 

A content analysis, 1987–1997. American 

Journal of Public Health 91 (2): 288–91. 

65. Clegg Smith, K., and M. Wakefield. 2006. 

Newspaper coverage of youth and tobacco: 

Implications for public health. Health 

Communication 19 (1): 19–28. 

66. Kennedy, G. E., and L. A. Bero. 1999. Print 

media coverage of research on passive 

smoking. Tobacco Control 8 (3): 254–60. 

67. Magzamen, S., A. Charlesworth, and 

S. A. Glantz. 2001. Print media coverage 

of California’s smokefree bar law. Tobacco 

Control 10 (2): 154–60. 

68. Champion, D., and S. Chapman. 2005. 

Framing pub smoking bans: An analysis 

of Australian print news media coverage, 

March 1996–March 2003. Journal of 

Epidemiology and Community Health

59 (8): 679–84. 

69. Clegg Smith, K. M., M. A. Wakefield, 

and M. Nichter. 2003. Press coverage of 

public expenditure of Master Settlement 

Agreement funds: How are non-tobacco 

control related expenditures represented? 

Tobacco Control 12 (3): 257–63. 

70. Chapman, S., K. McLeod, M. Wakefield, 

and S. Holding. 2005. Impact of news of 

celebrity illness on breast cancer screening: 

Kylie Minogue’s breast cancer diagnosis. 

Medical Journal of Australia 183 (5): 

247–50. 

71. Lawton, B., S. Rose, D. McLeod, and 

A. Dowell. 2003. Changes in use of hormone 

replacement therapy after the report from 

the Women’s Health Initiative: Cross 

sectional survey of users. British Medical 

Journal 327 (7419): 845–46. 

72. Haas, J. S., C. P. Kaplan, E. P. Gerstenberger, 

and K. Kerlikowske. 2004. Changes in the 

use of postmenopausal hormone therapy 

after the publication of clinical trial results. 

Annals of Internal Medicine 140 (3): 184–88. 

73. Yanovitzky, I., and J. Stryker. 2000. A norm 

transformation approach to mass media and 

public health: A longitudinal study of media 

effects on youth binge drinking. Paper 

presented at the 50th annual conference 

of the International Communication 

Association, Acapulco, Mexico.

74. Stryker, J. E. 2003. Media and marijuana: 

A longitudinal analysis of news media effects 

on adolescents’ marijuana use and related 

outcomes, 1977–1999. Journal of Health 

Communication 8 (4): 305–28. 

75. Nelkin, D. 1996. An uneasy relationship: 

The tensions between medicine and the 

media. Lancet 347 (9015): 1600–1603. 
355

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

76. Ling, J. C. S. 1989. New communicable 

diseases: A communication challenge. 

Health Communication 1 (4): 253–60. 

77. Chapman, S. 1993. Unravelling gossamer 

with boxing gloves: Problems in explaining 

the decline in smoking. British Medical 

Journal 307 (6901): 429–32. 

78. Asbridge, M. 2004. Public place restrictions 

on smoking in Canada: Assessing the role of 

the state, media, science and public health 

advocacy. Social Science & Medicine 58 (1): 

13–24. 

79. Reid, D. J., A. J. Killoran, A. D. McNeill, 

and J. S. Chambers. 1992. Choosing the 

most effective health promotion options for 

reducing a nation’s smoking prevalence. 

Tobacco Control 1 (3): 185–97. 

80. Laugesen, M., and C. Meads. 1991. 

Advertising, price, income and publicity 

effects on weekly cigarette sales in 

New Zealand supermarkets. British Journal 

of Addiction 86 (1): 83–89. 

81. Cummings, K. M., R. Sciandra, and 

S. Markello. 1987. Impact of a newspaper 

mediated quit smoking program. American 

Journal of Public Health 77 (11): 1452–53. 

82. Pierce, J. P., and E. A. Gilpin. 2001. News 

media coverage of smoking and health is 

associated with changes in population rates 

of smoking cessation but not initiation. 

Tobacco Control 10 (2): 145–53. 

83. Niederdeppe, J., M. C. Farrelly, K. Y. Thomas, 

D. Wenter, and D. Weitzenkamp. 2007. 

Newspaper coverage as indirect effects of 

a health communication intervention: 

The Florida Tobacco Control Program and 

youth smoking. Communication Research

34 (4): 382–405.

84. Smith, K. C., M. Wakefield, Y. Terry-McElrath, 

F. J. Chaloupka, B. Flay, L. Johnston, A. Saba, 

and C. Siebel. 2008. Relationship between 

newspaper coverage of tobacco issues and 

perceived smoking harm and smoking 

behavior among American teens. Tobacco 

Control 17 (1): 17–24.

85. U.S. Department of Health and Human 

Services. 1989. Reducing the health 

consequences of smoking: 25 years of 

progress. A report of the Surgeon General

(DHHS publication no. [CDC] 89-8411). 

Rockville, MD: U.S. Department of Health 

and Human Services, Public Health Service, 

Centers for Disease Control, National Center 

for Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health. 

http://profiles.nlm.nih.gov/NN/B/B/X/S/.

86. Landman, A. 2000. Push or be punished: 

Tobacco industry documents reveal 

aggression against businesses that 

discourage tobacco use. Tobacco Control

9 (3): 339–46. 

87. Whelan, E. M., M. J. Sheridan, K. A. Meister, 

and B. A. Mosher. 1981. Analysis of coverage 

of tobacco hazards in women’s magazines. 

Journal of Public Health Policy 2 (1): 28–35. 

88. Warner, K. E., L. M. Goldenhar, and 

C. G. McLaughlin. 1992. Cigarette advertising 

and magazine coverage of the hazards of 

smoking: A statistical analysis. New England 

Journal of Medicine 326 (5): 305–9. 

89. Amos, A., B. Jacobson, and P. White. 1991. 

Cigarette advertising policy and coverage 

of smoking and health in British women’s 

magazines. Lancet 337 (8733): 93–96. 

90. Howell, F. 1994. Tobacco advertising and 

coverage of smoking and health in women’s 

magazines. Irish Medical Journal 87 (5): 

140–41. 

91. Amos, A., and Y. Bostock. 1992. Policy 

on cigarette advertising and coverage of 

smoking and health in European women’s 

magazines. British Medical Journal

304 (6819): 99–101. 

92. DeJong, W. 1996. When the tobacco industry 

controls the news: KKR, RJR Nabisco, and 

the Weekly Reader Corporation. Tobacco 

Control 5 (2): 142–48. 

93. Sylvia, D., J. Richter, and A. Woytowich. 

Monitoring tobacco in the news: “Infoflow” 

tracking. Memorandum. 16 Jun 2000. 

Philip Morris. Bates No. 2076281730/1737. 

http://legacy.library.ucsf.edu/tid/ukx45c00.

94. Rowe, C., D. Leiderman, and K. Heyboer. 

1994. What’s your beef? Collected 

interviews. American Journalism Review

16 (9): 19–20. 

95. Whist, A. [Letter to Alexander Holtzman of 

Philip Morris]. 2 Apr 1970. Philip Morris. 

Bates No. 2015047992/7997. http://legacy

.library.ucsf.edu/tid/pvr53e00.

96. Philip Morris. The perspective of 

PM International on smoking and health 

issues. Speech. 29 Mar 1985. Philip Morris. 

Bates No. 2023268329/8348. http://legacy

.library.ucsf.edu/tid/nky74e00.

97. Philip Morris. The issues raised in Hamish’s 

memo. Mar 1985. Philip Morris. Bates 

No. 2023268384/8393. http://legacy.library

.ucsf.edu/tid/pus98e00.

98. Philip Morris. Notes for presentation. Press 

release. 14 Jan 1994. Philip Morris. Bates 
356

9 . H o w t h e N e w s M e d i a I n f l u e n c e To b a c c o U s e

No. 2023248098/8103. http://legacy.library

.ucsf.edu/tid/lon87e00.

99. Brown & Williamson. The Australian 

perspective. n.d. Brown & Williamson. 

Bates No. 620215677/5680. http://legacy

.library.ucsf.edu/tid/tdx83f00.

100. Spikes, S. 2004. Obesity beats passive smoke 

in media coverage-study. Wall Street Journal 

Online, June 3.
357

10

Role of Entertainment Media 

in Promoting or Discouraging 

Tobacco Use

Popular entertainment media are a powerful force in the lives of Americans. In particular, 

young Americans have been shown to spend an average of more than five hours per day 

exposed to a variety of media channels. This chapter examines the role of entertainment 

media in encouraging or discouraging tobacco use, including aspects such as

n	 Channels of media exposure, particularly for children

n	 Studies performed on tobacco use in the movie industry, ranging from trends in 

tobacco prevalence by movie type to issues such as how tobacco use is depicted, 

not portraying the health consequences of smoking, and brand-specific exposure

n	 Studies examining the influence of smoking in the movies on the social attitudes 

and behaviors surrounding smoking

n	 A summary of research on the portrayal of tobacco use in other media channels, 

such as television, music, magazines, and the Internet

n	 Current and future strategies for reducing public exposure to tobacco use 

in entertainment media, including policy interventions, efforts at industry 

self-regulation, and advocacy efforts aimed at both the public and the 

entertainment industry

The total weight of evidence from cross-sectional, longitudinal, and experimental studies 

indicates a causal relationship between exposure to movie smoking depictions and 

youth smoking initiation. Further research to better understand this relationship and 

to evaluate strategies to reduce youth exposure to tobacco portrayals in entertainment 

media is warranted.
358

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

It’s the movies that have really been running 

things in America ever since they were 

invented. They show you what to do, how 

to do it, when to do it, how to feel about it, 

and how to look how you feel about it.

—Andy Warhol (1928–87)

Introduction

This chapter examines and summarizes 

what is known about the use of tobacco 

in entertainment media and its effect on 

tobacco use in the population. A detailed 

look at the influence of one of America’s 

oldest entertainment media—the movies—

is followed by a discussion of how today’s 

overall media environment can influence 

tobacco use and steps that can be taken 

to reduce public exposure to tobacco use 

in the media. Given the continued rapid 

growth in media access, particularly among 

young people, reducing tobacco use in the 

media could serve as an important factor in 

changing social attitudes toward smoking.

It has long been believed that the 

entertainment industry has a profound 

impact on behavior, especially when it 

comes to what is perceived as fashionable. 

The entertainment industry produces 

stars who introduce large segments of the 

population to new products and behaviors 

depicted in mass media. To the extent 

that viewers form personal connections 

with these stars through their use of the 

media, the viewers’ own behavior may be 

influenced. The entertainment industry 

also serves to maintain behaviors already 

established in the population.

This chapter begins with a look at the 

media environment and its evolution as a 

backdrop for examining media channels that 

could potentially model smoking behavior. 

Perhaps because television and movies 

are so prominent in people’s leisure time 

entertainment, most of the research on the 

impact of entertainment media on behavior 

focuses on these media. The next sections of 

this chapter describe what is known about 

the smoking images contained in movies 

and how viewing them affects attitudes and 

behavior. The text begins with the historical 

relationship between the tobacco and movie 

industries, both of which came of age 

during the early 1900s in the United States. 

The chapter also summarizes research 

on portrayal of tobacco in other forms of 

entertainment media including television, 

music, magazines, and the Internet. Finally, 

efforts to reduce audience exposure to 

tobacco-related media content are discussed, 

and overall chapter conclusions are drawn.

What Are Entertainment Media?

Entertainment media include print media 

(books and magazines), audio media 

(radio and music), and audiovisual media 

(television, movies, Web-based media, and 

video/computer games). Just two decades 

ago, options for media delivery in the 

home increased with the introduction of 

the videocassette. Today, the options also 

include digital media (digital versatile discs 

[DVDs], compact discs [CDs], video games) 

and access to entertainment programming 

through cable/satellite and the World 

Wide Web. The Web provides unique 

entertainment options through Web sites 

that deliver everything from traditional 

venues, such as news, to options for playing 

interactive video games with multiple 

players and downloading podcasts of movies 

and television shows. The increase in home 

options for media and the multiplication 

of media viewing sites within the home 

(60% of U.S. households contain three or 

more television sets) have transformed 

home media viewing from a family event 

to a much more individualized and tailored 

pattern of media viewing among family 

members. For example, parents who grew 

up before video games or Music Television 

(MTV) may know little about the specific 

content of the video games their children 
359

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

play or the music videos and other video 

podcasts their adolescents watch because the 

parents generally do not play or watch them.

Surveys of media availability in U.S. 

households reveal broad access to each of 

the home media channels, with electronic 

media gaining market share over traditional 

media venues. Two studies that surveyed 

representative samples of U.S. families 

with children found similar results. 

Roberts and colleagues1 surveyed more 

than 3,000 families in 1999. Woodard and 

Gridina,2 surveyed some 1,200 families one 

year later. The proportions of families with 

two or more media delivery devices were 

88% for televisions, 58% for videocassette 

recorders, 85% for radios, 71% for tape 

players, 59% for CD players, 38% for video 

game players, and 21% for computers. 

In addition, most families reported having 

access to a wide variety of television channels, 

with about three-quarters of American 

families having cable/satellite television.1(p.9)

The only media services strongly related 

to socioeconomic status were computer 

ownership and Internet access. All other 

products were equally distributed across 

socioeconomic groups. For example, the 

median number of televisions in households 

was 2.8 for families with incomes under 

$25,000, 3.0 for those with incomes between 

$25,000 and $40,000, and 3.0 for families 

with incomes above $40,000. The percentages 

with cable/satellite television access for these 

income groups were 71%, 73%, and 77%, 

respectively. However, the percentages with 

Internet access were 23%, 42%, and 58%, 

respectively.1(p.11)

Media Use

The national surveys cited above also assessed 

media use by children and adolescents. 

These young Americans are considered most 

vulnerable to the effects of media messages, 

and much of the research discussed here 

addresses the effects of media on their use 

of tobacco. About one-half of U.S. children 

have a television in their bedrooms (65% of 

children and adolescents older than age 7). 

Most adolescents also have a radio and a CD 

player in their bedrooms.1(p.13) About one-half 

of families report that the television is almost 

always on, and 58% watch television during 

mealtimes.1(p.15) Average media exposure 

among children is 5.3 person-hours per day 

(3.3 hours for 2–7 year olds and 6.4 hours for 

8–18 year olds). Average media exposure is 

about one hour less for high-income families 

than for low-income families.1(p.19)

One study noted that children and 

adolescents distribute their time in using 

entertainment media in the following 

proportions: television, 46%; CDs and tapes, 

12%; movies and videos, 11%; print media, 

11%; radio, 10%; video games, 5%; and 

computer, 5%.1(p.20)

As children age, one-half of the additional 

time spent with media is due to an increase 

in television viewing; the remainder is due 

to increases in time spent watching taped 

television shows, taking trips to the movie 

theater, listening to the radio and music, 

and, for boys, playing video games.1(p.20–21)

Note that television viewing comprises both 

the viewing of television programming 

(traditional programming and movies from 

movie channels) plus nontraditional venues 

such as MTV. Thus, the viewing of television 

programming and movies takes up more 

than one-half of the five to six hours that 

children use media each day.

All of these media have the potential to 

influence the attitudes and behavior of 

young consumers toward tobacco products. 

A large body of research exists on the impact 

of tobacco use in movies on attitudes toward 

smoking. This medium therefore serves 

as a valuable exemplar for further study in 

how various mass media might influence 

the potential for tobacco use. Thus, movies 

are the primary focus of this chapter. Later 

sections examine research findings regarding 

exposure to tobacco in other media. Together 
360

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

with the existing body of knowledge 

surrounding the portrayal of tobacco use in 

movies, this chapter forms a base for future 

work on the impact of entertainment media 

on tobacco-related health issues.

Historical Perspective: 

Movies

Examination of the role of entertainment 

media in tobacco marketing is increasingly 

becoming an area of active research. Most of 

this work has focused on portrayal of tobacco 

in movies. Quantitative studies suggest that 

youth exposed to on-screen smoking are 

more likely themselves to initiate smoking.3–9

These reports should prompt more careful 

examination of the historical role that the 

entertainment industry may have played 

in the marketing of tobacco. Pierce and 

Gilpin10 have identified four key periods in a 

historical analysis of tobacco marketing and 

smoking initiation among U.S. adolescents 

and young adults. Tobacco companies 

marketed cigarettes to men during the 

first period, from the inception of the 

industry’s marketing practices in the 1880s 

to about 1920. By 1920, the market for men 

was established and considered mature.11

The industry then turned its attention to 

increasing sales among women.12 For the 

next two decades, the industry added to 

its marketing portfolio messages aimed 

at women. Campaigns explicitly targeted 

women, as exemplified by the Lucky Strike 

“Reach for a Lucky Instead of a Sweet” print 

media campaign during that period.13

This specific campaign focused on weight 

control. However, the cigarette also was 

positioned as a symbol of independence 

and equality for women. At about the same 

time, Chesterfield rolled out a campaign 

aimed at changing social norms regarding 

smoking, with an emphasis on the social 

interaction between men and women. The 

campaign was launched by a 1926 billboard 

depicting a man who is smoking, seated next 

to a woman who asks him to “blow some 

my way.” The company also recognized the 

role movie stars play in establishing social 

trends and recruited prominent actresses of 

the time to endorse the brand in their print 

advertisements. Chesterfield advertisements 

regularly featured glamour photographs 

of a Chesterfield “girl of the month,” 

primarily fashion models and Hollywood 

starlets. Some endorsers were actresses, 

including Joan Bennett, Claudette Colbert, 

Joan Crawford, Betty Grable, Rita Hayworth, 

Marion Hutton, and Rosalind Russell. 

During the late 1940s, the advertisements 

continued to feature glamorous women but 

also included male stars. Star endorsements 

during this period included Charles Boyer, 

Perry Como, Bing Crosby, Arthur Godfrey, 

Bob Hope, Dorothy Lamour, Virginia Mayo, 

Ethel Merman, Gregory Peck, Basil Rathbone, 

Ann Sheridan, Jo Stafford, and James Stewart.

From 1943 through 1946, advertisements 

for the Regent brand of cigarettes featured 

drawings of celebrities, including Fred 

Astaire, Diana Barrymore, Joan Blondell, 

Bing Crosby, Robert Cummings, Jinx 

Falkenberg, Arlene Francis, June Havoc, 

Celeste Holm, Guy Lombardo, Merle Oberon, 

and Jane Wyatt.14 These advertisements 

provide historical evidence of a strong, 

Early Lucky Strike advertisement 

targeted at women
361

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

mutually beneficial relationship between the 

cigarette industry and the movie industry. 

It would be reasonable to assume that the 

stars were paid for their appearances in 

the advertisements as well as receiving 

nonmonetary benefits, such as increased 

exposure. Public relations specialists of 

that era were beginning to perceive the 

potential power of celebrities and the 

media (including motion pictures) as ways 

to change social norms around smoking. 

The work by public relations pioneer 

Edward Bernays15 is particularly relevant; 

for example, he sponsored, on behalf of the 

American Tobacco Company’s Lucky Strike 

cigarettes, demonstrations in 1929 in which 

fashion models gathered on street corners to 

smoke their “torches of freedom.”

The tobacco industry advertising campaign 

aimed at women is credited with the steady 

increase in cigarette smoking initiation 

rates among women during this period 

(1925–39) (figure 10.1). After 1939, and 

through the mid-1960s, tobacco marketing 

no longer focused on any particular 

subgroup.10 However, smoking initiation 

rates among women continued to increase 

at the same pace as they did through the 

1920s and 1930s. Attending motion pictures 

was a national pastime by 1940, with 

Americans spending almost one-quarter 

of their total recreation dollars on movies 

Chesterfield cigarette advertisement 

featuring actress Joan Crawford

Note: from Ladies Home Journal 1949

Figure 10.1 Smoking Initiation Rates Among U.S. Males and Females Ages 14–17 Years, 

by Year

Calendar year

1910 1920 1930 1940 1950 1960 1970

0

0.01

0.02

0.03

0.04

0.05

0.06

0.07

0.08

0.09

0.10

0.11

0.12

Initiation rate

2 3 4 5

Period

Females

Males

Note. From Pierce, J. P., and E. A. Gilpin. 1995. A historical analysis of tobacco marketing and the uptake of smoking by youth 

in the United States: 1890–1977. Health Psychology 14 (6): 500–08. Copyright © 1995 American Psychological Association. 

Reprinted with permission.
362

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

(compared with only 2% today). Weekly 

attendance at U.S. theaters was more than 

90 million.16 By 1940, depictions of actors 

and actresses smoking in movies were an 

established routine.

An example of how smoking depictions in 

movies might have affected the population’s 

social perceptions of smoking is the 1942 

movie Now, Voyager, starring Bette Davis 

and Paul Henreid. Bette Davis plays a young 

Boston socialite who has been repressed 

and dominated by her mother. She smokes 

surreptitiously until she meets and falls in 

love with an older man (Paul Henreid) on 

a cruise.

The sequence is captured at the close of the 

voyage, when Henreid lights two cigarettes 

and hands one to his lover just before a 

parting embrace. Given the popularity 

of this movie and these stars at the time, 

this sequence may have influenced the 

socialization of women to take up smoking, 

in part by teaching men a novel way to offer 

a cigarette to a woman. Although no direct 

evidence supports an advertising motive 

for such scenes, they mirror the romantic 

themes included in cigarette advertising at 

the time, as illustrated by the Lucky Strike 

advertisements from the mid-1930s.

The use of stars to endorse cigarettes in 

advertisements continued into the 1950s, 

with Chesterfield endorsements from women 

movie celebrities, such as Dorothy Lamour, 

Virginia Mayo, Ethel Merman, Ann Sheridan, 

and Jo Stafford. In addition to leading 

ladies, the advertising of the 1950s heralded 

new young stars, such as James Dean who 

depicted rebellious adolescent characters 

and consolidated the image of the “bad 

boy” smoker. In Rebel Without a Cause,

the image of Dean smoking a cigarette was 

so intertwined with his character image that 

smoking was incorporated into publicity 

posters for his movies. Thus, smoking 

was promoted in another way—through 

publicity photographs and posters distributed 

worldwide (as the German rendition of the 

poster illustrates).

As television began to become a mass 

medium, the tobacco industry began 

Smoking: A Requirement of the Role

One case report describes an actor being introduced to smoking on the set of his first movie. In a 

New York Times Op Ed column,a

 Kirk Douglas states he never smoked during his Broadway career 

in the early 1940s. Mr. Douglas goes on to describe his first movie role, in 1946.

“My first picture was The Strange Loves of Martha Ivers, with Barbara Stanwyck and Van Heflin, 

in 1946. I was intimidated, but proud to be playing the role of Miss Stanwyck’s husband. I arrived 

at the set, very excited, to do my first scene with her. But I had spoken only a few lines when the 

director, Lewis Milestone, stopped the action and said, “Kirk, you should be smoking a cigarette 

in this scene.”

“I don’t smoke,” I replied timidly.

“It’s easy to learn,” he said, and had the prop man hand me a cigarette.

I continued with the scene, lighting and smoking my first cigarette. Suddenly, I began to feel sick 

to my stomach and dizzy.

“Cut,” yelled the director. “What’s the matter with you, Kirk? You’re swaying.”

I rushed to my trailer to throw up. But Mr. Milestone was right. It’s easy to learn to smoke. Soon I 

was smoking two to three packs a day.”a

a

Douglas, K. 2003. My first cigarette, and my last. New York Times, May 16.
363

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

sponsoring television shows, providing cash 

to this fledgling entertainment industry 

before it had a sizable audience to attract 

other types of mainstream advertising.17

Tobacco companies remained prominent 

sponsors until television advertising of 

tobacco was banned in the United States 

in January 1991. Television advertisements 

produced during the 1950s included 

endorsements by prominent movie stars. For 

example, John Wayne appeared in a number 

of Camel commercials during this period.

The extent to which the tobacco industry 

played a role in tobacco product placement in 

movies was speculative until specific evidence 

of financial links between the tobacco and 

movie industries emerged upon the release 

of tobacco company documents.18 Other 

documents indicate that several movie stars, 

including Pierce Brosnan, James Coburn, 

Roger Moore, and Charlie Sheen, were 

recruited to represent a James Bond type 

of figure in an advertising campaign for 

Lark cigarettes during the 1980s in Japan.19

Chapter 4 describes in detail paid product 

placement of tobacco images in movies. 

Although these documents pertain to brand 

placements in movies produced during the 

1970s and 1980s only, the practice probably 

preceded those decades. Schudson20 argues 

that the practice of deliberately mentioning 

or picturing particular products in films 

occurred earlier. “In the 1930s and 1940s, 

Scenes from Now, Voyager (1942)

Magazine advertisements for Lucky Strike documenting thematic similarities between cigarette advertising and movie 

depictions of smoking
364

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

De Beers increased the role of diamonds 

in Hollywood films, just as cigarette 

manufacturers saw to it that leading actors 

and actresses smoked cigarettes in movies 

in the 1920s.”20(p.101) It would be surprising 

if A. D. Lasker, Edward Bernays, and other 

public relations specialists of that era failed 

to recognize the potential power of motion 

pictures as a way to change social norms 

concerning smoking. As discussed below in 

“Movie Content,” smoking continues to be 

depicted in movies. Cigarette brands also 

appear, although movie scenes showing actors 

actually using a specific brand have declined.

In summary, the relationship between the 

media entertainment industry and the 

tobacco industry dates back to the 

inception of the media industry. The 

first focus was on marketing cigarettes 

to the U.S. population by securing 

endorsements from prominent stars 

and through prominent depiction of 

smoking in motion pictures. There is 

no early evidence of paid placement of 

tobacco products in movies. However, 

it seems likely that the depiction of 

smoking in films contributed to the 

establishment of social norms that 

encouraged women to smoke as a 

mark of independence and equality, 

as a way to establish a conversation 

(break the ice) between men and women, 

and in ways that paralleled other cigarette 

advertising themes at that time. Early movie 

images of male smokers as tough and 

independent also may have promoted to 

men the appeal of tobacco use. In addition, 

the entertainment industry was key in 

establishing the prototype of the rebellious 

adolescent cigarette smoker. This prototype 

continues to attract adolescents to smoking 

in the present.

Movie Content

Content analysis refers to a research method 

in which coders systematically count and 

Promotional posters for Rebel 

Without a Cause (in English 

and German)

Tobacco Portrayal Goes Beyond the Movie Itself

Tobacco product exposure in movies is not necessarily limited 

to the actual film content. The depiction of smoking and 

brands in promotional photographs still occurs. For example, 

the photograph shown here, released with a set of promotional 

photos by Screengems Productions for the movie Snatch,

was widely published in newspapers across the United States. 

The photograph shows Brad Pitt sitting at a desk with a pack 

of Marlboro Golds. Interestingly, no cigarette brand appeared 

in the actual movie. The practice of showing smoking and 

cigarette brands in movie promotional products has not been 

studied systematically. Therefore, it is difficult to determine how 

important these materials are from a communications standpoint.

Publicity photograph released with 

the movie Snatch, Screengems, 2000.
365

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

characterize media inputs. Published content 

analyses examining depictions of tobacco use 

in entertainment media have focused almost 

exclusively on movies. Less information is 

available concerning tobacco-related content 

in other entertainment media.

Study Selection

A number of content analyses have been 

conducted of portrayal of tobacco in popular 

movies. Fourteen peer-reviewed studies 

were identified as published in the medical 

literature (in English) by using a PubMed 

search strategy on MEDLINE with the 

following search terms and Medical Subject 

Headings (MeSH): 

((“tobacco”[MeSH Terms] OR tobacco[Text 

Word]) OR (“smoking”[MeSH Terms] OR 

smoking[Text Word])) AND (movie[All 

Fields] OR (“motion pictures”[MeSH 

Terms] OR motion picture[Text Word]))—

103 records obtained, May 9, 2006.

A search of PsycINFO using the key words 

((“tobacco” OR “smoking”) AND (“movie” 

OR “motion picture”)) and restricted to 

journal articles written in English identified 

no additional articles on movie content 

analysis than those already captured by the 

MEDLINE search (23 articles retrieved, by 

PsycINFO, May 9, 2006).

Citations in some of the above papers21

identified one more peer-reviewed paper 

that examined tobacco as well as other 

health-relevant behaviors in movies. 

Further citations to a study by Mekemson 

and colleagues,22 a Web-based report,23

provide additional findings from the 

American Lung Association’s “Thumbs Up! 

Thank You for Smoking

Jason Reitman’s 2006 satirical film, Thank You for Smoking,a

 based on Christopher Buckley’s 

novel, highlights some of the realities of the relationship between the media and tobacco. The 

main character in the movie, Nick Naylor, is a spokesperson for the fictional Academy of Tobacco 

Studies run by cigarette manufacturers. Naylor suggests that declining rates of teen smoking 

can be turned around through the use of smoking in upcoming Hollywood films. He travels to 

Los Angeles to meet with an agent and negotiate the use of cigarettes in a futuristic film “where 

smokers and nonsmokers live in perfect harmony.” Both Naylor and the agent acknowledge that 

the use of cigarettes by Catherine Zeta Jones and Brad Pitt will “sell a lot of cigarettes.”

Real-life tobacco companies have been banned from sponsoring Hollywood films since the 1998 

Master Settlement Agreement. However, the use of cigarettes in movies is still prominent, and 

studies examined later in this chapter show a positive correlation between exposure to on-screen 

smoking and smoking initiation rates for adolescents. One studyb of 6,522 randomly selected 

participants suggests that exposure to on-screen smoking is the primary independent risk factor 

for teen initiation rates. So Naylor’s prescription to have actors smoke on screen in order to “sell 

a lot of cigarettes” is, at least among adolescents, supported by academic research.

The correlation between on-screen smoking and smoking initiation rates has led to some tobacco 

control groups pushing for more restrictive ratings for movies portraying tobacco use. So far, 

these efforts have been unsuccessful. It is unlikely that these groups will switch to Thank You for 

Smoking’s final tobacco control idea: digital replacement of cigarettes in classic films with candy 

canes, steaming mugs of cocoa, and drum sticks.

a

Reitman, J. 2006. Thank You for Smoking [Motion picture]. United States: Fox Searchlight Pictures.

b

Sargent, J. D., M. L. Beach, A. M. Adachi-Mejia, J. J. Gibson, L. T. Titus-Ernstoff, C. P. Carusi, S. D. Swain, 

T. F. Heatherton, and M. A. Dalton. 2005. Exposure to movie smoking: Its relation to smoking initiation 

among US adolescents. Pediatrics 116 (5): 1183–91.
366

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

Thumbs Down!” ongoing content analysis. 

Four additional published reports on 

this subject were identified that were of 

methodological quality comparable with the 

peer-reviewed studies.24–27 These reports were 

commissioned by public agencies, including 

the White House Office of National Drug 

Control Policy and the U.S. Department 

of Health and Human Services’ Substance 

Abuse and Mental Health Services 

Administration;27 Center for Tobacco 

Control Research and Education, University 

of California;26 the Health Education 

Authority in the United Kingdom;24 and 

the Massachusetts Public Interest Research 

Group (a nongovernmental, voluntary 

organization).25 Table 10.1 summarizes the 

methods of movie selection and coding of 

tobacco use for the respective studies. 

Methodological Issues

Together, various studies have sampled and 

coded tobacco content in popular movies 

released from 1937 through 2003. However, 

the studies’ methodological differences 

make it difficult to compare the results. 

The most common criterion for selecting 

movies was based on their revenue status 

as “top box-office” movies, mostly in the 

United States. Some studies28–30 selected a 

random sample of top box-office movies for 

a given period. Others coded the top 10,24,31

25,32,33 50,22 100,34 125,35 or 200 movies per 

year,27 or those grossing at least $500,000 at 

the box office26 for a given period of years. 

In general, the longer the period examined, 

the fewer movies per year were coded. Other 

studies have selected the movie sample 

based on genre or rating only (e.g., G-rated 

animated movies)36,37 or a combination of 

rating and box-office revenue (e.g., top 10 

PG movies and video rentals).25 One study 

examining the prevalence of smoking 

among characters in contemporary 

American movies about American life in the 

1990s relative to U.S. population smoking 

rates selected movies on the basis of boxoffice revenue, rating, genre, and time and 

location of setting; that study excluded 

movies in which cigarette smoking was a 

central motif.38

Another study identified the “top 10” most 

popular actresses per year for a given 

period, then randomly sampled movies 

in which each played a leading role. 

A number of studies have excluded from 

their samples movies that were not set in 

the present—that is, period dramas and 

science fiction set in the future.21,38 Despite 

sampling differences among some studies, 

most have used sampling criteria based on 

audience reach. Therefore, the media inputs 

they documented are likely to provide a 

valid indication of the amount and nature 

of on-screen tobacco content presented to 

viewers. Polansky and Glantz26 extended 

their content analysis data to generating 

quantitative estimates of audience reach 

(see “Audience Reach” below).

Studies also vary in how they capture 

tobacco use, especially in terms of their 

unit of analysis. Many divided their movie 

samples into five-minute intervals and 

then counted the number of tobacco 

occurrences per five-minute interval of 

film.21,27–31,40 Others viewed and coded 

movies as a whole, counting tobacco 

occurrences within movies.22,24–26,32–38 Some 

included as one occurrence all smoking 

by one character during the course 

of a movie scene.32 Others counted an 

occurrence every time a cigarette entered 

the screen.22 These differences obscure 

comparisons in the absolute numbers of 

tobacco depictions reported among the 

studies. Moreover, it is not clear how well 

the various measures correlate or whether 

measurement affects trend analyses. 

However, Polansky and Glantz26 found that 

parents’ qualitative ratings of the amount 

of smoking in movies (using a six-point 

ordinal scale ranging from “none” = no 

tobacco content through “extreme” = movie 

is full of tobacco scenes) bore a statistically 

significant correspondence with coding 
367

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 10.1 Summary of Methods for Content Analysis Studies: Tobacco in Movies

Authors

Publication 

year Country

Movie years 

(release) Movie criteria Interrater reliability Unit of analysis Amount of smoking

Reported results of 

other variables

Goldstein et al.36 1999 U.S. 1937–99 All G-rated animation 

movies released by major production cos. (n = 50)

Not reported Whole movie Presence of tobacco 

use; duration

SC, HC, Chg, TT

Thompson and Yokota37 2001 U.S. 1937–2000 All G-rated animated 

feature movies (n = 81)

1 rater only Whole movie % movies depicting 

tobacco; duration of smoking scenes

SC, HC, Chg, CX, TT

McIntosh et al.39 1998 U.S. 1940–89 Random sample of 

5 films per decade sampled from top 20 films per year for period (n = 100)

Ranged from 0.74 to 0.94. At least 3 trained raters rated each film.

Whole movie % of characters who 

smoked at least once in target films

SC, HC, Chg

Glantz et al.29 2004 U.S. 1950–59, 

2001–02

Random sample of 20 top films released 1950–59, and 5 of top 20 films for 2001–02 (n = 30)

One coder, cite validity of this approach as per Hazan et al. 199428

5-min intervals of movies

No. of tobacco incidents/hr of movie time

Chg, Brand

Hazan et al.28 1994 U.S. 1960–99 2 movies randomly 

selected from top 20 per year, for each year (n = 62)

0.92 (sd = 0.07) Each movie divided 

into 5-min intervals (n = 1,505 5-min intervals)

% tobacco use per 5-min interval of movie (includes use and implied)

SC, HC, Chg, CX, TT (coded, but results not reported), Brand (coded, but results not reported)

Terre et al.21 1991 U.S. 1977–88 Top 20 movies per year 

(n = 169)

95% Each movie divided into 

5-min intervals

Tobacco incidents SC, HC, Chg, MT

Everett et al.31 1998 U.S. 1985–95 Top 10 movies per year 

(n = 110)

Not reported Each movie divided into 

5-min intervals

Presence of tobacco use (includes use and implied)

SC, HC, Chg, CX

Dalton et al.32 2002 U.S. 1988–97 Top 25 movies per year 

(n = 250)

At least 70% agreement on all measures

Whole movie No. of tobacco 

occurrences; time of tobacco use

SC, HC, CX, TT, MT

Note. cos. = companies; SC = smoker characteristics; HC = health consequences; Chg = change over time; TT = type of tobacco; CX = context; min = minutes; no. = number; hr = hour; Brand = brand appearances; sd = standard deviation; MT = movie type; MSA = Master Settlement Agreement; +ve = positive verbal reference; –ve = negative verbal reference; sci-fi = science fiction.
368

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a Table 10.1 Summary of Methods for Content Analysis Studies: Tobacco in Movies (continued) Authors Publication year Country Movie years (release) Movie criteria Interrater reliability Unit of analysis Amount of smoking Reported results of other variables Sargent et al.33 2001 U.S. 1988–97 Top 25 movies per year 

(n = 250)

Double coding of brand appearances, not reported

Whole movie % of movies with 

tobacco use

Chg: pre–post MSA, Brand, MT

Stockwell and Glantz30 1997 U.S. 1990–96 Random sample of 

5 from top 20 movies per year (n = 35)

One coder, not reported Each movie divided into 

5-min intervals

% tobacco use per 5-min interval of movie

SC, HC (antismoking signs or comments), Chg, CX (motivation to smoke), TT, Brand

MacKinnon and Owen24 1998 U.K. 1990 and 

1995

Top 10 U.K. box-office movies for these years (n = 20)

Not reported Whole movie? (not 

clear)

No. of smoking incidents

SC, HC (verbal references: +ve/–ve), Chg, CX, Brand

Escamilla et al.40 2000 U.S. 1993–97 For each top 10 actress, 

coded random selection of 5 movies in which they had leading roles (n = 50)

99% agreement on smoking variables

Each movie divided into 5-min intervals (n = 1,116 5-min intervals)

Occurrence of smoking in each interval coded % of 5-min intervals that depict smoking

SC, HC, CX, TT, MT

Mekemson et al.22American Lung 

Association of Sacramento23

2004 U.S. 1991–2000 

(+1994–2003)

Top 50 U.S. movies per year (1991–2000: n = 497) (1994–2003: n = 498)

All movies coded by 3 teen reviewers, kappa reliability scores >0.85

Whole movie Tobacco incident 

counted each time tobacco appears on screen

SC, HC, Chg, CX, TT, Brand, MT

Roberts et al.27 1999 U.S. 1996–97 200 most popular 

movie video rentals for 1996 and 1997 (n = 200)

Not reported Whole movie Tobacco appearances 

(use and implied) frequency of tobacco reported/5-min movie interval

SC, HC, CX, TT, Brand, MT

Ng and Dakake25 2002 U.S. 1996–97, 

1999–2000 (i.e., pre–post MSA)

Top 10 PG-13 movies and top 5 PG-13 video rentals for these years (n = 42)

Not reported Whole movie Length of tobacco 

use and tobacco appearance

SC (minors smoking), HC (–ve statements about tobacco use), Chg, CX (of brand appearances), TT, Brand, MT
369

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 10.1 Summary of Methods for Content Analysis Studies: Tobacco in Movies (continued)

Authors

Publication 

year Country

Movie years 

(release) Movie criteria Interrater reliability Unit of analysis Amount of smoking

Reported results of 

other variables

Polansky and Glantz26 2004 U.S. 1998–2003 U.S. produced, Englishspeaking movies 

grossing at least $500,000 at box office (n = 776)

Not reported, although good correspondence with tobacco incident data in a study by Dalton and colleagues32for equivalent films

Whole movie Qualitative descriptors 

of no. of tobacco incidents per movie

Chg, MT

Omidvari et al.41 2006 U.S. 1990–98 U.S. movies in top 10 

weekly box-office list, excluding G-rated, animated, and sci-fi movies, movies not set in 1990s, and movies with cigarette smoking as a central motif (n = 447)

Not reported Whole movie % of top 5 characters 

who smoke at least once in target films (excluding smoking by non-U.S. citizens or outside U.S.)

SC, MT

Stern35 2005 U.S. 1999–2001 Of 125 top-grossing 

movies per year, coded those where at least 1 adolescent was a central character (n = 43)

Ranged from 0.77 to 1.00

Whole movie % of major adolescent 

characters who smoke at least once in target films

SC, MT

Dozier et al.34 2005 U.S. 2002 100 top-grossing films 

in 2002 (n = 100)

Ranged from 0.84 to 0.99.

Whole movie % of movies with 

tobacco use, % of characters who smoke at least once in target films

SC, HC, CX, MT

Note. cos. = companies; SC = smoker characteristics; HC = health consequences; Chg = change over time; TT = type of tobacco; CX = context; min = minutes; no. = number; hr = hour; Brand = brand appearances; sd = standard deviation; MT = movie type; MSA = Master Settlement Agreement; +ve = positive verbal reference; –ve = negative verbal reference; sci-fi = science fiction.
370

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

conducted by Dalton and colleagues32 of 

the number of tobacco incidents for a 

sample of 389 movies coded by both studies 

(p < 0.001). This finding suggests a strong 

correspondence between the two different 

methods of coding the amount of on-screen 

smoking used in these studies.

The studies also vary in how rigorously they 

describe their coding procedure. Of the 

studies reviewed here, only eight reported 

interrater reliability agreement, with values 

ranging from 70% to 100% on key coding 

variables.21,22,28,32,34,35,39,40 Most studies used 

adults to code movie content, the exception 

being the “Thumbs Up! Thumbs Down!” 

project.22,23 The latter study trained teams of 

young people aged 14–22 years to code films 

according to a standard protocol. The adult 

coders in the study reported by Polansky 

and Glantz26 were parents working for a 

parental review and screening service at 

ScreenIt.com, a movie content database.

The criteria for coding tobacco events 

also varied. Explicit depictions of tobacco 

use refer to instances in which the use of 

tobacco was directly portrayed (e.g., the 

actor smokes on screen). Incidental 

depictions of tobacco refer to those in which 

the use of tobacco was implied, without 

being explicitly portrayed (e.g., the actress 

is shown placing a cigarette pack in her 

handbag), or when smoking-related props 

were shown (e.g., an ashtray on a table in a 

movie set). Some content-analysis studies 

only coded explicit depictions of tobacco 

use.32,38 Others differentiated between types 

of tobacco depictions.27 Some counted 

explicit and incidental depictions of tobacco 

together as tobacco events.29,31 Studies 

with broader criteria for a tobacco incident 

tended to report higher rates of depiction as 

a result of their more inclusive measure.

There is, however, considerable overlap in 

the content variables the studies attempted 

to assess (table 10.1). All quantified the 

amount of smoking in their movie samples. 

Characteristics of smoking role models and 

depictions of contexts and consequences 

associated with smoking also have been 

recorded. Some studies examined the 

types of tobacco presented (e.g., cigarettes, 

cigars, chewing tobacco), the appearances 

of specific tobacco brands, and whether 

tobacco portrayal varied with movie release 

year, Motion Picture Association of America 

(MPAA) rating, or genre. Common themes 

recurred in the findings of these studies, 

despite their methodological differences. 

The results of these studies are summarized 

below.

Tobacco Use in Movies

Prevalence by Movie Type

Mekemson and colleagues22 found that 

most top box-office movies from 1991 to 

2000 had some tobacco use. Polansky and 

Glantz 26 found that, of U.S. films released 

between 1999 and 2003, 80% included 

smoking. Similarly, content analyses of top 

box-office movies from 1988 to 1997 indicate 

that most movies (87%) portrayed tobacco 

use. However, tobacco use accounted for 

only a small proportion of screen time.32

In 75% of movies, tobacco exposure 

accounted for less than 4% of total screen 

time. Cigarettes were the predominant 

form of tobacco used, followed by cigars, 

with little use of smokeless tobacco.27,32

However, in children’s animated movies, 

cigar use was most common.36 Tobacco use 

typically increased with the “adultness” of 

the MPAA rating. R-rated movies contained 

more tobacco occurrences and were more 

likely to feature major characters using 

tobacco.22,26,27,32,34 For U.S. movies released 

from 1999 to 2003, a higher proportion of 

R-rated movies included smoking (90%) 

compared with PG-13 (80%) and G/PG 

movies (50%). However, because of a decline 

in the total number of R-rated movies 

released between 1999 and 2003, a shift 

occurred in the total distribution of movies 

containing smoking. Most of the movies 
371

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

released in 2002 and 2003 that contained 

smoking scenes had a youth rating (PG-13 

or G/PG).26

Tobacco use was more common in dramas 

than in comedies, science fiction, or child 

and family genres.32 Similarly, Dozier 

and colleagues34 found that characters 

in comedies smoked less frequently 

than in other genres among 2002’s topgrossing movies. The amount of tobacco 

use in movies did not have a significant 

association with the movies’ box-office 

success.32 This finding may suggest that 

including tobacco in movies provides 

no direct economic benefit to the 

entertainment industry. This notion is 

bolstered by experimental evidence that 

among adolescent moviegoers, stripping 

the smoking from a movie does not 

affect their satisfaction with the movie or 

willingness to recommend it to a friend.42

Trends in the Amount of Tobacco 

Depicted in Movies Across Years

Examination of changes over the years 

in the frequency of on-screen depiction 

of tobacco highlights some discrepancies 

between movie portrayals of smoking and 

the social reality of smoking. In a content 

analysis by Dalton and colleagues32 of the 

top 25 box-office hits from 1988 to 1997, 

the rate of tobacco use among 1,400 major 

characters was 25%. This finding was 

not discordant with the prevalence of 

smoking among U.S. adults during that 

period. McIntosh and colleagues39 found 

that the proportion of leading characters 

who smoked increased from 20% in the 

1940s to 31% in the 1950s. The proportion 

then declined to 18% in the 1960s, 17% in 

the 1970s, and finally 12% in the 1980s. 

Omidvari and others38 found that, among 

contemporary U.S. movie characters during 

the 1990s, smoking prevalence was similar 

to that in the general U.S. population. 

In these three studies, the proportion of 

characters who smoked does not appear 

to exceed historical trends for smoking 

prevalence.

However, trends in the sheer frequency 

with which tobacco appears in movies 

across years do appear to be discordant 

with declining smoking rates in the actual 

population. In a sample of top box-office 

U.S. films from 1950 to 2002, the number of 

smoking incidents per 5-minute interval of 

film declined from 10.7 incidents per hour 

in 1950 to a minimum of 4.9 in 1980 to 1982 

but increased to 10.9 in 2002.28–30 Another 

study found that, after an initial drop in 

the frequency of depicting tobacco in the 

1970s and mid-1980s, the rate subsequently 

increased.21 Dalton and colleagues32 found 

that the number of tobacco occurrences 

in top box-office U.S. movies remained 

constant between 1988 and 1997, despite 

declining trends for smoking prevalence in 

the actual U.S. population. Mekemson and 

others22 found a weak decline in the amount 

of tobacco use per minute of film between 

1991 and 2000. However, these rates 

appeared to increase again between 2001 

and 2003.23 MacKinnon and Owen24 found 

that smoking was depicted more frequently 

in movies released in 1995 than in 1990.

The depiction of smoking in children’s 

animated films did not decrease between 

1937 and 1997.36 Later analyses of the 

“Thumbs Up! Thumbs Down!” content 

analysis dataset23 found that in PG-13 films, 

the total number of tobacco incidents 

depicted per year increased substantially 

between 2000 and 2003. Thus, the argument 

that on-screen smoking reflects social 

realism does not hold up as a reason for 

trends in the rate of smoking depiction 

in movies across the years. Movie content 

appears to be out of step with declining 

smoking rates in the U.S. population. 

These results raise questions about 

the role of films in amplifying notions 

of tobacco smoking being widespread. 

A number of movie content analysis studies 

observed a pattern of increased depiction 
372

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

of smoking in the late 1980s and early 

1990s. This time span follows the period 

during which there is documented evidence 

of paid tobacco product placement deals 

occurring in relation to film. Examination 

of trends in the rate of movie depictions of 

tobacco in relation to key tobacco-control 

events suggests these events have not 

precipitated marked reductions in on-screen 

tobacco portrayals.33,36

Characteristics of On-Screen Smokers

As indicated earlier, smoking prevalence 

among characters in films was not markedly 

discordant with smoking prevalence in the 

actual population (i.e., 25%).32 However, 

Dalton and colleagues32 found that the social 

characteristics of leading characters were 

atypical (e.g., attractive, high socioeconomic 

status) so the characters represented as 

smokers did not reflect the social reality 

of smoking. Hazan and colleagues28 found 

that between 1960 and 1990, the prevalence 

of smoking among major characters with 

high socioeconomic status was nearly 

three times as high as among people of 

similar socioeconomic status in the actual 

U.S. population. In the 1980s, tobacco 

events involving young adults (aged 18–29 

years) more than doubled compared with 

the previous two decades. However, tobacco 

events involving somewhat older adults 

(aged 30–45 years) fell by nearly one-half.28

More recent movies tended to portray 

smoking by adults more often than smoking 

by adolescents. For popular movies from 

1996 and 1997, smoking rates of 17%, 26%, 

and 25% were recorded for major characters 

aged younger than 18, 18–39, and older 

than 39 years, respectively.27

Stern35 found an identical smoking 

prevalence (17%) among major teen movie 

characters for top-grossing films from 

1999 to 2001. Dozier34 found that only 2% 

of teenagers smoked in top-grossing films 

for 2002. The on-screen smokers tended to 

be adult, white, and male. Future studies 

replicating sampling and coding methods 

over time will be necessary to confirm 

whether a significant decline has occurred in 

on-screen smoking among teen characters. 

Dalton and colleagues32 found that only 3% 

of tobacco occurrences were adolescents 

smoking and that the typical smoker in 

movies was white, male, middle-aged, and of 

high socioeconomic status—traits possessed 

by most leading characters. Omidvari and 

colleagues38 found that among leading 

American movie characters portrayed in 

the United States in the 1990s, smoking 

on-screen was associated with being male 

and of lower socioeconomic class.

The different findings of these studies in 

relation to the apparent class of on-screen 

smokers may reflect the different sampling 

methods used. Dalton and colleagues32 and 

Dozier and colleagues34 selected movies 

solely on box-office rating. Omidvari and 

others38 selected a subset of top box-office 

movies based on a range of exclusion 

criteria (table 10.1). The findings of Dalton 

and colleagues provide an account of 

smoking prevalence among prominent 

movie characters during the 1990s across 

movies of all genres set in all eras. However, 

Omidvari and colleagues38 evaluated smoking 

prevalence among U.S. movie characters 

in films of realistic genres set in the 1990s. 

These researchers focused on this subset 

of movies on the grounds that they were 

examining how movies portrayed smoking 

prevalence in contemporary life. Films set 

in the present may present smokers as more 

socially disadvantaged than did films in 

previous eras. The study by Omidvari and 

colleagues provides a useful snapshot of how 

contemporary on-screen smoking depictions 

compare with smoking prevalence in the 

general U.S. population. However, they do 

not represent a complete picture in terms 

of audience reach and impact of on-screen 

smoking (this was not their aim). As Glantz 

and Polansky43 argue, there is no evidence 

that viewers, particularly adolescents, 

distinguish between portrayals of tobacco 
373

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

in historical, contemporary, and futuristic 

films or between portrayals of tobacco in 

American and non-American films to which 

they are exposed.

The concern about the types of characters 

who are predominantly depicted as 

smokers in movies is that smoking is 

modeled by characters bearing aspirational 

traits—such as good looks, maturity, 

affluence, and power—similar to the sorts 

of images traditionally promoted in tobacco 

advertisements. Theories of media influence 

and persuasion predict that role models 

bearing such traits are the most influential 

to audiences.44,45 As described later in this 

chapter, in “Effects on Attitudes, Beliefs, and 

Behavior: Movies,” some audience studies 

suggest that the sheer frequency of exposure 

(across all movie genres and settings) 

is important to media impact. Audience 

studies have not yet examined whether 

responses vary with the historical setting of 

smoking. Evidence is emerging, however, 

that responses vary with character traits of 

smoking models.

Other Social and Emotional Imagery

McIntosh and colleagues39 found that in 

popular films from 1940 to 1989, smokers 

were depicted as more romantically and 

sexually active and marginally more 

intelligent than nonsmokers. However, 

smokers and nonsmokers did not differ in 

terms of their attractiveness, goodness, 

socioeconomic status, aggressiveness, 

friendliness, or outcome at film’s 

end. In movies released from 1988 to 

1997,32,34 smoking often is depicted 

(1) in association with intimacy and 

social activity; (2) as motivated by certain 

mood states (e.g., agitation, sadness, 

happiness, relaxation, pensiveness); or 

(3) in conjunction with other risk-taking 

behaviors (e.g., drug use or violence).32

Among American movie characters 

portrayed as contemporary in the 1990s, 

smoking was more common among 

antagonists.38 Two cross-sectional surveys 

of movie content report that in movies 

released during the 1990s, smoking was 

increasingly associated with stress reduction 

and hostility.24,28 It is unclear whether this 

shift in imagery reflects changes in social 

norms concerning smoking, cinematic style, 

or commercial factors.

Health Consequences

A key concern about depictions of smoking 

on screen is that the health consequences of 

smoking are rarely shown. Content analyses 

of children’s animated films released 

between 1937 and 1997 indicated that 

more than two-thirds of the films included 

tobacco use without clear verbal messages 

of any negative long-term health effects of 

smoking.36 Similarly, Hazan and colleagues28

found that most tobacco events in movies 

from 1960 to 1990 did not include health 

messages. Roberts and others27 found that, 

among the 200 most popular movie rentals 

for 1996 and 1997, negative long-term 

health effects associated with substance 

use (smoking, drug use, or alcohol 

consumption) were rarely depicted (in less 

than 7% of movies). Similarly, an analysis 

by Everett and colleagues31 of top box-office 

U.S. films from 1985 to 1995 indicated that 

on average only 3.5% of tobacco events 

were antitobacco, compared with 32.3% 

of tobacco events that were categorized as 

protobacco. In top-grossing films for 2002, 

most (92%) incidents involving tobacco 

were portrayed without consequences.34

In another study, youth viewers found that 

74% of the top 50 movies between 2000 

and 2003 that depicted tobacco contained 

protobacco messages.23 Dalton and 

colleagues32 found that negative reactions 

to tobacco use (e.g., comments about health 

effects or gestures such as coughing) were 

depicted in only 6% of tobacco occurrences. 

Escamilla and others40 found that movies 

rated as PG/PG-13 were less likely than 

R-rated movies to contain negative messages 
374

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

about smoking. In PG/PG-13 films, only 

9 of 22 tobacco messages were antitobacco, 

compared with 21 of 31 messages in R-rated/

unrated films. It is especially of concern 

that health effects may be more frequently 

omitted from movies targeted toward 

younger audiences. As demonstrated by 

social learning theory,45 showing hazardous 

behaviors in the absence of negative 

consequences is likely to make viewers more 

inclined to mimic them than if the negative 

consequences were shown.

Brand Appearances

Content analyses suggest that appearances 

of specific tobacco brands in movies occur 

frequently, despite a voluntary agreement 

on the part of the tobacco industry to 

stop paying for their brands to appear 

(the Cigarette Advertising and Promotion 

Code incorporated a voluntary ban on 

paid product placement circa 1991). In a 

10-year sample of top box-office films from 

1988 to 1997, the most highly advertised 

U.S. cigarette brands also accounted for the 

most brand appearances in the movies, and 

no decline occurred after 1991.33 Most (85%) 

of the films contained some tobacco use, 

with specific brand appearances in 28% of 

the total film sample. Brand appearances 

were as common in films suitable for 

adolescent audiences as in films for adult 

audiences. Although 27 tobacco brands were 

depicted in the movies sampled, 4 cigarette 

brands accounted for 80% of brand 

appearances. The brands were Marlboro 

(40%), Winston (17%), Lucky Strike (12%), 

and Camel (11%). Other content analyses 

of movies sampled from the late 1990s 

have found that brand appearances for 

Marlboro occurred five to six times more 

frequently than those for other tobacco 

brands.24,27 The U.S. film industry’s use of 

the most heavily advertised tobacco brands 

(see chapter 4 for advertising expenditures 

by brand) in internationally distributed 

films suggests that film serves as a global 

advertising medium for tobacco, as about 

one-half of box-office receipts for these films 

are from overseas.33

Often, brand appearances involve only 

glimpses of cigarette packaging in the 

ambient scene environment. A subset of 

brand appearance of particular concern, 

termed actor endorsement, is display of 

the tobacco brand while an actor handles 

or uses a product.33 It is reasonable to 

single out actor endorsement, because the 

film industry does so in its negotiations 

for placements for various products, often 

asking for a higher payment when an actor 

uses a particular brand.33 Table 10.2 is 

derived from an ongoing content analysis 

of the top 100 box-office hits and covers 

the years 1996–2002. The table lists all 

actor endorsement tobacco events captured 

during the seven-year period. The table 

documents 46 tobacco brand endorsement 

scenes from 43 of the 700 movies, thus 

giving a measure of the scope of the 

activity. Table 10.2 also illustrates that 

foreign cigarette brands are rarely depicted, 

the Marlboro brand captures most actor 

endorsements (25 of 46 endorsements), 

actor endorsement is not limited to one or 

two actors, and actor endorsement usually 

occurs only once or twice during the 

course of a movie. The one exception is the 

movie 28 Days, which contains nine actor 

endorsements of Marlboro.

Audience Reach

One issue limiting the utility of content 

analysis studies is that most do not include 

an estimate of reach. Reach typically is 

defined as the number of people who see a 

particular form of advertising.46 Polansky and 

Glantz26 estimated reach among adolescents 

for smoking in movies released at the box 

office between 1999 and 2003. They first 

estimated the number of smoking depictions 

contained in 776 movies released during 

this period by using data from ScreenIt.com 

(i.e., about 5,500 tobacco incidents in all 

movies). They then used box-office data 
375

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 10.2 Brand Cigarette Use Depicted in Contemporary Movies

Actor name Brand endorsed

Number of

endorsement

scenes Movie name

Year of 

release

Drescher, Fran Marlboro 1 Jack 1996

Eldard, Ron Marlboro 1 Sleepers 1996

Davis, Geena Parliament 1 Long Kiss Goodnight, The 1996

Addy, Mark Foreign Brand 1 Full Monty, The 1997

Carlyle, Robert Foreign Brand 1 Full Monty, The 1997

Roberts, Julia Marlboro 2 My Best Friend’s Wedding 1997

Sheen, Charlie Marlboro 1 Money Talks 1997

Franz, Dennis Camel 1 City of Angels 1998

Newman, Paul Camel 1 Twilight 1998

Sarandon, Susan Camel 1 Twilight 1998

Hawke, Ethan Kool 1 Great Expectations 1998

Cage, Nicolas Marlboro 1 Snake Eyes 1998

Janssen, Famke Marlboro 1 Rounders 1998

Keaton, Michael Marlboro 1 Desperate Measures 1998

Reno, Jean Marlboro 1 Godzilla 1998

Eastwood, Clint Camel 2 True Crime 1999

Bujold, Genevieve Foreign Brand 1 Eye of the Beholder 1999

Leguizamo, John Marlboro 1 Summer of Sam 1999

Quaid, Dennis Camel 1 Frequency 2000

Bullock, Sandra Marlboro 4 28 Days 2000

Buscemi, Steve Marlboro 1 28 Days 2000

Dooly, Mike Marlboro 1 28 Days 2000

Pratt, Wendee Marlboro 1 28 Days 2000

Santoni, Reni Marlboro 1 28 Days 2000

Skye, Azura Marlboro 1 28 Days 2000

Vaughn, Vince Marlboro 1 Cell, The 2000

Carrey, Jim Marlboro 1 Me, Myself & Irene 2000

Wilhoite, Kathleen Marlboro 1 Pay It Forward 2000

Schwimmer, Rusty Marlboro 1 Perfect Storm, The 2000

Fisher, Carrie Marlboro 1 Scream 3 2000

Scott, Dougray VF 1 Mission: Impossible II 2000

West, Dominic Winston 1 28 Days 2000

Washington, Denzel Kool 1 Training Day 2001

Barrymore, Drew Marlboro 1 Riding in Cars with Boys 2001

Rockwell, Sam Marlboro 1 Heist 2001

Zahn, Steve Marlboro 1 Riding in Cars with Boys 2001

Germann, Greg Parliament 1 Joe Somebody 2001

Crowe, Russell Winston 1 Beautiful Mind, A 2001

de Matteo, Drea Winston 1 Swordfish 2001

Hoechlin, Tyler Bugler 1 Road to Perdition 2002

Johnson, Carl J. Marlboro 1 Men in Black II 2002

Note. From a content analysis of the top 100 movies each year from 1996 through 2002.
376

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

from the National Association of Theatre 

Owners and Nielsen data on average 

audience share by age as well as the MPAA 

ratings to determine the number of children 

6–17 years of age who purchased tickets to 

see these movies. The MPAA is the lobbying 

arm of the film industry. The researchers 

estimated that the thousands of smoking 

incidents in hundreds of movies multiplied 

by the number of tickets purchased to see 

these movies resulted in about 8.2 billion 

smoking depiction impressions for children 

and adolescents during the five-year period. 

Although these estimates are subject to 

error and may be overestimated, they are 

a general measure for the very large scale 

of exposure from a population standpoint. 

They also do not include viewings of movies 

as DVD releases or on television in the years 

following the theatre release dates. 

Effects on Attitudes, 

Beliefs, and Behavior: 

Movies

Content analysis studies are useful for 

documenting media inputs, but they 

do not provide evidence concerning 

audience responses to such content. This 

section reviews the results of research on 

audience responses to tobacco content in 

entertainment media. Most of the mediaeffects research on tobacco in entertainment 

media has focused on movies rather than 

on other forms of entertainment media. 

This section focuses, therefore, on the 

findings of that movie research.

Qualitative Studies

Researchers taking a cultural studies 

approach to media research place a 

heavy emphasis on the subjectivity of 

interpretation of media messages. They tend 

to use qualitative methods to investigate 

interpretations of media among small 

numbers of audience members. These 

studies provide informative descriptive 

data but do not provide conclusive 

information as to impact of the media. 

A search of PubMed identified seven such 

studies by using the following strategy:

((“focus groups”[MeSH Terms] OR focus 

group[Text Word]) OR qualitative[All 

Fields]) AND ((“tobacco”[MeSH Terms] OR 

tobacco[Text Word]) OR (“smoking”[MeSH 

Terms] OR smoking[Text Word])) 

AND (movies[All Fields] OR (“motion 

pictures”[MeSH Terms] OR motion 

picture[Text Word]) OR media[Text Word])) 

41 records obtained, May 9, 2006.

Five of the studies reported on focus groups 

conducted with adolescents;47–51 one was on 

focus groups and interviews with college 

students;52 and one was on interviews 

conducted with a convenience sample of 

writers, actors, directors, producers, studio 

executives, and others involved in the film 

industry.53 Two additional relevant focus 

group studies were identified via citations in 

other papers by MacFadyen and colleagues54

and the World Health Organization (WHO).55

All of these studies used an acceptable 

qualitative research methodology.

Similar results concerning young people’s 

interpretations of smoking imagery in 

film have been found for focus group 

studies conducted with college students in 

India (8 groups, N = approximately 50)52

and adolescents in Australia (16 groups, 

N = 117),47 New Zealand (approximately 

10 groups, N = 76;48 and approximately 

10 groups, N = 88),49 India (8 groups, number 

not reported),55 and the United States 

(178 groups, N = 1,175;51 and 31 groups, 

N = 205).50 Young people reported that 

movies are an important source of 

information about smoking and that these 

images convey the notion that smoking 

is a normative, acceptable behavior; offers 

a means of stress relief; conveys a certain 

social image; and may serve as a marker 

of adult independence. Together, these 
377

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

findings indicate that young people perceive 

images of smoking in movies as leading to 

positive social or personal consequences 

rather than as presenting information 

about the negative health consequences 

of smoking. Qualitative research further 

indicates that other mass media with a 

visual component (e.g., television, magazines) 

convey mainly protobacco information about 

smoking to youth audiences (12 groups, 

N = 70 approximately;54 and 178 groups, 

N = 1,175).51

Cross-Sectional Studies

Cross-sectional studies attempt to quantify 

the relationship between exposure to 

media and attitudes, beliefs, or behavior in 

population-based samples. One unpublished 

and eight published cross-sectional studies 

of the relationship between exposure to 

smoking in movies and adolescent smoking 

were identified. Articles from the medical 

literature were identified through the 

following PubMed search strategies:

1. (“Smoking”[MeSH] OR “Tobacco”[MeSH]) 

AND “Motion Pictures”[MeSH], 

79 records obtained, May 10, 2006

2. (“Smoking”[MeSH] OR “Tobacco”[MeSH]) 

AND (“movie star” OR “movie stars”), 

5 records obtained, May 10, 2006

Articles from the literature on psychology, 

marketing, and communications were 

identified by searching PsycINFO, using the 

following search strategy and limiting to 

articles in English:

KW=(smoking or tobacco) and 

KW=(movies or (motion picture), 

26 records obtained, May 10, 2006

The studies were reviewed for inclusion of 

design characteristics that increased the 

reviewer’s confidence that the relationship 

demonstrated in the studies was a true 

media effect for the study sample and 

that the findings were generalizable 

(see table 10.3 for summary scores of the 

studies). On the basis of these criteria, 

two cross-sectional studies were excluded 

from the review5,6 because they included 

no controls for covariate influences. 

The remaining studies—seven published 

and one unpublished—involved four crosssectional analyses of three U.S. samples7,9,56,57

and one unpublished Australian sample 

of adolescents.58

As shown in table 10.3, researchers have 

tended to use two general measures of 

movie influence. One assesses the smoking 

status of favorite movie stars,4,9,56,58 and the 

other relies on movie title recognition.3,7,57

The first measure, smoking status of favorite 

movie stars, is an exposure measure that 

taps the self-concept and the prototypical 

smoker. People choose behaviors that are 

consistent with their self-concepts.59 Selfconcept ratings of adolescent smokers, 

as well as susceptible nonsmokers, are more 

similar to their ratings of the prototypical 

smoker than are the self-concept ratings 

of nonsmokers.60–62 In theory, adolescents 

also may initiate behaviors as they modify 

their self-images. Behavioral depictions 

by favorite stars shape that process by 

determining what is “cool,” attractive, 

and grown up. To the extent that smoking 

portrayals are consistent with adolescents’ 

actual or ideal self-images or a prototype of 

the ideal group member (that is, appearing 

grown up), adolescents will be motivated to 

smoke to align their self-perceptions with 

personal ideals.63,64

In determining the smoking status of 

favorite stars, Distefan and colleagues4,56

and Dixon58 asked adolescents to list their 

favorite male and female movie stars. The 

researchers developed lists of the top 10 

male and female actors and subsequently 

used content analysis to determine the onscreen smoking status for these individuals. 

The Distefan study also determined these 

stars’ real-life smoking status. Other 
378

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

Table 10.3 Summary of Results of Cross-Sectional and Longitudinal Studies: Smoking 

and Movies

Study Study design Recruitment Subjects Country

Media influence 

measure

Distefan et al. 

199956

Cross-sectional Random digit dial 3,053 adolescents 

aged 12–17 years

U.S. Chooses favorite 

movie star of 

ever (vs. never) 

smokers

Dixon 200358 Cross-sectional School based 2,610 adolescents 

aged 12–18 years; 

attitudes assessed 

among subgroup 

of 1,858 never/

experimental smokers

Australia Movie smoking 

status of favorite 

star

Tickle and 

Sargent 20019

Cross-sectional School based 632 adolescents 

aged 10–19 years; 

attitudes assessed 

among subgroup of 

281 never smokers

U.S. Movie smoking 

status of favorite 

star

Sargent and 

Beach 20017

Sargent et al. 

200257

Cross-sectional School based 4,919 adolescents 

aged 10–15 years; 

attitudes assessed 

among subgroup of 

3,766 never smokers

U.S. Two-stage direct 

measure (movie 

title recog × amt 

of smoking)

Sargent et al. 

200565

Cross-sectional Random digit dial 6,522 adolescents 

aged 10–14 years

U.S. (national 

sample)

Two-stage direct 

measure (movie 

title recog × amt 

of smoking)

McCool et al. 

200566

Cross-sectional School based 3,041 adolescents 

aged 12–16 years

New Zealand Perceived 

frequency of 

viewing films 

(cinema and 

video)

Dalton et al. 

20033

Longitudinal School-based 

recruitment with 

teleph F/U

2,603 adolescents 

aged 10–15 years 

at inception

U.S. Two-stage direct 

measure (movie 

title recog × amt 

of smoking)

Distefan and 

Pierce 200467

Longitudinal Random digit dial 2,084 adolescents 

aged 12–17 years 

at inception

U.S. Movie smoking 

status of favorite 

star

Note. Teleph F/U = telephone follow-up; recog = recognition; amt = amount; S = sociodemographics; P = personality characteristics; 

Sch = school attachment and function; SI = other social influences (friend and family smoking); PS = parenting style; M = other 

media/advertising influences.

a

Statistically significant relation (p < .05) between movie smoking exposure and this outcome after covariate adjustment.

b

Significant correlation (no covariate adjustment).
379

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Validity, reliability

Additional 

outcome 

measures

Smoking 

outcome 

measure

Measure of 

association

Association 

size

Covariate 

adjustment 

categories

Not reported Susceptibilitya 0 0 0 S, P, Sch, SI, M

Not reported Intentions Index Adjusted 

proportional odds

1.16a S, Sch, SI

Not reported Susceptibilitya Initiation Adjusted odds 1.5a S, Sch, SI, M

3-week test–retest (average 

percent agreement) 92%.

Correct recall of titles seen up 

to 1 year prior = 90%.

Recalls having seen a sham 

title 3%.

Susceptibilitya

Norms—adulta

Norms—peer 

Positive expecta

Initiation Adjusted odds 1.7–2.7a S, P, Sch, PS, 

SI, M

3-week test–retest (average 

percent agreement) 92%.

Correct recall of titles seen up 

to 1 year prior = 90%.

Recalls having seen a sham 

title <2%.

0 Initiation Adjusted odds 1.7–2.6 S, P, Sch, PS, SI

Cronbach’s alpha = 0.65 Norms—moviesa

Nonchalance—

moviesa

Norms—peerb

Judgment—peera

Intentions

0 0 0 S

3-week test–retest (average 

percent agreement) 92%.

Correct recall of titles seen up 

to 1 year prior = 90%.

Recalls having seen a sham 

title 3%.

0 Initiation Adjusted relative 

risk

2.0–2.7 S, P, Sch, PS, 

SI, M

Not reported 0 Initiation Adjusted odds 1.3a S, Sch, PS, SI, M
380

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

researchers9 asked adolescents to name 

their favorite stars and determined smoking 

status in recently released movies for any 

star chosen by five or more adolescents. 

One problem with favorite star measures 

was the loss of sample size due to the 

great diversity of stars adolescents chose 

as “favorite.” Adolescents were excluded if 

their chosen star did not make the top 10 

list—51% were excluded in the Distefan 

study,56 and 37% were excluded by Dixon58—

or because fewer than five adolescents chose 

the star (50% excluded in a study by Tickle 

and colleagues).9

All studies have examined associations 

between stars’ on-screen smoking status 

and adolescents’ attitudes toward smoking. 

Two used an adolescent smoking measure 

termed susceptibility to smoking, which 

captures an individual’s inability to rule 

out smoking in the future or to rule out 

smoking if a peer offers cigarettes; this 

measure has been found to be a strong 

predictor of future smoking.68 Distefan and 

colleagues56 determined the favorite movie 

stars for a random sample of California 

adolescent smokers. They found that 

adolescent never smokers who preferred the 

favorite star of smokers were more likely 

to be susceptible to smoking. The favorite 

stars of smokers also were more likely to 

have smoked on screen and in real life. 

Tickle and colleagues9 determined favorite 

movie stars for a school-based sample of 

northern New England adolescents. Among 

never smokers, those choosing stars who 

smoked were significantly more likely to be 

susceptible to smoking. For each of these 

studies, the adjusted odds ratio (OR) was the 

measure of association with smoking and 

susceptibility to smoking. For the study by 

Distefan and colleagues, the adjusted OR was 

1.3 for adolescents who chose a favorite star 

among smokers. For the study by Tickle and 

others, the adjusted OR was 4.8 if the star 

had smoked in two or more recent movies. 

Dixon58 found no relationship between the 

on-screen smoking status of favorite stars 

and intentions to smoke in a sample of 

Australian adolescent never smokers and 

experimental smokers.

It is unclear whether the lack of association 

for intentions observed in Dixon’s study 

in contrast to the U.S. studies is due to 

a cultural difference in responsiveness 

to on-screen smoking by stars or due 

to methodological differences between 

the studies. For example, the Australian 

adolescents in Dixon’s study may have been 

less susceptible to the influence of smoking 

in movies because it did not resonate with 

their other media exposure in relation to 

tobacco. Unlike in the United States, most 

direct forms of tobacco advertising are 

illegal in Australia. Cross-cultural surveys 

using identical methods would be necessary 

to test these hypotheses.

Two studies9,58 also examined whether 

the smoking status of favorite stars was 

linked with adolescent smoking. Overall, 

the relationship between favorite stars’ 

smoking and adolescent smoking was 

statistically significant in both cases. Dixon58

estimated the effect on a smoking uptake 

index with a proportional odds model 

(adjusted proportional OR = 1.16). Tickle 

and colleagues9 estimated the effect on 

trying smoking with a logistic regression 

(adjusted OR = 1.5 [95% confidence 

interval (CI), 1.01–2.32] for adolescents 

whose favorite stars smoked in two recent 

movies and 3.1 [95% CI, 1.34–7.12] for 

adolescents whose favorite stars smoked 

in three or more movies). Dixon separated 

the effect by whether the favorite actor 

was male or female and the gender of the 

subject. She found that the association was 

significant for male actors’ smoking, and 

only in girls. Tickle and colleagues found 

no such gender-based interactions.

The second approach to measuring exposure 

to smoking in movies is a two-stage method 

that directly estimates exposure to smoking 

in movies.3,7 The first stage involves 
381

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

content analysis to determine the amount 

of smoking contained in the movie sample 

of interest. Because adolescents cannot be 

surveyed on all movies, the second stage 

of this method requires special survey 

techniques that present the adolescent with 

a movie title list (Sargent and colleagues7

chose to include 50 titles) that was randomly 

selected from the larger content-analyzed 

sample (table 10.4). This method has the 

advantage that exposure to smoking in 

movies can be estimated directly and in an 

unbiased fashion for all adolescents in the 

survey sample.

The method relies on adolescents’ ability to 

recall accurately whether or not they had 

seen a movie, when prompted by the movie 

title, and has been extensively validated 

by Sargent and colleagues.65 As a test of 

face validity, these researchers evaluated 

whether box-office success was related to the 

probability adolescents would say they had 

seen a movie. In their cross-sectional study, 

there was a high correlation (r = –0.73) 

between the box-office success of the 

top 100 movies released the year before the 

survey and the percentage of adolescents 

who had seen these films. Two of the movies 

included were foreign films not released in 

the United States and served as a validation 

against false reports. Of the students queried 

regarding the two foreign films, only about 

1% or less reported that they had seen the 

unreleased movies. These were the two 

lowest viewing rates reported for the survey. 

To further evaluate validity, Sargent and 

colleagues7 recontacted the 49 students 

who participated in their longitudinal pilot 

study. As part of the pilot, students were 

called once a month for 12 months; they 

were asked at each interview what movies 

they had seen in the past week. One year 

after the final interview, adolescents were 

asked whether or not they had seen items on 

a list of 50 movies. Each list contained up 

to 30 movie titles they reported having seen 

the previous year (average = 19), 10 false 

movie titles with real stars, 10 false movie 

titles with false stars, and other real movie 

titles to complete a list of 50. As shown 

in table 10.4, adolescents had excellent 

recognition of the movies they had seen 

and were very unlikely to report seeing 

false movies, even when associated with 

real actors.

Sargent and colleagues57 used the direct 

method described above to estimate 

exposure to smoking in movies from a 

sample of 601 popular contemporary movies 

among 4,919 adolescents in northern 

New England. The movie exposure measure 

provided an estimate of lifetime exposure 

to smoking scenes from the 601 movies. 

The subjects had seen an average of 30% 

of the movie sample; in these, they were 

exposed to an average of 1,160 depictions 

of smoking in movies (interquartile range 

640–1,970).69 A smoothed curve for the dose 

response shows a direct linear relationship 

between higher exposure to smoking in 

movies and higher rate of smoking through 

most of the exposure range, with the dose 

response flattening out past the 95th 

percentile of exposure (figure 10.2).

Table 10.4 Validity of Adolescents’ Recognition of Movie Titles

Have you seen this movie? (ascertained in 2001)

Movie category Yes No Don’t know

Adolescent reported seeing it in 1999 87.2% 12.6% 0.6%

False movie title, real actors 2.7% 96.7% 0.5%

False movie title, false actors 3.0% 96.4% 0.6%

Other movies 41.1% 54.2% 4.6%

Note. Data derived from research by Sargent, J. D., M. O. Beach, M. A. Dalton, and T. F. Heatherton.
382

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

There was almost no smoking among 

adolescents with little exposure to movies, 

and smoking peaked at almost 40% above 

the 95th percentile. The relationship 

between viewing smoking in movies and 

adolescent smoking remained after a broad 

range of confounders was controlled.57

The measure of association was the adjusted 

OR, with the adjusted odds of trying smoking 

being 1.9 (95% CI, 1.3–2.7), 2.6 (1.8–3.7), 

and 2.5 (1.7–3.5) for quartiles 2, 3, and 

4, respectively, compared with quartile 1. 

The effect of moving to a higher category of 

exposure to smoking in movies was similar 

to the adjusted OR for having siblings who 

smoke (1.7 [95% CI, 1.3–2.1]); the effect was 

higher than the effect of having parents who 

smoke (1.3 [95% CI, 1.1–1.6]) or owning 

tobacco-branded merchandise (1.2 [95% CI, 

0.97–1.5]) and lower than the effect of having 

peers who smoked (5.1 [95% CI, 4.0–6.4]).

The relationship between exposure to 

smoking in movies and attitudes toward 

smoking also was assessed among never 

smokers in the northern New England 

sample.57 Exposure to smoking in movies 

was associated with susceptibility to 

smoking, an indexed measure of positive 

expectations for smoking, and normative 

beliefs about adult smoking. The measure 

of association was the adjusted OR. Ranges 

(for the three higher quartiles) for the 

effect size for the association with exposure 

to smoking in movies were 1.2–1.7 for 

susceptibility to smoking, 1.2–1.4 for the 

endorsement of adult smoking as normative, 

and 1.2–1.4 for the endorsement of positive 

smoking expectations. Exposure to smoking 

in movies was not associated with normative 

beliefs about peer smoking, a finding that 

is consistent with the predominantly adult 

nature of depictions of smoking in movies. 

This finding is consistent with content 

analyses showing that movies rarely depict 

adolescent characters as smokers.32

Sargent and colleagues65 used the direct 

method described above to estimate 

exposure to smoking in movies from a 

sample of 532 popular contemporary movies 

among a nationally representative sample of 

Figure 10.2 Lowess Smoothed Curve Showing Cross-Sectional Relationship between 

Exposure to Movie Smoking Depictions and Adolescent Smoking Initiation in 

a Study of Northern New England Adolescents

Estimated exposure to movie smoking depictions*

0 2000 4000 6000

0

0.2

0.4

0.6

0.8

1.0

17.3% of the sample had tried smoking

95th percentile for exposure

Smoothed point estimate:

Prevalence of ever tried smoking

Note. Based on sample described in Sargent, J. D., M. L. Beach, M. A. Dalton, L. A. Mott, J. J. Tickle, M. B. Ahrens, and 

T. F. Heatherton. 2001. Effect of seeing tobacco use in films on trying smoking among adolescents: Cross sectional study. British 

Medical Journal 323 (7326): 1394–97. 

*From 601 popular contemporary motion pictures.
383

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

6,522 U.S. adolescents. Adolescents’ level of 

exposure to smoking in movies was divided 

into quartiles. Compared with adolescents 

in quartile 1, the adjusted ORs for having 

tried smoking were 1.7 (95% CI, 1.1–2.7) 

for quartile 2, 1.8 (95% CI, 1.2–2.9) for 

quartile 3, and 2.6 (95% CI, 1.7–4.1) for 

quartile 4 after controlling for potential 

confounders. This association between 

exposure to smoking in movies and 

smoking initiation was similar in size to the 

association with parent and sibling smoking 

(adjusted odds of smoking 1.8 [95% CI, 

1.5–2.3] and 2.3 [95% CI, 1.8–2.9], 

respectively) and held true within broad 

racial and ethnic categories, and regardless 

of residential location. The association 

was lower than the association with peer 

smoking (OR 3.3 [95% CI, 2.6–4.2]). 

An adjusted attributable risk fraction 

indicated that among 38% of adolescents 

who had tried smoking, exposure to 

smoking was an independent, primary risk 

factor for smoking initiation.

In addition to the measures of smoking 

status and movie title recognition, a 

third measure of movie influence—used 

in a single study—asked adolescents 

their perceived frequency of viewing 

movies. Using this crude estimate of 

exposure to on-screen smoking, McCool 

and colleagues66 examined a sample of 

3,041 New Zealand adolescents. The selfreported frequency of movie exposure 

was positively associated with perceived 

smoking prevalence among adolescents 

and among people in movies, and with 

nonchalance/apathy concerning smoking 

in films, when controlling for demographic 

variables. These researchers did not find a 

statistically significant association between 

exposure to film and smoking intentions 

(“smoking expectations”). However, path 

analytic techniques revealed that certain 

smoking belief variables that bore a direct 

association with movie exposure also were 

significantly associated with smoking 

intentions, leading the authors to argue that 

exposure to movies had an indirect effect 

on intentions, through its influence on 

mediating cognitions. Thus, this study, like 

that of Dixon,58 failed to find a statistically 

significant association between the movie 

exposure measure and smoking intentions. 

Owing to differing methods in the studies, 

it is not clear whether the lack of association 

observed with intentions is because onscreen smoking does not directly affect 

smoking intentions, whether the two studies 

that examined intentions used measures of 

exposure to media that lacked specificity in 

quantifying actual exposure to on-screen 

smoking, or whether the tobacco control 

environments in those countries (Australia 

and New Zealand) “dampen down” the 

protobacco effects of on-screen smoking. 

Intercountry surveys that use identical 

methods (including more direct measures 

of on-screen smoking) would be necessary 

to test these hypotheses.

The cross-sectional surveys not included 

(because of the lack of controls for 

confounding) are still interesting, 

because they suggest that an association 

between exposure to smoking in movies 

and youths’ smoking also occurs in nonWestern countries. However, because of 

the limitations of these studies, further 

research is needed to establish more 

clearly the effect of smoking depicted in 

movies on adolescents in non-Western 

countries. A survey of 1,338 Thai adolescents 

(aged 14–17 years) found that exposure to 

American movies was related to heightened 

levels of smoking-related behavior but not 

to smoking intentions.6 In addition, a survey 

of more than 1,700 Hong Kong adolescents 

indicated that viewing a greater number 

of movies was significantly associated with 

being more likely to have ever smoked and 

with intentions to smoke.5

Longitudinal Studies

Longitudinal studies attempt to quantify 

the relationship between exposure to 
384

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

media and behavior in population-based 

samples by using multiple-wave survey 

designs. These studies have the advantage 

of determining more clearly whether the 

exposure precedes the adoption of the 

behavior. Never smokers in two U.S. samples 

were followed longitudinally to determine 

which persons initiated smoking in the 

future as a function of baseline movie 

exposure.3,4 A longitudinal study published 

in 2004 examined the status of smoking in 

movies by favorite stars (assessed at baseline) 

as a predictor of trying smoking in the 

future.4 This study identified “favorite stars” 

who smoked in at least two movies during 

the three-year period prior to the survey. 

Consistent with Dixon’s cross-sectional 

study,58 female, but not male, adolescents 

who chose stars who were smokers were 

significantly more likely to initiate smoking 

during the follow-up period.

Initiation of smoking also was determined 

for never smokers in the study of northern 

New England adolescents in which exposure 

to smoking in movies was estimated 

directly.3 Figure 10.3 shows a smoothed 

curve for the dose response. As shown in the 

cross-sectional sample, there was a direct 

linear relation between higher exposure 

to smoking in movies and a higher rate 

of smoking through most of the exposure 

range. The dose response flattened past the 

95th percentile of exposure. Smoking during 

follow-up was almost zero for adolescents 

with minimal exposure to smoking in 

movies at baseline and approached 20% for 

adolescents in the highest exposure range.

The effect persisted when controlling 

for a large set of covariates, including 

other social influences, advertising 

influences, personality characteristics 

(e.g., rebelliousness), and parenting style. 

The effect size, measured as adjusted relative 

risk of smoking initiation, with baseline 

movie exposure categorized into quartiles, 

was 2.0 (95% CI, 1.3–3.2), 2.2 (95% CI, 

1.4–3.4), and 2.7 (95% CI, 1.7–4.3) for 

quartiles 2, 3, and 4, respectively, compared 

with quartile 1. This range of relative risks 

was similar in magnitude to the relative 

Figure 10.3 Lowess Smoothed Curve Showing the Longitudinal Relationship between 

Exposure to Movie Smoking Depictions and Adolescent Smoking Initiation in 

a Study of Northern New England Adolescents

Estimated baseline exposure to movie depictions*

0 1000 2000 3000 4000 5000

0

0.2

0.4

0.6

0.8

10% of the sample tried smoking during follow-up period

95th percentile for exposure

Smoothed point estimate:

incidence of smoking initiation during follow-up

Note. Based on sample described in Dalton, M. A., J. D. Sargent, M. L. Beach, L. Titus-Ernstoff, J. J. Gibson, M. B. Ahrens, 

J. J. Tickle, and T. F. Heatherton. 2003. Effect of viewing smoking in movies on adolescent smoking initiation: A cohort study. 

Lancet 362 (9380): 281–85.

*From 601 popular contemporary motion pictures.
385

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

risk of smoking associated with having 

parents who smoke (1.6 [95% CI, 1.2–2.0]), 

and higher than the relative risk associated 

with friends’ smoking (1.1 [95% CI, 

0.87–1.5]) or ownership of tobacco-branded 

merchandise (1.1 [95% CI, 0.85–1.5]). It is 

also notable that the estimates of the effect 

of viewing smoking in movies on smoking 

initiation in both longitudinal studies were 

almost identical to estimates obtained for 

the cross-sectional samples. This finding 

suggests that exposure to smoking in 

movies and its effect on adolescent smoking 

persist over time.

Taken together, these cross-sectional 

and longitudinal studies provide strong 

support for a direct association between 

exposure to smoking in movies and attitudes 

toward smoking and smoking initiation. 

The cross-sectional study of attitudes among 

never smokers57 suggests that exposure to 

smoking in movies enhances perceptions 

about the utility of smoking and increases 

adolescents’ intentions to try smoking. 

The longitudinal studies provide evidence 

of a temporal association—that is, exposure 

to on-screen smoking precedes smoking 

behavior among adolescents. The strongest 

associations have been demonstrated in 

studies using a direct measure of exposure. 

Cigarette smoking by a favorite movie star 

has a weaker association, probably because 

tobacco use by favorite stars is not a true 

measure of exposure to all smoking depicted 

in movies but instead taps the much 

narrower effect mediated by the adolescent’s 

identification with his or her favorite star. 

If this is the case, the gender findings in 

the studies by Dixon58 and Distefan and 

colleagues4 indicate that, in relation to 

movies, identification processes are more 

important in determining smoking onset 

for girls than they are for boys.

Experimental Studies

Experimental research enables media 

content variables of interest (e.g., smoking 

versus nonsmoking footage) to be 

manipulated and allows controlled 

assessment of audience reactions to such 

content. This method overcomes a key 

limitation of cross-sectional studies—

the inability to control for unknown or 

unmeasured confounders. In experimental 

studies, randomization of subjects to 

exposure categories is used to control 

for known and unknown confounders. 

The limitations of experimental studies 

are that the viewing conditions tend to be 

nonnaturalistic and it generally is feasible 

to assess only short-term responses to 

relatively brief media exposure. Nonetheless, 

these studies complement the crosssectional studies and provide further 

insights into the impact on audiences of 

movie depictions of tobacco and tobacco use.

The PubMed and PsycINFO searches 

reported under cross-sectional studies 

yielded two experimental studies42,70

and two quasi-experimental studies71,72

assessing reactions to depictions of tobacco 

in movies. The latter two studies are best 

classified as quasi-experimental, as they 

assessed naturalistic exposure to whole 

movies among actual cinema audiences.71,72

The strength of these studies was their 

larger audience sample size relative to 

the other studies. Their limitation was 

that viewers were not randomly allocated 

to conditions. The authors identified two 

further peer-reviewed experimental studies: 

one published73 and another conducted as 

part of a doctoral dissertation.58

Table 10.5 summarizes the methods and 

findings of the respective experimental 

studies assessing reactions to on-screen 

portrayals of tobacco. Most designs of 

the studies included an experimental 

manipulation that compared audience 

responses to movie footage depicting 

smoking (intervention) with responses to 

movie footage that did not depict smoking 

(control). Some studies included further 

experimental manipulations, such as varying 
386

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

the level of emotional arousal for the sample 

movie footage (study 1)42 or varying the 

social characteristics of the characters in 

the movie footage.58 Two studies assessed 

whether exposure to an antismoking 

advertisement (intervention) before 

viewing a movie that featured smoking 

promoted different audience responses 

compared with responses to viewing a movie 

without such an advertisement (control). 

One study assessed whether including 

antitobacco content within the movie71

(intervention) produced a different audience 

response than the response to viewing a 

movie that did not contain such content 

(control). Most of the studies used actual 

movie footage or whole movies for their 

stimulus material, often with some editing 

performed to achieve the experimental 

manipulation. The exception, the study 

by Jones and Carroll,73 used video clips 

of role plays produced specifically for the 

study. For studies using actual movie 

footage as stimuli, the strength is that 

Table 10.5 Summary of the Methods and Results of Experimental Studies Assessing 

Responses to On-Screen Tobacco Use

Methods

Study Subjects

Subgroups

examined Country

Stimulus

movie

Experimental

manipulation

Jones and Carroll 

199873

51 college students n = 40 females,

n = 11 males

Australia Video clips (role 

plays, not actual 

movie footage)

Smoking compared with 

nonsmoking footage

Pechmann and Shih 

1999 (study 1)42

607 ninth graders, 

nonsmokers

— US Scenes from 

Reality Bites and 

Wild at Heart

Smoking compared with 

nonsmoking footage x high 

compared with low positive 

arousal elicited by scenes

Pechmann and Shih 

1999 (study 2)42

232 ninth graders, 

nonsmokers

— US Whole movie 

Reality Bites

Smoking compared with 

nonsmoking footage x prefilm 

antismoking advertisement 

compared with no 

advertisement

Gibson and Maurer 

200070

120 college 

students

n = 36 smokers,

n = 84 nonsmokers

US 20-minute clip of 

Die Hard

Smoking, nonsmoking 

footage

Hines et al. 200074 151 college 

students

— US 6 scenes from 

6 popular films

Smoking compared with 

nonsmoking footage

Dixon et al. 200171 383 adult cinema

patronsa

n = 192 who 

completed follow-up 

interview within 

2 weeks of seeing 

movie

Australia Whole movie Antitobacco message 

(The Insider) compared with

control film (Erin Brokovich)

Edwards et al. 

200472

2,038 female 

adolescent cinema 

patronsa

n = 186 smokers,

n = 1,852 

nonsmokers

Australia Whole movies 

(depicting smoking)

Prefilm antismoking 

advertisement compared with 

no advertisement

Dixon 200358 374 seventh and 

eighth graders

— Australia 2 x 5 minute clips 

from popular movies

Smoking compared with 

nonsmoking footage of 

different character types

Note. – = variable not assessed; ns = variable not significantly affected by experimental manipulation.

a

Quasi-experimental study, using subject’s self-selected cinema exposure.

*p < .05. **p < .01. ***p < .001. Variable significantly affected by experimental manipulation (lowest p value achieved for variables 

in this response category).
387

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

the stimuli represent those the viewers 

might be exposed to in the “real world.” 

The disadvantage of this method is that 

to achieve the intended experimental 

manipulation (e.g., smoking versus 

nonsmoking footage), it is not always 

possible to obtain directly comparable 

control footage.58 Conversely, studies 

using nonprofessionally produced footage 

can more readily produce stimuli that 

are identical, with the exception of the 

experimental manipulation.73 However, 

the footage is of nonprofessional quality, 

limiting generalization of the results to the 

likely effects on audiences of “real world” 

movie viewing.

Most of the studies consisted of a posttestonly design in their assessment of the 

audience’s tobacco-related attitudes, beliefs, 

and intentions. Only one71 used pretest and 

posttest assessments of smoking-related 

beliefs, which would have increased the 

power to detect the effects of the media 

Response variables

Ratings of

the movie

Ratings of

characters

Ratings of

actors

Beliefs

about

smokers

Beliefs 

about

personally

smoking

Personal

intentions

to smoke Arousal

Beliefs 

about the 

tobacco

industry

— ** (females)

ns (males)

— — — — — —

— — — ** * — ** —

* ** — ** * * ** —

— * (smokers)

ns (nonsmokers)

* (smokers)

ns (nonsmokers)

* (nonsmokers) — ns (nonsmokers) — —

— *** — — — * — —

— — — — — * (completed 

follow-up within 

2 weeks of 

movie)

— ***

ns (smokers)

*** (nonsmokers)

— — — — * (smokers)

ns (nonsmokers)

— —

— ** — ns * ns — —
388

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

manipulation within subject analyses. 

However, several of the studies did include a 

pretest assessment of participants’ smoking 

status and demographic characteristics. 

This information enabled examination of 

responses as a function of key audience 

subgroups or inclusion of these variables as 

covariates in data analyses.70,74

The main methodological difference 

between the studies related to their 

respective sample sizes. The smallest 

audience sample consisted of approximately 

40 subjects, with about 20 viewers per 

condition.73 The largest audience sample 

consisted of 2,038 subjects, with about 

1,000 viewers per condition.72 Despite 

these marked differences in sample size, 

even the smaller studies found some 

statistically significant effects of the 

experimental manipulation on viewers’ 

responses.

To help inform the assessment of the effect 

sizes of these experimental studies, the 

authors examined meta-analyses of effect 

sizes observed in experimental research 

assessing the effects of violent media 

depictions on viewer aggression75 and of 

thin media models on body dissatisfaction.76

The meta-analysis of media violence studies 

found a mean effect size for laboratory 

experiments of approximately 0.25 (95% CI, 

0.23–0.28) and for field experiments 

approximately 0.2 (95% CI, 0.15–0.25). 

The absolute values for effect sizes in 

the body image studies were of a similar 

magnitude. The mean effect size across 

studies was –0.31 (95% CI, −0.40 to –0.23). 

(The positive direction of the effect in the 

violence studies reflects increased aggression 

following exposure to violent movie content. 

The negative direction of the effect in the 

body image studies reflects more negative 

body image perceptions following exposure 

to thin models in the media.)

To determine the effect sizes observed in 

experimental research assessing audience 

reactions to smoking in films, power 

calculations were performed, using the 

results observed in studies in which 

significant effects of the experimental 

manipulations were found on smokingrelated beliefs and intentions, with the use 

of Power and Precision software. To perform 

such calculations comparing mean response 

scores postintervention, it was necessary 

to specify means, standard deviations, and 

cell sizes for each experimental condition. 

This process was possible for all of the 

experimental studies, except for two that did 

not publish standard deviations with their 

results.42,70 The effect sizes achieved were 

within a range similar to those observed 

in the above meta-analyses of media 

experiments on other health topics (absolute 

values 0.1 through 0.8). The strongest effect 

size, 0.8 (95% CI, 0.41–1.19), was observed 

in the study by Jones and Carroll73 for the 

effects of a video character’s on-screen 

smoking status on perceptions of that 

character’s social characteristics. According 

to Cohen’s77 effect size conventions, this 

observation would be viewed as a “large” 

effect for social science research. The effect 

sizes observed for more self-referent beliefs 

about smoking (e.g., intentions) tended 

to be “small” (range: 0.1–0.3), as might be 

expected for studies assessing reactions 

to a brief media exposure. However, it 

is theoretically plausible that recurrent, 

naturalistic exposure to movie images of 

smoking have a larger cumulative effect 

on viewers’ propensity to smoke, and the 

findings of cohort studies3,4 are consistent 

with this hypothesis.

Effects of On-Screen Smoking on 

Viewers’ Smoking-Related Beliefs

Theories of media influence predict that 

role models bearing favored social attributes 

are likely to be especially persuasive.44,45

Several experimental studies have assessed 

whether stars who smoke on screen promote 

prosmoking beliefs among audiences.42,70,74
389

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Results of experimental studies suggest that 

viewing movie characters who are smoking 

enhances viewers’ perceptions of how 

socially acceptable smoking is. Pechmann 

and Shih42 found that exposure to movie 

scenes of popular, young stars smoking 

(versus nonsmoking) prompted adolescent 

viewers to report that adolescent smokers 

had higher social stature. This finding 

was replicated in a second experiment 

that assessed reactions to a whole movie 

(Reality Bites) depicting smoking compared 

with an edited version of the movie that 

excluded smoking depictions. Similarly, 

Gibson and Maurer70 found that, among 

nonsmoking college students, viewing 

a movie clip of a leading male character 

smoking (versus a comparable clip in which 

this character does not smoke) resulted 

in a greater willingness to become friends 

with a smoker. However, further analyses 

revealed that this effect was most marked 

for viewers low on “need for cognition” 

(a trait predicted to render someone more 

susceptible to persuasion via the peripheral 

route).78 This finding suggests that some 

people may be more susceptible than others 

to the persuasive impact of movie depictions 

of smoking.

Dixon58 found evidence suggesting that 

adolescents who watched footage of movie 

adult characters smoking on screen 

perceived adult smoking prevalence 

in the “real world” to be higher than 

did adolescents who watched footage 

of nonsmoking movie characters. This 

effect occurred irrespective of the social 

characteristics of the on-screen smokers 

that students viewed. Together, these 

findings suggest that movie depictions of 

smoking may promote perceptions that 

smoking is a normative behavior in the 

real world. These findings are of concern, 

since social learning variables, “especially 

peer smoking and approval, prevalence 

estimates, and offers/availability”79(p.1171)

have been found to be strongly predictive 

of smoking onset.

Exposure to on-screen smoking also has 

been found to influence viewers’ beliefs 

about the social consequences of personal 

smoking. Pechmann and Shih42 digitally 

changed the image frame to edit smoking 

out of the 1990s film Reality Bites.

Comparing adolescents’ responses to the 

original versus the nonsmoking version of 

the movie, they found that adolescent never 

smokers exposed to the original version 

showed enhanced perceptions of how their 

social stature would be viewed by others if 

they were to personally smoke. The video 

manipulation had no significant effects on 

participating adolescents’ perceptions of 

how popular, vital, or poised they would 

look if they were to smoke. Dixon58 found 

that beliefs about the social consequences 

of personal smoking were affected 

differentially, depending on the social 

characteristics of the on-screen smoker. 

Among adolescent viewers, attractive, highstatus characters who smoked on screen 

promoted positive beliefs about the benefits 

of smoking. However, unattractive, lowstatus characters who smoked on screen 

detracted from such beliefs.

Pechmann and Shih42 also found that 

exposure to the original version of 

Reality Bites promoted increased personal 

intentions to smoke among adolescent 

never smokers. For older viewers, two 

studies (with sample sizes of 150 or 

more) found a significant effect of onscreen tobacco depictions on personal 

intentions to smoke.71,74 However, another 

study (examining a smaller subgroup of 

84 nonsmokers) did not find such an effect.70

Hines and colleagues74 found that college 

students who viewed movie scenes in which 

the main characters smoke were more likely 

than those who viewed nonsmoking scenes 

to indicate a likelihood to smoke in various 

situations in which smoking is likely to 

occur. This effect persisted with controls 

for the smoking status of the participant. 

Furthermore, among male viewers who 

were regular or occasional smokers, the 
390

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

smoking film footage also promoted a 

higher current desire to smoke. In contrast, 

the study by Gibson and Maurer,70 with less 

statistical power, found that nonsmoking 

college students were no more likely to 

report intentions to smoke in the future 

after exposure to movie footage of a leading 

character smoking (versus nonsmoking). 

However, the direction of the trend in the 

overall cell means was toward smoking 

scenes promoting slightly higher scores on 

intentions. Because the sample size for this 

analysis was small (N = 84), it is likely that 

this study had insufficient power to detect a 

small or moderate effect size, if it existed.

Dixon and colleagues71 found that viewing a 

movie that portrayed the tobacco industry in 

a negative light and included information on 

the negative health consequences of smoking 

within the story (The Insider) promoted 

a short-term reduction in intentions to 

smoke among adult smokers and former 

smokers. Content analyses suggest that 

portrayal of information about the negative 

health consequences of smoking is a rare 

phenomenon. Experimental research 

indicates, however, that inclusion of such 

information in a movie can promote an 

antitobacco message. Dixon and colleagues71

also found that viewing The Insider

promoted more negative views among 

audience members of the tobacco industry’s 

business conduct. These results have some 

parallels with findings of evaluations of 

public responses to antitobacco media 

campaigns exposing industry manipulation. 

Surveys indicate that cigarette consumption 

declined in association with California’s 

Proposition 99 media campaign.80 Moreover, 

evaluation results for Florida’s “truth” 

campaign advertisements show evidence of a 

decline in youth smoking and a relationship 

between youth smoking behavior and 

changes in youth attitudes toward the 

tobacco industry’s manipulation.81

Chapter 12 on the effectiveness of mass 

media in discouraging smoking includes 

details of these antismoking campaigns.

Pechmann and Shih42 found that showing 

youth an antismoking advertisement 

immediately before viewing a movie 

depicting popular young stars smoking 

inoculated them against the prosmoking 

influence of the movie footage. The 

advertisement also generated more 

negative thoughts toward the leading 

movie characters, but it did not detract 

from the ratings of the movie’s overall 

action or storyline, or from the likelihood 

of recommending it to a friend. In fact, 

those who saw a movie preceded by an 

antismoking advertisement rated the 

movie storyline more favorably than 

those who saw a movie without such an 

advertisement. These findings are of great 

practical importance in providing evidence 

concerning the efficacy of one possible 

strategy for reducing the negative impact 

on-screen smoking has on youth audiences. 

That is, screening an antismoking 

advertisement before the movie immunized 

young viewers against the prosmoking 

effects of the movie, without detracting from 

their overall enjoyment of the movie.

This approach was subsequently evaluated 

using a quasi-experimental study of 

2,037 female adolescent moviegoers in 

Australia who had self-selected to see movies 

depicting smoking.72 The intervention group 

who viewed an antismoking advertisement 

before the movie was compared with 

a control group who did not view an 

antismoking advertisement screened 

before the movie. Among nonsmoking 

viewers, those who saw an antismoking 

advertisement before the movie showed 

stronger disapproval of smoking by 

characters in the movie. Among viewers 

who were current smokers, those who saw 

the antismoking advertisement showed 

significantly reduced intentions for future 

smoking. The antismoking advertisement 

did not affect nonsmokers’ intentions to 

smoke. Most nonsmoking subjects (95%) 

in both conditions reported they were 

unlikely to be smoking at this time next 
391

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

year. The results of these two studies 

suggest that screening antismoking 

advertisements before movies depicting 

smoking is an effective strategy for reducing 

the prosmoking persuasive effect of onscreen tobacco use by movie stars.

Effects of Smoking Depictions on 

General Reactions to Movies

In discussing audience reactions to smoking 

in movies, it also is relevant to examine 

responses from the perspective of audiences’ 

entertainment experience. Evidence is mixed 

as to whether audience perceptions of movie 

characters are affected by their on-screen 

smoking. Pechmann and Shih42 found 

that, among adolescent never smokers, 

there were no significant differences in the 

number of negative, neutral, or positive 

thoughts about the leading characters in 

a movie as a function of whether scenes 

of their smoking were viewed. Similarly, 

Gibson and Maurer70 found that, among 

college students who were nonsmokers, 

viewing movie scenes of a leading male 

character smoking (versus nonsmoking) 

did not markedly affect their ratings of that 

character. However, among college students 

who were smokers, viewing such movie 

scenes led them to rate the male actor and 

the character he played as more likeable 

when he smoked, compared with when he 

was not depicted as a smoker. Reactions 

appear to vary, however, depending on the 

movie character’s gender—smoking by 

females may be associated with negative 

character traits. Hines and colleagues74

found that female characters depicted as 

smokers were rated less favorably on a range 

of social characteristics (e.g., attractive, 

sexy, popular), but they found no such 

effects for male characters. Smoking 

by female characters also led audience 

members who were occasional smokers or 

nonsmokers to perceive themselves as less 

similar to the character. Jones and Carroll73

found that young women who viewed a 

young female smoking rated her as more 

outgoing, more sophisticated, not as easy 

to manipulate, and less emotional about 

breaking up with her boyfriend than those 

women who viewed a control video in 

which the young female did not smoke. 

In a study examining reactions to different 

movie character depictions of smokers, 

Dixon58 found that adolescents associated 

smoking by female antagonists with low 

social status. Ratings of the male characters 

did not differ in this way. Together, these 

results suggest that audience members 

may identify more with movie characters 

of similar smoking status. Moreover, 

on-screen smoking by female characters 

appears to carry some negative social 

connotations.

Pechmann and Shih42 found that, in more 

general reactions to on-screen smoking, 

viewing movie scenes depicting smoking 

evoked higher levels of positive arousal 

than did viewing similar scenes without 

smoking. Despite the effects of smoking 

on viewers’ emotional arousal, Pechmann 

and Shih42 found that adolescents’ ratings 

of a movie’s action or storyline or their 

willingness to recommend the movie to 

friends was no different for a version of 

the movie that edited the smoking out 

of the scene, compared with the original 

version of the movie. This finding has 

relevance to filmmakers in suggesting 

that excluding smoking from films does 

not detract from their overall appeal. 

This argument is further corroborated by 

Dalton and colleagues.32 They found that 

the amount of tobacco use depicted in 

movies is not significantly associated with 

box-office success. Pechmann and Shih42

also found that, for adolescent viewers who 

were shown an antismoking advertisement 

before viewing a movie depicting smoking, 

the effect of smoking depictions in the 

movie on arousal, perceptions of a smoker’s 

social stature, and personal intent to smoke 

were eliminated. This finding and those 

of Edwards and colleagues72 imply that 
392

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

showing antismoking advertisements before 

movies with smoking could modify the 

effect of prosmoking movie depictions on 

the audience’s smoking behavior.

Conclusions Concerning Media 

Effects Research

The findings from experimental studies 

contribute to the understanding of how 

vicarious learning effects may occur in 

response to smoking behavior symbolically 

modeled in movies. Along with the 

results of cross-sectional and longitudinal 

population-based studies, experimental 

research indicates that images of smoking 

in film can influence people’s beliefs 

about social norms for smoking, beliefs 

about the function and consequences of 

smoking, and ultimately their personal 

propensity to smoke. Certain movie 

depictions may be more likely than others 

to promote prosmoking beliefs. Audience 

members’ responsiveness to such imagery 

may vary as a function of their personal 

characteristics (especially smoking status 

and gender). Experimental studies found 

many statistically significant effects—of a 

similar magnitude to the effects observed 

in experimental media research on other 

health topics—for only brief exposure to 

movie images of smoking. 

Across the different study designs used 

to assess audience responses to onscreen tobacco use, there is considerable 

convergence in findings. Protobacco 

film content has been found to promote 

prosmoking beliefs and intentions in both 

experimental and cross-sectional studies. 

Exposure to on-screen smoking has been 

associated with smoking behavior in crosssectional studies and predictive of smoking 

behavior in longitudinal studies. A similar 

convergence of findings across different 

study types was observed in a meta-analysis 

examining the effects of media violence 

on aggression.75

Tobacco Content in 

Other Media

Television

Television began a close relationship to 

the tobacco industry in the 1950s. As it 

became clear that smoking was a cause of 

cancer, and with the elimination of cigarette 

advertising in the broadcast media in 1971, 

tobacco use also dropped out of network 

television in the United States. This resulted, 

in part, from the Public Airways Act.82

Several authors have analyzed content 

samples of prime time television 

programming for smoking depictions. Breed 

and De Foe’s83 content analysis of prime 

time U.S. television dramas and situation 

comedies produced between 1950 and 1982 

found a steady drop in the use of cigarettes 

over the three decades. In the period before 

the release of the first Surgeon General’s 

report (1950–63), nine times more 

cigarettes were used per hour than for the 

season 18 years later. Several authors have 

found that television smoking is more 

common in dramas than in other genres.83,84

Table 10.6 lists the number of smoking acts 

per hour observed in samples of television 

dramas selected for content analyses of 

television programming. The studies used 

similar coding methods but differed slightly 

in their methods of sampling television 

content. Taken together, the results suggest 

that the rate of smoking in prime time 

television dramas declined dramatically 

from 1950–63 (4.52 smoking acts per hour) 

to 1981–83 (0.35 smoking acts per hour). 

However, studies conducted in 1984 and 

1993 found slightly higher smoking rates 

(1.01 and 1.20 smoking acts per hour, 

respectively). A content analysis of television 

drama aired on Japanese television between 

1995 and 1996, however, found a rate of 

smoking depiction (4.22 per hour) similar to 

that found on U.S. television in the 1950s.85
393

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Christenson and colleagues90 analyzed 

content of 168 episodes of top-rated 

television dramas and situation comedies 

broadcast from 1998 to 1999. Tobacco was 

used in 19% of episodes. Comparing these 

results with those obtained in their content 

analysis of movies,27 they concluded that 

young viewers were considerably less likely to 

view smoking on television than in movies.

Gerbner and colleagues84 found that, in 

a 10-year sample of prime time dramatic 

television and a 3-year sample of television 

commercials, the prevalence of smoking 

among major television characters was 

quite low: 11% of males and 2% of females 

smoked. Similarly, Cruz and Wallack88 found 

that smoking was more prevalent among 

male than female television characters. 

Fernandez-Collado and colleagues86 found 

that in a sample of prime time dramatic 

television from 1976 to 1977, fewer smoking 

incidents occurred per hour during 

television programming with the largest 

child audiences. Similarly, Christenson and 

others90 found that in television programs 

from 1998 to 1999, tobacco was used less 

frequently in TVG-rated episodes (6%) 

Smoking Shifts to the Bad Guys

Social trends can influence not only the quantity of tobacco portrayal on television but also the 

context in which it is portrayed. For example, Breed and De Foe observed a shift over time in 

the manner of portraying smoking on television. Between 1950 and 1963, “all kinds of adults—

heroes and heroines as well as villains—were seen smoking.”a(p.263) Between 1971 and 1982, 

however, the typical smokers on television were villains or insecure characters; by the 1980s, 

scenes parodying cigarette smoking began to emerge. Cruz and Wallack, however, found that in 

prime time television in 1984, the majority of male smokers (70%) were in strong and enduring 

roles, with a minority viewed as antagonists.b

a

Breed, W., and J. R. De Foe. 1984. Drinking and smoking on television, 1950–1982. Journal of Public Health

Policy 5 (2): 257–70. 

b

Cruz, J., and L. Wallack. 1986. Trends in tobacco use on television. American Journal of Public Health 76 (6): 

698–99.

Table 10.6 Number of Smoking Acts per Hour of Television Drama for Different Content 

Analysis Studies Conducted in the United States 

Year of programming Smoking acts per hour Study

1950–63 4.52 Breed and De Foe 198483

1964–70 2.43

1971–77 0.70

1981–82 0.35

1976–77 0.71 Fernandez-Collado et al. 197886

1976–77 2.19 Greenberg et al. 198487,a

1977–78 2.66

1984 1.01 Cruz and Wallack 198688

1993 1.20 Hazan and Glantz 199589

1998–99 Not reported Christenson et al. 200090

a

Unlike the other studies, this one did not restrict its sample to prime time television.
394

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

compared with TVPG-rated (20%) and TV14-

rated (24%) episodes. In their total sample 

of television episodes, 8% of adult major 

characters used tobacco and no characters 

younger than 18 years of age were portrayed 

smoking. Byrd-Bredbenner and colleagues91

found that during 1998 prime time children’s 

television programming, depiction of tobacco 

was rare (shown in 2% of scenes), typically 

portrayed as a background activity performed 

by adults, mostly men.

Tobacco portrayal in prime time television 

is less common than in movies. Only a 

minority of portrayals (23%) express 

negative statements about smoking, almost 

none (less than 1%) mention or portray 

negative consequences of smoking, and none 

of the major characters depicted as smokers 

made on-screen attempts to quit smoking.90

These content analyses relate primarily to 

television programming in the United States. 

The studies document some smoking 

content but not to the extent seen in movies.

Three studies have examined the association 

between television viewing and smoking. 

One examined the association between 

viewing and smoking initiation for a sample 

of U.S. adolescents.92 The authors examined 

smoking initiation among 592 adolescent 

never smokers enrolled in the National 

Longitudinal Study of Youth and for whom 

data on television viewing were available 

at baseline (1990, when subjects were 

10–15 years of age). Initiation of smoking 

during the following two years was examined 

as a function of baseline television viewing, 

controlling for several socioeconomic and 

demographic factors (ethnicity, household 

poverty, marital status, number of children in 

the household), maternal factors (education, 

measured intelligence, employment), and 

child factors (gender and baseline child 

aptitude test scores). Children who watched 

more than five hours of television per day 

(above mean exposure) had significantly 

higher adjusted odds of smoking initiation 

(adjusted OR of 5.99) during the follow-up 

observation period than did those who 

watched less than two hours per day. 

A cross-sectional survey of adolescent 

smokers in Belgium found a positive, 

curvilinear association between television 

viewing volume and smoking volume; the 

relationship was stronger for higher levels 

of viewing.93 This association occurred 

in a multivariate regression analysis that 

controlled for other predictors of adolescent 

smoking. Adolescent smokers who watched 

five or more hours of television per day 

smoked 60–147 more cigarettes per week 

than those who watched one hour or less. 

Another longitudinal study of a New Zealand 

birth cohort94 found an association between 

higher exposure to television during 

childhood and smoking in young adulthood. 

This study controlled for childhood 

socioeconomic status and parental smoking.

These studies suggest the possibility that 

television viewing could be linked with 

smoking initiation and maintenance. If a 

social influence effect is assumed, it is not 

clear how much of the effect is mediated by 

smoking seen in television programming 

versus smoking depicted in televised movies, 

because movies comprise a substantial share 

of television programming. Additionally, 

in the longitudinal study by Dalton and 

colleagues3 on the relationship between 

exposure to smoking in movies and 

adolescent smoking initiation, self-report 

measures of exposure to daily television 

were not associated with smoking initiation 

after controlling for other social influences 

(exposure to smoking in movies, friend 

smoking, family smoking). Therefore, 

the argument for a social-influences link 

between exposure to smoking in television 

programming and adolescent smoking is 

not as well established as is the link for 

exposure to smoking in movies.

Popular Music

Roberts and colleagues27 analyzed the 

content of lyrics for the 1,000 most 
395

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

popular songs from 1996 and 1997. They 

found tobacco references were relatively 

uncommon in song lyrics (3% of songs). 

Tobacco references occurred more frequently 

in rap song lyrics than in other musical 

genres (7% of rap songs compared to 4% 

of alternative rock songs and 2% or less of 

other music genres). Similarly, a content 

analysis by DuRant and others95 of a sample 

of music videos (N = 518) televised during 

1994 found that rap music videos (30%) 

were most likely to depict smoking, followed 

in order by adult contemporary (23%), rock 

(22%), country (12%), and rhythm and blues 

(11%). A small number of videos (N = 11) 

contained 10 or more instances of smoking 

behavior. The results in these two studies 

suggest that visual references to tobacco 

in popular music videos are more common 

than verbal references to tobacco in popular 

song lyrics. However, because these studies 

used different sampling methods, the results 

are not directly comparable.

DuRant and colleagues95 found that portrayal 

of tobacco use was more common in music 

videos televised on MTV (26%) than on other 

networks (Video Hits 1 [VH1], 23%; Black 

Entertainment Television, 17%; and Country 

Music Television, 12%). Few videos contained 

branded tobacco advertising, and most of 

those were on MTV (N = 4) and VH1 (N = 3). 

In music videos that portrayed smoking, the 

lead singer was twice as likely to smoke as 

a background singer or musician. Smokers 

in music videos were mostly young adults 

(76%) and were more commonly Caucasian 

and male. Smoking scenes tended to have 

a positive emotional tone, but they were no 

more likely to contain sexual content than 

were videos that did not depict smoking.

Magazines

Numerous studies have examined the 

amount and nature of tobacco-related 

content in high-circulation magazines, 

particularly magazines for women and 

young people. Recognizing that magazines 

can present both positive and negative 

images and messages about smoking, these 

studies have focused on two key questions. 

First, what coverage do magazines give to 

smoking and health, and is this coverage 

related to whether they accept tobacco 

advertisements? Second, what is the nature 

and extent of positive images of smoking in 

editorial material, such as fashion pictures? 

Both questions are addressed below, and 

further discussion of the first question 

appears in chapter 9 in the section “Tobacco 

Industry Influence on News Reporting.”

Between 1967 and 1979, coverage of the 

health hazards of tobacco smoking in major 

women’s magazines in the United States 

was generally uncommon. Whalen and 

colleagues96 found that editors of such 

magazines frequently encouraged health 

writers to avoid the subject of tobacco. Those 

magazines that did run frequent articles on 

smoking and health did not accept tobacco 

advertising. Warner and others97 found, in 

a sample of 99 U.S. magazines published 

between 1959 and 1996, strong statistical 

evidence that cigarette advertising in 

magazines was associated with diminished 

coverage of the hazards of smoking—

especially in magazines directed toward 

women. These studies’ findings suggest that 

financial dependence on tobacco industry 

advertising may have influenced editorial 

policy. In the United States, between 1996 

and 1999, popular general interest and 

health magazines covered tobacco less than 

other health topics, and this discrepancy 

was more marked in the latter group.98

The authors argue that the relatively low 

coverage of tobacco and its hazards presents 

readers with a skewed account of the 

importance of smoking as a threat to their 

health relative to other health issues.

A survey of the tobacco policies of the 

most widely read European women’s 

magazines published in 1996 found that 

most of the magazines accepted cigarette 

advertisements, but a minority reported 
396

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

having published a major article on smoking 

and health.99 Magazines that accepted 

tobacco advertising were slightly less 

likely to have covered smoking and health 

compared with magazines that did not 

accept tobacco advertising. Other apparent 

obstacles to coverage of the health effects 

of smoking mentioned by editors were their 

opinions about smoking, their perceptions 

of their readers, a perception that the 

smoking story had been “done,” or, in some 

countries, a general ignorance of the subject. 

In contrast, nearly half of the magazines 

allowed editorial images of smoking, such 

as models smoking on fashion pages and 

celebrities smoking in feature articles.

In a study of popular Australian magazines, 

Chapman and colleagues100 found, after 

the introduction of a ban on tobacco 

advertising in print media in 1991, 

an initial increase in incidental depictions 

of smoking (6 months after the ban), 

followed by a reduction in such depictions 

in the subsequent 18 months. The authors 

found that photographs of smoking were 

infrequent in Australian magazines, with 

a mean of one incidental depiction of 

smoking per 147 pages. These findings 

indicate that, in Australian magazines 

produced in the context of bans on paid 

tobacco advertising, incidental magazine 

content presents nonsmoking as normative. 

In contrast, a study of cigarette advertising 

and health aspects of smoking in British 

magazines, before and after the introduction 

of a voluntary restriction on cigarette 

advertising in 1986, found that while the 

proportion of magazines accepting cigarette 

advertising decreased, the new restrictions 

did not cover the most popular magazines; 

thus, protobacco content remained prevalent 

in the highest circulation magazines.101

Furthermore, editorial coverage of the 

health aspects of smoking was low and did 

not increase following the voluntary ban.

A content analysis of the most popular 

British young people’s style magazines 

published in 1999 found major differences 

between young women’s and young men’s 

magazines.102 Young men’s magazines 

carried considerably more tobacco 

advertising and positive images and 

coverage of smoking in editorial pages than 

did young women’s magazines. In addition, 

very few young men’s magazines carried 

any smoking-or-health coverage. Editorial 

images of smoking were most frequent in 

features about personalities, such as an 

interview accompanied by a picture of the 

celebrity smoking. Second most common 

were smoking images in fashion pictures 

that included both posed as well as pseudo 

“real-life” fashion shots. Similar, though less 

prevalent, were smoking images in “slice of 

life” items about “real” people out having 

fun, for example, at nightclubs and music 

events. The amount of prosmoking coverage 

in the three most widely read young men’s 

magazines in 1999 averaged more than eight 

pages per issue, an increase of more than 

400% since 1991.102,103

Content analyses found that print media 

coverage of cigars also increased during 

the 1990s. In a sample of high-circulation 

U.S. newspapers and magazines, articles 

focused on cigars increased substantially 

between 1987 and 1997.104 The articles 

tended to portray cigars and the tobacco 

industry favorably but rarely mentioned 

the health risks of cigar smoking. Between 

1992 and 1998, a significant upward trend 

occurred in cigar images and images of 

women smoking cigars in U.S. women’s 

magazines with the highest readership of 

adolescent girls.105 Wenger104 found that 

cigar “lifestyle” magazines recurrently 

presented content that associated cigars 

with business stories, social events 

(including fundraisers for charities), and 

celebrities. Of the celebrities and public 

figures quoted or described in the articles, 

most (87%) were portrayed as having 

favorable attitudes toward cigars. Only 1% 

of cigar-focused articles focused primarily 

on the health effects of cigars. Cigar use was 
397

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

presented as normative behavior and as a 

key element of a successful lifestyle.

The second question addressed in research 

on tobacco-related content in magazines 

is the nature and extent of positive images 

of smoking conveyed in fashion pictures. 

Magazines have a potentially important 

influence on the social image of smoking, 

as they often have high readerships; are 

targeted toward and therefore tailored to 

appeal to different audiences on the basis of 

age, gender, ethnicity, and socioeconomic 

status; and are printed so they remain 

available for longer periods than other 

media (as reflected in the often high ratio 

of readership to circulation). Of particular 

concern are magazines aimed at young 

people. As discussed earlier, adolescence 

is a period of considerable change and 

transition during which young people 

engage in the active construction of their 

adult identities, not only about who a young 

person wants to become, but also how an 

image can be projected in particular social 

contexts.106 Young people’s magazines, 

by promoting certain styles, brands, and 

images, not only help create the latest 

fashions but define what and who is “in.” 

To appeal to young readers, these magazines 

attempt to embody attitudes and values by 

incorporating them into fashion spreads 

and articles that tap into and articulate 

what it means to be a young person today. 

Thus, it is theorized, both the extent to 

which magazines show smoking images and 

the types of such images may be important 

in influencing young people’s perceptions 

of the desirability of adopting a smoking 

identity and consequently affecting their 

behavior. So far, however, very few studies 

have explored how young people engage 

with magazine images of smoking or the 

effect of such images.

Two British studies used different methods to 

explore this question. A study by Amos and 

colleagues examined whether young people 

perceived smoking and nonsmoking images 

differently.107 Young people rated perfectly 

matched (other than the presence or absence 

of a cigarette) smoking and nonsmoking 

fashion pictures taken from youth and style 

magazines on a range of attributes. The study 

found that the presence of a cigarette affected 

how the pictures were rated and that the 

nature of this effect differed between pictures. 

In general, the smoking images were rated 

as being more “druggy,” wild, and depressed. 

Identical nonsmoking images were rated as 

being more healthy, rich, nice, fashionable, 

slim, and attractive. On the surface, the 

smokers’ attributes were negative, but some 

of the attributes represented images that 

young smokers aspired to and admired. 

Smokers, especially males, identified more 

strongly with the smoking images and 

attributes than did nonsmokers.107

The second study, by MacFadyen and 

colleagues, used focus groups of first-year 

college students, all smokers, to explore 

perceptions of smoking images in youth style 

magazines and the relationship between 

these perceptions and their own smoking 

images and identities.54 The research 

found the students perceived this imagery 

to be, on the whole, attractive, sociable, 

and reassuring. There was considerable 

synergy among the image of smoking, 

the personality of the magazines, and 

respondents’ self-images. The most popular 

magazines had personalities that were 

similar to the students’ image of smoking—

carefree hedonism, risky behavior, and 

antipolitical correctness. This finding 

suggests that the display of smoking in these 

magazines was likely to reinforce positive 

perceptions of smoking and contribute to 

the belief that smoking is a normative and 

important part of student culture.

The findings by MacFadyen and colleagues 

are similar to those from an Australian study 

that used focus groups to explore secondary 

school (both smoker and nonsmoker) 

students’ perceptions of smoking images 

in magazines and films.47 Smoking in 
398

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

magazines and films was perceived as 

normal and acceptable. Additionally, the 

young people felt that most of the images 

used in the study portrayed smoking 

positively in terms of mood attributes, 

such as being in control or confident. 

Such positive images of smoking portray 

smoking in a way that young people 

interpret as being a normal part of life.

Internet

Hong and Cody108 conducted a content 

analysis of protobacco Web sites (N = 318). 

These sites were predominantly e-commerce 

sites (50%), followed by hobby/recreation 

sites (19%), erotic/fetish sites (15%), other 

tobacco-related sites (8.8%), corporate 

sites (5.7%), and smoker’s rights/lobbyist 

sites (2.5%). Ribisl and colleagues109 also 

conducted a content analysis of protobacco 

Web sites (N = 30 sites). However, their 

sample excluded sites for individuals or 

organizations that manufacture or sell 

tobacco products. Despite the different 

sampling criteria used in these studies, 

they yielded similar findings. On e-commerce 

sites and sites featuring hobbies, recreation, 

and “fetishes,” imagery depicting smoking in 

association with glamour, relaxation, leisure, 

sex, or alternative lifestyles was prevalent; 

negative health effects of smoking were 

rarely depicted or mentioned.108,109

The models portrayed on such sites were 

predominantly young (18–34 years old) 

and Caucasian in appearance. Females 

tended to be portrayed as attractive and 

slim while males appeared more average 

in appearance.108 Hong and Cody argue that, 

in addition to portraying predominantly 

young role models, many protobacco Web 

sites contained features characteristic 

of the Web sites young people frequent. 

For example, they contain content related to 

“shopping, hobbies and recreation (including 

entertainment), sites featuring celebrities 

and sites featuring sex or sexually arousing 

visuals.”108(p.291) Both studies found that, 

despite sexually explicit content and/or the 

capacity to order tobacco-related products 

online on a number of these sites, most do 

not require age verification procedures. 

Ribisl and others also found that one-third 

of such Web sites featured smoking stories 

that “instructed would-be smokers on the 

merits of smoking and provided reasons 

for resuming smoking for those who have 

already quit.”109(p.74)

Further information on the use of the 

Internet in tobacco marketing appears in 

chapter 4.

Other Entertainment Media

Smoking content in newer forms of 

entertainment media, such as increasingly 

realistic video games (e.g., cigar smoking 

in the video game Halo 2), has been largely 

ignored despite the widespread use of these 

games (see chapter 4). T-rated (teen-rated) 

video games comprised 28% of video and 

computer sales in 2002.110 In a content 

analysis of T-rated video games, Haninger 

and Thompson111 found that 5 (6%) of 

81 games showed tobacco use (either 

a character used tobacco or a tobacco 

product otherwise appeared in the game). 

It is unclear what social normative effects 

(e.g., smoking norms) are associated with 

playing these games. However, in domains 

other than smoking, the games have 

influenced behavior in children and young 

adults. For example, playing violent video 

games has been shown to increase aggression 

in children and young adults.75 More research 

is needed on these influences. Assessing 

whether tobacco is portrayed in a negative 

or positive light also is important. Haninger 

and Thompson111 state that a character in 

the video game Shadow of Destiny decides 

to quit smoking cigarettes because, he says, 

“I don’t want to die,” reinforcing negative 

health consequences of cigarette smoking.

The effects of smoking by people performing 

in live concert and theater venues also 
399

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

might be studied. Some research on a 

live theater production to encourage 

nonsmoking has been reported.112 However, 

the effects of characters smoking on stage 

during live theater performances have 

not been examined. Some of the other 

entertainment venues in which smoking 

influences have been understudied include 

smoking by musicians in live concerts, 

depictions of smokers in comic books,113,114

and (noted earlier) smoking images in 

movie promotional material. 

Efforts to Reduce 

Exposure

Legal/Policy Issues: Artistic or 

Commercial Speech?

One of the foundations of democratic 

society involves freedom to express 

a diversity of views (see chapter 8). 

Expression of diverse viewpoints is 

valuable for enabling communicators to 

espouse a cause or position and defend 

it. The expression of diverse viewpoints 

provides audiences with material on which 

to base informed judgments about the 

world around them. This freedom applies 

not only to political commentary but also 

to commentary on behaviors within the 

culture. Thus, most free societies give 

artists and other communicators the 

ability to reflect on, depict, and comment 

on their perception of the world around 

them. In the United States, this freedom is 

incorporated into the constitution as the 

First Amendment of the Bill of Rights.

Interviews conducted by Shields 

and colleagues53 with film industry 

representatives illustrate the value 

producers and actors place on freedom of 

speech and their fears about censorship. 

The movie industry does not welcome 

public health strategies that advocate 

for restricting the freedom to depict 

tobacco use in its films. However, paid 

product placement deals between some 

movie production companies and tobacco 

companies, and contracts precluding 

unattractive movie depictions of smoking,18

reveal that some in the entertainment 

industry have been compensated by the 

tobacco industry to add branded smoking 

and other signage to their artistic output. 

Given the history of product placement 

in movies and the similarities between 

the social imagery of smoking in movies 

and in tobacco advertising, it is likely 

that the social iconography of smoking 

in films derives in large part from images 

of smoking that the tobacco industry 

cultivated strategically.

In the past, the American movie industry 

was not afforded the First Amendment 

protections it now enjoys in the United 

States115 and was subject to censorship 

at both state and local levels. The movie 

industry fought censorship, arguing that it 

interfered with First Amendment speech. 

But in 1915, in Mutual Film Corporation 

v. Industrial Commission of Ohio, the 

U.S. Supreme Court determined that 

motion pictures did not constitute part of 

the “press” and therefore were not entitled 

to First Amendment protection from 

censorship. This case arose in response to 

the passing of a statute creating a Board 

of Censors that had to approve all motion 

pictures prior to their exhibition. Localities 

continued to censor movies until 1952, 

when the Supreme Court granted full 

First Amendment protection to movies in 

Joseph Burstyn, Inc. v. Wilson. At that time, 

there was little or no product placement 

in movies, but this is no longer the case. 

Paid product placement is an integral 

commercial element in almost every movie. 

Given the increasing number of product 

placements in movies, the question is now 

whether or not depictions of brands in 

movies should be reclassified as commercial 

speech, which would be subject to a lower 

level of First Amendment protection.
400

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

Self-regulation by eliminating cigarette 

brands already is happening in some movie 

production companies. For example, 

Robert Reiner requires justification for 

smoking scenes in movies he produces for 

Castle Rock Entertainment.116 As a WHO 

document on this issue states, “The film 

industry cannot be accused of causing 

cancer, but they do not have to promote a 

product that does.”117 In contrast to violence, 

which may be linked with box-office success, 

the evidence indicates that the inclusion of 

smoking is not necessary for the commercial 

success of movies.32,42

Product placement deals are not the sole 

reason for on-screen smoking. The decision 

to portray a character as a smoker may 

arise from a range of motives, such as a 

desire to make the character seem realistic, 

reliance on cigarettes as a prop, and personal 

smoking behavior of an actor.53 Nevertheless, 

movie characters for the most part represent 

the affluent and most powerful segment of 

society.3,28 When these actors smoke, whether 

they play the bad or good guy, the risk is that 

adolescents will emulate the behavior.3,4

Movie Rating Systems

In most countries, movie rating systems 

exist to protect children from exposure to 

forms of media society deems harmful or 

objectionable. The rationale for most rating 

systems is that society wishes to protect 

children from seeing media that may have 

undue influence on their behavior. Most 

countries have government-sponsored 

censor boards charged with evaluating the 

appropriateness of entertainment media for 

children. The procedures of governmentsponsored censor boards are subject to 

regulation by government and to revision if 

new data arise regarding a media threat to 

children. Governments in some countries 

have attempted to regulate smoking content 

in entertainment media. In 2001, Russia’s 

lower house of parliament passed a bill to 

ban images of people smoking in movies 

and television programs unless smoking is 

an essential part of the action.118 The Indian 

Government had planned to impose a ban on 

smoking scenes in new films and television 

serials in July 2006.119 Thailand’s Film 

Censorship Board has censored depictions 

of smoking in movies. For example, the 

release of the movie Som + Bank (Bangkok 

for Sale) was delayed, as the board required 

that the images of smoking be blurred out.120

In other countries, efforts are under way 

to incorporate smoking into government 

censorship and movie rating systems. For 

example, the Lung Association in Ontario, 

Canada, has called upon the government 

to censor smoking.121 Some countries also 

censor aspects of films considered offensive 

to most adults in their societies. For example, 

many Arab countries do not allow movies 

that depict use of tobacco and alcohol to 

be shown in public places, because doing 

so violates mainstream religious beliefs 

(personal communication from R. Kelishadi, 

M.D., Isfahan University of Medical Sciences, 

Isfahan, Iran, to J. Sargent, 2004).

Because of unique protections on First 

Amendment speech in the United States, this 

country does not have censor boards. Instead, 

the United States is the only country that 

allows its film industry to rate its own motion 

pictures. Rating is done through the MPAA. 

This rating system, established in November 

1968, has undergone only minor changes. 

In the voluntary MPAA rating system, most 

producers allow their films to be subjected 

to review by a rating board. Movies are 

rated primarily according to what the board 

determines parents would find objectionable 

(or what Congress might regulate). In its 

explanation of the ratings system, the MPAA 

lists violence, nudity, sensuality, language, 

and drug use as factors the board considers 

when rating movies. Board members must 

have parental experience, and the board 

president is chosen by the MPAA’s president. 

The MPAA and the National Association 

of Theatre Owners presidents jointly set 

decisions regarding rating criteria.122
401

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

The MPAA promotes the ratings system as 

a guide to parents. Some might argue that 

the real purpose of the voluntary movie 

ratings system is to protect the studios 

from more intrusive government regulation. 

In that regard, the film industry has operated 

in much the same way as the tobacco and 

alcoholic beverage industries, with the former 

changing its voluntary rating standard, 

the Cigarette Advertising and Promotion 

Code, only when Congress was considering 

stricter regulations (see the section “Failure 

of Self-Regulation” in chapter 3).

Voluntary Efforts

Tobacco Industry

Voluntary Advertising Standards

U.S. tobacco companies’ voluntary Cigarette 

Advertising and Promotion Code was 

modified in 1990 to prohibit paid product 

placement. The tobacco industry initiated the 

voluntary ban on paid product placements 

in the same year that the U.S. Federal Trade 

Commission conducted an inquiry into 

product placement activities of various 

tobacco firms. Little change occurred in the 

prevalence of cigarette brand appearances 

after the initiation of the voluntary ban.33

Moreover, the frequency of on-screen 

smoking increased in the 1990s, compared 

with the 1970s and 1980s, suggesting that 

the ban had little impact on either on-screen 

product placement or smoking practices.28–30

Master Settlement Agreement

In 1998, the U.S. Master Settlement 

Agreement (MSA) prohibited participating 

cigarette manufacturers (e.g., Brown & 

Williamson, Lorillard, Philip Morris, 

R.J. Reynolds) from product placement 

activities. The settlement bans payments to 

promote tobacco products “in any motion 

picture, television show, theatrical production 

or other live performance, live or recorded 

performance of music, commercial film or 

video, or video game.”123(p.18) The MSA also 

prohibits participating tobacco companies 

from directly or indirectly targeting youth 

in marketing. No studies have yet been 

published on cigarette brand placements 

in movies since the signing of the MSA. 

However, a number of movies released after 

this agreement have included cigarette brand 

placements. Because the U.S. attorneys 

general are charged with enforcing the MSA, 

the continued appearance of cigarette brands 

in movies has become a topic of interest. 

So far, the tobacco industry has denied 

violating the MSA by obtaining cigarette 

brand placements; the denials are in response 

to several inquiries by the state attorneys 

general (for more information, see the 

statement by J. Joseph Curran, Jr., Attorney 

General of Maryland in appendix 10A).

Movie Industry

Before describing efforts by some in the 

movie industry to limit the depiction of 

smoking, it is necessary to describe the 

industry. Although the industry changes 

from year to year with buyouts and mergers, 

the U.S. film industry in 2004 was organized 

around seven major production companies 

that finance and distribute motion 

pictures: Buena Vista Pictures (Disney), 

Sony Pictures, Metro-Goldwyn-Mayer, 

Paramount Pictures, Twentieth Century Fox, 

Universal City Studios, and Warner Brothers 

Entertainment. Many of the names seen in 

movies are subsidiaries of these companies. 

For example, Miramax is a subsidiary of 

Buena Vista Pictures. These large studios 

hire production executives responsible 

for financing their major in-house movie 

efforts. Many independent film producers 

also make movies. For independent movies 

to be successful, the producer must 

partner with one of the major studios for 

the widespread distribution of the film. 

Other players in the industry (the artists) are 

organized through guilds, bodies that serve 

as financial advocates for their constituents 

(directors, actors, screenwriters, etc.) in 

much the same way that labor unions act on 

behalf of their members.
402

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

The MPAA represents the domestic interests 

of the major studios, and the Motion Picture 

Association represents the international 

interests. The president of the MPAA is 

also the chief lobbyist for the industry in 

Washington, D.C. When approached by the 

state attorneys general in August 2003, 

Jack Valenti, the MPAA president at the 

time, sponsored a series of meetings that 

included himself, the NATO president, and 

various guilds. However, Valenti declined to 

incorporate smoking into the MPAA rating 

system. (For more information on the 

dialogue between the state attorneys general 

and the motion picture industry, see the 

statement by Maryland Attorney General 

Curran in appendix 10A.) Four years later, in 

February 2007, the Harvard School of Public 

Health recommended that the MPAA take 

action to “eliminate the depiction of tobacco 

smoking from films accessible to children and 

youth.”124 In May 2007, 31 attorneys general 

wrote a letter to major movie studio heads 

supporting this recommendation and stating 

the dangers of exposing children to smoking 

depictions in movies. In a response released 

that same month, former congressman 

Dan Glickman, Valenti’s successor as 

president of MPAA, stated that the MPAA 

would begin to consider smoking depictions 

when rating movies. However, a letter to the 

MPAA in June of 2007 from U.S. Senators 

Durbin, Kennedy, and Lautenberg described 

MPAA’s new policy as “not enough to curb the 

influence of smoking in the movies on the 

health of children.”125 Six months after the 

new policy began, Polansky, Glantz, and Titus 

reported that there was no substantial change 

in the percentage of G, PG, or R-rated movies 

that included smoking depictions compared 

with the same time period in each of the four 

previous years.126

Efforts to Induce/Promote Change

A number of interested government and 

citizen groups have attempted to exert 

influence on media policy and production 

in relation to tobacco use and other 

health behaviors in entertainment media, 

particularly movies. Their strategies can 

be broadly categorized as collaborative or 

confrontational.

Collaborative Approaches

The Council for Excellence in Government 

and the University of Southern California, 

Annenberg School for Communications, 

Norman Lear Center, published a review 

of all efforts to engage the entertainment 

industry in developing prosocial messages 

into entertainment.127 The report, How 

Pro-Social Messages Make Their Way into 

Entertainment Programming, summarizes 

these programs and provides a guide to 

some of the following discussion.

Office on Smoking and Health 

The Office on Smoking and Health (OSH) is 

a division of the National Center for Chronic 

Disease Prevention and Health Promotion 

of the Centers for Disease Control and 

Prevention (CDC). The OSH maintains a Web 

page that encourages members of the public 

to work with the entertainment industry 

to promote accurate depiction of tobacco 

use and health information in movies, 

television, and other media.128 By “accurate,” 

the group means that movies should show 

the health consequences of smoking. Since 

1997, the OSH has developed a collaborative 

relationship with the entertainment industry 

to achieve three strategic aims: (1) educate 

and provide accurate science and resources 

to the creative community for television 

programming and films containing tobaccorelated themes; (2) develop public relations 

campaigns and provide media training for 

volunteer celebrity advocates who want to 

use their public profile to advance tobaccofree lifestyles; and (3) develop educational 

materials, with the cooperation of the 

entertainment industry, that can be used 

in schools and by health partners to teach 

and reinforce messages about the dangers of 

tobacco use. The approach is to encourage 

the entertainment industry to deglamorize 
403

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

and denormalize tobacco and its use. It is not 

clear how successful the group has been in 

persuading individuals in the entertainment 

industry to reduce or eliminate smoking.

Seeking Tobacco Alternatives with Realistic 

Solutions Project

The American Lung Association of 

Sacramento-Emigrant Trails initiated the 

Seeking Tobacco Alternatives with Realistic 

Solutions (STARS) project in 1998. The aims 

of the project were to work

with the entertainment industry to 

reduce the unintentional glamorization 

of smoking in film and television, provide 

media education to the general community 

regarding pro-tobacco messages, and 

conduct research regarding the impact of 

the tobacco industry on the entertainment 

community and acts to reduce this 

impact.129(pp.10–11)

With support from the California Tobacco 

Control Program, STARS produced an awardwinning documentary, Cigarettes, Cinema, 

and the Myth of Cool.129 This film features 

writers, directors, and actors speaking 

about social responsibility and smoking in 

movies. During the course of the project, a 

Blue Ribbon Advisory Committee regularly 

convened; the committee included Hollywood 

directors and producers. It is not clear that 

progress was made during the project in 

eliminating smoking from movies, and the 

project ceased in 2003 because of lack of 

funds. However, STARS did result in a wellregarded documentary that showed both 

sides of the debate over smoking in film.

Entertainment Industries Council

The Entertainment Industries Council 

(EIC) is a nonprofit organization that aims 

to provide information, awareness, and 

understanding of major health and social 

issues among the entertainment industries 

and to audiences at large. The EIC was 

founded in 1983 by entertainment industry 

leaders. The EIC has three areas of focus: 

“First Draft,” a technical resource service 

that provides information on request; 

“Spotlight on Depiction,” resources for 

writers; and “Generation Next,” educational 

resources for film students. In addition, the 

EIC annually presents the PRISM awards, a 

nationally televised awards show recognizing 

the accurate depiction of drug, alcohol, and 

tobacco use and addiction in film, television, 

interactive, music, video, and comic book 

entertainment.130 Established in 1997, the 

PRISM awards honor productions that are 

powerfully entertaining and realistically 

show substance abuse and addiction. The 

Robert Wood Johnson Foundation, the 

OSH, the National Institute on Drug Abuse, 

and the CDC are among the groups that 

jointly sponsor these awards. The intent of 

the PRISM awards is to encourage artists 

to “make the most of their rights to free 

creative expression, while at the same time 

showing the reality of substance abuse and 

addiction on screen, in song and on the 

page.” The awards serve to communicate and 

reward realistic depictions of substance use. 

However, it is not clear to what extent the 

awards foster change or even to what extent 

directors and screenwriters are aware of 

them or use the resources the EIC provides.

Attorneys General/Master Settlement 

Agreement

The state attorneys general have an interest 

in reducing youth smoking as part of their 

involvement in the MSA (see appendix 10A, 

a statement from Maryland Attorney General 

J. Joseph Curran Jr., for details on this 

initiative). To this end, they have begun 

to collaborate with the movie industry 

with the aim of decreasing the prevalence 

of depictions of smoking in movies. 

The underlying concern raised by the 

attorneys general is the role movies play in 

smoking by youth. In August 2003, 28 state 

attorneys general, led by Mr. Curran, 

approached Mr. Valenti, the MPAA president, 

asking the organization to reduce smoking 

in movies. A letter from Mr. Valenti then 

invited the attorneys general to a series 
404

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

of discussions on the issue (see letters 

in appendix 10B). This letter may have 

been the first public statement made by a 

movie industry spokesperson on smoking 

in movies, despite many press inquiries 

as a result of scientific publications that 

linked smoking in movies with teens’ 

smoking. The initial dialogue resulted 

in a series of meetings among scientists, 

several attorneys general, and movie 

industry leaders. In May 2007, 31 attorneys 

general once again approached the MPAA, 

NATO, and major studio heads to decrease 

depictions of smoking in movies directed at 

youth.131 It also led to a hearing convened 

in April 2004 by the Senate Committee on 

Commerce, Science, and Transportation, 

to consider the impact of smoking in 

movies on children. The Senate hearing is 

evidence of an expanding demonstration 

of substantial interest in major political 

institutions in the United States regarding 

tobacco use in movies and its potential 

impact on children. In addition to meeting 

with industry representatives, the attorneys 

general have addressed the tobacco industry 

with respect to movie brand appearances. 

Assistant Attorney General Dennis Eckhart 

of California sent letters to the legal 

counsels of tobacco companies whose brands 

appeared in movies after the MSA. In each 

case, the letters prompted communication 

between counsel for the tobacco industry 

and counsel for the movie industry to verify 

that there was no violation of the MSA in 

the form of a payment to place the brand 

(see example in appendix 10C). This legal 

activity was a sign to tobacco companies that 

they are being monitored. It is also possible 

that, as a result, the motion picture industry 

will act upon requests by tobacco companies 

not to have their brands used in movies.

Confrontational Approaches

Smoke Free Movies and the Rate Smoking 

“R” Public Health Campaign

Smoke Free Movies is a public health 

campaign started by Stanton A. Glantz in 

2001.132 The campaign aims to reduce the 

impact of smoking in movies on adolescents 

through four specific, voluntary changes in 

movie industry policy:

Rate new smoking movies R. Any film 

that shows or implies tobacco use should 

be rated R. The only exceptions should be 

when the presentation of tobacco clearly 

and unambiguously reflects the dangers 

and consequences of tobacco use or is 

necessary to represent smoking by a real 

historical figure.

Certify no payoffs. The producers should 

post a certificate in the credits at the end 

of the movie declaring that nobody on 

the production received anything of value 

(cash money, free cigarettes or other 

gifts, free publicity, interest-free loans, 

or anything else) from anyone in exchange 

for using or displaying tobacco or its use.

Require strong antismoking advertisements.

Studios and theaters should require a 

genuinely strong antismoking advertisement 

(not one produced by a tobacco company) 

to run before any film with any tobacco 

presence, regardless of its MPAA rating.

Stop identifying tobacco brands. There 

should be no tobacco brand identification 

and no presence of tobacco brand imagery 

(such as billboards) in the background of 

any movie scene.

The aim of the Smoke Free Movies 

campaign is to create a groundswell of 

support for these policy aims within the 

public health community and, eventually, 

among public policymakers to bring 

pressure to bear on the industry. By 2004, 

the campaign gained the endorsement of 

many mainstream health organizations, 

including WHO, the American Medical 

Association, the American Academy 

of Pediatrics, and the American Heart 

Association. The Smoke Free Movies 

media campaign began by rolling out a 
405

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Example of a Smoke Free Movies advertisement
406

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

controversial print advertising campaign 

in March 2001 that was aimed at members 

of the movie industry. The campaign was 

designed to raise awareness about the 

effect of smoking in movies on adolescent 

smoking; to place responsibility for change 

on studio executives, theater owners, 

and actors; and to suggest government 

oversight.133 Along with the advertising 

campaign, Smoke Free Movies has organized 

and maintains a network of public health 

activists at state and local levels. These 

groups have developed awareness campaigns 

aimed at youth (in New York, Texas, and 

Vermont, among others), have engaged in a 

national letter-writing campaign to movie 

stars, and have encouraged other forms 

of activism, such as e-mail messages to 

movie executives. 

The most controversial policy aim of 

Smoke Free Movies is the R rating for 

smoking. This policy aim has been 

under the control of the movie studios 

and theater owners, the two entities 

that run the MPAA rating system. From 

the original perspective of the movie 

industry, the movie rating system was 

designed for concerned parents and was 

not designed in relation to public health 

considerations. However, the ratings do 

include violence. After the Columbine 

High School shootings in 1999, public 

health considerations were added when 

efforts by President Clinton, the Senate, 

and public health experts led to changes 

in the movie industry’s depiction of 

violence in R-rated films. The movie 

industry deleted the most violent scenes 

from soon-to-be released films and 

increased restrictions on how R-rated 

movies are marketed. From a public health 

perspective, limiting the portrayal of 

tobacco in movies is important because of 

its link to adolescent smoking (see earlier 

discussion) and the severity of the health 

consequences of smoking compared 

with some other depictions of behavior 

(e.g., using foul language). 

Another issue that has been raised is 

whether the balance between adolescents’ 

desire to see R-rated movies and parental 

attempts to limit viewing of these movies 

weighs in favor of higher or lower exposure 

rates for R-rated movies among young 

adolescents. If adolescents successfully 

circumvent attempts by parents and 

theaters to restrict their exposure to 

these movies, their viewing rates would 

be expected to be similar to other rating 

categories. The R rating for the smoking 

campaign, in this case, would be futile 

and possibly even counterproductive. 

If view rates for R-rated movies are in fact 

lower among young adolescents, then the 

argument could be made that rating movies 

with smoking R could limit adolescent 

exposure despite making them “forbidden 

fruit.” To shed light on these possibilities, 

researchers7,134 examined the reach of 

movies, as determined by MPAA ratings, 

for a sample of young adolescents.

The adolescents were part of an already 

published cross-sectional survey of 

4,946 students, 10–14 years of age, attending 

15 junior high schools in New Hampshire 

and Vermont.7,134 Each student was surveyed 

on whether he or she had seen a randomly 

selected subsample of 50 movies, drawn 

from 601 popular contemporary movies 

(based on year of release and box-office 

success). Almost 50% of the movies were 

rated R. Because movies were randomly 

selected, each title appeared on an average 

of 470 surveys (standard deviation of seven). 

Therefore, it was possible to determine 

accurately the percentage of adolescents 

who had seen each title (termed reach in 

the marketing literature). G-rated movies 

were seen by most of the adolescents, with 

a median reach of 67% of adolescents. 

As the rating becomes more restrictive 

toward adolescents, reach drops. This is 

especially true for the transition from 

PG-13 rating to R rating, for which the 

median and interquartile ranges for 

reach drop substantially. Whereas the 
407

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

75th percentile for reach in PG-13 movies 

was more than 60%, the 75th percentile 

for R-rated movies barely exceeded 30%. 

These data provide convincing evidence 

that movies in the R-rating category are 

seen by many fewer young adolescents 

compared with movies that are not rated R. 

This result is probably because parents 

restrict access (see below) and because 

theaters generally enforce the R-rating 

as part of their participation in the MPAA 

ratings system.

Would the R rating for smoking have 

a substantial immediate impact on 

adolescents’ exposure to smoking in 

movies? Smoke Free Movies is calling 

for the R rating to be applied only to new 

movies. Most adolescents’ exposure to 

R movies is through seeing older movies 

on video and DVD. The prospective R rating 

for smoking would therefore substantially 

cut exposure to depictions of smoking at 

theaters that air new releases and would 

have a more pronounced impact over time 

because of the cumulative effects of the 

rating change. On the other hand, if the 

R rating for smoking caused parents to 

pay less attention to the ratings system, 

it could result in the reach of R-rated movies 

increasing among younger adolescents. 

Because of these concerns, it may be wise to 

also consider, along with implementation of 

this policy change, surveillance of R-rated 

movie viewership among adolescents 

and inclusion of a motivational effort to 

convince parents to take the ratings system 

literally and seriously.

Other Potential Strategies

Parental Supervision of Entertainment 

Media

Most media exposure occurs in the 

household. Therefore, parental supervision 

of their children’s access to media could 

affect the children’s exposure to media 

depictions of smoking, and some evidence 

supports this idea. Most research involves 

restriction of access to movies in the 

R-rated category.

R-Rated Movie Restriction

The prevalence of smoking depicted in 

movies increases with high levels of movie 

rating. In a sample of 250 contemporary 

movies, Dalton and colleagues32 showed that 

the median number of smoking depictions 

was 8.5 for R-rated movies, 4 for PG-13–rated 

movies, 3.5 for PG-rated movies, and 1 for 

G-rated movies. About one-half of the movies 

produced in 1990 were R rated, and that 

percentage dropped to one-third after 2000. 

Thus, by restricting access to R-rated movies, 

parents reduce movie exposure overall 

by a factor of one-third to one-half and 

eliminate movies that contain the highest 

concentration of smoking.

Two studies examining the effect of parental 

R-rated movie restriction on adolescent 

smoking were identified. The studies of a 

sample of Vermont and New Hampshire 

children aged 10–14 years at baseline 

assessed parental restriction of R-rated 

movies through the question, “How often 

do your parents allow you to watch movies 

or videos that are rated ‘R’?” (never, once 

in a while, sometimes, all the time). 

In the cross-sectional study,135 90% of the 

4,544 students were younger than 14 years 

of age. However, only 16% reported they 

were never allowed to watch R-rated 

movies. One-third (31%) indicated that 

their parents never restricted them from 

viewing R-rated movies. Thus, restriction 

of R-rated movies was not a major focus for 

most of the parents of the children in this 

sample. Among adolescents who reported 

R-movie restriction, exposure to R-rated 

movies was about one-eighth as high as that 

for adolescents who reported no restriction. 

Exposure to PG-13 movies was also reduced 

by about 50%. Thus, reports of R-rated 

parent restriction seemed to be associated 

with lower exposure to such movies.
408

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

Importantly, initiation of alcohol 

consumption and tobacco use was much 

lower in adolescents reporting movie 

restriction, even after controlling for a 

number of other covariates. These variables 

included sociodemographics, social 

influences (smoking by friends and 

family), personality (sensation seeking, 

rebelliousness), and parenting style 

(authoritative parenting). Compared 

with adolescents with no R-rated movie 

restriction, the adjusted relative risk 

(95% CI) for smoking initiation was 

0.74 (0.65–0.85) for adolescents with 

partial restriction and 0.29 (0.19–0.45) 

for those who were completely restricted 

from viewing R-rated movies.

The never smokers in the cross-sectional 

study were followed up one to two years 

later. Smoking incidence (10% tried 

smoking during the observation period) 

was examined as a function of parental 

R-movie restriction at baseline.8 Adolescents 

allowed to see R-rated movies at baseline 

were three times more likely to try smoking 

(relative risks adjusted for a full set of 

covariates) compared with those who were 

never allowed to watch R-rated movies. 

The effect was stronger for adolescents 

from nonsmoking families, among whom 

only 3 of 399 with complete R-rated movie 

restriction tried smoking. In this group, 

the adjusted relative risk of smoking given 

no R-movie restriction was 10. Students 

were asked again about movie restriction 

at follow-up. Most reported no change in 

restriction status, indicating that many 

parents are able to continue enforcing 

restriction as adolescents age during junior 

high school. Moreover, compared with 

adolescents reporting no change, relaxation 

of restriction was associated with higher risk 

of smoking in each of the baseline restriction 

categories. This longitudinal study provides 

strong evidence that supports interventions 

to motivate and assist parents in enforcing 

media restrictions as a smoking prevention 

measure aimed at young adolescents.

Devices That Restrict Access

This is a rapidly changing area as technology 

offers parents more control of the home 

media environment. The shift toward 

automated control of home media was 

spearheaded by the television V-Chip, 

a device that enables parents to block 

television channels and also to block based 

on television and movie ratings. In the 

Telecommunications Act of 1996,136 Congress 

required manufacturers of televisions to 

include a control device that could be used 

by parents to block unwanted programming. 

In the words of the legislation, the device

enables parents to block programming 

based on identifying programs without 

ratings,

is available to consumers at a cost which 

is comparable to the cost of technology 

that allows parents to block programming 

based on common ratings, and

will allow parents to block a broad range 

of programs on a multi-channel system 

as effectively and as easily as technology 

that allows parents to block programming 

based on common ratings ...

Since 2000, the V-Chip is included on all 

televisions distributed in the United States 

with screens larger than 13 inches. In 

addition to the V-Chip, many modern video 

and DVD players contain software that 

gives parents the ability to block television 

programs by rating, so that their children 

cannot play material above a certain 

threshold rating. Given the prevalence of 

this kind of technology and the interest in 

protecting children from the ill effects of 

media, one would have expected a number 

of interventions involving the V-Chip. Yet a 

MEDLINE search on “V-Chip” conducted 

in September 2004 yields only four articles, 

and a search on PsycINFO yields only six—

none of which involves cross-sectional or 

interventional data. Although this technology 

is in its infancy, the potential benefits of 
409

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

widespread application are clear. One study 

examining the effect of a blocking device 

that restricted television time showed that 

mean daily television time for children in the 

intervention dropped, as did their increase in 

body mass index.137 This randomized clinical 

trial provides strong evidence for a powerful 

intervention effect.

Internet

It may be too early to consider interventions 

aimed at the Internet as relatively little is 

known about how people use it. In a study 

published in 2004, a sample of underage 

adolescents were asked to purchase 

cigarettes over the Internet.138 The authors 

reported that 29 of 30 subjects were able 

to make a purchase by using a parent’s 

credit card, and 75% received the product 

in the mail. This study shows that access to 

cigarettes by minors is possible. However, 

as yet the prevalence of such purchasing 

behavior among the adolescent population 

is unknown.

Hong and Cody108 recommend the following 

actions to counteract the presence and 

influence of tobacco on the Web: (1) online 

tobacco retailers should be required to use 

age verification and should not sell tobacco 

products without a bona fide age check; 

(2) consumer awareness information on the 

hazards associated with smoking should 

be displayed for visitors to protobacco 

Web sites; (3) popular portal sites for the 

general public and adolescents should be 

encouraged to provide links or banner 

advertisements to sites on tobacco cessation 

or to provide educational material on the 

health effects of smoking; and (4) tobacco 

control advocates should use the Web more 

proactively to advocate smoke-free, healthy 

environments (e.g., work to have a more 

noticeable Web presence and use some 

of the engaging, interactive features that 

appeal to audiences). By 2004, however, 

Congress had not passed any restrictions on 

Internet purchases.

Efforts to Modify 

Response to Exposure

Antitobacco Advertising in 

Theaters

As described in the experimental studies 

section, there is some evidence that showing 

an antitobacco advertisement before a movie 

with smoking blunts the movie’s effect on 

attitudes. On the basis of this evidence, one 

aim of Smoke Free Movies is to require 

the distributing production studio to pay 

for antitobacco advertising in theaters. 

Another possibility raised in discussions 

between the representatives of the National 

Association of Attorneys General and the 

movie industry is attaching an antismoking 

message ahead of any videotape or DVD that 

contained smoking. This action would cost 

the industry little or nothing. In 2007, at 

least one major studio executive announced 

that the studio planned to add anti-smoking 

PSAs on DVDs of future films that feature 

cigarette smoking.139

As noted earlier, through the impetus of 

state attorneys general, the possibility of 

communications about smoking depictions 

in movies has been raised with the president 

of the National Association of Theatre 

Owners as well as owner-members. Because 

movies appeal strongly to adolescents, movie 

theaters may be ideal places for antitobacco 

advertising campaign messages. However, 

the source of funding for such a campaign 

is unclear.

Media Literacy

Media literacy refers to educational 

approaches to help viewers better understand 

media inputs. Some counteradvertising 

campaigns and contests, discussed in 

the section “Media Activism” in chapter 

11, can be considered a form of media 

literacy. Critical viewing skills are a 
410

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

major component of most media literacy 

educational programs.140 From the 

standpoint of persuasion theory,44,78,141

these programs aim to affect the way the 

recipient processes media information. 

Many of the media images viewers see are 

processed implicitly, without much thought. 

In theory, adolescents are affected in a 

cumulative fashion by the images of smoking 

in the media. As they see literally thousands 

of depictions of smoking—by affluent 

characters and without portrayal of negative 

health effects—in movies, television, and 

tobacco marketing materials, over time, they 

associate smoking with positive expectations. 

By teaching about the mechanisms by 

which media persuade, media literacy 

programs should cause the recipient to 

become a more effortful processor of the 

media—for example, to be more skeptical 

of commercial messages and images.141

An adolescent who is knowledgeable about 

the role of product placement in marketing 

and the persuasive power of movie images 

of smoking will be more resistant to 

automatically accepting the positive 

expectancies associated with the image.

Media literacy has great appeal as theory. 

However, only scant evidence suggests 

that these programs have short- or longterm effects on adolescents. One study was 

identified that evaluated a youth tobacco use 

prevention intervention that included media 

literacy skills among high school students.142

Using a quasi-experimental design, the 

investigators assigned 448 students in 

15 classes in three schools to receive the 

intervention; 161 students in 5 classes 

in one school served as a control group. 

The intervention curriculum included 

health education (consequences of tobacco 

use, social norms, parental use of tobacco), 

media literacy skills training (media analysis, 

media production, product presentation, 

and media advocacy), and skills training in 

resisting peer influence. The investigators 

measured preintervention (one week before 

intervention) and postintervention (one week 

after the intervention) knowledge about 

health consequences, protobacco attitudes, 

and use of tobacco. The intervention 

was associated with significantly higher 

knowledge scores, a decrease in protobacco 

attitudes, and a decrease in current tobacco 

use. Limitations of the study include 

measurement of short-term outcomes 

only and inability to attribute attitudinal 

and behavior change to the media literacy 

component of the intervention.

Another study examined the effect of a 

media literacy curriculum on attitudes 

toward alcohol use in a sample of thirdgrade students. Austin and colleagues143

examined the immediate and delayed 

effects of a media literacy program on 

alcohol in 246 third-grade students. They 

proposed a model in which more critical 

attitudes toward televised portrayals of 

alcohol use (less perceived realism, less 

identification, less desirability) would 

affect alcohol expectancies and, ultimately, 

behavior. Students were randomly assigned 

to one of four groups according to two 

factors: pretest/no pretest and treatment/

no treatment. Outcomes were measured 

immediately and at three months posttest. 

Children in the intervention group watched 

a 28-minute videotape Buy Me That,

which Consumer Reports produced for 

children and which discusses techniques 

used by advertisers to make products look 

appealing. The videotape was followed by a 

guided discussion of four advertisements 

(two for beer and two for soda pop). 

Outcomes surveyed included understanding 

of persuasive intent (“Ads on TV tell the 

truth”), realism (“Real people act like 

people in ads”), social norms (“Most teens 

drink”), similarity (“I do things that people 

in ads do”), desirability (“People in beer 

ads are popular”), identification (“I want 

to have my life like people in beer ads”), 

and expectancies (“Drinking makes you 

happier”). Results of the experiment 

generally were very supportive of the notion 

that media literacy training has a strong 
411

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

immediate effect on raising skepticism 

toward advertising and decreasing 

participants’ intent to engage in the 

behaviors depicted in advertisements. 

Some of these effects persisted, albeit to a 

lesser degree, at delayed posttest.

These studies suggest that media literacy 

may have a role in training children to 

resist entertainment messages. However, 

this intervention area is still very little 

studied, especially considering the extent 

to which this practice already has been 

implemented in educational settings. 

Until better data are available regarding the 

long-term effectiveness of media literacy, 

emphasis—especially for young children 

and adolescents—should be directed at 

reducing exposure.

Summary

Content analyses of popular entertainment 

media indicate that portrayal of tobacco 

use is common in movies and is often 

modeled by stars bearing favored social 

attributes. The negative health effects of 

tobacco use are rarely depicted. Tobacco 

portrayal appears to be less common in 

popular television and music than in 

movies. Tobacco exposure in online media 

is an area for further study.

The results of cross-sectional and 

longitudinal studies assessing audience 

responses to portrayals of tobacco use 

in movies are remarkably consistent in 

showing an association between seeing 

smoking in movies and more positive 

attitudes toward smoking and adolescent 

smoking initiation. The population-based 

data include cross-sectional samples from 

different regions of the United States, 

Australia, New Zealand, and Asia, and 

a nationally representative sample of 

U.S. adolescents—all supporting a link 

between viewing smoking in movies and 

adolescent smoking.

The two published longitudinal studies 

show an independent link between 

exposure to smoking in movies at baseline 

and smoking initiation in the future; 

estimates of the effect size are consistent 

with their cross-sectional counterparts. 

The experimental studies examine shortterm responses, generally supporting an 

effect of seeing movie stars smoking on 

screen on attitudes such as favorable ratings 

of smokers and intent to smoke in the 

future. The experimental studies suggest 

also that the findings among adolescents 

may be applicable to young adult college 

students. As a whole, this rich research base 

provides strong support for the notion that 

smoking in entertainment media plays a 

causal role in smoking initiation among 

adolescents, and this role warrants action 

at the individual and societal levels.

Still more research is needed on the 

important role of popular entertainment 

media, such as movies, in influencing young 

people to initiate smoking. Research has 

not yet determined the role entertainment 

smoking may play in maintaining 

experimental smoking or in prompting 

relapse among smokers who have quit. 

In addition, no published intervention 

studies have evaluated whether adolescents’ 

exposure can be decreased by motivating 

parents to restrict access or by teaching 

adolescents to process depictions of smoking 

in movies with more skepticism. 

Such research should continue to inform 

the ongoing effort to reduce exposure 

through media to tobacco use and/or 

counteract the effects of such exposure. 

Numerous efforts already have contributed 

to reducing tobacco use in the media. These 

efforts include policy interventions such as 

tobacco advertising and product placement 

restrictions, public education, and advocacy 

efforts targeting entertainment providers. 

In the future, research on trends—ranging 

from encouraging increased parental 

responsibility to controversial initiatives 
412

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

such as R ratings for movies featuring 

tobacco use—will continue to build on this 

base of knowledge. Continued efforts to 

reduce exposure to tobacco through media 

may potentially affect social attitudes and 

behavior toward smoking, which in turn 

may have a long-term effect on the public’s 

disease burden attributable to tobacco use.

Conclusions

1. Children and adolescents in the 

United States have heavy exposure to 

entertainment media, with an average 

of 5.5 person-hours of media use per 

day. Tobacco use often is integrated into 

entertainment media programming, 

especially in movies.

2. Portrayals of tobacco in movies include 

images of tobacco use and images of 

tobacco product brand names and logos. 

Depictions of smoking are pervasive in 

movies, occurring in three-quarters or 

more of contemporary box-office hits. 

Cigar use also is commonly depicted in 

movies, but use of smokeless tobacco 

is not. Smoking is more common in 

movies rated for adults (i.e., R-rated), 

but depiction of smoking is not related 

to box-office success. Identifiable 

cigarette brands appeared in about 

one-third of movies released during 

the 1990s. In contrast to its frequent 

depiction in movies, tobacco use is found 

in about 20% of television shows and 

25% of music videos.

3. Smoking prevalence among 

contemporary movie characters is 

approximately 25%, about twice what it 

was in the 1970s and 1980s. In contrast, 

smoking in the general population 

has declined since the 1970s. Smokers 

in movies differ from smokers in the 

general population: the former are 

more likely to be affluent and white. 

The health consequences of smoking 

are rarely depicted in movies.

4. Cross-sectional studies show that, 

among adolescents, exposure to 

smoking in movies is associated with 

initiation of smoking, independent of 

several other factors such as smoking 

by friends and family. Cross-sectional 

studies also indicate that among 

adolescent never smokers, exposure 

to smoking in movies is associated 

with more positive attitudes toward 

smoking.

5. Two longitudinal studies demonstrate 

that adolescents with higher exposure 

to smoking in movies at baseline 

are 2.0 to 2.7 times more likely to 

try cigarette smoking in the future. 

More studies are needed on the role 

exposure to smoking in movies plays 

in adolescents’ smoking beyond the 

initiation phase. 

6. Experimental studies show that 

images of cigarette smoking in film 

can influence adolescent and adult 

viewers’ beliefs about social norms for 

smoking, beliefs about the function 

and consequences of smoking, 

and their personal intentions to 

smoke. Protobacco movie content 

(e.g., stars smoking, absence of health 

consequences portrayed) appears 

to promote prosmoking beliefs and 

intentions. The effects observed for 

experimental studies of smoking in 

movies on viewers’ smoking-related 

beliefs are of a similar magnitude 

as those observed in experimental 

media research on other health topics 

(e.g., effects of media violence on 

viewers’ aggression).

7. Experimental studies indicate that 

antitobacco advertisements screened 

before films can partially counter the 

impact of tobacco portrayals in movies. 

8. The total weight of evidence from 

cross-sectional, longitudinal, and 

experimental studies, combined with 

the high theoretical plausibility from 
413

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

the perspective of social influences, 

indicates a causal relationship between 

exposure to movie smoking depictions 

and youth smoking initiation.

9. One longitudinal study indicates that 

parental steps to reduce the exposure 

of never smokers (aged 10–14 years) 

to R-rated movies, which have higher 

numbers of smoking events, produced 

a corresponding reduction in their 

smoking initiation. 

10. Efforts to reduce media exposure 

to tobacco include restrictions on 

tobacco advertising and product 

placements, advocacy targeted to 

entertainment providers, media literacy 

interventions aimed at the general 

public, continued dialogue with key 

stakeholders in the entertainment 

industry, and proposed self-regulation 

by the movie industry (e.g., tobaccorelated ratings).
414

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

Appendix 10A. Statement by Attorney General 

Curran of Maryland on Role of the State 

Attorneys General

EFFORTS OF STATE ATTORNEYS GENERAL

TO SEEK MOVIE INDUSTRY COOPERATION

IN REDUCING YOUTH EXPOSURE TO SMOKING IN MOVIES

By

J. JOSEPH CURRAN, JR.

ATTORNEY GENERAL OF MARYLAND

TOBACCO LITIGATION & THE 1998 MASTER SETTLEMENT AGREEMENT (MSA)

When I filed Maryland’s lawsuit in 1996 against the nation’s largest tobacco companies, 

as did my fellow Attorneys General from across the country, we sought restitution for the 

billions of dollars paid by our states to treat tobacco related illnesses. Just as important, we 

also sought to stop the tobacco companies’ marketing campaigns that target and encourage 

children to purchase and consume tobacco products.

In November 1998, I was one of the 46 state Attorneys General who signed the historic 

Master Settlement Agreement (MSA) which settled our state suits. Under the MSA, the 

tobacco companies are required to pay the settling states more than $200 billion over 

25 years. Equally important, tobacco companies are restricted from targeting youth or 

making tobacco brand names ubiquitous through apparel or other merchandise, billboard 

and bus ads, sponsorships or product placements in the media, including movies.1

The MSA states in part:

No participating tobacco manufacturer may...make, or cause to be made, any payment or 

other consideration to any person or entity to use, display, make reference to or use as a 

prop any Tobacco Product, Tobacco Product package, advertisement for a Tobacco Product, 

or any other item bearing a Brand Name in any motion picture, television show, theatrical 

production or other live performance, live or recorded performance of music, commercial 

film or video, or video game (“Media”)....

1

The MSA prohibits, generally and with exceptions not listed here: any action to target youth in the 

advertising or marketing of tobacco products; cartoons in cigarette advertising or packaging; outdoor 

and transit ads; brand name sponsorships of concerts or sporting events and naming rights to sports 

venues; tobacco brand name merchandise; free samples of tobacco products; tobacco coupons or credits 

to children; and payment for use of tobacco products in the media.
415

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

MSA, Section III (e).2 Moreover, the MSA also prohibits the participating manufacturers 

from authorizing any third party to use a brand name in a way in which a participating 

manufacturer may not.3

IN SPITE OF THE MSA PROHIBITIONS, DEPICTIONS OF SMOKING AND BRAND 

APPEARANCES PERSIST IN THE MOVIES

In spite of these express prohibitions, smoking in movies—particularly in youth rated 

movies—remains as prevalent today as it was before the MSA—and by some measures has 

increased. Since the MSA, movie stars continue to smoke on-screen.

Most films portray smokers and smoking in a positive or neutral light and few films appear 

to contain negative statements about tobacco use. Moreover, even after the MSA, movies 

continue to show tobacco brand names.

THE TOBACCO COMPANIES DENY A ROLE IN MOVIE BRAND APPEARANCES

In March 2003, California Attorney General Bill Lockyear wrote to each of the four major tobacco 

companies to express concern over depictions of smoking and tobacco brand appearances since 

the MSA. In light of the MSA’s express prohibitions, General Lockyear asked each manufacturer 

whether it had played a role in the appearance of its cigarette brands in post-MSA movies 

identified in his letters. All four companies denied any role in the appearances of their products 

in movies. Indeed, at General Lockyer’s urging that the tobacco companies take commercially 

reasonable steps against brand appearances, Philip Morris, Lorillard and R.J. Reynolds have sent 

letters notifying movie studios that they do not want their products to appear in the movies. Most 

recently, we are pleased that Philip Morris and R.J. Reynolds have taken commercially reasonable 

steps to ask studios to remove references to their tobacco brand names from two particular 

movies before the films are released on DVD or video or licensed for broadcast.

IN LIGHT OF THE SCIENTIFIC EVIDENCE AND POLICY RECOMMENDATIONS, 

ATTORNEYS GENERAL SEEK COOPERATION OF THE MOVIE INDUSTRY

In August 2003, compelled by the strength of the research linking seeing smoking in movies 

with teen smoking, I wrote a letter, joined by the Attorneys General of 27 other states and 

jurisdictions, to Mr. Jack Valenti, President of the Motion Picture Association of America 

(MPAA), seeking cooperation of the motion picture industry to reduce the depiction of 

smoking in movies. Mr. Valenti promptly responded by extending an invitation to my 

2

Under the MSA, “Tobacco Products” means cigarettes and smokeless tobacco products. Section II (vv). 

3

MSA Section III(i) provides that “no Participating Manufacturer may license or otherwise expressly 

authorize any third party to use or advertise within any Settling State any Brand Name in a manner 

prohibited by this Agreement if done by a Participating Manufacturer itself.... Following such written 

notice, the Participating Manufacturer will promptly take commercially reasonable steps against any 

such non-de minimis third party activity.” In other words, tobacco companies are required to take 

affirmative steps such as written demands to third parties to cease and desist the unauthorized activity.
416

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

colleagues and me to meet and share with him the details of the study. Mr. Valenti further 

proposed setting up a round-table in discussion in Los Angeles with representatives of the 

creative guilds and movie production companies.

My colleagues and I have followed up on Mr. Valenti’s offer, several times over. In October 

2003, Connecticut Attorney General Richard Blumenthal. former Pennsylvania Attorney 

General Mike Fisher, Utah Attorney General Mark Shurtleff, Vermont Attorney General 

Bill Sorrell, and I met with Mr. Valenti and his staff in Washington, D.C. After presenting the 

research, Dr. James D. Sargent, a pediatrician and lead investigator of the Dartmouth study, 

handed Mr. Valenti the following “prescription” which mirrors the policy recommendations 

endorsed by a growing number of our leading major medical and public health organizations:

n Give smoking movies an R-rating;

n Eliminate brand identification;

n Certify that no consideration was received for smoking in the movie; and

n Run antismoking messages before any movie that depicts smoking.

Although Mr. Valenti unequivocally rejected the R-rating for movies that depict smoking, 

he proposed a series of round table discussions with other members of the movie industry. 

Since that initial October 2003 meeting, my colleague attorneys general and I have taken our 

message, accompanied by Dartmouth scientists Dalton and Sargent, to Hollywood. As proposed 

by Mr. Valenti, on December 17, 2003, we spent a morning in Los Angeles at the Directors 

Guild of America (DGA) with their executive staff and directors who serve on the DGA’s Social 

Responsibility Task Force. Later that same day, we met and discussed the research and its 

implications for movies and youth smoking with senior production executives of the MPAA 

studios: Metro-Goldwyn-Mayer Studios, Paramount Pictures, Universal Pictures, Warner Bros., 

Sony Pictures Entertainment, Walt Disney Pictures, and 20th Century Fox Film Corporation. 

Representatives of the Screen Actors Guild and the Writers Guild of America also participated 

in the afternoon discussion. In these two sessions, after Dr. Dalton presented her findings, 

the attorneys general voiced our concerns directly to these directors, writers, actors and movie 

studio executives that depictions of smoking in their youth rated films and the persistence of 

cigarette brand names in any movie works against the goals of the MSA. We encouraged them 

to adjust and enhance their voluntary movie ratings system—designed to provide America’s 

parents with the information necessary to make informed and responsible decisions about 

their childrens’ movie-going choices—so that parents can be as informed about smoking 

in movies as they currently are about foul language. Given the state attorneys general’s 

responsibility to enforce the MSA prohibition against cigarette brand placements in the media 

by tobacco companies, we also asked for the opportunity to learn more from the MPAA studio 

executives about the circumstances surrounding appearances of cigarette brands in movies.

We also have taken our message to the National Association of Theatre Owners. In April 2004, 

Vermont Attorney General Bill Sorrell, Dr. Dalton and I had the opportunity to address 

the NATO Board of Directors at its annual meeting in Washington, D.C. In addition to the 

Dartmouth research, Dr. Dalton also reviewed the promising findings that antismoking PSAs 
417

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

run before movies can “inoculate” youth to depictions of smoking in films.4 Given NATO’s 

joint power with the MPAA over the movie ratings system and its members’ exclusive control 

over their movie screens, NATO has a unique opportunity to protect our youth from smoking 

by making smoking a criterion in movie ratings (equal to foul language) and by running 

antismoking PSAs before movies.

And, because we believe that educating the movie industry is a crucial first step toward 

achieving the changes we seek in reducing youth exposure to smoking depictions and 

eliminating cigarette brand appearances, we are very pleased to report that the DGA has 

agreed to feature an article on this important subject in the June issue of its widely circulated 

magazine. We are hopeful that this message will be communicated most effectively by 

directors to directors and other movie makers and will guide their creative decisions.

With regard to the MPAA and its member studios, we will continue our educational efforts by 

seeking mutually agreeable ways to sensitize these individuals and organizations to the public 

health benefits of reducing youth exposure to smoking depictions and eliminating cigarette 

brand name appearances.

Most recently, on May 11, 2004, I presented the concerns and efforts of the state attorneys 

general at a hearing before the United States Senate Committee on Commerce, Science & 

Transportation which was convened to consider the impact of smoking in movies on children. 

At the hearing, at which Senator John Ensign presided, Mr. Valenti testified on behalf of the 

MPAA and Mr. LeVar Burton testified on behalf of the Social Responsibility Task Force of 

the Directors Guild of America. Dr. Madeline Dalton reviewed the method and compelling 

findings of the Dartmouth research. Dr. Stanton Glantz argued for the adoption by the 

movie industry of the four policy recommendations. I was very pleased that Senators Ensign, 

Ron Wyden and Bill Nelson agree that the movie industry should avail itself of its unique 

opportunity to eliminate cigarette brand appearances, reduce or eliminate smoking depictions 

in movies and run antismoking public service announcements in theaters. Moreover, 

Mr. Burton announced at the hearing that he and other colleagues would donate their time 

and talent to create antismoking public service announcements.

CONCLUSION

Reducing youth exposure to depictions of smoking and eliminating tobacco brand 

appearances in movies will require bold, voluntary action by the entire movie industry. 

The DGA’s pledge to feature this issue in their magazine and Mr. Burton’s willingness to 

create antismoking PSA’s to be run in theaters are very important and positive steps. I am 

hopeful that such leadership will prompt similar commitments of resources from the entire 

movie industry—studios, actors, writers and theater owners—to become part of the solution 

to the nation’s deadliest preventable problem of smoking.

4

Pechmann, C., Shih, C-F. Smoking scenes in movies and antismoking advertisements before movies: 

effects on youth. J. Marketing. 1999; 63(3) 1-13.
418

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

Appendix 10B. Letter from 28 State Attorneys 

General to Jack Valenti and Response
419

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a
420

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 
421

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a
422

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

Appendix 10C. Letter from Lorillard to California 

Assistant Attorney General Dennis Eckhart 

Regarding Brand Appearance of Newport in 

the Movie City by the Sea
423

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

References

1. Roberts, D. F., U. G. Foehr, V. J. Rideout, 

and M. Brodie. 1999. Kids and media @ the 

new millennium: A comprehensive national 

analysis of children’s media use. Menlo Park, 

CA: Kaiser Family Foundation. http://www

.kff.org/entmedia/1535-index.cfm.

2. Woodard IV, E. H., and N. Gridina. 2000. 

Media in the home: The Fifth Annual 

Survey of Parents and Children. Survey 

series 7. Philadelphia: Univ. of Pennsylvania, 

Annenberg Public Policy Center.

3. Dalton, M. A., J. D. Sargent, M. L. Beach, 

L. Titus-Ernstoff, J. J. Gibson, M. B. Ahrens, 

J. J. Tickle, and T. F. Heatherton. 2003. 

Effect of viewing smoking in movies on 

adolescent smoking initiation: A cohort 

study. Lancet 362 (9380): 281–85. 

4. Distefan, J. M., J. P. Pierce, and E. A. Gilpin. 

2004. Do favorite movie stars influence 

adolescent smoking initiation? American 

Journal of Public Health 94 (7): 1239–44. 

5. Goldberg, M. E. 2003. American media and 

the smoking-related behaviors of Asian 

adolescents. Journal of Advertising Research

43 (1): 2–11. 

6. Goldberg, M. E., and H. Baumgartner. 2002. 

Cross-country attraction as a motivation for 

product consumption. Journal of Business 

Research 55 (11): 901–6. 

7. Sargent, J. D., M. L. Beach, M. A. Dalton, 

L. A. Mott, J. J. Tickle, M. B. Ahrens, and 

T. F. Heatherton. 2001. Effect of seeing 

tobacco use in films on trying smoking 

among adolescents: Cross sectional study. 

British Medical Journal 323 (7326): 1394–97. 

8. Sargent, J. D., M. L. Beach, M. A. Dalton, 

L. T. Ernstoff, J. J. Gibson, J. J. Tickle, and 

T. F. Heatherton. 2004. Effect of parental 

R-rated movie restriction on adolescent 

smoking initiation: A prospective study. 

Pediatrics 114 (1): 149–56. 

9. Tickle, J. J., J. D. Sargent, M. A. Dalton, 

M. L. Beach, and T. F. Heatherton. 2001. 

Favourite movie stars, their tobacco use in 

contemporary movies, and its association 

with adolescent smoking. Tobacco Control

10 (1): 16–22. 

10. Pierce, J. P., and E. A. Gilpin. 1995. 

A historical analysis of tobacco marketing 

and the uptake of smoking by youth in 

the United States: 1890–1977. Health 

Psychology 14 (6): 500–508. 

11. Wagner, S. 1971. Cigarette country: Tobacco 

in American history and politics. New York: 

Praeger.

12. U.S. Department of Health and Human 

Services. 2001. Women and smoking. A 

report of the Surgeon General. Rockville, 

MD: U.S. Department of Health and Human 

Services, Public Health Service, Office of 

the Surgeon General. http://www.cdc.gov/

tobacco/data_statistics/sgr/sgr_2001/index

.htm#full.

13. O’Keefe, A. M., and R. W. Pollay. 1996. 

Deadly targeting of women in promoting 

cigarettes. Journal of the American Medical 

Women’s Association 51 (1–2): 67–69. 

14. Pollay, R. W. 1993. Cigarette advertising 

and life (1937–1947): The history of 

advertising and archives. Vancouver: 

Univ. of British Columbia.

15. Tye, L. 1998. The father of spin: Edward L. 

Bernays and the birth of public relations.

New York: Crown Publishers.

16. Pautz, M. 2002. The decline in average 

weekly cinema attendance, 1930–2000. 

Issues in Political Economy. http://www

.elon.edu/ipe/Vol%2011%202002.htm.

17. Ingram, B. 2004. Video vault: Cigarette 

advertising on TV. http://www.tvparty.com/

vaultcomcig.html.

18. Mekemson, C., and S. A. Glantz. 2002. How 

the tobacco industry built its relationship 

with Hollywood. Tobacco Control 11 Suppl. 

1: i81–i91. 

19. Lambert, A., J. D. Sargent, S. A. Glantz, 

and P. M. Ling. 2004. How Philip Morris 

unlocked the Japanese cigarette market: 

Lessons for global tobacco control. Tobacco 

Control 13 (4): 379–87. 

20. Schudson, M. 1984. Advertising, the uneasy 

persuasion: Its dubious impact on American 

society. New York: Basic Books.

21. Terre, L., R. S. Drabman, and P. Speer. 

1991. Health-relevant behaviors in media. 

Journal of Applied Social Psychology 21 

(16): 1303–19. 

22. Mekemson, C., D. Glik, K. Titus, A. Myerson, 

A. Shaivitz, A. Ang, and S. Mitchell. 2004. 

Tobacco use in popular movies during the 

past decade. Tobacco Control 13 (4): 400–402. 

23. American Lung Association of Sacramento. 

2004. Ten year report on tobacco in the 

movies: 1994–2003.

24. MacKinnon, L., and L. Owen. 1998. 

Smoking in films: A review. London: Univ. 
424

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

of North London and Health Education 

Authority. http://www.globalink.org/tobacco/

docs/misc-docs/0003films.shtml.

25. Ng, C., and B. Dakake. 2002. Tobacco 

at the movies: Tobacco use in PG-13 

films. http://static.masspirg.org/reports/

TobaccoattheMovies.pdf.

26. Polansky, J. R., and S. A. Glantz. 2004. Firstrun smoking presentations in U.S. movies, 

1999–2003. http://repositories.cdlib.org/

cgi/viewcontent.cgi?article=1047&context

=ctcre.

27. Roberts, D. F., L. Henriksen, and 

P. G. Christenson. 1999. Substance use in 

popular movies and music. http://ncadi

.samhsa.gov/govstudy/mediastudy/default

.aspx.

28. Hazan, A. R., H. L. Lipton, and S. A. Glantz. 

1994. Popular films do not reflect current 

tobacco use. American Journal of Public 

Health 84 (6): 998–1000. 

29. Glantz, S. A., K. W. Kacirk, and C. McCulloch. 

2004. Back to the future: Smoking in movies 

in 2002 compared with 1950 levels. American 

Journal of Public Health 94 (2): 261–63. 

30. Stockwell, T. F., and S. A. Glantz. 1997. 

Tobacco use is increasing in popular films. 

Tobacco Control 6 (4): 282–84. 

31. Everett, S. A., R. L. Schnuth, and 

J. L. Tribble. 1998. Tobacco and alcohol use 

in top-grossing American films. Journal of 

Community Health 23 (4): 317–24. 

32. Dalton, M. A., J. J. Tickle, J. D. Sargent, 

M. L. Beach, M. B. Ahrens, and 

T. F. Heatherton. 2002. The incidence and 

context of tobacco use in popular movies 

from 1988 to 1997. Preventive Medicine

34 (5): 516–23. 

33. Sargent, J. D., J. J. Tickle, M. L. Beach, 

M. A. Dalton, M. B. Ahrens, and 

T. F. Heatherton. 2001. Brand appearances 

in contemporary cinema films and 

contribution to global marketing of 

cigarettes. Lancet 357 (9249): 29–32. 

34. Dozier, D. M., M. M. Lauzen, C. A. Day, 

S. M. Payne, and M. R. Tafoya. 2005. Leaders 

and elites: Portrayals of smoking in popular 

films. Tobacco Control 14 (1): 7–9. 

35. Stern, S. R. 2005. Messages from teens on 

the big screen: Smoking, drinking, and 

drug use in teen-centered films. Journal of 

Health Communication 10 (4): 331–46. 

36. Goldstein, A. O., R. A. Sobel, and 

G. R. Newman. 1999. Tobacco and alcohol 

use in G-rated children’s animated films. 

JAMA: The Journal of the American Medical 

Association 281 (12): 1131–36. 

37. Thompson, K. M., and F. Yokota. 2001. 

Depiction of alcohol, tobacco, and other 

substances in G-rated animated feature 

films. Pediatrics 107 (6): 1369–74. 

38. Omidvari, K., K. Lessnau, J. Kim, 

D. Mercante, A. Weinacker, and C. Mason. 

2005. Smoking in contemporary American 

cinema. Chest 128 (2): 746–54. 

39. McIntosh, W. D., D. G. Bazzini, S. M. Smith, 

and S. M. Wayne. 1998. Who smokes in 

Hollywood? Characteristics of smokers in 

popular films from 1940 to 1989. Addictive 

Behaviors 23 (3): 395–98. 

40. Escamilla, G., A. L. Cradock, and I. Kawachi. 

2000. Women and smoking in Hollywood 

movies: A content analysis. American 

Journal of Public Health 90 (3): 412–14. 

41. Omidvari, K., K. Lessnau, C. Mason, and 

A. Weinacker. 2006. Smoking in movies. 

Chest 129 (2): 495–96. 

42. Pechmann, C., and C.-F. Shih. 1999. 

Smoking scenes in movies and antismoking 

advertisements before movies: Effects on 

youth. Journal of Marketing 63 (3): 1–13. 

43. Glantz, S. A., and J. Polansky. 2006. Smoking 

in movies. Chest 129 (2): 495–96. 

44. McGuire, W. J. 1985. Attitudes and attitude 

change. In Handbook of social psychology,

vol. 2, 3rd ed., ed. G. Lindzey and E. Aronson, 

233–346. New York: Random House.

45. Bandura, A. 1994. Social cognitive theory 

of mass communication. In Media effects: 

Advances in theory and research, ed. 

J. Bryant and D. Zillmann, 61–90. Hillsdale, 

NJ: Lawrence Erlbaum.

46. King 3rd, C., and M. Siegel. 2001. The 

Master Settlement Agreement with the 

tobacco industry and cigarette advertising 

in magazines. New England Journal of 

Medicine 345 (7): 504–11. 

47. Watson, N. A., J. P. Clarkson, R. J. Donovan, 

and B. Giles-Corti. 2003. Filthy or 

fashionable? Young people’s perceptions of 

smoking in the media. Health Education 

Research 18 (5): 554–67. 

48. McCool, J. P., L. D. Cameron, and K. J. Petrie. 

2001. Adolescent perceptions of smoking 

imagery in film. Social Science and Medicine

52 (10): 1577–87. 

49. McCool, J. P., L. D. Cameron, and K. J. Petrie. 

2003. Interpretations of smoking in film by 

older teenagers. Social Science and Medicine

56 (5): 1023–32. 
425

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

50. Plano Clark, V. L., D. L. Miller, J. W. Creswell, 

K. McVea, R. McEntarffer, L. M. Harter, 

and W. T. Mikelson. 2002. In conversation: 

High school students talk to students about 

tobacco use and prevention strategies. 

Qualitative Health Research 12 (9): 1264–83. 

51. Crawford, M. A. 2001. Cigarette smoking 

and adolescents: Messages they see and hear. 

Public Health Reports 116 Suppl. 1: 203–15. 

52. Nichter, M., M. Nichter, and D. Van Sickle. 

2004. Popular perceptions of tobacco 

products and patterns of use among male 

college students in India. Social Science 

and Medicine 59 (2): 415–31. 

53. Shields, D. L., J. Carol, E. D. Balbach, and 

S. McGee. 1999. Hollywood on tobacco: 

How the entertainment industry understands 

tobacco portrayal. Tobacco Control 8 (4): 

378–86. 

54. MacFadyen, L., A. Amos, G. Hastings, and 

E. Parkes. 2003. “They look like my kind of 

people”—Perceptions of smoking images 

in youth magazines. Social Science and 

Medicine 56 (3): 491–99. 

55. World Health Organization. 2003. 

Bollywood: Victim or ally? A WHO study on 

the portrayal of tobacco in Indian cinema. 

http://www.who.int/tobacco/wntd/2003/en/

bollywood-exesum.pdf.

56. Distefan, J. M., E. A. Gilpin, J. D. Sargent, 

and J. P. Pierce. 1999. Do movie stars 

encourage adolescents to start smoking? 

Evidence from California. Preventive 

Medicine 28 (1): 1–11. 

57. Sargent, J. D., M. A. Dalton, M. L. Beach, 

L. A. Mott, J. J. Tickle, M. B. Ahrens, and 

T. F. Heatherton. 2002. Viewing tobacco 

use in movies: Does it shape attitudes that 

mediate adolescent smoking? American 

Journal of Preventive Medicine 22 (3): 

137–45. 

58. Dixon, H. G. 2003. Portrayal of tobacco 

use in popular films: An investigation 

of audience impact. PhD thesis, Univ. of 

Melbourne.

59. Swann, W. B. 1983. Self-verification: 

Bringing social reality into harmony with 

the self. In Psychological perspectives on the 

self, vol. 2, ed. J. Suls and A. G. Greenwald, 

33–66. Hillsdale, NJ: Lawrence Erlbaum.

60. Chassin, L., C. C. Presson, S. J. Sherman, 

E. Corty, and R. W. Olshavsky. 1981. 

Self-images and cigarette smoking in 

adolescents. Personality and Social 

Psychology Bulletin 7 (4): 670–76. 

61. Burton, D., S. Sussman, W. B. Hansen, 

C. A. Johnson, and B. R. Flay. 1989. Image 

attributions and smoking intentions among 

seventh grade students. Journal of Applied 

Social Psychology 19 (8): 656–64. 

62. Grube, J. W., I. L. Weir, and S. Getzlaf. 

1984. Own value system, value images, and 

cigarette smoking. Personality and Social 

Psychology Bulletin 10: 306–13. 

63. Barton, J., L. Chassin, C. C. Presson, and 

S. J. Sherman. 1982. Social image factors 

as motivators of smoking initiation in early 

and middle adolescence. Child Development

53 (6): 1499–1511. 

64. Aloise-Young, P. A., K. M. Hennigan, and 

J. W. Graham. 1996. Role of the self-image 

and smoker stereotype in smoking onset 

during early adolescence: A longitudinal 

study. Health Psychology 15 (6): 494–97. 

65. Sargent, J. D., M. L. Beach, A. M. AdachiMejia, J. J. Gibson, L. T. Titus-Ernstoff, 

C. P. Carusi, S. D. Swain, T. F. Heatherton, 

and M. A. Dalton. 2005. Exposure to movie 

smoking: Its relation to smoking initiation 

among US adolescents. Pediatrics 116 (5): 

1183–91. 

66. McCool, J. P., L. D. Cameron, and K. J. Petrie. 

2005. The influence of smoking imagery on 

the smoking intentions of young people: 

Testing a media interpretation model. 

Journal of Adolescent Health 36 (6): 475–85. 

67. Distefan, J. M., and J. P. Pierce. 2004. 

Smoking in movies influences adolescents 

to start smoking: A longitudinal study. 

American Journal of Public Health 94 (7): 

1239–44. 

68. Pierce, J. P., W. S. Choi, E. A. Gilpin, 

A. J. Farkas, and R. K. Merritt. 1996. 

Validation of susceptibility as a predictor of 

which adolescents take up smoking in the 

United States. Health Psychology 15 (5): 

355–61. 

69. Sargent, J. D., M. A. Dalton, T. Heatherton, 

and M. Beach. 2003. Modifying exposure 

to smoking depicted in movies: A novel 

approach to preventing adolescent smoking. 

Archives of Pediatrics and Adolescent 

Medicine 157 (7): 643–48. 

70. Gibson, B., and J. Maurer. 2000. Cigarette 

smoking in the movies: The influence of 

product placement on attitudes toward 

smoking and smokers. Journal of Applied 

Social Psychology 30 (7): 1457–73. 

71. Dixon, H. G., D. J. Hill, R. Borland, and 

S. J. Paxton. 2001. Public reaction to the 
426

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

portrayal of the tobacco industry in the film 

The Insider. Tobacco Control 10 (3): 285–91. 

72. Edwards, C. A., W. C. Harris, D. R. Cook, 

K. F. Bedford, and Y. Zuo. 2004. Out of 

the Smokescreen: Does an anti-smoking 

advertisement affect young women’s 

perception of smoking in movies and their 

intention to smoke? Tobacco Control 13: 

277–82. 

73. Jones, B., and M. Carroll. 1998. The effect 

of a video character’s smoking status 

on young females’ perceptions of social 

characteristics. Adolescence 33 (131): 

657–67. 

74. Hines, D., R. N. Saris, and L. ThrockmortonBelzer. 2000. Cigarette smoking in popular 

films: Does it increase viewers’ likelihood to 

smoke? Journal of Applied Social Psychology

30 (11): 2246–69. 

75. Anderson, C. A., and B. J. Bushman. 2002. 

The effects of media violence on society. 

Science 295 (5564): 2377–79. 

76. Groesz, L. M., M. P. Levine, and S. K. Murnen. 

2002. The effect of experimental presentation 

of thin media images on body satisfaction: 

A meta-analytic review. International Journal 

of Eating Disorders 31 (1): 1–16. 

77. Cohen, J. 1992. A power primer. Psychological 

Bulletin 112: 155–59. 

78. Petty, R. E., and J. R. Priester. 1994. Mass 

media attitude change: Implications of the 

elaboration likelihood model of persuasion. 

In Media effects: Advances in theory and 

research, ed. J. Bryant and D. Zillmann, 

91–122. Hillsdale, NJ: Lawrence Erlbaum.

79. Conrad, K. M., B. R. Flay, and D. Hill. 1992. 

Why children start smoking cigarettes: 

Predictors of onset. British Journal of 

Addiction 87 (12): 1711–24. 

80. Balbach, E. D., and S. A. Glantz. 1998. 

Tobacco control advocates must demand 

high-quality media campaigns: The California 

experience. Tobacco Control 7 (4): 397–408. 

81. Zucker, D., R. S. Hopkins, D. F. Sly, J. Urich, 

J. M. Kershaw, and S. Solari. 2000. Florida’s 

“Truth” campaign: A counter-marketing, 

anti-tobacco media campaign. Journal of 

Public Health Management and Practice

6 (3): 1–6. 

82. Federal Communications Commission. 

1934. Communications Act of 1934. 

http://www.cybertelecom.org/notes/

communications_act.htm.

83. Breed, W., and J. R. De Foe. 1984. Drinking 

and smoking on television, 1950–1982. 

Journal of Public Health Policy 5 (2): 

257–70. 

84. Gerbner, G., L. Gross, M. Morgan, and 

N. Signorielli. 1981. Health and medicine 

on television. New England Journal of 

Medicine 305 (15): 901–4. 

85. Sone, T. 1999. Tobacco-related scenes 

in television dramas for young Japanese 

audiences. Tobacco Control 8 (3): 350. 

86. Fernandez-Collado, C. F., B. S. Greenberg, 

F. Korzenny, and C. K. Atkin. 1978. Sexual 

intimacy and drug use in TV series. Journal 

of Communication 28 (3): 30–37. 

87. Greenberg, B. S., C. Fernandez-Collado, 

D. Graef, F. Korzenny, and C. K. Atkin. 

1984. Trends in use of alcohol and other 

substances on television. In Drug abuse. 

Foundation for a psychosocial approach,

ed. S. Eiseman, J. A. Wingard, and 

G. J. Huba, 187–97. Farmingdale, NY: 

Baywood.

88. Cruz, J., and L. Wallack. 1986. Trends in 

tobacco use on television. American Journal 

of Public Health 76 (6): 698–99. 

89. Hazan, A. R., and S. A. Glantz. 1995. Current 

trends in tobacco use on prime-time 

fictional television. American Journal of 

Public Health 85 (1): 116–17. 

90. Christenson, P. G., L. Henriksen, and 

D. F. Roberts. 2000. Substance use in 

popular prime-time television. http://www

.mediacampaign.org/publications/primetime/

tv_toc.html.

91. Byrd-Bredbenner, C., M. Finckenor, and 

D. Grasso. 2003. Health related content 

in prime-time television programming. 

Journal of Health Communication 8 (4): 

329–41. 

92. Gidwani, P. P., A. Sobol, W. DeJong, 

J. M. Perrin, and S. L. Gortmaker. 2002. 

Television viewing and initiation of smoking 

among youth. Pediatrics 110 (3): 505–8. 

93. Gutschoven, K., and J. Van den Bulck. 2004. 

Television viewing and smoking volume in 

adolescent smokers: A cross-sectional study. 

Preventive Medicine 39 (6): 1093–98. 

94. Hancox, R. J., B. J. Milne, and R. Poulton. 

2004. Association between child and 

adolescent television viewing and adult 

health: A longitudinal birth cohort study. 

Lancet 364 (9430): 257–62. 

95. DuRant, R. H., E. S. Rome, M. Rich, 

E. Allred, S. J. Emans, and E. R. Woods. 

1997. Tobacco and alcohol use behaviors 

portrayed in music videos: A content 
427

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

analysis. American Journal of Public Health

87 (7): 1131–35. 

96. Whelan, E. M., M. J. Sheridan, K. A. Meister, 

and B. A. Mosher. 1981. Analysis of coverage 

of tobacco hazards in women’s magazines. 

Journal of Public Health Policy 2 (1): 28–35. 

97. Warner, K. E., L. M. Goldenhar, and 

C. G. McLaughlin. 1992. Cigarette advertising 

and magazine coverage of the hazards of 

smoking: A statistical analysis. New England 

Journal of Medicine 326 (5): 305–9. 

98. Sciacca, J., and N. Antonucci. 2003. Tobacco 

coverage in popular magazines: 1996–1999. 

American Journal of Health Behavior 27 (1): 

25–34. 

99. Amos, A., C. Bostock, and Y. Bostock. 1998. 

Women’s magazines and tobacco in Europe. 

Lancet 352 (9130): 786–87. 

100. Chapman, S., Q. Jones, A. Bauman, and 

M. Palin. 1995. Incidental depiction of 

cigarettes and smoking in Australian 

magazines, 1990–1993. Australian Journal 

of Public Health 19 (3): 313–35. 

101. Amos, A., B. Jacobson, and P. White. 1991. 

Cigarette advertising policy and coverage 

of smoking and health in British women’s 

magazines. Lancet 337 (8733): 93–96. 

102. Amos, A., G. Hastings, E. Parkes, and 

L. MacFayden. 2000. Smoking and youth 

magazines: An exploration of images, 

perceptions and messages in magazines and 

the implications for cessation among older 

teens. Final report to the Department of 

Health, London. Stirling, Scotland: Center 

for Tobacco Control Research.

103. Amos, A. 1992. Style and image: Tobacco and 

alcohol images. London: Health Education 

Authority.

104. Wenger, L., R. Malone, and L. Bero. 2001. 

The cigar revival and the popular press: 

A content analysis, 1987–1997. American 

Journal of Public Health 91 (2): 288–91. 

105. Feit, M. N. 2001. Exposure of adolescent 

girls to cigar images in women’s magazines, 

1992–1998. American Journal of Public 

Health 91 (2): 286–88. 

106. Plumridge, E. W., L. J. Fitzgerald, and 

G. M. Abel. 2002. Performing coolness: 

Smoking refusal and adolescent identities. 

Health Education Research 17 (2): 167–79. 

107. Amos, A., C. Currie, D. Gray, and R. Elton. 

1998. Perceptions of fashion images from 

youth magazines: Does a cigarette make 

a difference? Health Education Research

13: 491–501. 

108. Hong, T., and M. J. Cody. 2002. Presence 

of pro-tobacco messages on the Web. 

Journal of Health Communication 7 (4): 

273–307. 

109. Ribisl, K. M., R. E. Lee, L. Henriksen, and 

H. H. Haladjian. 2003. A content analysis of 

Web sites promoting smoking culture and 

lifestyle. Health Education and Behavior

31 (1): 64–78. 

110. Interactive Digital Software Association. 

2003. Essential facts about the computer 

and video game industry: 2003 sales 

demographics and usage data. Washington, 

DC: Interactive Digital Software Association.

111. Haninger, K., and K. M. Thompson. 2004. 

Content and ratings of teen-rated video 

games. JAMA: The Journal of the American 

Medical Association 291 (7): 856–65. 

112. Perry, C. L., K. A. Komro, B. Dudovitz, 

S. Veblen-Mortenson, R. Jeddeloh, R. Koele, 

I. Gallanar, K. Farbakhsh, and M. H. Stigler. 

1999. An evaluation of a theatre production 

to encourage non-smoking among 

elementary age children: 2 Smart 2 Smoke. 

Tobacco Control 8 (2): 169–74. 

113. Lippman, M. 1995. Smokers in Marvel 

comics. Tobacco Control 4 (2): 196.

114. Nakahara, S., M. Ichikawa, and S. Wakai. 

2005. Smoking scenes in Japanese comics: 

a preliminary study. Tobacco Control

14 (1): 71.

115. Doherty, T. 1999. Pre-code Hollywood: Sex, 

immortality, and insurrection in American 

cinema, 1930–1934. New York: Columbia 

Univ. Press.

116. Adato, A. 2002. The education of Meathead. 

Los Angeles Times, January 20.

117. World Health Organization. 2003. WNDT 

2003: Tobacco free film, tobacco free 

fashion: Action! http://www.euro.who.int/

mediacentre/PR/2003/20030527_1.

118. People’s Daily Online. 2001. Russian 

Parliament votes to ban smoking at work 

and on film. http://english.peopledaily.com

.cn/english/200106/22/eng20010622_73253

.html.

119. Indlaw Communications Pvt. Limited. 

2006. Ban on smoking scenes to be deferred 

till July 31. http://www.indlawnews.com/

NewsDisplay.aspx?f008d022-5c4a-485c-91f9-

2309f5670831.

120. Hollywood Reporter. 2003. Thai censors 

delay film. Hollywood Reporter, February 7.

121. CTV.ca News. 2004. Keep teens from movies 

with smoking: Activists. http://toronto.ctv
428

1 0 . R o l e o f E n t e r t a i n m e n t M e d i a 

.ca/servlet/an/local/CTVNews/20040121/

smoking_movies_040121?hub=Toronto

Home%5B/url.

122. Motion Picture Association of America. 

2004. Classification and ratings. http://www

.mpaa.org/FilmRatings.asp.

123. National Association of Attorneys General. 

1998. Master Settlement Agreement and 

amendments. Washington, DC: National 

Association of Attorneys General. http://

www.naag.org/backpages/naag/tobacco/msa.

124. Harvard School of Public Health. 2007. 

HSPH releases presentations made to 

Motion Picture Association of America 

on the depiction of tobacco smoking in 

movies. Press release. Boston: Harvard 

Univ. http://www.hsph.harvard.edu/news/

press-releases/2007-releases/press04032007

.html.

125. U.S. Senators. 2007. Letter to MPAA. 

http://smokefreemovies.ucsf.edu/pdf/Senate

%20Letter%20to%20MPAA%2006%2021

%2007.pdf

126. Polansky, J. R., S. Glantz, and K. Titus. 

2007. Six months later: Are MPAA’s tobacco 

ratings protecting movie audiences? Paper. 

Center for Tobacco Control Research and 

Education. Tobacco Control Policy Making. 

http://repositories.cdlib.org/ctcre/tcpmus/

MPAA2007.

127. Council for Excellence in Government. 

Univ. of California, Norman Lear Center. 

2004. How pro-social messages make their 

way into entertainment programming: 

A report to the Carnegie Foundation on 

the Media, Citizens & Democracy. http://

learcenter.org/pdf/MCDReport.pdf.

128. Centers for Disease Control and Prevention. 

2006. Entertainment: A powerful tool in 

communicating health issues. http://www

.cdc.gov/tobacco/media_communications/

countermarketing/entertainment/strategies

.htm.

129. Business Wire. 2001. STARS and Hollywood 

speak out: Premier and gala set to debut 

new film; “Scene smoking: cigarettes, 

cinema and the myth of cool” takes a hard 

look at a controversial subject. http://

findarticles.com/p/articles/mi_m0EIN.

130. Entertainment Industries Council. 2007. 

http://www.eiconline.org/aboutus/.

131. Smoke Free Movies. http://smokefreemovies

.ucsf.edu/actnow/encourage_ags.html.

132. Smoke Free Movies. 2006. Web site. 

http://www.smokefreemovies.ucsf.edu/

ourads/ad_inbedroom_nyt.html.

133. Smoke Free Movies. 2006. Bedroom 1. 

http://www.smokefreemovies.ucsf.edu/

ourads/ad_inbedroom_nyt.html.

134. Sargent, J. D., T. F. Heatherton, M. B. Ahrens, 

M. A. Dalton, J. J. Tickle, and M. L. Beach. 

2002. Adolescent exposure to extremely 

violent movies. Journal of Adolescent Health

31 (6): 449–54. 

135. Dalton, M. A., M. B. Ahrens, J. D. Sargent, 

L. A. Mott, M. L. Beach, J. J. Tickle, and 

T. F. Heatherton. 2002. Relation between 

parental restrictions on movies and 

adolescent use of tobacco and alcohol. 

Effective Clinical Practice: ECP 5 (1): 1–10. 

136. Federal Communications Commission. 1996. 

Telecommunications act of 1996. http://www

.fcc.gov/vchip/legislation.html#vchip.

137. Robinson, T. N. 1999. Reducing children’s 

television viewing to prevent obesity: 

A randomized controlled trial. JAMA: 

The Journal of the American Medical 

Association 282 (16): 1561–67. 

138. Jensen, J. A., N. J. Hickman 3rd, H. Landrine, 

and E. A. Klonoff. 2004. Availability of 

tobacco to youth via the Internet. JAMA: The 

Journal of the American Medical Association

291 (15): 1837. 

139. Reuters. 2007. Disney-branded films to 

ban depictions of smoking. http://www

.reuters.com/article/domesticNews/

idUSN2535342320070725.

140. Brown, J. A. 2001. Media literacy and 

critical television viewing in education. 

In Handbook of children and the media,

ed. D. G. Singer and J. L. Singer, 681–97. 

Thousand Oaks, CA: Sage.

141. Wright, P. 1986. Schemer schema: 

Consumers’ intuitive theories about 

marketers’ influence tactics. Advances in 

Consumer Research 13: 1–3. 

142. Gonzales, R., D. Glik, M. Davoudi, and 

A. Ang. 2004. Media literacy and public 

health: Integrating theory, research, and 

practice for tobacco control. American 

Behavioral Scientist 48 (2): 189–201. 

143. Austin, E. W., and K. K. Johnson. 1997. 

Effects of general and alcohol-specific media 

literacy training on children’s decision 

making about alcohol. Journal of Health 

Communication 2 (1): 17–42.
429

Tobacco Control Media 

Interventions

Part

4

The success of tobacco control efforts over the last several decades is closely intertwined 

with use of the media, ranging from antismoking advertisements under the 1960s 

Fairness Doctrine to today’s integrated media campaigns and Internet-based resources. 

This part examines how media interventions are used in tobacco control efforts and 

assesses their effectiveness. 

After tracing the evolution of media efforts in tobacco control and the most successful 

advertising themes used in these interventions, the first chapter weighs the potential 

for new media approaches such as interactive health communications. The chapter 

closing this part examines the evidence that mass media antitobacco campaigns alone 

or in conjunction with other interventions can affect smoking behavior. The discussion 

recognizes the methodological challenges in measuring the effectiveness of media 

interventions, including the infeasibility of randomized studies or the presence of 

concurrent secular trends that complicate the evaluation of the evidence. Both chapters 

discuss key findings in the current evidence on the role of media in tobacco control that 

point to an overall positive impact in the reduction of smoking behavior.

431

11

An Overview of Media 

Interventions in Tobacco Control: 

Strategies and Themes

Media interventions for tobacco control have a history dating back to the 1960s. This 

chapter examines current and future trends in these types of interventions, including

n	 The evolution of media efforts in tobacco control, from their roots under the 

Federal Communications Commission’s Fairness Doctrine to initiatives involving 

tobacco prevention and cessation advertising campaigns funded by state 

authorities and the 1998 Master Settlement Agreement

n	 Examples of advertising themes used in public-health-sponsored tobacco 

control programs, as well as other efforts, such as commercial advertising for 

smoking cessation products and the tobacco industry’s own youth smoking 

prevention campaigns

n	 A summary of research on factors that determine performance of antitobacco 

advertisements

n	 The potential impact of and future directions for new-media channels such as 

interactive health communications using the Internet

Today, a solid evidence base exists for developing antitobacco advertising that can garner 

positive outcomes in terms of target audience appraisal, recall, and indicators of message 

processing. Numerous areas for future study exist, ranging from better understanding of 

effects on specific population groups to designing effective online interventions.
432

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

Introduction

This chapter examines how media 

interventions have been used in tobacco 

control, their trends over time, and factors 

that make them effective. It begins with 

an historical overview of mass media 

interventions aimed at discouraging 

tobacco use. Subsequent sections describe 

traditional antitobacco mass media 

interventions that have been or continue 

to be used, how their characteristics 

and intensity have varied, and the target 

audiences to whom they have been directed. 

Next, the relative effectiveness of different 

antitobacco televised advertising messages 

is summarized. The chapter then concludes 

with observations about the development 

and direction of traditional and new media 

interventions in tobacco control.

This chapter describes the environment 

for tobacco control media interventions, 

with media channels being used as a key 

tool for stakeholders on both sides of the 

tobacco issue. Chapter 12 describes studies 

of the effects of antitobacco advertising 

interventions as a whole on smoking 

behavior, and other chapters explore 

countervailing media efforts on the part of 

protobacco interests. Chapter 10 examines 

the influence of the entertainment media, 

including “new media,” such as the Internet 

and video games, on adolescent and adult 

smoking behavior. A later section of this 

chapter summarizes how new-media 

interventions could be applied to tobacco 

control to make effective cessation 

practices available to a broader audience 

at lower costs.

Historical Overview

Over the past 50 years, the representation 

of cigarettes on television and radio has 

changed radically. Fifty years ago, cigarettes 

were associated with glamour, good times, 

and fun. Their images were accompanied 

by jaunty jingles extolling their quality, 

taste, and mildness. Tap-dancing Old Gold 

cigarette packs appeared at the opening of 

some of the most popular television shows.1

This feel-good atmosphere was interrupted 

in September 1968 when William Talman, 

who played the prosecutor on the 

Perry Mason television series, appeared in 

a public service announcement looking 

thin and pale from the ravages of lung 

cancer. After opening pictures of the 

actor’s children playing in the yard of their 

home in Encino, California, the camera 

focused on Talman. The actor explained 

that he had lost his first case when he was 

only 12 years old by starting to smoke 

cigarettes. He knew he now was going to 

die and would have only a little more time 

“with this family that I love so much.” 

He enjoined the audience, “Don’t be a 

loser. Don’t smoke.” Indeed, Talman had 

died the month before the spot aired.2 In 

the years following this memorable appeal, 

numerous other celebrities went on the 

air to decry the health damage done by 

smoking. In 1985, Yul Brynner, best known 

as the Siamese king in The King and I, 

advised, “Don’t smoke whatever you do!” 

in a spot aired shortly after he had died of 

lung cancer.

Dancing cigarette advertisement from 1950s quiz show
433

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

The use of the mass media in the 

United States to discourage tobacco use 

often is traced back to July 1, 1967. At that 

time, lawyer John Banzhaf III succeeded 

in having the Federal Communications 

Commission apply the Fairness Doctrine 

to cigarette advertising, requiring that 

broadcasters offer free air time for one 

antitobacco message for every three 

cigarette commercials they aired.3 This 

practice was followed until 1971, when 

cigarette advertising in the broadcast 

media was banned. Over that period, nearly 

$200 million in commercial advertising 

time (in 1970 dollars) was donated for 

this purpose.4 That figure is equivalent to 

approximately $341 million in 2006 dollars. 

Chapter 12 describes several empirical 

studies assessing the effect of these 

antitobacco advertisements, concluding 

that they essentially neutralized the effect 

of cigarette advertising during the period.

Since 1970, mass media have been used 

in a variety of formats to promote the 

goals of tobacco control. The National 

Clearinghouse for Smoking and Health 

(NCSH) produced public service 

announcements.5 (NCSH was the 

forerunner of the Office on Smoking 

and Health [OSH] of the Centers for 

Disease Control and Prevention [CDC].) 

Voluntary agencies such as the American 

Lung Association and the American 

Cancer Society (ACS) used television 

and media events to involve the public 

in community-based smoking cessation 

programs. The National Institutes of 

Health sponsored research on community 

intervention trials, which sometimes 

included a mass media component.6–8

In the United States, the first statewide 

antismoking mass media campaign was 

conducted in Minnesota in 1986 as a 

result of state government funding of 

approximately $2 million per year.9,10

The decision to invest in such a campaign 

followed presentations of the experience 

of a successful mass media intervention in 

Australia.11–13 Advertisements designed to 

increase youth awareness of the negative 

social consequences of smoking and to 

change normative expectations for smoking 

among adolescents were broadcast on 

television and radio and displayed in 

newspapers and on billboards.

Developments Since 1990

Starting with California in 1990, 

44 states have used mass media as part 

of comprehensive antitobacco programs 

to reduce tobacco use among their adult 

and youth citizens. Eighty percent of 

these efforts began after 1998 with funds 

received as part of the Master Settlement 

Agreement (MSA).* However, in practice, 

since the MSA, few states have devoted 

the amount recommended by CDC to 

tobacco control efforts.14,15 Since 1992, 

with the development of pharmaceutical 

products to help smokers quit, extensive 

commercial advertising on television 

and in print media has promoted these 

products.

In 1998, two tobacco companies, 

Philip Morris and Lorillard, initiated their 

own mass media youth smoking prevention 

campaigns, with advertisements directed 

toward youth and parents.16 From early 

2000, the American Legacy Foundation 

(Legacy)—the nonprofit foundation created 

as part of the MSA—mounted a national 

antitobacco campaign.

Wakefield and colleagues17 used archival 

records of television advertising 

exposures from Nielsen Media Research 

*

The MSA was an agreement between 46 state attorneys general and U.S. tobacco companies in November 

1998 to settle state lawsuits to recover billions of dollars in costs for treating smoking-related illnesses 

(http://www.naag.org/tobacco.php; see chapter 3).
434

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

for the largest 75 media markets in the 

United States to compare the levels of 

potential exposure of households and 

adolescents aged 12–17 years with a 

variety of types of antitobacco advertising. 

These marketing messages included 

advertisements produced by state tobacco 

control programs and the national Legacy 

program, tobacco-company-sponsored 

youth smoking prevention advertising 

targeted toward youth and parents, 

pharmaceutical company advertising 

for nicotine replacement therapy (NRT) 

and bupropion (a prescription smoking 

cessation aid), and other miscellaneous 

antitobacco advertising.

Table 11.1 shows that from 1999 to 

2003, pharmaceutical companies 

were the largest individual sponsor of 

antitobacco advertising for households 

(10.37 advertisements per month) and 

provided significant potential exposure 

among adolescents (2.61 advertisements 

per month). Combined tobacco company 

youth/parent advertising potential 

exposures were close to those for combined 

state/Legacy campaigns—respectively, 

4.56 versus 4.97 advertisements per month 

among households and 3.05 versus 

3.38 advertisements per month among 

adolescents. This study demonstrates that 

both youth and adults in the United States 

may be exposed to public-health-sponsored 

antitobacco campaigns as frequently as 

tobacco-industry-produced campaigns 

(see chapters 6 and 12).

A more detailed investigation of potential 

exposure to state-sponsored antitobacco 

campaigns showed that in 37 states studied, 

average exposure for television households 

increased from 1.30 ads per month in 

1999 to 3.63 ads per month in 2002. 

For adolescents aged 12–17 years, such 

exposure increased from 0.84 ads per month 

in 1999 to 1.43 ads per month in 2002. 

In 2003, although a few more states ran 

paid media campaigns, average population 

exposure to antitobacco advertising 

campaigns declined to 3.20 ads per month 

among television households and 1.13 ads 

per month among adolescents aged 

12–17 years, reflecting an overall reduction 

of campaign funding that states attributed 

to budget crises.18,19 Tables 11.2 and 11.3 

show the average household exposure 

and adolescent exposure, respectively, to 

state-sponsored antitobacco advertising 

by state. After 2003, additional cuts in 

antitobacco funding may further reduce 

the number of states with antitobacco 

media campaigns.

Nontelevised Mass 

Media Antitobacco 

Interventions

Many different mass media channels have 

been used for tobacco control messages. 

Table 11.4 lists, by sponsor, mass media 

antitobacco campaigns conducted since 

1990 by individual state health departments, 

state foundations established with funds 

from the MSA, and, in one case, a city 

(New York). This table was adapted from 

information provided by the CDC’s Media 

Campaign Resource Center (MCRC). 

A service of OSH, the MCRC has licensed 

many of the advertisements that state 

health departments and other groups have 

produced. The MCRC facilitates access 

to those advertisements and provides 

technical assistance for states and nonprofit 

organizations wishing to implement 

tobacco control mass media campaigns. 

The MCRC maintains a searchable online 

database of available advertisements that 

may be used by health departments and 

health-related organizations that are 

developing tobacco countermarketing 

campaigns.20 Data in table 11.4 on media 

channels, audiences targeted, and themes 

of advertisements are based on records 

of advertisements the MCRC received as 

well as advertisements ordered by various 
435

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 11.1 Mean Monthly Exposures per Year to Tobacco-Related Television Advertising for Television Households and Adolescents Aged 12–17 

Years, Based on the Top 75 Designated Market Areas in the United States

Exposure Type

1999 2000 2001 2002 2003 1999–2003

M SE Rangea M SE Range

M SE Range

M SE Range

M SE Range

M

Household exposures, by sponsorAmerican Legacy Foundation

—

—

— 4.24 .10 0.0–15.1 1.83 .05 0.0–8.6 3.67 .09 0.5–14.5 2.83 .06 0.4–12.4 2.51

State tobacco control programs 1.30 .10 0.0–27.8 1.14 .09 0.0–22.7 3.03 .18 0.0–38.2 3.63 .15 0.0–29.8 3.20 .17 0.0–46.4 2.46

Tobacco parent 1.74 .09 0.0–10.6 1.69 .04 0.0–5.2 1.96 .05 0.0–7.6 3.34 .03 0.8–8.5 3.17 .01 0.3–15.3 2.38Tobacco youth 4.32 .06 0.6–11.7 3.70 .06 0.9–11.0 2.23 .03 0.5–5.6 0.31 .01 0.0–2.1 0.32 .01 0.0–1.4 2.18

Tobacco corporateb 1.57 .10 0.0–18.8 9.03 .19 0.2–34.8 3.81 .06 0.2–10.9 0.00 0.00 0.00 1.83 .09 0.0–14.3 3.25

Pharmaceutical 14.34 .29 1.4–51.8 9.70 .21 0.0–29.9 7.92 .13 1.5–19.8 7.83 .17 2.6–27.2 12.07 .23 1.3–34.6 10.37Other 0.10 .01 0.0–2.6 0.07 .02 0.0–8.8 0.03 .01 0.0–6.8 0.14 .01 0.0–1.6 0.06 .01 0.0–3.0 0.08

Total public health-sponsoredc 1.30 5.38 4.86 7.30 6.03 4.97

Total tobacco youth + parent 6.06 5.39 4.19 3.65 3.49 4.56

Total tobacco-sponsoredd 7.63 14.42 8.00 3.65 5.32 7.81

Teen exposures, by sponsorAmerican Legacy Foundation 

—

—

— 4.20 .10 0.0–17.5 1.73 .05 0.0–7.3 3.05 .06 0.5–10.3 2.52 .05 0.3–8.3 2.30

State 0.84 .07 0.0–16.1 0.65 .05 0.1–13.8 1.32 .07 0.0–14.7 1.44 .06 0.0–13.9 1.13 .06 0.0–18.3 1.08Tobacco parent 0.73 .04 0.0–4.5 0.66 .02 0.0–2.7 0.73 .02 0.0–6.5 1.26 .02 0.3–4.8 0.76 .02 0.1–2.9 0.83

Tobacco youth 4.43 .07 0.5–12.5 3.69 .06 0.6–13.8 2.37 .04 0.6–8.7 0.32 .02 0.0–3.1 0.29 .01 0.0–1.3 2.22

Tobacco corporate 0.45 .03 0.0–5.7 2.08 .04 0.1–7.0 0.87 .01 0.1–1.9 0.00 0.00 0.00 0.26 .01 0.0–2.4 0.73Pharmaceutical 3.88 .08 0.4–13.5 2.44 .05 0.0–8.3 2.17 .03 0.6–4.8 2.00 .04 0.7–7.2 2.58 .05 0.2–8.6 2.61

Other 0.02 .00 0.0–1.0 0.04 .02 0.0–4.2 0.01 .00 0.0–2.8 0.04 .00 0.0–0.5 0.02 .00 0.0–0.4 0.03

Total public health-sponsored 0.84 4.85 3.05 4.49 3.65 3.38

Total tobacco youth + parent 5.16 4.35 3.10 1.58 1.05 3.05

Total tobacco-sponsored 5.61 6.43 3.97 1.58 1.31 3.78

Note. M = mean; SE = standard error. From Wakefield, M., G. Szczypka, Y. Terry-McElrath, S. Emery, B. Flay, F. Chaloupka, and H. Saffer. 2005. Mixed messages on tobacco: Comparative exposure to public health, and tobacco company- and pharmaceutical company-sponsored tobacco-related television campaigns in the United States, 1999–2003. Addiction 100 (12): 1875–83.

aRange of actual monthly means for 75 markets. bIncludes advertisements publicizing the company Web site (www.quitassist.com), which began in 2003. cIncludes all state and American Legacy Foundation advertising. dIncludes all tobacco company advertising.
436

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

Table 11.2 States Ranked for Mean Monthly Exposures to State Antitobacco Television 

Advertising (Households, Gross Rating Points [GRPs])

1999 2000 2001 2002 2003

Rank State Mean State Mean State Mean State Mean State Mean

1 AZ 14.75 UT 6.67 UT 19.32 UT 15.22 UT 24.03

2 CA 5.87 AZ 6.38 NY 10.96 GA 7.66 WA 10.10

3 MA 5.81 MA 6.00 MN 8.45 NY 7.46 MN 7.67

4 FL 4.04 OR 4.38 WI 7.68 OR 7.10 IN 7.64

5 IN 3.20 CA 3.97 MA 7.33 OH 7.01 CA 6.25

6 OR 2.51 IN 2.57 WA 7.31 IN 6.83 OH 6.09

7 OK 1.67 FL 2.37 CA 5.95 CA 6.58 AZ 5.98

8 HI 1.28 MN 2.00 NM 5.82 WI 5.75 AR 5.52

9 UT 1.09 WA 1.60 AZ 5.60 WA 5.66 WI 4.99

10 MI 0.68 HI 1.50 GA 5.07 FL 5.37 NY 4.81

11 NM 0.42 NY 1.33 OR 4.40 MN 5.35 HI 4.46

12 NY 0.19 MI 0.83 IA 3.97 HI 5.22 NM 4.29

13 MO 0.15 KS 0.69 FL 3.96 NE 4.84 NE 3.68

14 WI 0.13 TX 0.51 NE 3.60 AZ 4.78 CO 3.15

15 GA 0.13 IA 0.41 HI 2.84 MD 4.69 OR 2.94

16 IA 0.10 WI 0.07 OK 2.75 PA 3.82 VA 2.88

17 WA 0.09 MO 0.02 IN 1.65 VA 3.28 WV 2.69

18 AR 0.09 NC 0.01 CT 1.00 AL 2.91 GA 2.67

19 IL 0.07 IL 0.01 AL 0.57 CO 2.52 OK 2.20

20 KS 0.07 NE 0.01 CO 0.51 MA 2.25 IA 2.18

21 NV 0.05 OH 0.01 TX 0.50 DC 1.96 PA 2.17

22 TN 0.05 TN 0.01 MI 0.45 IL 1.84 CT 2.15

23 CO 0.04 CT 0.01 MO 0.40 IA 1.41 DC 2.01

24 TX 0.04 OK 0.00 PA 0.32 WV 1.15 MA 1.87

25 NC 0.04 NV 0.00 MD 0.25 MI 1.00 FL 1.51

26 OH 0.04 VA 0.00 DC 0.14 OK 0.94 MI 1.31

27 VA 0.04 KY 0.00 OH 0.08 TX 0.61 AL 0.70

28 LA 0.03 NM 0.00 VA 0.04 NV 0.43 TX 0.53

29 CT 0.03 AR 0.00 SC 0.01 NM 0.40 NV 0.52

30 MN 0.03 GA 0.00 KY 0.01 MO 0.21 TN 0.22

31 KY 0.03 LA 0.00 WV 0.01 NC 0.09 IL 0.06

32 PA 0.02 CO 0.00 NC 0.00 KS 0.09 MO 0.06

33 MD 0.02 PA 0.00 TN 0.00 TN 0.01 KS 0.05

34 NE 0.02 SC 0.00 AR 0.00 KY 0.01 NC 0.04

35 SC 0.01 WV 0.00 IL 0.00 SC 0.00 KY 0.04

36 WV 0.01 DC 0.00 KS 0.00 AR 0.00 MD 0.01

37 DC 0.01 AL 0.00 LA 0.00 CT 0.00 LA 0.00

38 AL 0.00 MD 0.00 NV 0.00 LA 0.00 SC 0.00

Mean 1.30 1.14 3.03 3.63 3.20

Note. GRP ratings data reported for top 75 designated market areas (DMAs); states not covered in the top 75 DMAs are not included 

in rankings (AK, DE, ID, ME, MS, MT, NH, NJ, ND, RI, SD, VT, WY). For states with multiple DMAs, the mean for each market 

was averaged. From Szczypka, G., M. Wakefield, S. Emery, B. Flay, F. Chaloupka, S. Slater, Y. Terry-McElrath, and H. Saffer. 2005. 

Population exposure to state funded televised anti-tobacco advertising in the United States—37 States and the District of Columbia, 

1999–2003. ImpacTeen Research Paper series 31. Chicago: Univ. of Illinois at Chicago. http://www.impacteen.org/ab_rpno31_2005.htm. 

Reprinted with permission.
437

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 11.3 States Ranked for Mean Monthly Exposures to State Antitobacco Television 

Advertising (Adolescents Aged 12–17 Years, Target Rating Points [TRPs])

1999 2000 2001 2002 2003

Rank State Mean State Mean State Mean State Mean State Mean

1 AZ 10.25 AZ 4.36 UT 8.73 UT 6.98 UT 10.01

2 FL 4.88 UT 3.48 MN 4.62 FL 3.72 WA 3.12

3 IN 2.70 FL 2.87 FL 4.19 OH 3.17 OH 2.99

4 MA 2.55 MA 2.11 AZ 3.76 MN 2.99 MN 2.70

5 CA 1.79 MN 1.91 NY 3.19 IN 2.79 IN 2.70

6 OR 1.00 IN 1.74 WA 3.16 VA 2.66 VA 2.31

7 HI 0.54 OR 1.20 WI 2.83 DC 2.44 DC 1.93

8 MI 0.51 CA 1.15 NE 2.19 GA 2.41 AR 1.67

9 OK 0.43 WA 1.09 IA 2.10 HI 2.37 AZ 1.42

10 UT 0.39 TX 0.55 MA 1.83 OR 2.12 WI 1.32

11 WI 0.13 NY 0.42 CA 1.57 NY 1.95 CA 1.32

12 NM 0.10 MI 0.38 HI 1.51 WI 1.94 NY 1.27

13 GA 0.07 HI 0.37 IN 1.33 NE 1.93 CO 1.11

14 MO 0.06 IA 0.29 NM 1.31 MD 1.66 FL 1.07

15 KS 0.06 KS 0.24 GA 1.31 WA 1.54 WV 1.00

16 NY 0.06 WI 0.03 OK 0.99 CA 1.51 IA 0.96

17 IL 0.05 MO 0.01 OR 0.81 IA 0.98 HI 0.91

18 NC 0.04 TN 0.01 TX 0.55 AZ 0.94 NE 0.81

19 VA 0.04 NE 0.01 MO 0.43 CO 0.81 GA 0.65

20 WA 0.04 IL 0.01 CT 0.37 AL 0.78 NM 0.60

21 OH 0.04 VA 0.01 CO 0.22 PA 0.71 OR 0.59

22 TN 0.03 OH 0.00 MD 0.21 IL 0.69 CT 0.58

23 TX 0.03 NV 0.00 AL 0.13 TX 0.58 OK 0.57

24 MD 0.03 NC 0.00 MI 0.11 MA 0.40 TX 0.49

25 CO 0.03 KY 0.00 PA 0.11 OK 0.38 PA 0.47

26 IA 0.03 OK 0.00 VA 0.04 WV 0.31 MA 0.30

27 PA 0.03 CT 0.00 OH 0.02 MI 0.24 MI 0.25

28 KY 0.03 AR 0.00 DC 0.01 MO 0.22 AL 0.09

29 AR 0.03 LA 0.00 SC 0.01 KS 0.08 TN 0.09

30 SC 0.03 CO 0.00 WV 0.00 NM 0.06 NV 0.07

31 MN 0.02 PA 0.00 KY 0.00 NV 0.04 IL 0.07

32 NV 0.02 WV 0.00 NC 0.00 NC 0.02 MO 0.04

33 CT 0.02 SC 0.00 AR 0.00 TN 0.00 KS 0.04

34 LA 0.02 NM 0.00 IL 0.00 AR 0.00 KY 0.01

35 NE 0.02 AL 0.00 KS 0.00 CT 0.00 NC 0.01

36 WV 0.01 DC 0.00 LA 0.00 KY 0.00 MD 0.00

37 DC 0.01 GA 0.00 NV 0.00 LA 0.00 LA 0.00

38 AL 0.00 MD 0.00 TN 0.00 SC 0.00 SC 0.00

Mean 0.84 0.65 1.32 1.43 1.13

Note. TRP ratings data reported for top 75 designated market areas (DMAs); states not covered in the top 75 DMAs are not included 

in rankings (AK, DE, ID, ME, MS, MT, NH, NJ, ND, RI, SD, VT, WY). For states with multiple DMAs, the mean for each market 

was averaged. From Szczypka, G., M. Wakefield, S. Emery, B. Flay, F. Chaloupka, S. Slater, Y. Terry-McElrath, and H. Saffer. 2005. 

Population exposure to state funded televised anti-tobacco advertising in the United States—37 States and the District of Columbia, 

1999–2003. ImpacTeen Research Paper series 31. Chicago: Univ. of Illinois at Chicago. http://www.impacteen.org/ab_rpno31_2005.htm. 

Reprinted with permission.
438

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l Table 11.4 Mass Media Antitobacco Campaigns in the United States, 1990–2004 Organization Campaign history Media types Audience Themes Ad sources State Start of campaign End of campaign Years of campaign (as of 2004) TV Radio Print Bill- board State Adults only Youth only Adults and youth Other

Youth prevention

Cessation

Secondhand smoke

Smokeless tobacco Produce their own ads? Use other states’ ads?

California Department of Health Services

CA 1990

— 14







 CA    GLBT

Asian AmericansPregnant womenHispanicsAfrican Americans

 





 

Massachusetts Department of Public Health

MA 1993 2002 9 





 MA    No



    

Arizona Department of Health Services

AZ 1996

— 8 





 AZ    Hispanics

Pregnant women













Kansas Health Foundation KS 1997 2000 3 





 KS

   No      

Florida Department of Health FL 1998

— 6 





 FL   No

     

Partnership for a Healthy Mississippi (MSDH is part)

MS 1998

— 6 





 MS    No





  



Utah Department of Health UT 1998

— 6 





 UT    No





  



Minnesota Department of Health MN 1999 2003 4 





 MN    No

     

Minnesota Partnership for Action Against Tobacco

MN 1999

— 5 





 MN

   No  

   

Oregon Department of Human Services OR 1999

— 5 





 OR    No





  



Colorado Department of Public Health and Environment

CO 2000

— 4 





 CO    Hispanics





  



Georgia Department of Human Resources

GA 2000

— 4 





 GA

   No  

   

Iowa Department of Public Health IA 2000

— 4 





 IA    No



   



Illinois Department of Public Health IL 2000

— 4 





 IL    No

     

Partnership for a Tobacco Free Maine (MBH is part)

ME 2000

— 4 





 ME    Pregnant women





   

Michigan Department of Community Health

MI 2000

— 4 





 MI    No





   
439

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Organization

Campaign history Media types Audience Themes Ad sources

State

Start of 

campaign

End of 

campaign

Years of 

campaign 

(as of 2004) TV Radio Print

Billboard State Adults only Youth only

Adults 

and 

youth Other

Youth prevention

Cessation

Secondhand smoke

Smokeless tobacco Produce their own ads? Use other states’ ads?

Montana Tobacco Use Prevention Program (MDPHHS works with)

MT 2000

— 4 





 MT    Native Americans





  



Nebraska Health and Human Services NE 2000

— 4 





 NE    No













Texas Department of Health TX 2000

— 4 





 TX    Hispanics





  



Vermont Department of Health VT 2000

— 4 





 VT    No





  



American Lung Association of Alaska AK 2001

— 3 





 AK    Pregnant women

Native Americans





  



Alabama Department of Public Health AL 2001 2001 0     AL

   No      

Delaware Division of Public Health DE 2001

— 3 





 DE

   No  

  



Hawaii Department of Health HI 2001

— 3 





 HI    Asian Americans

African Americans





   

Idaho Department of Health and Welfare

ID 2001

— 3 





 ID    No  

  



Indiana Tobacco Prevention and Cessation Agency

IN 2001

— 3 





 IN    No

    



Kansas Department of Health and Environment

KS 2001

— 3 





 KS    No





   

New Jersey Department of Health and Senior Services

NJ 2001

— 3 





 NJ

   No      

New Mexico Department of Health NM 2001

— 3 





 NM    Native Americans





  



New York City Department of Health and Mental Hygiene

NY 2001

— 3   

 NY

   Hispanics

African Americans

 

  



New York State Department of Health NY 2001

— 3 





 NY    No





  



Ohio Department of Health OH 2001

— 3 





 OH    No





   

Rhode Island Department of Health RI 2001

— 3 





 RI    No  

  



Washington State Department of Health

WA 2001

— 3 





 WA    No





  



Arkansas Department of Health AR 2002 2002 0 

   AR

   African Americans  

   

— = ongoing through 2004;  = no; 

 = yes
440

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l Organization Campaign history Media types Audience Themes Ad sources State Start of campaign End of campaign Years of campaign (as of 2004) TV Radio Print Bill- board State Adults only Youth only Adults and youth Other

Youth prevention

Cessation

Secondhand smoke

Smokeless tobacco Produce their own ads? Use other states’ ads?

Connecticut Department of Public Health

CT 2002

— 2     CT    No





   

Maryland Department of Health and Mental Hygiene

MD 2002

— 2 





 MD    No

     

New Hampshire Department of Health and Human Services

NH 2002 2003 1 

   NH

   No     



Ohio Tobacco Use Prevention and Control Foundation

OH 2002

— 2 





 OH    No





  



Oklahoma State Department of Health

OK 2002

— 2 





 OK    No





  



South Dakota Department of Health SD 2002

— 2 





 SD    No







  

Virginia Tobacco Settlement Foundation

VA 2002

— 2 





 VA    Pregnant women





   

West Virginia Department of Health and Human Services

WV 2002

— 2 





 WV    No

   

 

Louisiana Department of Health and Hospitals

LA 2003

— 1  

  LA

   No     



Pennsylvania Department of Health PA 2003

— 1 





 PA    No





  



Wisconsin Department of Health and Family Services

WI 2003

— 1 





 WI    No

     

Wyoming Department of Health WY 2003

— 1 

   WY

   No      

Total (out of 47 campaigns) 46 44 42 41 13 7 27 33 37 36 5 38 33

Percentage 98 94 89 87 28 15 57 70 79 77 11 81 70

Note. — = ongoing through 2004;  = no; 

 = yes. Not all themes of advertisements are listed here. Information compiled by the Centers for Disease Control and Prevention/Office on Smoking and Health’s 

Table 11.4

Media Campaign Resource Center, June 10, 2004. To date, the following states did not have campaigns in the years between 1990 and 2004: KY, MO, NC, ND, NV, SC, TN, and DC. GLBT = gay, lesbian, bisexual, transgendered; MSDH = Mississippi State Department of Health; MBH = Maine Bureau of Health; MDPHHS = Montana Department of Public Health and Human Services.

Mass Media Antitobacco Campaigns in the United States, 1990–2004 (continued)
441

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

programs. Information about campaign 

start and end dates was collected from 

program Web sites and, in some cases, 

telephone interviews with state health 

department staff. Other audience targets 

and themes may have been addressed 

using materials not shared with the MCRC.

Table 11.4 shows that 98% of 47 campaigns 

tracked by CDC’s MCRC used television 

advertisements, 94% used radio, 89% 

used print (including paid newspaper 

advertisements and transit advertisements), 

and 87% used billboards. The choice 

of channel has an important impact on 

cost as well as on the campaign’s reach 

(i.e., the proportion of the population 

exposed to the message), the specificity of 

the audience reached, and the extent of 

involvement with the message that will 

result from exposure.21

Population surveys of youth in California22

and youth and adults in Massachusetts23,24

compared the proportion of the population 

who recalled antitobacco advertisements on 

television, radio, and billboards. Mass media 

campaigns in California and Massachusetts 

had used these three channels. These 

studies demonstrate that antitobacco 

advertisements on television were recalled 

by about twice as many respondents as 

those on the radio. Youth in both states 

were more likely to recall antitobacco 

advertisements on billboards compared 

with those on the radio.

Among adults, Nelson and colleagues25

demonstrated, using a national adult 

population survey of media usage 

in 2002–03, that smokers tend to be 

heavier users of television and radio 

than nonsmokers but are less likely to be 

magazine or newspaper readers. In this 

study, nearly one-third of smokers were 

regular daytime or late-night television 

viewers. Television is the medium for 

achieving the greatest exposure among 

smokers or potential smokers (youth). 

Although the cost per thousand people 

reached (in terms of size of intended 

target audience that could be exposed) via 

television generally is lower than that in 

other media, its cost, in absolute terms, 

is the highest.26 When sufficient funds are 

not available for television advertisements, 

other channels can be used. 

Most of the literature on antitobacco 

media campaigns has focused on television 

advertisements. Therefore, much of 

the following discussion addresses this 

particular channel. Despite the relatively 

good population reach to smokers offered 

by radio25 and the low cost of producing 

and airing radio ads, there has been little 

published research on the impact of 

advertising using this medium. However, 

tobacco control efforts have used other 

forms of media to involve individuals 

in tobacco control activities in their 

communities, through short-term cessation 

events, media-based cessation contests, 

and media advocacy.

Media-Based, Short-Term 

Cessation Events

Around the globe, several major media 

events of varying duration promote tobacco 

control and prevention. These events 

encourage tobacco users, especially those 

who already are interested in quitting, 

to discontinue or decrease their use for a 

short time. The events’ objectives are to 

(1) increase smokers’ confidence about 

their ability to quit their tobacco use 

permanently after a short-term success, 

(2) heighten awareness about the dangers 

of tobacco use among all audiences, and 

(3) promote policies that encourage a 

tobacco-free lifestyle.

One of the longest-running media events of 

this type is ACS’s Great American Smokeout, 

held annually on the third Thursday in 

November. The inspiration came from a 
442

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

1971 event that Arthur P. Mullaney had 

organized in Randolph, Massachusetts. 

Mullaney asked people to give up smoking 

for one day and donate the money they 

would have spent on tobacco to a high 

school scholarship fund. After statewide 

smokeout days proved successful in 

Minnesota (1974) and California (1976), 

the event became national in 1977.27

The smokeout initiative continued to 

expand over the years. In 1996, ACS 

increased its visibility considerably by 

including paid advertisements on television 

and in magazines and newspapers. 

Population survey results show that the 

number of respondents participating 

in the event (trying either to quit or to 

reduce smoking) increased from 18% 

the previous year to 26%. Also, sales of 

over-the-counter nicotine medications 

increased 11% between a four-week baseline 

period and the four-week promotion period 

surrounding the event.28

Over the years, the smokeout initiative 

has focused on a variety of issues and 

audiences—for example, teenagers, 

blue-collar populations, and minorities29,30

Local organizers—who also coordinate 

media coverage and distribute smokeout 

kits throughout their communities—

often create specific themes. Participation 

remains reasonably high, with an estimated 

19% of the nation’s smokers taking part 

in the 2002 smokeout and 6% of those 

smokers still refraining from smoking 

1 to 5 days after the event.31

The United Kingdom has reported success 

with a similar event called No Smoking 

Day, held by a charity of the same name 

based in London. The event began in 1984 

and is held annually in March.32 Organizers 

redesign the campaign and its slogans 

each year. However, the objective remains 

constant: help smokers who already have 

decided to quit to reach their goal. The 

group reports that almost 1.5 million 

smokers have participated in the event 

each year and the campaign has helped 

1.4 million smokers to quit smoking 

completely.33

A third daylong antitobacco event is World 

No Tobacco Day, held each year on May 31. 

The World Health Organization (WHO) 

sponsors the event and invites all countries 

to recruit smokers who will give up 

tobacco for the day. Local organizers often 

develop activities that focus on promoting 

support of tobacco cessation services and 

specific themes chosen each year,34 such 

as “Second-Hand Smoke Kills—Let’s Clear 

the Air” in 2001, “Tobacco Free Sports—

Play it Clean” in 2002, and “Tobacco Free 

Film, Tobacco Free Fashion” in 2003.35–37

The campaign appears to have been 

relatively successful in recruiting smokers 

to participate. In 1999, the Coalition for 

World No Tobacco Day reported, “30 percent 

of tobacco users who were aware of World 

No Tobacco Day tried to reduce their habit, 

including 9 percent who tried to quit 

smoking.”38(p.15) 

Media-Based Cessation 

Contests

Stop-smoking days offer tobacco users a 

supportive atmosphere in which they are 

surrounded by others with the shared goal 

of quitting tobacco use. Stop-smoking 

contests offer a similar support structure 

along with additional incentives, such 

as cash prizes or free travel packages. 

These “quit and win” contests typically span 

several weeks. They were pioneered in the 

United States in the 1980s and later were 

incorporated into broader cardiovascular 

health programs, such as the Minnesota 

Heart Health Program and the North Karelia 

Project in Finland.39,40

North Karelia’s first contest was held in 

1985. It blossomed into a national contest 

in 1986, and Estonia joined in for a second 
443

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

national contest in 1989.40 WHO coordinated 

the first International Quit and Win 

Campaign in 1994 within its Countrywide 

Integrated Noncommunicable Disease 

Intervention framework. The event has 

since been held nearly every other year. 

A total of 63,000 smokers from 13 countries 

participated in 1994.41 The number of 

participants has continued to rise, reaching 

700,000 in 2002. Organizers expected up to 

1 million tobacco users from 100 countries 

to participate in the 2004 contest.42

Any adults who have used tobacco products 

for at least one year are eligible to take 

part in the International Quit and Win 

Campaign. Participants attempt to quit 

smoking (and/or quit using other forms of 

tobacco) for four weeks (May 2 to May 29) 

leading up to World No Tobacco Day. 

Some of the contests also have included 

supporters’ contests, in which nonusers 

continue to abstain from tobacco use and 

work to promote the cause and spread 

information.40 National and local organizers 

are responsible for implementing the 

contest and its activities and for seeking 

media coverage.42 Winners are drawn after 

one month has passed, and two witnesses 

and laboratory tests verify their abstinence.41

Chapter 12 in this monograph discusses 

attempts to evaluate the effectiveness of 

these events.

Media Activism

Media activism includes strategies that 

directly oppose tobacco industry messages 

and advertisements, often through humor 

and parody. Many of these activities can be 

considered a form of media literacy, which 

is discussed in chapter 10.

In 1977, Alan Blum founded Doctors Ought 

to Care (DOC). This group was a pioneer 

in developing counteradvertisements that 

parody tobacco industry advertising and 

its products, images, brand names, and 

corporate messages.43–45

Another form of media activism is 

demonstrating against a live event sponsored 

by tobacco companies or tobacco products. 

Well-known examples include the many 

demonstrations sponsored by DOC and other 

groups at Virginia Slims tennis tournaments 

and other cigarette-sponsored events.46–48

A particularly noteworthy example was 

the use of the “Statue of Nicotina” by the 

Washington State chapter of DOC to oppose 

the Philip Morris “Bill of Rights” tour 

throughout the fall of 1989.49 These activities 

have often earned free media coverage 

through news stories (chapter 9 in this 

monograph discusses “earned media”).

Groups such as DOC have demonstrated 

the use of nontraditional media in their 

campaigns. For example, in the late 1970s, 

DOC purchased $3,000 worth of bus-bench 

advertisements in Miami, Florida (less than 

$25 per month per bench). The benches 

often were located alongside billboards 

promoting cigarettes. One bus-bench 

advertisement welcomed passersby to the 

taste of “country fresh arsenic.” Others 

featured slogans such as “full bodied cyanide” 

and “ten year supply only $7,000.” In a 1988 

regatta off the coast of Corpus Christi, Texas, 

DOC sponsored a sailboat “flying the largest 

no smoking symbol known to exist.”50

Children and adolescents, often as part 

of school competitions, also can create 

DOC-sponsored bus bench advertisement for CountryFresh Arsenic
444

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

antitobacco advertisements.51,52 An early 

example is the winning entry in a DOC 

competition among schoolchildren in 

Iowa that was published in the Medical 

Journal of Australia in 1983.53 Booklets 

containing artwork from these types 

of competitions have been published 

by Smokefree Educational Services in 

1991,54 the Washington State chapter of 

DOC in 1995,55 and the Wayne County 

(Michigan) Medical Society Foundation 

in 2003.56 The American Academy of 

Family Physicians Tar Wars program57

combines a national antitobacco advertising 

poster contest with a school educational 

program targeting students in grades 4 

and 5.58

Occasionally, media outlets have donated 

free space for counteradvertisements, 

particularly those developed by youth. 

Viacom Outdoor donated space on 60 small 

billboards (30-sheet panels) for the display 

of award-winning artwork from the 

Wayne County Medical Society Foundation’s 

counteradvertising contest held in 

2002 among several schools in the Detroit, 

Michigan, area.52

Smokefree Educational Services sponsored 

“ad-spoof” contests and attempted to 

purchase space on New York City’s subway 

trains for its award-winning artwork. 

A 12-year-old girl designed the winning 

poster in the 1989 contest. The poster 

showed a skeletal cowboy riding through 

a graveyard beneath the heading, “Come 

to where the Cancer is,” as a parody of 

a well-known Marlboro advertisement 

(“Come to Where the Flavor Is”). Gannett 

Transit initially rejected the advertisement 

on the grounds that the line drawing 

style used in the “Come to where the 

Cancer is” poster was “graffiti prone.” 

After the New York City commissioner of 

consumer affairs urged the Metropolitan 

Transportation Authority to reverse 

Gannett’s decision, Gannett agreed to run 

the advertisement on all 6,000 subway 

cars during November of 1990.59–61

In April 1990, R.J. Reynolds test-marketed 

the Dakota cigarette brand, aimed at young 

blue-collar women.49 An advertisement for 

Dakota appeared in newspapers in Houston 

(one of the test-market sites), asking 

readers to choose between Dakota and 

Media Activism: Taking Aim at Tobacco Advertising

Artist Bonny Vierthaler at the BADvertising Institutea

 has produced more than 70 advertisements 

by, according to her Web site, “doctoring-up tobacco ads to make them honest.” The Web site 

continues, “By juxtaposing silly, gross and disgusting images on top of deceitful ads, we jolt 

people into realizing how tobacco ads are concealing the truth about smoking.” For example, 

her version of an advertisement for a “new crush-proof box” for Merit cigarettes features a large 

wooden casket.b

Some advocacy groups and individual activists have taken this form of advertising further by 

using civil disobedience. The Australian group Billboard Utilising Graffitists Against Unhealthy 

Promotions (BUGA UP) spray-painted graffiti on tobacco billboards, often attempting to change 

advertising slogans to antitobacco messages. Thus, “Marlboro” became “it’s a bore,” and “Gold 

[cigarettes] is the perfect mixer” became “Cancer is the perfect fixer.” Similar graffiti activities 

followed in the United Kingdom, the United States, and Canada.c

a

BADvertising Web site. http://www.badvertising.org.

b

American Medical News. 1986. Spoofing the “Joy of Smoking.” December 5, pp 1, 29.

c

Chapman, S. 1996. Civil disobedience and tobacco control: The case of BUGA UP. Tobacco Control 5(3): 

179–85. http://tc.bmjjournals.com/cgi/reprint/5/3/179.pdf.
445

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Philip Morris’s Marlboro cigarettes. DOC 

produced a parody offering a choice between 

Dakota tumors and “Barfboro” radiation 

treatments, underlined by the slogan, 

“Dakota, DaCough, DaCancer, DaCoffin.” 

Major daily newspapers in Houston rejected 

the DOC counteradvertisement. However, 

an alternative newspaper accepted it and 

lost its R.J. Reynolds advertising as a result.62

The Smoke Free Movies63 project at the 

University of California at San Francisco 

has placed more than 20 advertisements 

in the New York Times and Variety

(a movie industry trade publication), 

attacking smoking in the movies. The 

sixth and seventh advertisements in the 

series criticized the movie In the Bedroom

and its lead actress, Sissy Spacek, for 

“gratuitously promoting Marlboro brand 

cigarettes on screen and in dialogue.” 

The New York Times published the 

paid advertisements in January and 

February of 2002, but Variety and the 

Hollywood Reporter rejected them,64,65

possibly related to nominations of In 

the Bedroom for five Academy Awards 

(including Best Picture) and the upcoming 

74th Annual Academy Awards ceremony, 

scheduled for March 24, 2002.

One study assessed the comparative effect 

on smoking-related attitudes of a workshop 

for junior high school students involving 

discussion and analysis of cigarette and 

antitobacco ads and a production workshop 

in which students discussed, analyzed, 

and then created their own antitobacco 

advertisements. Results showed overall 

support for the production workshop 

in eliciting more attention and positive 

perceptions of antitobacco messages as 

well as a reduction in positive attitudes 

about smoking, compared with the analysis 

workshop.66 Aside from this study, there 

have been no empirical studies on the 

impact of this kind of media activism 

and related informal advertising on 

individual attitudes and behavior, tobacco 

industry activity, and media coverage. 

Chapter 12 provides more details about 

the impact of this style of advertising, 

as used in formal televised antitobacco 

advertising for some state tobacco control 

programs and Legacy.

Televised Antitobacco 

Advertisements

Broadcast antitobacco campaigns have 

been a central component of many 

government- and foundation-sponsored 

tobacco control efforts. Mass media have 

the power to educate and inform the 

public and influence policymakers,49,67,68

and the CDC recommends that states and 

communities spend between $1 and $3 per 

capita on antitobacco advertising campaigns 

that include paid television advertising.14

Although the intensity of televised 

campaigns has varied, most major tobacco 

control programs have included them.

Public-Health-Sponsored 

Campaigns

Campaigns sponsored by public health 

agencies have varied in their target 

Smokefree Educational Services contest-winning poster 

displayed on New York City subway cars
446

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

audiences as well as their predominant 

themes and messages. This section 

provides examples that highlight these 

variations.

California—Changing Social Norms 

about Smoking

The California Tobacco Control Program, 

funded in 1989 by Proposition 99, was the 

first ongoing, comprehensive statewide 

tobacco control program in the United States. 

In California, the allocation of funding to 

antismoking advertising was approximately 

59¢ per capita (for the population age 

18 years or older), or 17% of total program 

expenditure, in the period 1989 to 1992–93.69

The allocation was 41¢ per capita, or 

20% of program expenditure, in the period 

1993–94 to 1995–96.

The California Tobacco Control Program’s 

overarching goal is to change social norms 

about tobacco use so that smoking no 

longer is viewed as a normal, acceptable 

practice.70 Rather than focusing on 

changing individual smokers, the mass 

media campaign is designed to engage the 

entire population, smokers and nonsmokers 

alike, and to change the environment. 

Messages focusing on secondhand smoke 

accounted for 44% of media spending in 

1997–98, anti-industry messages accounted 

for 34%, and cessation/prevention 

messages accounted for 20%.71

Reducing youth smoking initiation is 

another program goal. The designers 

believe the most effective way to achieve 

this goal is by targeting the older 

generation’s norms to change the social 

environment. The California media 

campaign is seen as an essential component 

of the statewide tobacco control program, 

lending support to local tobacco control 

interventions. The media campaign is 

designed to frame the issues and attract 

and sustain public attention.

Australia—Showing the Physical 

Damage of Smoking

In Australia, a national antismoking media 

campaign targeted toward adults aged 

18–39 years used fear-based messages 

graphically depicting the potential short-term 

consequences of smoking. The campaign, 

which began in 1997, presented these 

negative outcomes as certain, as opposed 

to probable, consequences of smoking.72,73

With the tag line, “Every cigarette is doing 

you damage,” the campaign was specifically 

designed to increase a smoker’s sense of 

urgency about giving up cigarettes. It tried 

to connect the mundane rituals of lighting a 

cigarette and inhaling the smoke to images 

of damage to the smoker’s internal organs. 

Six of the seven advertisements produced 

since 1997 graphically portray health damage 

to evoke a strong visceral response of disgust 

in the viewer. For example, the advertisement 

Stroke depicts a smoker’s brain being cut in 

half to reveal blood oozing from a clot, and 

Eye shows a smoker’s retina with bursting 

blood vessels leading to blindness.74 In the 

first three years of the campaign, four of 

these types of advertisements were created, 

portraying the incremental development 

of emphysema, atherosclerosis, genetic 

damage leading to cancer, and stroke. Two 

advertisements depicting smoking as causing 

incremental damage leading to blindness 

in one case and chronic lung disease in 

another were added in the fourth year of the 

campaign. One of the advertisements used 

a different approach. Call showed a smoker 

picking up a telephone, calling a quitline, and 

a counselor responding to the call. Evaluation 

studies from this campaign are discussed in 

chapter 12.

Kansas—Making Smokers into 

“Heroes”

Between 1997 and 2000, the Kansas 

Health Foundation sponsored a media 
447

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

campaign titled, “Take it Outside.” 

It featured television, radio, and print 

advertisements that focused on the harm 

to children from exposure to secondhand 

smoke. The program designers’ formative 

research suggested smokers’ homes and 

cars were their last refuges for smoking 

and challenging their right to smoke in 

those places would be met with hostility. 

The research also convinced program 

designers that smokers rejected the 

“more hard-line ‘scare’ tactics of existing 

media campaigns.”75(p.36) Their approach 

was to depict people who smoked outside 

and away from children as “heroes.”75

The stark black-and-white advertisements 

were intended to evoke a sense of family 

obligation for smokers to protect their 

children.20 In one, an older adolescent 

with his baby brother on his lap speaks to 

the camera while telling his parents that 

as a child he was unable to avoid their 

secondhand smoke and that while he now 

can leave to escape it, his baby brother 

cannot. He asks them, “Please, if you have 

to smoke, take it outside.”

Florida and the American Legacy 

Foundation—Questioning Tobacco 

Industry Positions

A settlement between the state of Florida 

and tobacco companies provided funding 

for the Florida Tobacco Pilot Program.76

Targeting youth aged 12–17 years, the 

program used an anti-industry approach 

in attempting to reduce tobacco use. 

This campaign’s strategy was to market 

a youth brand called “Truth” as the 

counterpoint to the “lies” marketed by 

tobacco companies. The campaign designers 

rejected the heavy “life or death” tone of 

other antitobacco campaigns. They claimed 

that social marketing approaches used 

in other states were having little impact, 

and the campaign needed to provide a 

brand that would give youth a way to 

identify themselves.77

Campaign designers’ research with youth 

led them to believe that the deadly nature 

of cigarettes made them appealing to 

youth as a tool of rebellion. The designers 

decided that the best way to counter 

that appeal was to make the tobacco 

industry’s duplicity and manipulation a 

target for adolescent rebellion. Television 

advertisements created for this campaign 

portray industry executives as unconcerned 

in response to information about the 

negative health effects of cigarettes. Other 

advertisements use youth actors to convey 

the notion that cigarettes are addictive. 

Evaluation findings from the Florida 

campaign are discussed in chapter 12.

Legacy’s “truth” campaign was modeled 

after the Florida campaign. Launched in 

2000 with more than $100 million per year 

for media, the Legacy “truth” campaign was 

a national landmark event in the history 

of tobacco counteradvertising.78 It focused 

specifically on youth aged 12–17 years 

who were susceptible to smoking.79 Legacy 

has run a variety of advertising themes, 

most focusing on the tobacco industry’s 

misleading and cynical practices.

The “Body Bags” series began with an 

advertisement showing young people 

jumping out of a truck and piling body 

bags on the sidewalk outside of what was 

labeled a “major tobacco company.” Using 

a megaphone to reach the workers in 

the building, a youth says, “This is what 

1,200 dead people looks like.” Another series 

(“1 out of 3”) used fantasized scenes such 

as an exploding soda can to convey the 

message that tobacco is the only product 

that results in the premature death of one 

out of three people who use it. Shifting 

to a testimonial approach, a later series 

(“Follow the Dots”) featured young people 

speaking in emotional segments about loved 

ones they have lost purportedly because 

of smoking. Evaluation studies from the 

Legacy media campaign are presented in 

chapter 12.
448

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

Virginia—Making Smoking Look 

“Stupid”

In 2002, Virginia launched a youth-focused 

campaign designed to empower the 

youth of the state to “choose not to use 

tobacco products.” The campaign included 

television, radio, and print advertisements 

as well as a Web site.80 The campaign 

used a core tag line, “Can anybody tell us 

why smoking isn’t stupid?” Many of the 

advertisements featured the humorous 

character “Buttman,” described as 

“America’s most pathetic superhero.”81

The character was shown to be incompetent 

in social situations because of his smoking. 

Another series showed young actors engaged 

in gross or dangerous behavior, such as 

licking garbage cans or climbing a pole in 

a thunderstorm, the stupidity of which was 

equated with smoking.

Advertisements for Commercial 

Products

Advertisements for NRT products and 

other pharmaceutical aids to tobacco use 

cessation have been a feature on television 

since 1992.82 The intensity of this marketing 

increased exponentially, from $13 million to 

$220 million in 1996, when the U.S. Food and 

Drug Administration (FDA) approved nicotine 

replacement products for over-the-counter 

sale.83 The following year, the FDA relaxed 

rules governing direct-to-consumer 

advertising of prescription drugs, prompting 

a major increase in television advertising 

for bupropion. These advertisements tended 

to describe the benefits of one medication 

in contrast to another and suggested that 

the product can be a great help in achieving 

cessation. Unlike most government-sponsored 

advertisements, these advertisements have 

so far narrowly targeted smokers who 

are ready to take action to quit smoking. 

Analyses have shown that advertising for NRT 

patches increases sales of those products, 

but advertising for nicotine gum does not.84

Pharmaceutical advertisements on television 

may be designed to encourage uptake of 

pharmaceutical smoking cessation products 

among adult smokers who are ready to 

quit. However, televised advertisements 

can reach all television viewers (table 11.1), 

including nonsmokers and smokers not 

ready to quit. Bolton and colleagues85

demonstrated experimentally that compared 

with participants exposed to information on 

techniques of unaided quitting, participants 

exposed to information about the features 

and benefits of NRT indicated that they 

considered smoking significantly less risky 

and reported lower intentions to quit. They 

concluded that among adult smokers who 

are not ready to quit, implying that these 

products offer an “escape from danger” may 

lead smokers to defer quit attempts and 

lower their perceptions of smoking risks.85

Others have suggested that these types of 

advertisements could encourage smoking 

among adolescents by inadvertently 

conveying the message that quitting can be 

easy if these products are used.82 This is a 

concern because optimism about quitting 

is a predictor of smoking experimentation 

and progression to heavier smoking among 

youth.86 However, two experimental studies 

exposing youth to combinations of NRT, 

bupropion, quitline, and tobacco control 

advertisements have found limited support 

for adverse effects of the advertisements.82,87

Population-based research on this 

little-explored subject seems important 

for adults and youth, especially because 

advertising for pharmaceutical smoking 

cessation products is the leading source of 

tobacco-related advertising exposures on 

television (table 11.1).

Tobacco-Industry-Sponsored 

Antitobacco Advertisements

Tobacco companies in the United States 

have launched their own antismoking mass 

media campaigns in response to increasing 
449

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

documentary evidence and consequent 

growing liability that tobacco companies 

marketed their products to youth and 

misled consumers and the general public 

about the health risks of tobacco use.88

One of Philip Morris’s campaigns had an 

annual budget of $100 million before it was 

withdrawn in the United States in January 

2003. Its slogan was, “Think. Don’t Smoke.” 

These advertisements were targeted to youth 

between 10 and 14 years of age.89 The first 

group of these advertisements featured 

an off-camera adult asking teenagers in 

various locations whether they smoked 

cigarettes. All of the adolescents interviewed 

were nonsmokers who responded that they 

did not need to smoke to be cool. Later 

executions showed young actors involved 

in popular activities such as karate and 

skateboarding, demonstrating that they were 

better off for not smoking.

In July 1999, Philip Morris launched 

a campaign emphasizing parental 

responsibility for talking to children about 

smoking, with the slogan, “Talk. They’ll 

Listen.”90 In one of these advertisements, a 

teenager was shown being reminded by her 

father not to smoke before she went out for 

the evening and then refusing an offer of 

cigarettes during the course of her evening 

out. In October 1999, Lorillard also launched 

a youth smoking prevention campaign with 

the slogan “Tobacco Is Whacko if You’re a 

Teen.”91 Its budget was around $13 million.16

Research pertaining to the effectiveness of 

these campaigns is presented and discussed 

in chapters 6 and 12.

Relative Performance of 

Televised Antitobacco 

Advertising Approaches

Paid television advertisements tend to be the 

most costly component of comprehensive 

tobacco control programs. Therefore, it is 

imperative for program designers to make 

evidence-based and cost-effectiveness 

decisions about the design of advertisements 

for particular audiences (i.e., what themes 

and execution styles are likely to be most 

effective for which target groups). A first 

step toward answering these questions is to 

examine some useful parameters on which 

advertisements can differ. The marketing 

literature conceptualizes the characteristics 

of advertisements in terms of the message 

strategy (i.e., what is said) and the execution 

strategy (i.e., how it is said)26 or, similarly, the 

informational content, emotional content, 

and format.92 Table 11.5 presents a relatively 

simplified scheme for characterizing message 

and execution strategies incorporating the 

major factors seen in the research.

Establishing an empirical basis for choosing 

among these characteristics is difficult. It is 

challenging to establish how one specific 

audience (e.g., young teenagers susceptible 

to smoking) responds to variations in 

advertisement parameters, let alone to 

determine how these parameters might 

interact with each other and with audience 

characteristics to affect individual responses. 

Controlled experiments could investigate 

these questions, and some of this work is 

reported below. However, when individuals 

are asked to view an advertisement to rate 

its characteristics, the manner in which 

they respond to the advertisement is likely 

to be different than if they were to view the 

advertisement in a natural setting.93 Perhaps 

the ideal is to search for consistencies in 

findings across multiple studies. This section 

reviews research that compares audience 

response to antitobacco advertisements that 

vary along one or more of the characteristics 

listed in table 11.5. Table 11.6 summarizes 

these audience response studies.

Studies Using Controlled 

Exposure

Several studies have evaluated responses 

of youthful audiences to antitobacco 
450

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

advertisements in forced-exposure 

situations. In the first published study of 

this type, Goldman and Glantz94 reviewed 

reports of 186 focus groups, containing 

more than 1,500 youth and adults, that had 

been conducted by advertising agencies as 

part of pretesting of some 118 broadcast 

antitobacco advertisements or advertising 

concepts. The authors concluded that 

advertisements portraying tobacco industry 

manipulation or featuring the health effects 

of secondhand smoke were the “most 

effective,” ads featuring addiction and 

cessation messages were “average,” and ads 

concerned with limiting youth access to 

tobacco, short- or long-term health effects of 

smoking, and teens rejecting tobacco were 

“not effective.” This study was criticized for 

failing to provide transparent criteria for 

what was described as “effectiveness.”95,96

In later studies, groups first viewed 

individual advertisements and then rated 

them on a variety of scales that measure 

some aspect of response thought to bring 

the target audience closer to not smoking. 

A well-cited, but unpublished, study involved 

20 focus groups of 7th to 10th graders in 

Arizona, California, and Massachusetts in 

early 1999. The study sought to assess the 

extent to which a series of 10 antismoking 

advertisements made them “stop and think” 

about smoking.97 Advertisements were 

shown, and group members made individual 

ratings of the advertisements and discussed 

them as a group.

Findings from the three states in this study 

were quite consistent. Advertisements that 

graphically, dramatically, and emotionally 

portrayed serious negative consequences 

of smoking received the highest ratings by 

respondents. These types of advertisements, 

which tell stories about real people, 

were very compelling to respondents. 

Advertisements using industry manipulation 

Table 11.5 Characterizations of Antitobacco Advertisements’ Content and Style

Informational Content

Consequences of smoking and quitting: negative health, psychological, and social consequences to smoker 

of smoking; negative health consequences to others of secondhand tobacco smoke; benefits to smoker of quitting 

smoking; benefits to others of quitting smoking

Advice and tips for quitting: coping techniques; motivational techniques; sources of help (quitlines, health care 

providers); support and encouragement; pharmaceutical aids

Anti-industry information: chemical content of cigarettes; deceptive marketing (light cigarettes); predatory 

marketing (targeting youth, women, minorities, the poor)

Emotional Content

Level of emotion evoked: high to low

Valence of emotion evoked: positive emotions: pride, joy, happiness, hope, amusement/humor, love, devotion; 

negative emotions: fear, sadness, loss, anger, disgust

Format or Stylea

Testimonial or endorsement: real people discussing their experiences with smoking

Scientific evidence: statistics or research results sometimes presented by experts

Graphic image: a visual graphic depiction of the health consequences of smoking

Fantasy: use of unrealistic characters or situations

Slice of life or lifestyle: staged scenes with actors portraying consequences of smoking or benefits of not smoking 

or quitting

a

Adapted from Kotler, P., N. Roberto, and N. Lee. 2002. Social marketing: Improving the quality of life. 2nd ed. Thousand Oaks, CA: Sage.
451

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 11.6 Studies Examining the Relative Performance of Different Advertising Messages

Study Advertisement comparisons Target group Study design Main outcomes

Goldman and Glantz 199894 118 antitobacco ads aired in the 

United States and additional ad concepts that were not progressed to advertisements

Youth who did and did not smoke and adult smokers

Review of 186 focus groups of over 1,500 youth and adults conducted by advertising agencies as part of concept testing and qualitative advertising evaluation 

Ads featuring anti-industry and 

secondhand smoke messages were deemed “the most effective.” Ads concerned with limiting youth access to tobacco, short- or long-term health effects, and romantic rejection of smoking by youth were concluded to be not “effective.” 

Teenage Research Unlimited 199997

10 state-funded antitobacco advertisements

7th to 10th graders in AZ, CA, and MA who were “at risk” of using tobacco because they indicated an intention to try smoking in the next year, had some to most of their family or close friends who were smokers, or held particular beliefs indicating a likely disposition to use tobacco

Controlled exposure: participants in 20 focus groups viewed each of 10 antitobacco advertisements in early 1999, made ratings of each, and discussed them as a group.

Advertisements that graphically, dramatically, and emotionally portrayed the serious negative consequences of smoking were rated highest. Advertisements using an industry manipulation theme were only rated high in terms of “stop and think” value by respondents in groups in CA. Advertisements with a theme emphasizing that teens need to make a choice about whether or not to smoke had the lowest ratings.

Murphy 200098 10 state-funded antitobacco 

advertisements and 1 CDC advertisement

11–18-year-olds in Utah, with a mix of smokers and nonsmokers

8 focus groups viewed each of 11 ads, made ratings of each, and discussed them as a group.

Both smokers and nonsmokers indicated that the ads communicating real-life experiences about the harm of tobacco were more thought provoking and more likely to change their smoking intentions. An ad featuring a cartoon character talking about quitting was perceived as least effective. 
452

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l Table 11.6 Studies Examining the Relative Performance of Different Advertising Messages (continued) Study Advertisement comparisons Target group Study design Main outcomes Pechmann et al. 2003102 The 7 antitobacco advertisement themes were disease and death, endangers others, cosmetic effects, smokers’ negative life circumstances, refusal skills role model, marketing tactics, and selling disease and death. 8 advertisements had each of these themes, 56 advertisements in total. 1,667 7th and 10th graders Controlled exposure: youths were randomly assigned to view 1 message type, after which they were asked about feelings and thoughts in relation to the advertisements, attitudes toward smoking, and intention to smoke. Advertisements featuring 3 themes (endangers others [smoke and smoking hurts family members], smokers’ negative life circumstance [smokers are “uncool,” unwise, and misguided], and refusal skills role model [nonsmokers are popular and respected]) reduced intentions to smoke. Youth Smoking and the Media – U.S. study— Terry-McElrath et al. 2005;99 Wakefield et al. 2003;100 Wakefield et al. 2005101 Pharmaceutical advertisements, tobacco company youth smoking prevention advertisements, tobacco control advertisements, and within tobacco control advertisements: 8 message themes, 2 executional styles, and target group of advertisements (youth vs. general audience) 268 8th-, 10th-, and 12th-grade susceptible nonsmokers or experimenters in Boston, MA, and Chicago, IL; the study was replicated in Australia and Britain for a total of 615 8th-, 10th-, and 12th-grade susceptible nonsmokers or experimenters in U.S., Australia, and Britain. Controlled exposure: youth completed immediate ratings after viewing each of 10 advertisements in late 2000/early 2001, selected highest “stop and think” advertisement at end of session; 

1-week telephone follow-up to establish recall and discussion about advertisements. 

Compared with tobacco control advertisements, tobacco company advertisements are more likely to elicit positive emotions and be of less interest to youth. Pharmaceutical advertisements were less likely to cognitively engage youth in the session or be thought about or discussed at follow-up. Tobacco control advertisements with personal testimonial or visceral negative characteristics achieved greater appraisal, recall, and discussion at follow-up. After accounting for executional characteristics, advertisement target audience and theme were unrelated to outcome measures. Youth in the 3 countries responded in similar ways to the same advertisements.
453

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 11.6 Studies Examining the Relative Performance of Different Advertising Messages (continued)

Study Advertisement comparisons Target group Study design Main outcomes

Biener et al. 2000103 9 MA advertisements that 

featured negative consequences of smoking, positive consequences of quitting, or advice about quitting. Advertisements also varied in level of emotional arousal and whether the tone was negative (sad or frightening), positive (funny and entertaining), or neutral.

1,544 MA adults who completed a telephone survey in 1993 and 1996

Naturalistic exposure: in the 1996 survey, interviewers briefly described each advertisement and asked if respondents recalled seeing it; if so, respondents rated each one on a scale of 0–10 indicating how good an antitobacco advertisement it was perceived to be.

Sad/frightening advertisements, which were highly emotional and dealt with the serious health consequences of tobacco use, scored significantly higher on perceived effectiveness than did funny or neutral advertisements for all respondents.

Biener 2002104 The most prominent antitobacco 

advertisements broadcast by the Massachusetts Tobacco Control Program and those produced by Philip Morris. 4 categories: illness, outrage, other MA, and Philip Morris

733 youth 14–17 years of age Naturalistic exposure: youth were 

asked in telephone survey whether they had seen any antitobacco advertisements on television in the previous month. If so, they were asked to describe one in detail and to rate its effectiveness on a 10-point scale.

Advertisements featuring serious consequences of smoking were seen as significantly more effective by youth than MA advertisements that did not discuss illness and Philip Morris “Think. Don’t Smoke.” advertisements.

Farrelly et al. 200279 American Legacy Foundation 

“truth” advertisements featuring industry manipulation messages compared with Philip Morris youth smoking prevention advertisements asking youth to “Think. Don’t Smoke.”

6,897 12–17-year-olds in baseline survey and 6,233 in postlaunch survey

Naturalistic exposure: nationally representative cross-sectional telephone surveys prior to campaign launch and 10 months after launch; measures were confirmed of recall, smoking attitudes and beliefs, and intention to smoke in the next year.

Exposure to “truth” advertisements was associated with an increase in antitobacco attitudes and beliefs; those exposed to Philip Morris advertisements were not. Those exposed to Philip Morris advertisements were more likely to be open to smoking.

Donovan et al. 200374 5 advertisements graphically 

featured the serious health effects of smoking; 1 advertisement encouraged smokers to call a quitline.

9,033 18–40-year-old smokers and 

recent quitters in Australia

Naturalistic exposure: repeated cross-sectional telephone surveys over a total of 43 weeks of 3 phases of a campaign in 1997–99. Respondents were asked about confirmed advertisement recall and recognition. 

Advertisements with clear figure-ground executional formats were more memorable than those without. Advertisements illustrating the serious health effects of smoking had higher memorability than those encouraging calls to a quitline.
454

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l Table 11.6 Studies Examining the Relative Performance of Different Advertising Messages (continued) Study Advertisement comparisons Target group Study design Main outcomes Biener et al. 2004105 MA advertisements broadcast over the period leading up to 1997: 4 advertisements featured serious illness, 2 advertisements used humor, 2 advertisements were about normative behavior. 618 MA youth aged 12–15 years Naturalistic exposure: cohort study surveyed youth by telephone in 1993 and 1997, which determined confirmed advertisement recall and perceived effectiveness using a scale from 0 to 10. Youth were more likely to recall and perceive as effective advertisements featuring messages about serious health consequences that had been independently rated as high in negative emotion, compared with advertisements featuring messages about normative behavior or advertisements relying on humor. Pechmann and Reibling 2006106 8 types of advertisements including serious health effects of smoking (disease and suffering, dying parent, secondhand smoke); tobacco industry manipulation (activism and marketing tactics); and social themes (acceptance, cosmetic) 1,725 9th graders in CA Controlled exposure: youths were randomly assigned to view a television program in which particular themed advertisements or control advertisements were embedded in 2002. At baseline, personality traits were measured, and after exposure, students were asked about smoking intentions, feelings and beliefs, and advertisement appraisal. Advertisements focusing on young victims suffering from serious smoking-related disease elicited disgust, enhanced anti-industry motivation, and reduced intentions to smoke, but counterindustry and tobacco company youth smoking prevention advertisements did not. Youth with conduct disorders were not influenced by any advertisements’ themes.
455

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

as a theme were rated high in terms of 

“stop and think” value only by groups 

in California, where this approach was a 

familiar one. Respondents in the other 

states often misunderstood the anti-industry 

message that the advertisements attempted 

to communicate. Finally, advertisements 

with a theme emphasizing that teenagers 

need to make a choice about whether or 

not to smoke had the lowest ratings. These 

results imply that advertising campaigns that 

use teenager-choice approaches exclusively, 

such as Philip Morris’s youth smoking 

prevention campaign and the Virginia 

“Ydouthink.com” campaign, are likely to be 

relatively ineffective in motivating youth to 

stop and think about smoking. This may be 

because these advertisements fail to change 

broader population-wide social norms 

relating to tobacco use.107

Murphy98 reported on eight focus groups 

of 11- to 18-year-olds in Utah, where 

participants viewed and discussed ads made 

by other state tobacco control programs. 

Both smoking and nonsmoking youth 

indicated that ads about real life experiences 

were more thought provoking and more 

likely to change their smoking intentions. 

The advertisements Janet Sackman (former 

Lucky Strike model shares her throat cancer 

story), Cowboy (Marlboro Man’s lung cancer 

story told by his brother), Pam Laffin

(26-year-old discusses her experience with 

emphysema), and Voicebox (Pam Laffin 

smokes through her stoma) were rated 

the highest on these attributes by youth in 

these groups.

Terry-McElrath and colleagues99 asked 

268 8th-, 10th-, and 12th-grade susceptible 

nonsmokers or experimental smokers 

(those who have experimented with smoking 

cigarettes) in Boston, Massachusetts, 

and Chicago, Illinois, to view a set of 

10 advertisements selected as representative 

of all advertisements produced between 

1997 and 2001 by tobacco control programs, 

tobacco companies, and pharmaceutical 

companies. Five different sets of 

advertisements were tested, totaling 

50 advertisements in all. After viewing each 

advertisement twice, the youths completed 

a rating form. The outcome measures 

included comprehension (open-ended 

responses to a query about the main point of 

the advertisement) and appraisal (an index 

of the perceived effectiveness of items).

A follow-up telephone call one week later 

was used to obtain the following additional 

outcome measures: recall (whether the 

advertisement was correctly described) and 

engagement (whether the youth reported 

having thought about and discussed the 

advertisement during the intervening week). 

Unlike immediate ratings of attributes 

of the ad, later ruminations about, or 

discussion of, an advertising message are 

evidence of further cognitive processing 

of the advertisement.108–111 The predictor 

variables included target audience (whether 

the advertisement was designed for a youth 

or an adult audience); theme (health effects, 

cessation, secondhand smoke, health 

benefits, industry manipulation, or smoking 

being “uncool”); format (use of either the 

testimonial technique or visceral negative 

imagery); and sponsor.

The pharmaceutical industry advertisements 

were rated as the least engaging, and at 

follow-up, were the least likely of the three 

sponsors to generate ad-related thoughts 

or discussion. The use of the personal 

testimonial and visceral negative formats 

had the strongest and most consistent 

relationships with high appraisal, and at 

follow-up, with greater recall and ad-related 

additional thoughts and discussion. When 

format was controlled in multivariate 

analyses, the message had no consistent 

effect on outcome. This was due to the 

correlation between format and message. 

Testimonial executions were used in 

advertisements addressing health effects, 

secondhand smoke, and industry activities, 

but not with the other themes.
456

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

Pechmann and colleagues102 reached 

a different conclusion. Their two-part 

study to categorize and rate different 

antismoking advertisements included 

almost 3,000 7th and 10th graders. Less 

than one-half of the youths (n = 1,129) 

grouped 194 antismoking advertisements 

into seven distinct message themes. The 

remainder (n = 1,667) were involved in 

a copy test of the advertisement types. 

The copy test used 8 randomly selected 

advertisements to represent each of the 

seven message themes—56 advertisements 

in total. Participants were randomly 

assigned to view just one message theme. 

They then were immediately asked about 

their feelings and thoughts in relation to the 

advertisements, attitudes toward smoking, 

and intention to smoke. The seven message 

themes were disease and death, endangers 

others, cosmetic effects, smokers’ negative 

life circumstances, refusal skills role 

model, marketing tactics, and selling 

disease and death.

LISREL analyses demonstrated that three 

of the seven message themes reduced 

reported intention to smoke: endangers 

others (smoke and smoking hurts 

family members); smokers’ negative life 

circumstances (smokers are “uncool,” 

unwise, and misguided); and refusal skills 

role model (nonsmokers are popular and 

respected). (LISREL is a structural equation 

modeling method for empirical assessment 

of scientific theories.) These message themes 

resonated with the participants by increasing 

perceptions that smoking entailed an 

increased risk of social rejection. On the 

basis of these findings, the investigators 

found antismoking advertisements that 

focus on negative social consequences of 

smoking more effective than those focusing 

on health effects. Even though health 

messages increased youths’ perception of 

the health risks of smoking, the messages 

did not increase their perceptions of 

vulnerability to those risks as protection 

motivation theory would require.112

A study by Pechmann and Reibling106

randomly exposed 1,725 9th-grade students 

in California schools to one of nine 

videotapes containing a television show 

embedded with antismoking or control 

advertisements. Advertisements focusing 

on young victims suffering from serious 

diseases caused by tobacco elicited disgust, 

enhanced anti-industry attitudes, and 

reduced intentions to smoke among all 

participating adolescents except those with 

conduct disorders. However, advertisements 

portraying tobacco company conduct and 

tobacco company youth smoking prevention 

advertisements did not significantly lower 

participants’ smoking intentions.

Studies Using Naturalistic 

Exposure

Several other studies have examined the 

relative performance of different types of 

antitobacco advertising by using data from 

segments of the target audience of the 

various campaigns. Farrelly and colleagues79

used telephone tracking surveys to examine 

the responses of youth and young adults to 

Legacy’s “truth” and Philip Morris’s “Think. 

Don’t Smoke” campaigns. The researchers 

associated confirmed recall of each 

campaign with antitobacco attitudes and 

openness to smoking. Recall of Legacy’s 

“truth” advertisements was more strongly 

associated with endorsement of antitobacco 

attitudes than was recall of “Think. Don’t 

Smoke” advertisements. Furthermore, 

respondents who recalled the “Think. Don’t 

Smoke” advertisements were more likely to 

be open to smoking than those who recalled 

the “truth” advertisements.

The Massachusetts Tobacco Control 

Program conducted a well-funded media 

campaign between 1993 and 2001. Over 

the course of eight years, the campaign 

addressed a variety of audiences (youth, 

adult smokers, and a general audience) 

and focused on different goals: increasing 
457

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

cessation, discouraging uptake, and 

promoting tobacco control policies.113–115

Population surveys conducted each year 

were designed to evaluate various aspects of 

response to the media campaign. In 1996, 

more than 1,500 adults who had previously 

been interviewed for the 1993 baseline 

study of smoking in Massachusetts were 

recontacted. They were surveyed about 

their reactions to nine Massachusetts 

advertisements that had been selected to 

vary in terms of the following messages: 

negative consequences of smoking, positive 

consequences of quitting, and advice about 

quitting. The advertisements also varied in 

the level of emotional arousal and whether 

the tone was negative (sad or frightening), 

positive (funny and entertaining), or 

neutral. Interviewers briefly described each 

advertisement to respondents and asked if 

they recalled seeing it. If respondents had 

recalled viewing advertisements, interviewers 

asked them to rate each one on a scale of 

0 to 10 indicating how good an antitobacco 

advertisement it was perceived to be.

The sad/frightening advertisements, which 

were highly emotional and addressed 

serious health consequences of tobacco use, 

scored significantly higher on perceived 

effectiveness than did both the humorous 

and neutral advertisements. Other analyses 

examined perceptions of the advertisements 

according to respondents’ smoking status 

category. Sad/frightening advertisements 

were rated as significantly more effective 

than either the humorous or neutral 

advertisements by all groups: smokers who 

quit during the campaign, smokers who 

continued smoking, and individuals who 

were nonsmokers at both baseline and 

follow-up.103

Other researchers105 conducted a similar 

study with a cohort of Massachusetts youth 

interviewed first in 1993 and again in 1997, 

with similar results. Respondents were more 

likely to recall and perceive as effective the 

advertisements featuring messages about 

serious health consequences that had been 

independently rated as high in emotional 

arousal and in negative emotion, compared 

with advertisements featuring messages 

about normative behavior for teenagers or 

advertisements relying on humor.

Another youth study used a slightly 

different approach. More than 700 teenagers 

between ages 14 and 17 years were asked 

in a telephone survey whether they had 

seen any antitobacco advertisements 

on television in the previous month. 

If they had, they were asked to describe 

one advertisement in detail and then to 

rate its effectiveness. The Massachusetts 

Tobacco Control Program and Philip Morris 

produced the most widely broadcast 

antitobacco advertisements in Massachusetts 

during the time covered by the survey. 

The advertisements described by respondents 

were grouped into four categories based 

on their sponsor and approach: illness, 

outrage, other Massachusetts-produced ads, 

and all Philip Morris ads. The illness and 

outrage categories included advertisements 

that both aroused negative emotion (fear, 

sadness, or anger) and presented serious 

health consequences of smoking. The 

“other Massachusetts” ads and Philip Morris 

categories included advertisements that 

did not discuss consequences in a serious 

manner. Instead, they focused on normative 

issues, such as smoking is not “cool,” 

smoking makes it hard to do well at sports, 

smoking sets a bad example for siblings, and 

such. In this study, youth saw advertisements 

featuring the serious consequences of 

smoking as significantly more effective than 

both the Massachusetts advertisements that 

did not discuss illness and the Philip Morris 

“Think. Don’t Smoke” advertisements.104

A limitation of the foregoing Massachusetts 

research is that the outcome measure 

was “perceived effectiveness.” It is unclear 

whether advertisements perceived to be 

effective also led to longer term changes in 

behavior and attitudes.
458

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

One study used a somewhat different 

approach but found similar results.116

A population-based sample of more than 

700 Massachusetts adults who had quit 

smoking in the prior two years was asked 

whether “any television commercial about 

tobacco contributed to [their] quitting 

smoking.”116(p.219) Those who responded 

affirmatively were asked to describe one 

such commercial. Their open-ended 

descriptions were coded into a number 

of generic themes. The rate of mentions 

of each theme was compared to its 

media weight.

Of those who had quit smoking in the prior 

two years, 32% reported being influenced 

by a television commercial. Of those 

who reported having been helped by a 

television commercial, 70% described an 

advertisement featuring an emotional or a 

graphic depiction of the harm done to the 

protagonist or a loved one by smoking. Only 

20% of the media weight of all mentioned 

advertisements was in this category. A mere 

7% described an emotional advertisement 

depicting a smoker’s resolve to quit for the 

sake of his or her child. Only 2% of the 

media weight was in this category. As few as 

5% described one of Legacy’s “Body Bags” 

advertisements, which earned only 2% of 

the total media weight. Only 1% of the 

individuals described a pharmaceutical 

advertisement although 58% of the total 

media weight was due to pharmaceutical 

advertisements. Although people are only 

partially aware of factors that influence their 

behavior, this study provides evidence that 

emotional advertisements about negative 

health consequences may be effective in 

promoting smoking cessation.

Summary of Studies of Relative 

Performance

Of 11 known studies that assessed responses 

of research participants to different types 

of advertisements, 9 yielded similar 

results. Among those 9, advertisements 

addressing serious harm resulting from 

tobacco use in an emotionally evocative 

way performed well. Advertisements 

that used humor—whether to make fun 

of teenagers who smoked, make fun of 

tobacco companies, or portray the health 

benefits of nonsmoking in an exaggerated 

way (e.g., a Massachusetts advertisement 

showing an infant performing gymnastics 

because of the healthy air in his home)—

performed relatively poorly. Philip Morris’s 

“Think. Don’t Smoke” advertisements also 

performed relatively poorly.

In looking at table 11.5, what can be said 

to media campaign designers about the 

optimal themes, emotional content, and 

formats for antitobacco advertisements? 

In practice, informational content, level of 

emotion, valence of emotion, and format 

tend to correlate. With regard to theme and 

valence of emotion, advertisements that 

portray negative health consequences of 

smoking—to smokers or to those around 

them—tend also to evoke negative emotions 

of fear, sadness, anger, disgust, or loss. 

Advertisements focusing on the benefits of 

quitting and those providing information or 

support for quitting tend to evoke positive 

emotions such as humor, pride, and hope. 

Advertisements that focus on the social 

consequences of smoking—both negative 

(e.g., peer disapproval, cosmetic effects) 

and positive (e.g., athletic achievement, 

peer acceptance)—also tend to evoke 

positive emotions. Advertisements that 

focus on anti-industry messages are more 

difficult to summarize. Some attempt to 

evoke anger and outrage by showing that 

tobacco companies are aware of the harms 

of tobacco, whereas others use parody to 

evoke humor.99,103,105

The valence of emotion evoked in 

advertisements tends to be correlated with 

the amount of emotion inspired, such that 

advertisements evoking negative emotions 

are rated as more “moving” or “powerful” 

than those inspiring positive emotions.103,105
459

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Furthermore, format and content tend 

to be related. Personal testimonials 

from “real people” (nonactors) are most 

often used to illustrate negative health 

consequences of smoking. Visceral imagery 

also is associated with health consequences. 

Humorous advertisements usually are 

staged with actors or use a fantasy approach. 

Consequently, it is unclear whether 

the relatively successful performance 

of advertisements focusing on negative 

health consequences of smoking through 

testimonials or visceral negative imagery 

is due to the theme, format, negative 

emotion, or level of emotion, or some 

combination of these factors.

Arousal, Negative Emotion, and 

Advertising Impact

In advertising theory, for an advertisement 

to be effective it must first be attended 

to, then decoded and understood, and 

ultimately acted upon.93,117 Following the 

work of Miller,118 Lang and colleagues119

maintain that viewers have a finite 

mental capacity for these activities. Those 

cognitive resources are distributed to a 

number of potential sources of incoming 

information in the environment. The 

viewer’s interests, motivations, and 

needs play a role in how those resources 

are allocated. However, Lang and other 

colleagues120,121 have demonstrated that 

automatic responses to the content and 

structural features of what is broadcast 

control these processes to some extent. 

These researchers conducted a series of 

experiments on the role of level of arousal 

and valence of emotion on attention to 

and memory for media messages. This 

research helps account for the consistent 

finding that antitobacco advertisements 

that perform well in immediate ratings and 

indicators of message processing evoke high 

levels of negative emotion using personal 

testimonials of loss and pain; include 

graphic shots of diseased bodily organs; 

or use other strategies that arouse anger, 

disgust, fear, or sadness.

By using physiological measures of 

attending to and processing information 

(i.e., reduced heart rate and slowed reaction 

time on a competing task), experimental 

studies have demonstrated that broadcast 

messages with negative emotional content 

elicit greater attention than those without 

such content.119,122 The researchers reiterate 

that negative messages usually are more 

arousing than positive ones and that 

arousing messages are remembered better 

than less arousing ones.119,121 When the 

arousal level of a message with positive 

emotional content could be raised to 

equal that of a message with negative 

emotional content, the positive messages 

were remembered better than the negative 

ones.121 If an antitobacco advertisement 

with positive emotional appeal could be 

constructed so that the level of emotion 

evoked was very high, it could perform as 

well as one with negative emotional appeal. 

The studies reviewed here, however, suggest 

that this is difficult to accomplish with 

antitobacco messages.

Some structural features of advertisements 

that tend to increase the extent to 

which they are perceived as arousing 

are independent of the informational or 

emotional content. These include pacing, 

use of loud music, and cuts or edits,120

which are linked to increased message 

sensation value.123 One study demonstrated 

that antitobacco advertisements with more 

features that enhance perceived message 

sensation value evoke higher levels of 

message processing.124 Future research 

should investigate whether these message 

characteristics can improve the impact of 

advertisements that use positive emotional 

appeals. Many organizations that resist 

sponsoring advertisements that arouse high 

levels of negative emotion would welcome 

this type of outcome. Administrators prefer 

to associate their agencies with positive 
460

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

uplifting messages rather than with those 

that emphasize the darker consequences 

of health-damaging behaviors. This is 

true even though the latter messages 

demonstrate a more successful performance.

Corrective Advertising for “Light” or 

“Low-Yield” Cigarettes

Tobacco manufacturers have long marketed 

low-tar or “light” cigarettes to smokers who 

are concerned about the health effects of 

their smoking125,126 (see chapter 5). However, 

authoritative reviews have concluded that 

low-yield cigarettes are designed to allow 

compensatory smoking behaviors that 

enable a smoker to derive a wide range of 

tar and nicotine yields from the same brand, 

offsetting much of the theoretical benefit of 

a cigarette with reduced tar.127 Consequently, 

there is little evidence of reduced risk of 

disease from use of low-yield cigarettes.127

Despite this, studies have shown that a 

substantial proportion of American smokers 

believe that using “light” cigarettes is less 

risky than using regular cigarettes.128–130 This 

has led some tobacco control programs to 

attempt to correct smokers’ misperceptions 

through advertising. 

For example, in 1994, the Massachusetts 

Department of Public Health aired 

two 30-second television advertisements 

about “light” cigarettes. One advertisement 

focused on vent blocking; that is, the 

small vent holes around the filters of most 

“light” cigarettes can dilute the inhaled 

smoke, but in practice smokers may 

block these filter holes with their fingers 

when inhaling, thus delivering a higher 

dose of smoke constituents. In the other 

advertisement, an animated “skull and 

crossbones” speaks, saying it should be—

but is not—warning smokers about light 

cigarettes. An evaluation survey showed 

that within Massachusetts, compared with 

a nationwide sample, smokers who saw the 

anti-light-cigarette advertisements were 

less likely to think light cigarettes decreased 

the risk of health problems (26% versus 

44%) and more likely to know of filter vents 

(64% versus 47%).131 However, compared 

with other states, Massachusetts had other 

antitobacco advertising and stronger tobacco 

control policies that may have influenced 

smoking beliefs and behavior in the state. 

Thus, this quasi-experimental, posttest-only 

study provides weak evidence that the 

advertising may have influenced some 

participants’ smoking beliefs and behavior.

A study by Koslowski and colleagues 

randomized smokers of light cigarettes who 

participated in a telephone survey to hear 

(n = 293) or not hear (n = 275) a 60-second 

radio advertisement cautioning that 

light cigarettes are no safer than regular 

cigarettes and that listeners should think 

about quitting.131 Those who heard the 

advertisement were more likely to report 

that one light cigarette could give a smoker 

the same amount of tar as one regular 

cigarette, and 55% said the message made 

them feel more like quitting. Koslowski and 

colleagues followed up about one-half of the 

respondents in each group who could be 

contacted seven months later to determine 

whether there were any persistent effects 

from hearing the radio advertisement.132

The message group respondents were more 

likely than the control group to report that 

one light cigarette equaled one regular 

cigarette in tar yield to smokers, light 

cigarettes did not decrease health risks, 

and they wanted to quit smoking. However, 

they did not report greater intention to quit 

or more knowledge of filter ventilation. 

These results suggest that smokers found 

the information in the radio advertisement 

important and remembered it, especially 

given that the information was played only 

once seven months beforehand. 

Shiffman and colleagues also experimentally 

assessed responses to differently framed 

persuasive messages about light cigarettes. 

In randomized studies of radio messages133
461

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

and 30-second television advertising 

concepts,134 smokers were most likely to 

change their beliefs about light cigarettes 

and be more interested in quitting when 

exposed to a message emphasizing that 

the sensory effect of light cigarettes can 

be deceptive. 

Taken together, these experimental 

studies suggest that advertising to dispel 

misperceptions about light or low-yield 

cigarettes can improve smokers’ awareness 

of and knowledge about these cigarettes 

and may move smokers toward quitting. 

However, studies have not yet examined 

quit rates among those exposed or not 

exposed to this type of advertising.

Tobacco manufacturers have introduced 

a variety of nontraditional tobacco and 

nicotine products that claim to reduce the 

risk of smoking (potential reduced-exposure 

products [PREPs]). As discussed in chapter 5, 

PREPs include Eclipse and Advance. 

Several studies have shown that advertising 

promoting these products leads smokers to 

consider them to have lower health risks and 

fewer carcinogens than do light cigarettes135

and reduces smokers’ interest in quitting.136

Depending on the extent to which PREPs 

become more widely promoted and used, a 

future communications challenge in tobacco 

control will be to enable consumers to have 

access to risk assessments aligned with 

scientific evidence about the risks these 

products pose.

Targeting and Tailoring of Antitobacco 

Advertisements

Commercial advertisers spend a great 

deal of effort on audience segmentation 

(see chapter 3). This involves identifying 

population subgroups whose members are 

similar to each other and distinct from 

other groups along dimensions that are 

meaningful in the context of the product 

being marketed or the behavior to be 

changed.137 In the realm of antitobacco 

advertising, major segments have been 

defined by age, race/ethnicity, or nationality. 

It is important to know whether tailoring 

antitobacco advertisements yields a 

substantial improvement in effectiveness 

because tailoring increases the cost of 

producing media campaigns.

Targeting Age Groups

Most campaigns create different types of 

advertisements for youth and for adults. 

Beaudoin138 performed a content analysis of 

197 antitobacco advertisements produced 

between 1991 and 1999. Among the 

dimensions coded were (1) the type of 

consequence presented (health, social, 

or both); (2) whether the consequences 

were short term, long term, or both; and 

(3) whether the appeal used humor, fear, 

sociability, or several other strategies. 

Beaudoin found that advertisements 

targeting youth commonly used sociability 

and humor appeals and presented 

short-term consequences. Advertisements 

targeting adults commonly used fear 

appeals and addressed the long-term 

health consequences.

At first glance, these differences seem logical 

and appropriate. Some common objectives 

for youth and adult advertisements exist 

(e.g., presenting cigarettes in a negative 

light and having the audience reject 

them). However, issues relevant for adult 

smokers (e.g., overcoming the addiction, 

coping with withdrawal, giving up one’s 

“best friend”)139 are quite different from 

those relevant for youthful nonsmokers 

(e.g., appearing to be grown up, conforming 

to group norms, establishing an identity). 

However, the empirical findings presented 

in this section indicate that, like adults, 

youth tend to respond more favorably 

to advertisements warning of serious 

long-term health consequences of smoking 

presented in an emotionally evocative way. 

Several studies that explicitly compared 

teenagers’ responses to youth-targeted 

versus adult-targeted advertisements 
462

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

found that youth respond favorably to 

adult-targeted advertisements.

Wakefield and colleagues140 showed that 

the adult cessation focus of the Australian 

campaign (“Every Cigarette Is Doing You 

Damage”) was as likely as a teen-focused 

campaign to make teenagers in South 

Australia feel they should not smoke. 

This was true despite the teen campaign’s 

favorable pretesting with a youth audience. 

By using national and state survey data in 

Victoria, Australia, White and colleagues141

found that youth perceived the adult 

campaign as relevant to them and effective 

in promoting antismoking attitudes.

Schar and Gutierrez142 describe an evaluation 

of the English testimonial campaign that 

targeted adults and featured a 34-year-old 

man with lung cancer and a teenage girl 

speaking about her father who has lung 

cancer. Surveys of youth (11–15 years old) 

and adults indicated comparable levels 

of campaign awareness and perceived 

effectiveness among the two groups.

Considerable debate has occurred about 

whether tobacco control campaigns should 

focus primarily on youth (because most 

people initiate smoking before age 18) 

or on adults.107,143 The findings reported 

here suggest that an adult-targeted 

campaign appears to be as effective in 

communicating with youth as with adults. 

This may be due to such adult-targeted 

campaigns changing broader social norms 

about smoking.107

Targeting by Race/Ethnicity or Nationality

Antitobacco media campaigns are believed 

to be more effective if they are tailored to 

the cultural values of various targeted racial 

and ethnic groups.144 Members of different 

ethnic groups have different beliefs and 

attitudes about the social appropriateness of 

smoking, associated risks, and acceptability 

of using professional help.145,146 Therefore, 

tailoring messages in a manner that takes 

those differences into account would appear 

to increase an advertisement’s effectiveness. 

There is a surprising dearth of empirical 

support for this hypothesis, however. 

Very few campaign evaluations pit a 

general-audience message against a tailored 

message to compare audience reactions.

Several studies of youth have demonstrated 

that advertisement characteristics are 

more important than either ethnicity or 

nationality in determining participants’ 

reactions to antitobacco advertising. Farrelly 

and colleagues147 conducted a content 

analysis of 51 advertisements broadcast by 

Legacy (“truth” campaign), Philip Morris 

(“Think. Don’t Smoke”), and Lorillard 

(“Tobacco Is Whacko if You’re a Teen”). 

Advertisements were coded as to message 

sensation value, an index of features believed 

to elicit arousal reactions: number of cuts, 

use of loud music, surprise endings, intense 

visual images, and theme (e.g., long-term 

versus short-term health effects, industry 

manipulation, smoking as a personal choice). 

Repeated cross-sectional telephone surveys 

of white, African American, Hispanic, and 

Asian youth assessed recall and appraisal 

of varying groups of advertisements. 

Multivariate analyses demonstrated that 

advertisement characteristics were more 

important than audience race/ethnicity as 

a determinant of appraisal.

Wakefield and colleagues100 repeated in 

Australia and Great Britain the study in the 

United States described earlier.99 In that 

study, groups of young people viewed and 

rated a series of counteradvertisements 

and were reinterviewed by telephone one 

week later to determine which of the 

advertisements were recalled and had 

stimulated further thoughts. The purpose 

of this study was to determine whether 

youth of different nationalities responded 

similarly or differently to antitobacco 

advertisements. The researchers found that 

participants in these three English-speaking 

countries responded in very similar ways 
463

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

to the advertisements. As was true in 

Chicago and Boston, youth in Australia 

and Great Britain responded not to the 

theme or target audience but to the arousal 

characteristics of the advertisements.

These findings suggest that advertisements 

that perform well on immediate ratings 

and indicators of message processing 

tend to do so among many population 

subgroups. This implies that the added 

expense of designing tailored executions 

for small subgroups may not need to 

be incurred. The findings also suggest 

that advertisements can be shared, at 

least among more-developed countries, 

provided language requirements can be 

met. This could reduce costs in areas where 

funding for tobacco control advertising is 

scarce. At this point, research is inadequate 

to generalize to less-developed nations.

New-Media Interactive 

Health Communications 

for Smoking Cessation

Interactive health communications 

(IHC), also called “consumer health 

informatics” and “eHealth,” can include 

the Internet, personal digital assistants, 

computer-tailored print materials, 

interactive voice response, computer-driven 

kiosks, and CD-ROMs. This section, 

however, focuses on the Internet as the 

leading instantiation of IHC, given its 

ready accessibility to smokers.

The proportion of adults (18 years and 

older) in the United States with Internet 

access in 2007 exceeded 72%.148 The 

proportion of adults with home Internet 

access increased from 56% in 2001 to 

65% in 2007.148 Moreover, the number of 

hours spent online by adult Internet users 

increased from 9.7 hours per week in 2001 

to 15.9 hours per week in 2007.148 In a Pew 

survey149 of U.S. adults with access to the 

Internet, 63% reported using the Web to 

obtain information on a specific disease 

or medical problem and 6% had used the 

Web for information about how to quit 

smoking. A study by Biener and colleagues 

of 787 Massachusetts adults surveyed in 

2001–02 who had quit smoking in the past 

two years found that 3.9% had accessed 

a Web site for help to quit compared 

with 0.8% who had accessed telephone 

quitlines.116 Although more than four times 

as many former smokers had accessed the 

Internet than had used telephone quitlines, 

almost all of those who accessed these 

sources of help reported them to be helpful. 

Those who are less likely to access 

the Internet tend to be less educated, 

African American, and 65 years or older.150

In addition, population survey data from 

the Health Information National Trends 

Survey indicate that smokers who use the 

Internet are more likely to have higher 

income and be employed, despite being 

younger, compared to smokers who do not 

use the Internet.151 This study also found 

that Internet-connected smokers reported 

less psychological distress, fewer barriers 

to health care, and a greater interest in 

quitting smoking. 

Why do people use the Internet as 

opposed to other sources of assistance 

and information? An earlier Pew report152

found that of those using the Internet 

for health information, 93% thought it 

was important to obtain the information 

at any convenient hour and 80% liked 

the ability to obtain health information 

anonymously without having to talk to 

anyone. In addition, cigarette smokers 

who use the Internet have expressed a 

desire for anonymity and noted discomfort 

in speaking with human counselors.153

While the reach of public Internet sites 

for smoking cessation appears to be high 

relative to alternative treatment modalities, 

the quality of these sites remains largely 
464

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

untested. In a systematic analysis of the 

content, quality, and usability of smoking 

cessation treatments on the Internet, 

Bock and colleagues154 found that 80% of 

such sites failed to address one or more 

key components of recommended smoking 

cessation treatment guidelines, with the 

interactive nature of the Internet generally 

ignored. In reviews of computer-generated 

health behavior change interventions, 

the application of theoretically informed 

approaches for health behavior change 

and/or decision making has been found to 

be poor or nonexistent.155 A key concern is 

that individuals with limited understanding 

of smoking cessation theory and practice 

generate most of the information on the 

Internet. Thus, digital “pamphlet racks” 

persist as the most common type of 

smoking cessation Internet sites because 

they are easy to build. Unfortunately, 

research on Internet-based health 

programming continues to focus on these 

simple information transfer models.156

The Internet and IHC in general, providing 

they are informed by smoking cessation 

theory and research, offer greater potential 

than a simple clearinghouse of smoking 

cessation pamphlets.

Bock and colleagues154 provide an excellent 

review of, and criteria for, Internet-based 

smoking cessation programming. This 

section focuses instead on: (1) ideas for 

advancing smoking cessation programming 

using IHC’s interactive capabilities, (2) the 

dissemination of these programs, and 

(3) the future of such programs.

Types of Interactivity

A key advantage of IHC is its interactivity 

within a mass audience, reflecting how 

individuals normally seek help and 

advice. Four types of interactivity relevant 

to smoking cessation programming 

are (1) user navigation, (2) expert 

systems, (3) collaborative filtering, and 

(4) human-to-human interaction.

User Navigation: A Vast Library at 

Users’ Fingertips

The interactive strategy most commonly 

used on the Internet requires users to search 

through the Internet, identifying what they 

consider as the most relevant sites and 

information within those sites. Once in a site, 

users search for the information relevant to 

their needs and interests. Similar to a library, 

the Internet has methods of searching for the 

large amount of available health information. 

Also like a library, however, the Internet 

does not automatically make available the 

best information or advice that an individual 

needs at a particular time.

A number of studies in the general 

non-Internet-specific educational literature 

have found that, when compared with fixed 

sequencing of instructional material, user 

control results in deviations from important 

information or methods of instruction 

and subsequent lower performance.157–161

Users who begin a program with low levels 

of knowledge or ability about the subject 

matter appear to perform even more poorly 

in user-navigated environments.157,159,162

Applying these findings to the area of IHC, 

it seems plausible that users with little 

prior knowledge, experience, or perceived 

competence might be less successful 

with user-navigated IHC programming. 

As discussed in the next section, IHC 

programming that provides guidance tailored 

to an assessment of needs and interests 

may help users become more effective and 

efficient in their search process. 

Expert Systems: When a Counselor 

Is Needed

A second interactive approach, closely 

approximating a counseling experience, 

is termed an expert system. These systems, 

which have undergone more experimental 

research than any other IHC system, 
465

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

attempt to apply an expert’s assessment, 

decision rules, and feedback strategies 

to software. The expert systems tested in 

the health behavior area typically require 

(1) a collection of characteristics, at an 

individual level, relevant to the targeted 

behavior change; (2) an algorithm that 

uses these data to generate messages 

tailored to the specific needs of the user; 

and (3) a feedback protocol that combines 

these messages in a clear, vivid manner. 

The inferences made from the data are 

an attempt to reflect standards of a 

human expert.163,164

Over the past 10 years, expert-tailored print 

interventions for smoking cessation have 

been developed and evaluated in diverse 

settings. Some of these tailored programs 

have been migrated to the Internet after 

testing in non-Internet-based settings, 

such as by telephone or print-mediated 

delivery systems.165–167 A generally positive 

body of evidence demonstrates the efficacy 

of print-based, computer-tailored smoking 

cessation interventions in adults.168 In a 

Cochrane Collaboration meta-analysis of 

smoking cessation materials developed 

by expert systems, Lancaster and Stead168

found an average odds ratio (OR) of 1.42 

(95% confidence interval [CI], 1.26–1.61) 

for such materials compared with untailored 

or stage-matched materials in 17 trials. 

The evidence was strongest for tailored 

materials compared with no intervention but 

also supported tailored materials as more 

helpful than standard materials. The review 

concluded that part of this effect could be 

due to the additional contact or assessment 

required to obtain individual data.

Results of two randomized clinical trials of 

Internet-based expert systems for smoking 

cessation have been positive and consistent 

with the results of computer-tailored print 

materials. In a randomized clinical trial of 

visitors to a smoking cessation Web site, 

Etter165 found an OR (7-day point-prevalence 

abstinence) of 1.24 (95% CI, 1.08–1.43) 

10 weeks after program entry. The study 

compared an Internet-based program 

tailored to coping strategies, health risks, 

nicotine dependence, and use of NRT with 

an Internet-based program focusing largely 

on nicotine dependence and use of NRT. 

In a study of nicotine patch users, Strecher 

and colleagues166 found an OR (10-week 

continuous abstinence) of 1.33 (95% CI, 

1.13–1.57) 12 weeks after program entry. 

This study compared an Internet-based 

program tailored to the individual’s 

self-efficacy deficits, cessation motives, 

smoking history, social support, and health 

risks against an Internet-based program with 

a very similar graphic design but untailored 

smoking cessation information. The results 

of this study were very similar to those 

found in two previous trials of tailored print 

materials tested among NRT users.169,170

Will underserved individuals, particularly 

those with low literacy skills, respond to 

tailored materials? A noteworthy study by 

Lipkus and colleagues171 found a significantly 

higher cessation rate among low-income 

and indigent African-American smokers 

receiving tailored smoking cessation 

materials plus provider advice than among 

those who received provider advice alone. 

Supporting these results, McDaniel and 

colleagues172 found high satisfaction among 

100 low-income inner-city female smokers 

who participated in a usability study of an 

interactive, computer-mediated smoking 

cessation program in Indianapolis, Indiana. 

At a one-week follow-up, there was a 

significant decrease in favorable attitudes to 

smoking and an increase in cognitive change 

processes related to smoking. However, a 

challenge for the reach of these kinds of 

programs is that low-income populations 

have less access to the Internet.173

With increasing reach and greater potential 

for interactivity and lower cost, expert 

systems delivered via the Internet offer 

significant potential for smoking cessation. 
466

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

Further published controlled trials of 

Internet-based expert systems in this 

area are greatly needed. One barrier to 

conducting these studies is the complexity 

of building expert system interventions 

on the Internet. This situation is likely to 

improve as content management systems 

and tailoring of application frameworks are 

further developed and implemented.

Collaborative Filtering: What Other 

Smokers Like You Are Doing to Quit

It is common to use the actions and 

subsequent outcomes of peers to inform 

one’s own decisions. A local bookseller may 

say, “I know six other customers like you who 

enjoy John le Carré mysteries.... They’re now 

really reading this new Tom Clancy novel.” 

Using a similar approach, a collaborative 

filtering system on the Internet is able to 

convey that, “We have six hundred thousand 

other customers who, like you, enjoy 

John le Carré mysteries.... Many of them are 

now reading this new Tom Clancy novel.”

Larger numbers of individuals allow 

greater discrimination in filtering, with the 

potential for creating more useful advice. 

Collaborative filtering on the Internet could 

match coping strategies and preferences 

of similar smokers with specific needs and 

interests. For example, a female smoker in 

her late 20s who is trying to quit but worried 

about gaining weight could be linked to 

coping strategies of other women of similar 

age, diet, and physical activity levels who 

have successfully maintained their weight 

while quitting smoking. At present, however, 

in the field of health-related behavior, the 

application of this concept has yet to be 

subjected to formal research inquiry.

Human-to-Human Interaction: 

A Channel for Social Support

Evidence for integrating social support, 

or “buddy systems,” into smoking cessation 

programming is decidedly mixed.174 Notable 

examples of improved short-term outcomes 

from buddy systems exist.175 However, 

a review of 10 studies examining social 

support and buddy systems found only 2 that 

demonstrated even short-term positive 

effects. Nonetheless, it is possible that such 

systems work well for a small proportion of 

smokers who need this type of assistance.

Online support groups give users a 

convenient way to provide and receive 

informational and emotional support.176,177

The 24/7 accessibility of online support 

may be a significant advantage to smokers. 

Again, anonymity is a frequently cited 

benefit of computer-mediated groups. 

As one participant stated in the study 

by Shaw and colleagues, “It’s a gift to be 

able to tell people as much or as little as 

you want about yourself.”177(p.141) No study 

could be found that examined the reach or 

effectiveness of online discussion groups 

for smoking cessation. Although some 

have questioned the reach of face-to-face 

group cessation programs,178 the anonymity 

and convenience of online groups might 

encourage participation among many 

people who would not normally use a 

face-to-face group.

Another human-to-human interaction 

relevant to IHC involves online therapists. 

This approach is similar to the model for 

telephone hotlines that involve counselors 

or information specialists and could be 

proactive or reactive, although this has not 

yet been reported in the literature. Outside 

the field of tobacco control, however, 

Tate and colleagues179 found that using an 

online counselor with an Internet-based 

weight loss program significantly 

contributed to 12-month weight loss 

compared to the Internet program alone. 

Online Internet interactions with smoking 

cessation counselors offer significant 

convenience to both the user and counselor. 

They also may offer an added degree of 

anonymity and therefore the possibility 
467

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

of more honest expressions of behaviors, 

attitudes, and emotions. As is the case with 

telecounseling services, however, proactive 

online therapy could be difficult and 

expensive to disseminate with high quality 

to large populations of smokers.

Dissemination of Interactive 

Health Communications

Adoption, implementation, and maintenance 

of high-quality IHC for smoking cessation 

through clinical practices, health 

maintenance organizations, voluntary health 

organizations, state and federal agencies, 

and employers will evolve only when such 

programming has been demonstrated to 

have several capabilities. These include 

(1) high reach to the population in need, 

(2) high efficacy in achieving desired 

outcomes, and (3) low cost. Decision 

makers will require a greater understanding 

of the importance of theoretically and 

empirically informed programming in 

achieving desired outcomes. 

Many larger health organizations typically 

prefer to create their own smoking cessation 

materials. However, they are beginning to 

understand that developing Internet sites 

that extend beyond the digitization of their 

pamphlets involves significant expertise, 

effort, and expense. IHC development 

for smoking cessation is most likely to 

be accomplished by for-profit companies 

and large nongovernment organizations. 

These organizations would need to devote 

significant resources to development but 

offer the final programming to millions of 

smokers at a very low per-person fee. 

Innovative financial models for Internet 

dissemination may move from per-user 

fees to fee scales based on the size of the 

population. This approach encourages 

the organization licensing the software to 

promote the cessation programming to the 

largest number of smokers, lowering the 

per-user fee with every new participant.

To maximize its acceptability to funders and 

potential users, IHC programming would 

need to run without significant problems, 

work for a variety of user interfaces 

(e.g., operating systems and connection 

speeds), and work well under extreme loads. 

Crossing the chasm from research prototype 

to real-world product is a huge endeavor, 

and partnerships with the IHC industry are 

considered advisable.

Future Directions for Interactive 

Health Communications

The IHC field continues to change rapidly 

with respect to information technologies, 

access to these technologies, and consumer 

attitudes toward the technologies and 

associated interventions. Many studies 

published even a few years ago used 

information technologies that now are dated 

among subjects with different attitudes 

toward the technology. For example, early 

research on even crudely tailored print 

materials for smoking cessation may have 

found positive outcomes due to the central 

processing of information considered novel 

and interesting to the user.180 However, 

it is likely that most people have tired of 

receiving countless “Hello <your name>!” 

materials through the Internet and 

conventional mail. 

Scientists and others have not fully 

explored the potential factors relevant 

to tailored IHC. The idea of tailoring 

interactive programming to the learning 

style of the user is not new,181 but it has yet 

to elicit research interest. Other individual 

characteristics that may be considered 

relevant for tailored communications 

include previous experience with smoking 

cessation, perceived competence, cultural 

factors, self-efficacy, need for cognition, 

motivation, and locus of control, among 

many others.

An interesting area of research within 

this field moves beyond the Internet to 
468

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

technologies that allow more-immediate 

methods of data collection and feedback.182

Collection of data in real time from a realworld environment may offer the possibility 

of instantaneously providing tailored 

feedback within that environment through 

call phones, pagers, and other devices. 

Additional ideas for enhancing interactivity 

and studying effects on users have been 

discussed elsewhere.183–187

More difficult to predict are the emergent 

interactions among consumer health 

informatics systems discussed in 

this section and medical informatics 

(e.g., electronic medical records), 

bioinformatics (e.g., genomics), and public 

health informatics (e.g., surveillance, 

epidemiological). These interactions should 

provide greater efficiencies and effectiveness 

at both clinical and population levels. 

Summary

Media interventions have become a key 

component of tobacco cessation efforts 

over the past four decades. A wide variety 

of antitobacco media campaigns have been 

broadcast in the United States and other 

countries, with television advertising being 

the most commonly selected medium. 

Advertisements have used a range of 

different themes and executional formats 

and have targeted different population 

subgroups, such as adults or youth, 

and various racial/ethnic groups.

The U.S. population is exposed to a wide 

range of antismoking messages in the media. 

These include television advertisements 

from state and national tobacco control 

campaigns, commercial advertising 

for smoking cessation products, and 

advertisements advocating youth smoking 

prevention from tobacco companies.

A strong evidence base is emerging for 

antitobacco advertising, with a consensus 

that advertisements that arouse strong 

negative emotions perform better than those 

that do not. These advertisements tend 

to depict serious harm done by smoking 

or secondhand smoke in an authentic 

way and sometimes include depictions of 

tobacco industry awareness of the dangers 

of smoking. Experimental research on 

information processing supports the 

hypothesis that advertisements that evoke 

high arousal will receive greater viewer 

attention and will be remembered more 

readily than those that do not. Further, 

negative content tends to produce higher 

levels of arousal than does positive content. 

Targeting these types of advertisements 

to specific demographic groups remains 

an area for future study. However, there 

is evidence that the content of these 

advertisements is more important than 

such targeting. In particular, youth notice, 

understand, and are positively influenced by 

adult-oriented antitobacco advertisements.

With the increasing reach, interactivity, 

media richness, and speed of the Internet, 

greater research attention could be focused 

on its efficacy and “active ingredients” to 

promote and maintain smoking cessation. 

More than four times the number of 

smokers appear to use the Internet 

for help in quitting than to seek help 

through quitlines.116 Yet, the quality of 

publicly available cessation services on 

the Internet generally is poor and lacks 

evidence-based content. Looking toward 

the future, new-media channels for IHC 

include tailored print materials and tailored 

Web-based programs. Although not directly 

compared, reviews of each independently 

suggest that the effectiveness of tailored 

print materials for smoking cessation may 

be nearly equivalent to other high-reach 

but more expensive smoking cessation 

programming (e.g., quitlines). Further 

research is needed to examine expert 

systems and other interactive approaches 

among smokers requiring the greatest 

assistance in quitting.
469

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Conclusions

1. From their beginnings with the 

successful 1967–70 application of 

the Fairness Doctrine to cigarette 

advertising in the broadcast media, 

media interventions for tobacco 

control have evolved to become a key 

component of tobacco control efforts. 

These interventions have been aided 

by funding from the 1998 Master 

Settlement Agreement.

2. Media channels commonly used for 

tobacco control advertising include 

television, radio, print, and billboards. 

Much research on tobacco control 

media interventions revolves around 

television, regarded as the most 

powerful medium.

3. Public-health-sponsored antitobacco 

advertising has included themes such 

as the health risks of smoking, exposure 

to secondhand smoke, questioning 

the accuracy of tobacco industry 

communications, and the declining 

social acceptability of smoking. Other 

forms of smoking-relevant advertising 

include advertisements for commercial 

smoking cessation products as well as 

the tobacco industry’s youth smoking 

prevention and adult cessation programs. 

4. Numerous studies have shown 

consistently that advertising carrying 

strong negative messages about health 

consequences performs better in 

affecting target audience appraisals 

and indicators of message processing 

(such as recall of the advertisement, 

thinking more about it, discussing 

it) compared with other forms of 

advertising, such as humorous or 

emotionally neutral advertisements. 

Some of these negative advertisements 

also portray deception on the part of 

the tobacco industry. Advertisements 

for smoking cessation products and 

tobacco-industry-sponsored smoking

prevention advertising have been 

shown to elicit significantly poorer 

target audience appraisals than do 

advertisements based on negative 

health consequences.

5. Studies have shown that particular 

characteristics of advertisements 

(such as those eliciting negative 

emotion) are more important than 

demographic factors (such as race/

ethnicity, nationality, and age group) 

in driving immediate advertising-related 

appraisals and indicators of message 

processing. 

6. Because many smokers search the 

Internet for help to quit, interactive 

Web-based health communications may 

have potential for assisting smoking 

cessation. However, these services need 

to be informed by smoking cessation 

theory and research and structured to 

expose users to appropriate information.
470

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

References

1. TV Acres. 2008. Dancers. http://www.tvacres

.com/dance_butts.htm.

2. Lerner, B. H. 2001. Medical: Remembering 

the man who always lost to Perry Mason 

and then died of cancer. Boston Globe,

November 13.

3. Siegel, M. 1998. Mass media antismoking 

campaigns: A powerful tool for health 

promotion. Annals of Internal Medicine

129 (2): 128–32. 

4. Warner, K. E. 1979. Clearing the airwaves: 

The cigarette ad ban revisited. Policy 

Analysis 5 (4): 435–50. 

5. U.S. Department of Health and Human 

Services. 1989. Reducing the health 

consequences of smoking: 25 years of 

progress. A report of the Surgeon General

(DHHS publication no. [CDC] 89-8411). 

Rockville, MD: U.S. Department of Health 

and Human Services, Public Health Service, 

Centers for Disease Control, National Center 

for Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health. 

http://profiles.nlm.nih.gov/NN/B/B/X/S/.

6. Worden, J. K., B. S. Flynn, B. M. Geller, 

M. Chen, L. G. Shelton, R. H. Secker-Walker, 

D. S. Solomon, L. J. Solomon, S. Couchey, 

and M. C. Costanza. 1988. Development of 

a smoking prevention mass media program 

using diagnostic and formative research. 

Preventive Medicine 17 (5): 531–58. 

7. Flynn, B. S., J. K. Worden, R. H. SeckerWalker, G. J. Badger, B. M. Geller, and 

M. C. Costanza. 1992. Prevention of cigarette 

smoking through mass media intervention 

and school programs. American Journal of 

Public Health 82 (6): 827–34. 

8. Flynn, B. S., J. K. Worden, R. H. SeckerWalker, P. L. Pirie, G. J. Badger, 

J. H. Carpenter, and B. M. Geller. 1994. 

Mass media and school interventions for 

cigarette smoking prevention: Effects 

2 years after completion. American Journal 

of Public Health 84 (7): 1148–50. 

9. Murray, D. M., C. L. Perry, G. Griffin, 

K. C. Harty, D. R. Jacobs Jr., L. Schmid, 

K. Daly, and U. Pallonen. 1992. Results from 

a statewide approach to adolescent tobacco 

use prevention. Preventive Medicine 21 (4): 

449–72. 

10. Murray, D. M., A. V. Prokhorov, and 

K. C. Harty. 1994. Effects of a statewide 

antismoking campaign on mass media 

messages and smoking beliefs. Preventive 

Medicine 23 (1): 54–60. 

11. Pierce, J. P., T. Dwyer, G. Frape, S. Chapman, 

A. Chamberlain, and N. Burke. 1986. 

Evaluation of the Sydney “Quit. For 

Life” anti-smoking campaign. Part 1. 

Achievement of intermediate goals. Medical 

Journal of Australia 144 (7): 341–44. 

12. Dwyer, T., J. P. Pierce, C. D. Hannam, and 

N. Burke. 1986. Evaluation of the Sydney 

“Quit. For Life” anti-smoking campaign. 

Part 2. Changes in smoking prevalence. 

Medical Journal of Australia 144 (7): 344–47. 

13. Pierce, J. P., R. N. Aldrich, S. Hanratty, 

T. Dwyer, and D. Hill. 1987. Uptake and 

quitting smoking trends in Australia 1974–

1984. Preventive Medicine 16 (2): 252–60. 

14. Centers for Disease Control and Prevention. 

2007. Best practices for comprehensive 

tobacco control programs—2007. Atlanta: 

U.S. Department of Health and Human 

Services, Centers for Disease Control and 

Prevention, National Center for Chronic 

Disease Prevention and Health Promotion, 

Office on Smoking and Health. http://www

.cdc.gov/tobacco/tobacco_control_programs/

stateandcommunity/best_practices/.

15. Campaign for Tobacco-Free Kids. 2007. 

A broken promise to our children: The 1998 

state tobacco settlement nine years later.

http://www.tobaccofreekids.org/reports/

settlements/2008/fullreport.pdf.

16. Farrelly, M. C., J. Niederdeppe, and 

J. Yarsevich. 2003. Youth tobacco prevention 

mass media campaigns: past, present, and 

future directions. Tobacco Control 12 

Suppl. 1: i35–47.

17. Wakefield, M., G. Szczypka, Y. Terry-McElrath, 

S. Emery, B. Flay, F. Chaloupka, and 

H. Saffer. 2005. Mixed messages on tobacco: 

Comparative exposure to public health, 

and tobacco company- and pharmaceutical 

company-sponsored tobacco-related 

television campaigns in the United States, 

1999–2003. Addiction 100 (12): 1875–83. 

18. Szczypka, G., M. Wakefield, S. Emery, B. Flay, 

F. Chaloupka, S. Slater, Y. Terry-McElrath, 

and H. Saffer. 2005. Population exposure 

to state funded televised anti-tobacco 

advertising in the United States—37 States 

and the District of Columbia, 1999–2003. 

ImpacTeen Research Paper series 31. 

Chicago: Univ. of Illinois at Chicago. 

http://www.impacteen.org/generalarea

_PDFs/ITExposure_Paper31_2005.pdf. 
471

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

19. Centers for Disease Control and Prevention. 

2005. Estimated exposure of adolescents 

to state-funded anti-tobacco television 

advertisements—37 states and the District 

of Columbia, 1999–2003. Morbidity and 

Mortality Weekly Report 54 (42): 1077–80. 

20. Centers for Disease Control and Prevention. 

2007. Media Campaign Resource Center: 

Tobacco counter-advertising collection. 

http://apps.nccd.cdc.gov/mcrc.

21. Flora, J. A., M. N. Saphir, C. Schooler, and 

R. N. Rimal. 1997. Toward a framework for 

intervention channels: Reach, involvement, 

and impact. Annals of Epidemiology 7 (S7): 

S104–S112. 

22. Gilpin, E. A., M. M. White, V. White, 

J. M. Distefan, D. R. Trinidad, L. James, 

L. Lee, J. Major, S. Kealey, and J. Pierce. 

2003. Tobacco control successes in 

California: A focus on young people; Results 

from the California Tobacco Surveys, 

1990–2002. Final Report. La Jolla: Univ. 

of California, San Diego.

23. Biener, L., F. J. Fowler Jr., and A. M. Roman. 

1994. 1993 Massachusetts Tobacco Survey: 

Tobacco use and attitudes at the start 

of the Massachusetts Tobacco Control 

Program. Technical Report. Boston: Univ. of 

Massachusetts, Center for Survey Research.

24. Biener, L., A. Nyman, A. M. Roman, 

C. A. Flynn, and A. B. Albers. 2001. 

Massachusetts Adult Tobacco Survey: 

Tobacco use and attitudes after seven years 

of the Massachusetts Tobacco Control 

Program; Technical Report and Tables 

1993–2000. Boston: Univ. of Massachusetts, 

Center for Survey Research.

25. Nelson, D. E., M. Gallogly, L. L. Pederson, 

M. Barry, D. McGoldrick, and E. W. Maibach. 

2008. Use of consumer survey data to target 

cessation messages to smokers through 

mass media. American Journal of Public 

Health 98 (3): 536–42.

26. Kotler, P., N. Roberto, and N. Lee. 2002. 

Social marketing: Improving the quality of 

life. 2nd ed. Thousand Oaks, CA: Sage.

27. American Cancer Society. 1996. All about 

the event. http://www.cancer.org/docroot/

PED/content/PED_10_5_Great_American

_Smokeout_History.asp?sitearea=PED.

28. Centers for Disease Control and Prevention. 

1997. Impact of promotion of the Great 

American Smokeout and availability of 

over-the-counter nicotine medications, 

1996. Morbidity and Mortality Weekly 

Report 46 (37): 867–71. 

29. Dakutis, P. 1991. Smokeout targets new 

audiences. Cancer News 45 (1): 4–5. 

30. Zoller, H. 1992. Smokeout offers quitters a 

lighter day. Cancer News 46 (2): 8–10. 

31. Centers for Disease Control and Prevention. 

2003. Great American Smokeout. Morbidity 

and Mortality Weekly Report 52 (45): 1106. 

32. No Smoking Day. 2004. History of No 

Smoking Day. http://www.nosmokingday

.org.uk/corporate/history.htm.

33. No Smoking Day. 2008. The campaign. 

http://www.nosmokingday.org.uk/corporate/

thecampaign.htm.

34. Coalition for World No Tobacco Day. 2004. 

World No Tobacco Day. http://www.euro.who

.int/tobaccofree/Projects/20030905_2.

35. Centers for Disease Control and Prevention. 

2001. World No-Tobacco Day: May 31, 2001. 

Morbidity and Mortality Weekly Report

50 (20): 401. 

36. Centers for Disease Control and Prevention. 

2002. World No-Tobacco Day: May 31, 2002. 

Morbidity and Mortality Weekly Report

51 (20): 439. 

37. Centers for Disease Control and Prevention. 

2003. World No-Tobacco Day: May 31, 2003. 

Morbidity and Mortality Weekly Report

52 (21): 502. 

38. American Public Health Association. 2000. 

World No Tobacco Day set for May 31. 

Nation’s Health 30 (4): 15. 

39. Lando, H. A., T. F. Pechacek, P. L. Pirie, 

D. M. Murray, M. B. Mittelmark, 

E. Lichtenstein, F. Nothwehr, and C. Gray. 

1995. Changes in adult cigarette smoking 

in the Minnesota Heart Health Program. 

American Journal of Public Health 85 (2): 

201–8. 

40. Korhonen, T., E. L. Urjanheimo, 

P. Mannonen, H. J. Korhonen, A. Uutela, 

and P. Puska. 1999. Quit and Win campaigns 

as a long-term anti-smoking intervention 

in North Karelia and other parts of Finland. 

Tobacco Control 8 (2): 175–81. 

41. Korhonen, T., S. Su, H. J. Korhonen, 

A. Uutela, and P. Puska. 1997. Evaluation 

of a national Quit and Win contest: 

Determinants for successful quitting. 

Preventive Medicine 26 (4): 556–64. 

42. World Health Organization. 2008. Quit and 

Win campaign. http://www.euro.who.int/

tobaccofree/Projects/20040324_6.

43. Blum, A. 1980. Medicine vs Madison 

Avenue. Fighting smoke with smoke. JAMA: 
472

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

The Journal of the American Medical 

Association 243 (8): 739–40. 

44. Medical Journal of Australia. 1983. What’s 

up, DOC? Medical Journal of Australia 1:246.

45. Shank, J. C. 1985. DOC as an integral part 

of the community medicine curriculum. 

Family Medicine 17 (3): 96–98. 

46. Zdenkowski, A. 1983. Shameless tobacco 

advertising. Medical Journal of Australia

1 (5): 200–202. 

47. Miller, C. 1985. MOP-UP battles tobacco 

sponsorship—legally. New York State 

Journal of Medicine 85: 436. 

48. Sweda, E. 1985. Sham news and sports 

events exposed. New York State Journal of 

Medicine 85: 377. 

49. U.S. Department of Health and Human 

Services. 2000. Reducing tobacco use: 

A report of the Surgeon General. Atlanta: 

U.S. Department of Health and Human 

Services, Centers for Disease Control and 

Prevention, National Center for Chronic 

Disease Prevention and Health Promotion, 

Office on Smoking and Health. http://www

.cdc.gov/tobacco/data_statistics/sgr/sgr

_2000/index.htm

50. Richards, R. 1988. When smoke gets in your 

sails. DOC News and Views, 1. 

51. Davis, R. M., F. Howell, A. Tobias, and 

R. Jaffe. 1996. Counter-advertising by kids. 

Tobacco Control 5 (2): 100–4. 

52. Davis, R. M. 2003. Kids campaign against 

tobacco. Tobacco Control 12 (3): 243–44.

53. Medical Journal of Australia. 1983. A prime 

target: Teenagers and children. Medical 

Journal of Australia 1:247. 

54. Tobias, A. 1991. Kids say don’t smoke: 

Posters from the New York City smoke-free 

contest. New York: Workman Publishing.

55. Doctors Ought to Care. 1995. Keep our 

world tobacco free: Washington state 

students speak out about tobacco. Seattle: 

Washington Doctors Ought to Care.

56. Wayne County Medical Society Foundation. 

2003. Kids campaign against tobacco. 

Detroit: Wayne County Medical Society 

Foundation. http://www.counteradvertising

.com/articles/WCMSF%20Kids%20Campaign

%20Against%20Tobacco.pdf. 

57. Tar Wars. Web site. http://www.tarwars.org.

58. Cain, J. J., T. E. Dudley, and M. K. Wilkerson. 

1992. Tar wars—A community-based 

tobacco education project. Journal of 

Family Practice 34 (3): 267–68. 

59. New York Coalition for a Smoke-Free City. 

1990. Award-winning, pro-health poster to 

ride in the New York City subways. Press 

release. http://www.nycsmokefree.org/.

60. New York Times. 1990. A drop-dead poster. 

New York Times, June 22.

61. New York Times. 1991. Topics of the times; 

early warning on smoking. New York Times,

July 9. http://query.nytimes.com/gst/fullpage

.html?res=9D0CE3DD113CF93AA35754C0A

967958260&sec=&spon=.

62. Silver Gate Group. 2001. Q & A with 

Alan Blum. Prevention File: 18–20. http://

www.silvergategroup.com/public/PREV.16.1/

NAT16.1.pdf.

63. Smoke Free Movies. 2006. Web site. 

http://www.smokefreemovies.ucsf.edu/

ourads/index.html.

64. Smoke Free Movies. 2006. Bedroom 1. 

http://www.smokefreemovies.ucsf.edu/

ourads/ad_inbedroom_nyt.html.

65. Smoke Free Movies. 2006. Bedroom 2. 

http://www.smokefreemovies.ucsf.edu/

ourads/ad_inbedroom_nyt.html.

66. Banerjee, S. C., and K. Greene. 2006. 

Analysis versus production: Adolescent 

cognitive and attitudinal responses to 

antismoking interventions. Journal of 

Communication 56 (4): 773–94. 

67. Hopkins, D. P., P. A. Briss, C. J. Ricard, 

C. G. Husten, V. G. Carande-Kulis, 

J. E. Fielding, M. O. Alao, et al. 2001. 

Reviews of evidence regarding interventions 

to reduce tobacco use and exposure to 

environmental tobacco smoke. American 

Journal of Preventive Medicine 20 Suppl. 2: 

S16–S66. 

68. American Journal of Preventive Medicine. 

2001. Recommendations regarding 

interventions to reduce tobacco use and 

exposure to environmental tobacco smoke. 

American Journal of Preventive Medicine

20 Suppl. 2: S10–S15. 

69. Independent Evaluation Consortium. 1998. 

Interim report: Independent evaluation of 

the California Tobacco Control Prevention 

and Education Program: Wave 2 data, 

1998; Wave 1 and wave 2 data comparisons, 

1996–1998. Rockville, MD: Gallup 

Organization.

70. California Department of Health Services. 

1998. A model for change: The California 

experience in tobacco control. Paper 

presented at the National Tobacco 

Conference, Saint Paul. http://web.archive
473

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

.org/web/20000925170524/http://www.dhs

.ca.gov/tobacco/documents/modelforchange

.pdf.

71. Lavack, A. M. 2001. Tobacco industry 

denormalization campaigns: A review and 

evaluation. Winnipeg: Univ. of Winnipeg.

72. Hill, D., S. Chapman, and R. Donovan. 1998. 

The return of scare tactics. Tobacco Control

7 (1): 5–8. 

73. Hill, D., and T. Carroll. 2003. Australia’s 

National Tobacco Campaign. Tobacco 

Control 12 Suppl. 2: ii9–ii14. 

74. Donovan, R. J., J. Boulter, R. Borland, 

G. Jalleh, and O. Carter. 2003. Continuous 

tracking of the Australian National Tobacco 

Campaign: Advertising effects on recall, 

recognition, cognitions, and behaviour. 

Tobacco Control 12 Suppl. 2: ii30–ii39. 

75. Bradley, T., E. Thorson, V. Bothner, and 

T. Allen. 2000. When the target audience 

is hostile to the behavior change: A case 

study in strategy development in social 

marketing. Social Marketing Quarterly

6 (3): 35–38. 

76. Wakefield, M., and F. Chaloupka. 2000. 

Effectiveness of comprehensive tobacco 

control programmes in reducing teenage 

smoking in the USA. Tobacco Control 9 (2): 

177–86. 

77. Hicks, J. J. 2001. The strategy behind 

Florida’s “Truth” campaign. Tobacco Control

10 (1): 3–5. 

78. American Legacy Foundation. 2002. 

Building the foundation for a tobacco-free 

future: American Legacy Foundation; 

Progress report, 2000–2001. Washington, 

DC: American Legacy Foundation.

79. Farrelly, M. C., C. G. Healton, K. C. Davis, 

P. Messeri, J. C. Hersey, and M. L. Haviland. 

2002. Getting to the truth: Evaluating 

national tobacco countermarketing 

campaigns. American Journal of Public 

Health 92 (6): 901–7. 

80. Ydouthink. 2006. Web site. http://ydouthink

.com.

81. CBS News. 2004. ‘Buttman’ wants to save 

your lungs. http://www.cbsnews.com/

stories/2004/02/10/health/printable599343

.shtml.

82. Wakefield, M., and R. Durrant. 2007. 

Effects of exposure of youths at risk 

for smoking to television advertising 

for nicotine replacement therapy and 

Zyban: An experimental study. Health 

Communication 19 (3): 253–58. 

83. Ono, Y. 1997. Advertising: Tobacco pact may 

heat up the patch wars. Wall Street Journal, 

June 25.

84. Tauras, J. A., F. J. Chaloupka, and S. Emery. 

2005. The impact of advertising on nicotine 

replacement therapy demand. Social 

Science and Medicine 60 (10): 2351–8. 

85. Bolton, L. E., J. B. Cohen, and P. N. Bloom. 

2004. The marketing of “Get Out of Jail 

Free Cards”: How remedies encourage 

risky consumption. Philadelphia: Univ. of 

Pennsylvania, Wharton School.

86. Romer, D., P. Jamieson, and R. K. Ahern. 

2001. The catch-22 of smoking and quitting. 

In Smoking: Risk, perception and policy, ed. 

P. Slovic, 216–26. Thousand Oaks, CA: Sage.

87. Durkin, S., M. Wakefield, and M. Spittal. 

2006. Looking for boomerang effects: 

A pre-post experimental study of the 

effects of exposure of youth to television 

advertising for nicotine replacement 

therapy and Zyban®. Addictive Behaviors

31 (12): 2158–68. 

88. Landman, A., P. M. Ling, and S. A. Glantz. 

2002. Tobacco industry youth smoking 

prevention programs: Protecting the industry 

and hurting tobacco control. American 

Journal of Public Health 92 (6): 917–30. 

89. Hays, C. L. 1998. Philip Morris assembles 

$100 million anti-smoking program aimed 

at teens. New York Times, December 3.

90. Fairclough, G. 2002. Study slams Philip 

Morris ads telling teens not to smoke: How 

a market researcher who dedicated years to 

cigarette sales came to create antismoking 

ads. Wall Street Journal, May 29.

91. Sussman, S. 2002. Tobacco industry youth 

tobacco prevention programming: A review. 

Prevention Science 3 (1): 57–67. 

92. de Pelsmacker, P. 1998. Advertising 

characteristics and the attitude towards 

the ad. Marketing and Research Today

26 (4): 166–79. 

93. Agostinelli, G., and J. W. Grube. 2003. 

Tobacco counter-advertising: A review of 

the literature and a conceptual model for 

understanding effects. Journal of Health 

Communication 8 (2): 107–27. 

94. Goldman, L. K., and S. A. Glantz. 1998. 

Evaluation of antismoking advertising 

campaigns. JAMA: The Journal of the 

American Medical Association 279 (10): 

772–77. 

95. Balch, G. I., and G. Rudman. 1998. 

Antismoking advertising campaigns for 
474

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

youth. JAMA: The Journal of the American 

Medical Association 280 (4): 323–24. 

96. Connolly, G. N., and J. E. Harris. 1998. 

Evaluating antismoking advertising 

campaigns. JAMA: The Journal of the 

American Medical Association 280 (11): 

964–65. 

97. Teenage Research Unlimited. 1999. 

Counter-tobacco advertising exploratory 

summary report. Northbrook, IL: Teenage 

Research Unlimited.

98. Murphy, R. L. 2000. Development of a 

low-budget tobacco prevention media 

campaign. Journal of Public Health 

Management and Practice 6 (3): 45–48. 

99. Terry-McElrath, Y., M. Wakefield, E. Ruel, 

G. I. Balch, S. Emery, G. Szczypka, 

K. Clegg-Smith, and B. Flay. 2005. The 

effect of antismoking advertisement 

executional characteristics on youth 

comprehension, appraisal, recall, 

and engagement. Journal of Health 

Communication 10 (2): 124–43. 

100. Wakefield, M., R. Durrant, Y. Terry-McElrath, 

E. Ruel, G. I. Balch, S. Anderson, 

G. Szczypka, S. Emery, and B. Flay. 2003. 

Appraisal of anti-smoking advertising 

by youth at risk for regular smoking: 

A comparative study in the United States, 

Australia, and Britain. Tobacco Control

12 Suppl. 2: ii82–ii86. 

101. Wakefield, M., G. I. Balch, E. Ruel, Y. TerryMcElrath, G. Szczypka, B. Flay, S. Emery, and 

K. Clegg-Smith. 2005. Youth responses to 

anti-smoking advertisements from tobaccocontrol agencies, tobacco companies, and 

pharmaceutical companies. Journal of 

Applied Social Psychology 35 (9): 1894–1910.

102. Pechmann, C., G. Zhao, M. E.Goldberg, 

and E. T. Reibling. 2003. What to convey in 

antismoking advertisements for adolescents: 

The use of protection motivation theory to 

identify effective message themes. Journal 

of Marketing 67 (April): 1–18. 

103. Biener, L., G. McCallum-Keeler, and 

A. L. Nyman. 2000. Adults’ response to 

Massachusetts anti-tobacco television 

advertisements: Impact of viewer and 

advertisement characteristics. Tobacco 

Control 9 (4): 401–7. 

104. Biener, L. 2002. Anti-tobacco advertisements 

by Massachusetts and Philip Morris: What 

teenagers think. Tobacco Control 11 Suppl. 

2: ii43–ii46. 

105. Biener, L., M. Ji, E. A. Gilpin, and 

A. B. Albers. 2004. The impact of emotional 

tone, message, and broadcast parameters in 

youth anti-smoking advertisements. Journal 

of Health Communication 9 (3): 259–74. 

106. Pechmann, C., and E. T. Reibling. 2006. 

Antismoking advertisements for youths: 

An independent evaluation of health, 

counter-industry, and industry approaches. 

American Journal of Public Health 96 (5): 

906–13. 

107. Hill, D. 1999. Why we should tackle adult 

smoking first. Tobacco Control 8 (3): 333–35.

108. Flay, B. R. 1987. Selling the smokeless 

society: 56 evaluated mass media programs 

and campaigns worldwide. Washington, DC: 

American Public Health Association.

109. Hafstad, A., and L. E. Aaro. 1997. Activating 

interpersonal influence through provocative 

appeals: Evaluation of a mass media-based 

antismoking campaign targeting adolescents. 

Health Communication 9 (3): 253–72. 

110. Morton, T. A., and J. M. Duck. 2001. 

Communication and health beliefs: Mass 

and interpersonal influences on perceptions 

of risk to self and others. Communication 

Research 28 (5): 602–26. 

111. Rogers, E. M., and J. D. Storey. 1987. 

Communication campaigns. In Handbook 

of Communication Science, ed. C. R. Berger 

and S. H. Chaffee, 817–46. Newbury Park, 

CA: Sage.

112. Rogers, R. W. 1975. A protection motivation 

theory of fear appeals and attitude change. 

Journal of Psychology 91:93–114. 

113. Abt Associates, W. L. Hamilton, and 

G. diStefano Norton. 1998. Independent 

evaluation of the Massachusetts Tobacco 

Control Program: Fifth annual report. 

Cambridge, MA: Abt Associates.

114. Miller, A. 1998. Designing an effective 

counteradvertising campaign—

Massachusetts. Cancer 83 (S12A): 2742–45. 

115. DeJong, W., and K. D. Hoffman. 2000. 

A content analysis of television advertising 

for the Massachusetts Tobacco Control 

Program media campaign, 1993–1996. 

Journal of Public Health Management and 

Practice 6 (3): 27–39. 

116. Biener, L., R. L. Reimer, M. Wakefield, 

G. Szczypka, N. A. Rigotti, and G. Connolly. 

2006. Impact of smoking cessation aids 

and mass media among recent quitters. 

American Journal of Preventive Medicine

30 (3): 217–24. 

117. McGuire, W. 1989. Theoretical foundations 

of campaigns. In Public communication 
475

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

campaigns, 2nd ed., ed. R. E. Rice and 

C. K. Atkin, 43–65. Newbury Park, CA: Sage.

118. Miller, G. A. 1956. The magical number 

seven plus or minus two: Some limits on 

our capacity for processing information. 

Psychological Review 63 (2): 81–97. 

119. Lang, A., K. Dhillon, and Q. Dong. 1995. 

The effects of emotional arousal and valence 

on television viewers’ cognitive capacity 

and memory. Journal of Broadcasting and 

Electronic Media 39:313–27. 

120. Lang, A., P. Bolls, R. F. Potter, and 

K. Kawahara. 1999. The effects of 

production pacing and arousing content 

on the information processing of television 

messages. Journal of Broadcasting and 

Electronic Media 43 (4): 451–75. 

121. Bolls, P. D., A. Lang, and R. F. Potter. 2001. 

The effects of message valence and listener 

arousal on attention, memory, and facial 

muscular responses to radio advertisements. 

Communication Research 28 (5): 627–51. 

122. Lang, A., J. Newhagen, and B. Reeves. 1996. 

Negative video as structure: Emotion, 

attention, capacity, and memory. Journal of 

Broadcasting and Electronic Media 40 (4): 

460–77. 

123. Palmgreen, P., M. T. Stephenson, 

M. W. Everett, J. R. Baseheart, and 

R. Francies. 2002. Perceived message 

sensation value (PMSV) and the dimensions 

and validation of a PMSV scale. Health 

Communication 14 (4): 403–28. 

124. Niederdeppe, J. D. 2005. Syntactic 

indeterminancy: Perceived message 

sensation value-enhancing features 

and message processing in the context 

of anti-tobacco advertisements. 

Communication Monographs 72 (3): 

324–44. 

125. Pollay, R. W. 2000. Targeting youth and 

concerned smokers: Evidence from 

Canadian tobacco industry documents. 

Tobacco Control 9 (2): 136–47. 

126. Benowitz, N. 2001. Compensatory 

smoking of low-yield cigarettes. In Risks 

associated with smoking cigarettes 

with low machine-measured yields 

of tar and nicotine (Smoking and 

tobacco control monograph no. 13, 

NIH publication no. 02-5074), 39–63. 

Bethesda, MD: National Cancer Institute. 

http://cancercontrol.cancer.gov/tcrb/

monographs/13/index.html.

127. Burns, D. 2001. Smoking lower yield 

cigarettes and disease risks. In Risks 

involved with smoking cigarettes and 

low machine-measured yields of tar and 

nicotine (Smoking and tobacco control 

monograph 13, NIH Publication. no. 

02–5074), 65–158. Bethesda, MD: National 

Cancer Institute. http://cancercontrol

.cancer.gov/tcrb/monographs/13/index.html

128. Weinstein, D. D. 2001. Public understanding 

of risk and reasons for smoking low-yield 

products. In Risks associated with smoking 

cigarettes with low machine-measured 

yields of tar and nicotine (Smoking 

and tobacco control monograph no. 13, 

NIH Publication no. 02-5074), 193–98. 

Bethesda, MD: National Cancer Institute. 

http://cancercontrol.cancer.gov/tcrb/

monographs/13/index.html.

129. Kozlowski, L. T., M. E. Goldberg, B. A. Yost, 

E. L. White, C. T. Sweeney, and J. L. Pillitteri. 

1998. Smokers’ misperceptions of light 

and ultra-light cigarettes may keep them 

smoking. American Journal of Preventive 

Medicine 15 (1): 9–16. 

130. Borland, R., H. H. Yong, B. King, 

K. M. Cummings, G. T. Fong, T. EltonMarshall, D. Hammond, and A. McNeill. 

2004. Use of and beliefs about light 

cigarettes in four countries: Findings from 

the International Tobacco Control Policy 

Evaluation Survey. Nicotine Tobacco 

Research 6 Suppl. 3: S311–S321. 

131. Kozlowski, L. T., M. E. Goldberg, 

C. T. Sweeney, R. F. Palmer, J. L. Pillitteri, 

B. A. Yost, E. L. White, and M. M. Stine. 

1999. Smoker reactions to a “radio message” 

that Light cigarettes are as dangerous as 

regular cigarettes. Nicotine & Tobacco 

Research 1 (1): 67–76. 

132. Kozlowski, L. T., R. Palmer, M. M. Stine, 

A. A. Strasser, and B. A. Yost. 2001. Persistent 

effects of a message counter-marketing light 

cigarettes: Results of a randomized controlled 

trial. Addictive Behaviors 26 (3): 447–52. 

133. Shiffman, S., J. L. Pillitteri, S. L. Burton, 

J. M. Rohay, and J. G. Gitchell. 2001. Effect 

of health messages about “Light” and “Ultra 

Light” cigarettes on beliefs and quitting 

intent. Tobacco Control 10 Suppl. 1: i24–i32. 

134. Shiffman, S., S. L. Burton, J. L. Pillitteri, 

J. G. Gitchell, M. E. Di Marino, C. T. Sweeney, 

P. A. Wardle, and G. L. Koehler. 2001. Test of 

“Light” cigarette counter-advertising using 

a standard test of advertising effectiveness. 

Tobacco Control 10 Suppl. 1: i33–i40. 

135. Hamilton, W. L., G. Norton, T. K. Ouellette, 

W. M. Rhodes, R. Kling, and G. N. Connolly. 
476

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

2004. Smokers’ responses to advertisements 

for regular and light cigarettes and potential 

reduced-exposure tobacco products. Nicotine 

& Tobacco Research 6 Suppl. 3: S353–S362. 

136. Shiffman, S., J. L. Pillitteri, S. L. Burton, 

and M. E. Di Marino. 2004. Smoker and 

ex-smoker reactions to cigarettes claiming 

reduced risk. Tobacco Control 13 (1): 78–84. 

137. Siegel, M., and L. Doner. 1998. Marketing 

public health: Strategies to promote social 

change. Rockville, MD: Aspen Publishers.

138. Beaudoin, C. E. 2002. Exploring antismoking 

ads: Appeals, themes, and consequences. 

Journal of Health Communication 7 (2): 

123–37. 

139. Carter, S., R. Borland, and S. Chapman. 

2001. Finding the strength to kill your 

best friend: Smokers talk about smoking 

and quitting. Sydney: Australian Smoking 

Cessation Consortium and GlaxoSmithKline 

Consumer Healthcare.

140. Wakefield, M., C. Miller, and L. Roberts. 

1999. Comparison of the National Tobacco 

Campaign with a youth targeted South 

Australian campaign. In Australia’s National 

Tobacco Campaign: Evaluation report 

volume one; Every cigarette is doing you 

damage, ed. K. Hassard, 255–68. Canberra, 

Australia: Commonwealth Department of 

Health and Aged Care.

141. White, V., N. Tan, M. Wakefield, and D. Hill. 

2003. Do adult-focused anti-smoking 

campaigns have an impact on adolescents? 

The case of the Australian National 

Campaign. Tobacco Control 12 Suppl. 2: 

ii23–ii29. 

142. Schar, E. H. and Gutierrez, K. K. 2004. 

Lessons learned from global reviews of 

mass media campaigns designed to reduce 

smoking and exposure to secondhand 

smoke. http://www.cdc.gov/pcd/issues/2004/

apr/03_0034p.htm.

143. Myers, M. L. 1999. Adults versus teenagers: 

A false dilemma and a dangerous choice. 

Tobacco Control 8 (3): 336–38. 

144. U.S. Department of Health and Human 

Services. 1998. Tobacco use among 

U.S. racial/ethnic minority groups—

African Americans, American Indians and 

Alaska Natives, Asian Americans and Pacific 

Islanders, and Hispanics: A report of the 

Surgeon General. Atlanta: U.S. Department 

of Health and Human Services, Centers for 

Disease Control and Prevention, National 

Center for Chronic Disease Prevention and 

Health Promotion, Office on Smoking and 

Health. http://www.cdc.gov/tobacco/data

_statistics/sgr/sgr_1998/index.htm.

145. Marin, B. V., E. J. Perez-Stable, G. Marin, 

F. Sabogal, and R. Otero-Sabogal. 1990. 

Attitudes and behaviors of Hispanic smokers: 

Implications for cessation interventions. 

Health Education Quarterly 17 (3): 287–97. 

146. Perez-Stable, E. J., G. Marin, and S. F. Posner. 

1998. Ethnic comparison of attitudes and 

beliefs about cigarette smoking. Journal of 

General Internal Medicine 13 (3): 167–74. 

147. Farrelly, M. C., J. Niederdeppe, K. C. Davis, 

and M. L. Haviland. 2003. Exploring the 

role of message sensation value in designing 

effective tobacco countermarketing 

advertisements. Paper presented at the 

World Conference on Tobacco OR Health, 

Helsinki.

148. Center for the Digital Future. 2008. Center 

for the Digital Future, Annenberg School 

for Communication, University of Southern 

California (Los Angeles, CA), http://www

.digitalcenter.org/. (E-mail communication 

from Michael Suman and Liuning Zhou to 

Ronald M. Davis, May 23, 2008.)

149. Fox, S., and D. Fallows. 2003. Internet 

health resources: Health searches and 

email have become more commonplace, 

but there is room for improvement in 

searches and overall Internet access. 

http://www.pewinternet.org/pdfs/PIP

_Health_Report_July_2003.pdf.

150. Fox, S. 2005. Digital divisions: There are 

clear differences among those with 

broadband connections, dial-up connections, 

and no connections at all to the Internet. 

http://www.pewinternet.org/pdfs/PIP_Digital

_Divisions_Oct_5_2005.pdf.

151. Stoddard J. L., and E. M. Augustson. 2006. 

Smokers who use internet and smokers who 

don’t: Data from the Health Information and 

National Trends Survey (HINTS). Nicotine & 

Tobacco Research 8 Suppl. (1): S77–S85. 

152. Rainie, L., and D. Packel. 2001. More online, 

doing more: 16 million newcomers gain 

Internet access in the last half of 2000 

as women, minorities, and families with 

modest incomes continue to surge online. 

Pew Internet and American Life Project. 

http://www.pewinternet.org/pdfs/PIP

_Changing_Population.pdf.

153. Frisby, G., T. L. Bessell, R. Borland, and 

J. N. Anderson. 2002. Smoking cessation and 

the Internet: A qualitative method examining 

online consumer behavior. Journal of 

Medical Internet Research 4 (2): E8. 
477

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

154. Bock, B., A. Graham, C. Sciamanna, 

J. Krishnamoorthy, J. Whiteley, 

R. N. R. Carmona-Barros, and D. Abrams. 

2004. Smoking cessation treatment on the 

Internet: Content, quality, and usability. 

Nicotine & Tobacco Research 6 (2): 207–19. 

155. Revere, D., and P. J. Dunbar. 2001. Review 

of computer-generated outpatient health 

behavior interventions: Clinical encounters 

“in absentia.” Journal of the American 

Medical Informatics Association 8 (1): 

62–79. 

156. Cline, R. J., and K. M. Haynes. 2001. 

Consumer health information seeking on 

the Internet: The state of the art. Health 

Education Research 16 (6): 671–92. 

157. Steinberg, E. R. 1977. Review of student 

control in computer-assisted instruction. 

Journal of Computer-Based Instruction

3 (3): 84–90. 

158. Ross, S. M., and E. A. Rakow. 1981. Learner 

control versus program control as adaptive 

strategies for selection of instructional 

support on math rules. Educational 

Psychology 73 (5): 745–53. 

159. Gay, G. 1986. Interaction of learner 

control and prior understanding in 

computer-assisted video instruction. Journal 

of Educational Psychology 78 (3): 225–27. 

160. Steinberg, E. R. 1989. Cognition and learner 

control: A literature review. Journal of 

Computer-Based Instruction 16 (4): 117–21. 

161. Niemiec, R. P., C. Sikorski, and H. J. Walberg. 

1996. Learner-control effects: A review of 

reviews and a meta-analysis. Journal of 

Educational Computing Research 15 (2): 

157–74. 

162. Ross, S. M., and G. R. Morrison. 1989. 

In search of a happy medium in instructional 

technology research: Issues concerning 

external validity, media replications, and 

learner control. Educational Technology, 

Research, and Development 37 (1): 19–33. 

163. Negotia, C. V. 1985. Expert systems and 

fuzzy systems. Menlo Park, CA: Benjamin/

Cummings.

164. Velicer, W. F., C. C. D. Clemente, J. S. Rossi, 

J. L. Fava, and J. H. Steiger. 1993. An expert 

system intervention for smoking cessation. 

Addictive Behaviors 18 (3): 269–90. 

165. Etter, J. F. 2005. Comparing the efficacy 

of two Internet-based, computer-tailored 

smoking cessation programs: A randomized 

trial. Journal of Medical Internet Research

7 (1): e2. 

166. Strecher, V. J., S. Shiffman, and R. West. 

2005. Randomized controlled trial of a 

Web-based computer-tailored smoking 

cessation program as a supplement to 

nicotine patch therapy. Addiction 100 (5): 

682–88. 

167. Borland, R., J. Balmford, and D. Hunt. 2004. 

The effectiveness of personally tailored 

computer-generated advice letters for 

smoking cessation. Addiction 99 (3): 369–77.

168. Lancaster, T. and Stead, L. F. 2004. Self-help 

interventions for smoking cessation. 

Cochrane Review Art. No.: CD001118. 

DOI:10.1002/14651858.CD001118.pub2. 

http://www.cochrane.org/reviews/en/

ab001118.html.

169. Shiffman, S., J. A. Paty, J. M. Rohay, 

M. E. Di Marino, and J. Gitchell. 2000. 

The efficacy of computer-tailored smoking 

cessation material as a supplement to 

nicotine polacrilex gum therapy. Archives of 

Internal Medicine 160 (11): 1675–81. 

170. Shiffman, S., J. A. Paty, J. M. Rohay, 

M. E. Di Marino, and J. G. Gitchell. 2001. 

The efficacy of computer-tailored smoking 

cessation material as a supplement to 

nicotine patch therapy. Drug and Alcohol 

Dependence 64 (1): 35–46. 

171. Lipkus, I. M., P. R. Lyna, and B. K. Rimer. 

1999. Using tailored interventions to enhance 

smoking cessation among African-Americans 

at a community health center. Nicotine & 

Tobacco Research 1 (1): 77–85. 

172. McDaniel, A. M., S. Hutchison, G. R. Casper, 

R. T. Ford, R. Stratton, and M. Rembusch. 

2002. Usability testing and outcomes of an 

interactive computer program to promote 

smoking cessation in low income women. 

Proceedings of the AMIA Symposium, 

509–13. 

173. Whaley, K. C. 2004. America’s digital divide: 

2000–2003 trends. Journal of Medical 

Systems 28 (2): 183–95. 

174. May, S., and R. West. 2000. Do social 

support interventions (“buddy systems”) 

aid smoking cessation? A review. Tobacco 

Control 9 (4): 415–22. 

175. West, R., M. Edwards, and P. Hajek. 1998. 

A randomized controlled trial of a “buddy” 

system to improve success at giving up 

smoking in general practice. Addiction

93 (7): 1007–11. 

176. Brennan, P. F., and S. V. Fink. 1997. 

Health promotion, social support, and 

computer networks. In Health promotion 

and interactive technology: Theoretical 
478

1 1 . O v e r v i e w o f M e d i a I n t e r v e n t i o n s i n To b a c c o C o n t r o l

applications and future directions, ed. 

R. L. Street Jr., W. R. Gold, and T. Manning, 

157–69. Mahwah, NJ: Lawrence Erlbaum.

177. Shaw, B. R., F. McTavish, R. Hawkins, 

D. H. Gustafson, and S. Pingree. 2000. 

Experiences of women with breast cancer: 

Exchanging social support over the CHESS 

computer network. Journal of Health 

Communication 5 (2): 135–59. 

178. Chapman, S. 1985. Stop-smoking clinics: 

A case for their abandonment. Lancet

1 (8434): 918–20. 

179. Tate, D. F., E. H. Jackvony, and R. R. Wing. 

2003. Effects of Internet behavioral 

counseling on weight loss in adults at risk 

for Type 2 diabetes: A randomized trial. 

JAMA: The Journal of the American Medical 

Association 289 (14): 1833–36. 

180. Bull, F. C., C. L. Holt, M. W. Kreuter, 

E. M. Clark, and D. Scharff. 2001. 

Understanding the effects of printed health 

education materials: Which features lead 

to which outcomes? Journal of Health 

Communication 6 (3): 265–79. 

181. Burger, K. 1985. Computer assisted 

instruction: Learning style and academic 

achievement. Journal of Computer-Based 

Instruction 12 (1): 21–22. 

182. Stone, A. A., and S. Shiffman. 1994. 

Ecological momentary assessment (EMA) in 

behavioral medicine. Annals of Behavioral 

Medicine 16 (3): 199–202. 

183. Lepper, M. R., and J. L. Gurtner. 1989. 

Children and computers: Approaching the 

twenty-first century. American Journal of 

Psychology 44 (2): 170–78. 

184. Abrams, D. B., S. Mills, and D. Bulger. 

1999. Challenges and future directions 

for tailored communication research. Annals 

of Behavioral Medicine 21 (4): 299–306. 

185. Kreps, G. J. 2003. The impact of 

communication on cancer risk, incidence, 

morbidity, mortality, and quality of life. 

Health Communication 15 (2): 161–69. 

186. Neuhauser, L., and G. L. Kreps. 2003. 

Rethinking communication in the e-health 

era. Journal of Health Psychology 8 (1): 7–23. 

187. Collins, L. M., S. A. Murphy, V. N. Nair, 

and V. J. Strecher. 2005. A strategy for 

optimizing and evaluating behavioral 

interventions. Annals of Behavioral 

Medicine 30 (1): 65–73. 
479

12

Assessing the Effectiveness of 

the Mass Media in Discouraging 

Smoking Behavior

Mass media have been used as a population-level strategy to reduce tobacco use for 

several decades. However, studies of media interventions pose numerous methodological 

challenges. This chapter studies the use of mass media in tobacco control and health 

promotion, on the basis of a literature review, and examines research results relative to 

changing smoking behavior in light of the methodological issues. The following specific 

areas are covered:

n	 Controlled field experiments involving antismoking media campaigns aimed 

at youth and adults. These include longitudinal community-based studies 

promoting cardiovascular health, such as the North Karelia Project in Finland 

and the Stanford Three Community Study. In addition, controlled field 

experiments are addressed that included mass media as only one part of a 

multicomponent community- or school-based intervention.

n	 Population-level studies, including longitudinal and cross-sectional studies of 

national and state media campaigns. Some of these are part of multicomponent 

tobacco control programs. Examples include the Fairness Doctrine campaign, 

Australia’s “Quit for Life” and National Tobacco Campaign efforts, the national 

“truth” campaign in the United States, the tobacco industry’s own youth tobacco 

use prevention efforts, and the California Tobacco Control Program.

The methodological challenges of evaluating these studies include quasi-experimental 

designs without randomization, lack of accounting for homogeneity within intervention 

or control conditions, baseline differences, contamination of control groups, the presence 

of secular trends, and problems inherent in both cross-sectional and longitudinal studies. 

Many of the studies reviewed show a relationship between mass media interventions and 

positive outcomes for reduced tobacco use. Although methodological limitations present 

problems in interpretation, the preponderance of evidence suggests that mass media can 

be effective in reducing tobacco use.
480

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

Introduction

This chapter reviews the evidence mainly 

from two types of studies on the effects 

of mass media campaigns on tobacco use 

behaviors: controlled field experiments and 

population-based studies. Controlled field 

experiments, often called quasi-experimental 

designs, generally were feasibility or 

demonstration projects funded through 

research grants. In these studies, mass 

media interventions were delivered alone 

or in combination with other interventions 

(e.g., school or community programs) to 

subsets of a defined population, usually 

at the community level. The goal was to 

assess whether the intervention(s) could 

alter health behavior, including smoking, 

in the targeted communities. Comparison 

or control groups (in a few cases randomly 

selected) not receiving the intervention(s), 

and consisting of subsets of communities 

that are more or less comparable, were used 

as the basis for determining intervention 

efficacy. As will be seen below, these studies, 

although not definitive, were promising 

enough to warrant investigators’ continued 

efforts in this area.

On the basis of the results of these 

controlled field experiments, mass media 

and other interventions subsequently 

were delivered to entire populations via 

specially funded government programs, 

generally at the state or national level. 

To justify continued program funding, 

evaluations of program effectiveness 

were conducted. In some of these 

population studies, preprogram measures 

were obtained for comparison with 

postprogram measures to determine 

whether changes in smoking behavior 

had occurred. In other cases, trends in 

behavior over time for the population 

(e.g., state) receiving the intervention were 

compared to trends in other populations 

not receiving it (e.g., all other or selected 

groups of states). 

Some studies do not fit neatly into either 

of the groups described above and are 

discussed below under the broad heading 

that is most appropriate. The analytical 

challenges facing the evaluation of both 

controlled field experiments and population 

studies are outlined at the beginning of each 

of the main sections below. 

Research Methodology

For this chapter, a comprehensive and 

systematic review of the literature was 

conducted using standard search tools and 

the databases PubMed, PsycINFO, Web of 

Science, Scopus, and EMBASE. Search 

terms included (tv OR television OR radio

OR broadcast* OR mass media OR advertis* 

OR marketing OR countermarketing) AND 

(prevent* OR cessation OR initiat*) AND 

(tobacco OR smoking). Articles published in 

languages other than English and editorials 

and letters were excluded. The review 

extended from 1970 through May 2007. 

The focus was on studies that assessed 

the influence of mass media interventions 

(e.g., television, radio, print, and outdoor 

advertising) alone or in combination 

with other interventions (e.g., school, 

community, policy). The goal was to review 

how these interventions influenced tobacco 

use outcomes among youth and adults in 

the United States and elsewhere. Studies 

selected for formal review fit either the 

definition of controlled field experiments 

or of population studies as described above. 

Existing review articles also were obtained 

and are mentioned below.

Prior Reviews

The use of mass media to influence health 

behavior has been studied extensively. 

Some previous reviews specifically focused 

on media efforts to change smoking 

behavior.1–8 With few exceptions,1,5,7 these 

dealt only with the effects of mass media on 

youth. The scope of other reviews included 
481

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

studies of a number of health behaviors, 

such as drug or alcohol use, cancer 

screening, AIDS prevention, and seat belt 

use; smoking was just one of the behaviors 

considered.9–12 Despite the presence in all 

these reviews of studies that did not find 

significant intervention behavioral effects, 

the authors concluded, in general, that mass 

media campaigns, alone or in conjunction 

with other interventions, have brought 

about changes in health behavior. 

The introduction to a book edited by 

Hornik13 reviews the reasons for the mixed 

results of studies in this area. In some 

cases, controlled field experiments were 

not well enough funded to deliver enough 

media messages so that exposure was 

sufficiently different in the intervention 

and control communities. In other cases, 

media from other sources, or effects of other 

ongoing programs, generated changes in 

population norms that made the studies 

difficult to evaluate. At times, favorable 

secular trends were present in the control 

communities, diminishing the chances 

of showing a difference. Furthermore, 

the design and evaluation of such trials 

are not as straightforward as they are for 

controlled clinical trials of new medications 

or therapies. Hornik notes that studies 

(generally adequately funded population 

studies) that have demonstrated a behavioral 

outcome effect tend to achieve high levels 

of media exposure in the target group or 

population. This media exposure apparently 

fostered a process that led to a change in 

social norms and in turn affected behavior. 

The design and context of the controlled 

field experiments and population studies 

aimed at addressing the impact of 

antismoking media messages on smoking 

behavior have varied widely. The types, 

extent, and length of media campaigns 

have differed. Some studies used purchased 

broadcast time, and others relied on donated 

time or public service announcements 

(PSAs). There were differences in the 

outcomes measured, the types of assessment 

surveys (cross-sectional or longitudinal), 

the timing of outcome assessment, the 

theoretical foundations, and the advertising 

style and messages. A number of articles 

have aimed to synthesize the lessons 

learned from these previous studies and 

provide guidelines for the design of future 

controlled field experiments and populationbased media programs, both alone and in 

conjunction with other communitywide 

interventions.7,9,13–19 All of the differences 

among the studies mentioned above 

complicate efforts to synthesize study 

findings, but it is agreed that sufficient 

resources to assure adequate campaign 

exposure are essential. Much remains 

to be learned regarding the intensity, 

timing, duration, and targeting of mass 

media campaigns to achieve and optimize 

reductions in smoking. Chapter 15 further 

discusses this point.

Chapter Focus

This chapter serves as part of a broader 

framework within this monograph for 

examining the role of media in influencing 

tobacco use. Chapter 2 discusses how media 

work to influence behavior in general. 

Chapter 9 discusses the role of news media 

(as opposed to paid advertising or PSAs) 

in influencing behavior. News media 

coverage of communitywide, statewide, 

and national health promotion campaigns 

and their associated activities help raise 

public awareness. Finally, Chapter 11 

reviews the variety of campaign messages 

that have been broadcast, as well as the 

characteristics of antitobacco media 

messages that appear to perform well, in 

terms of target audience appraisal and 

indicators of message processing.

This chapter examines previous media 

interventions to reduce tobacco use 

within the context of the methodological 

challenges associated with both controlled 

field experiments and population studies. 
482

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

It outlines the statistical methodological 

principles that enable a meaningful 

evaluation to be conducted and the resulting 

limitations of the conclusions that can be 

drawn. Other resources that address these 

issues include a book edited by Hornik10 and 

a series of articles concerning the evaluation 

of the National Youth Anti-Drug Media 

Campaign published in an edition of Social 

Marketing Quarterly.

20 

Controlled Field 

Experiments

Overview

Early community-based studies of 

cardiovascular disease prevention evaluated 

communitywide education activities 

aimed at modifying a broad array of 

behavioral risk factors, including smoking. 

These mostly quasi-experimental efficacy 

studies included the North Karelia Project 

in Finland21–24 and the Stanford Three 

Community Study.25 In particular, the youth 

component of the North Karelia Project 

(described in more detail below) placed a 

strong emphasis on smoking prevention by 

using peer- and teacher-led social influence 

programs in schools, in addition to an adultfocused antismoking mass media campaign, 

and community activities. Results from 

these studies for both youth and adults 

provide initial indications that communitybased interventions can effectively reduce 

aggregate levels of cardiovascular disease 

risk factors.

Later studies concerning cardiovascular 

disease prevention, with smoking as an 

associated risk factor, used approaches 

similar to the North Karelia Project and 

the Stanford Three Community Study. 

Like the earlier studies, this second wave of 

studies (e.g., the Stanford Five-City Project, 

the Minnesota Heart Health Program) 

documented declines in cardiovascular 

disease risk factors.26,27 However, some of 

these studies also observed that favorable 

secular trends occurred simultaneously 

with the interventions, so researchers were 

unable to differentiate the intervention 

from the control communities after secular 

trends were taken into account.10 Some 

of the studies that focused on prevention 

of smoking among youth or smoking 

cessation in adults also had to contend 

with secular trends.

Methodological Issues

Besides the presence of secular trends, 

a number of methodological problems 

may explain in part why some controlled 

field experiments conducted to determine 

intervention efficacy have failed to show 

overall significant intervention effects. 

These studies are outlined below.

Although some controlled field experiments 

described in this section used a randomized 

controlled trial,25,28–30 others did not. 

A sufficient number of primary sampling 

units randomly assigned generally produce 

comparable study groups. However, in 

most cases, logistic constraints ruled out 

a randomized design. In the absence of 

randomization, most studies attempted to 

control for baseline differences by matching 

communities according to demographic 

characteristics and known or hypothesized 

correlates of smoking behavior. However, 

matching communities on the basis of 

variables that may be only moderately 

(or weakly) associated with smoking 

behavior can reduce the statistical power 

and make it difficult to find a difference that 

exists, which would constitute a type II error. 

In addition, precision would not necessarily 

increase, and the degrees of freedom to 

estimate the model are also reduced in 

a matched-pair design.31 Adjusting for 

factors that are not comparable between the 

communities in a statistical analysis also 

reduces the degrees of freedom that would 

be available to test for the interaction effect.
483

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Further complicating the issue of statistical 

power is that appropriate analyses of field 

experiments should base the analysis on 

the primary study units receiving the 

intervention (e.g., communities, schools). 

In most experimental studies, cost 

considerations dictate that the number of 

such study units is not large. 

A related issue is the practice of analyzing 

individuals rather than the primary study 

unit. If all individuals in the primary 

sampling units receiving the intervention 

simply are compared to all those in the 

primary sampling units not receiving 

the intervention, the study sample size is 

artificially inflated, increasing the chance 

of inferring that a small difference is 

significant (inflating the type I error).32

The underlying principle of experimental 

design is that the units of randomization 

(or assignment) to the experimental 

condition and the units of analysis should 

be the same.

To better understand the necessity to 

consider variability within primary study 

units, consider a set of communities 

assigned randomly to receive, or not 

receive, a media intervention. Within each 

community, a random survey of residents 

is conducted to measure outcomes. 

By nature of their shared experience 

within the community, there will be a 

shared component to their response. 

Thus, differences in average response 

between a control community and an 

intervention community will in part be due 

to community-level differences unrelated 

to the study. The randomization of many 

communities to each study condition 

will average out these community-level 

differences. If the community-level source 

of variation is not included in the analysis, 

differences between communities may be 

mistakenly ascribed to an interventioncontrol difference, inflating the chance of 

a type I error. Of course, if the variation 

of average response from community to 

community is small, the effect on the 

type I error also will be small. Studies that 

use only one community per intervention 

condition cannot estimate this effect 

at all; any difference found may simply 

be due to differences between the two 

communities. 

To further understand the need to account 

for community-level effects, suppose it were 

possible to randomize individuals within 

communities to receive, or not receive, the 

intervention. In this case, individuals from 

both the intervention and control groups 

would be living in each community, and 

community-level differences would affect 

both groups similarly, effectively subtracting 

out the community-level effect. 

Although some experimental studies of 

the use of media to change health behavior 

have used analytical techniques that 

account for the hierarchical nature of the 

design and take into account the variability 

between the sampling units at each level, 

others have not. Most analytical techniques 

to handle these designs are based on mixedeffect models, with careful attention paid 

to specification of the model terms so that 

these effects can be properly estimated. 

Such models, including those now termed 

hierarchical linear models, can also handle 

multiple covariates, as is often necessary, 

for the reasons given above. Describing the 

specifications of these models is beyond the 

scope of this section, but these analytical 

techniques are well presented elsewhere.32,33

It should be noted that these analytic 

methods did not become fully developed 

with available software until the early 1990s. 

Many researchers understood this problem 

and dealt with it to the extent possible by 

considering the intraclass correlation or 

other measures of nonhomogeneity within 

and between their primary sampling units. 

Designs that account for variability between 

the primary sampling units will be more 

precise but at the cost of a reduction in 

statistical power.32,34
484

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

When there are a sufficient number of 

primary sampling units, true matching, 

appropriate and multiple measures obtained 

pre- and postintervention, and analyses that 

account for the nesting of individuals within 

the primary sampling units, the quasiexperimental design is considered ideal for 

the evaluation of field experiments such as 

the ones described below.32 In reality, the 

design and conduct of such ideal studies 

are not possible. As Hornik10 acknowledged, 

designs and analyses appropriate to the 

laboratory are not necessarily applicable to 

the field, and new approaches to reflect the 

realities of such research are needed.

Generally, the controlled field experiments 

used surveys (cross-sectional, longitudinal, 

or both) to measure outcomes. Multiple 

cross-sectional surveys often were used to 

measure trends over time, at preintervention 

to establish previous secular trends, and 

during and after intervention, to assess 

differential change over time. Such a study 

design can strengthen the basis for causal 

inference when matching is deficient because 

each community serves as its own historical 

control. As long as the samples obtained are 

representative, and the primary sampling 

units are not changing their demographics 

or other characteristics differentially over 

time, repeated cross-sectional evaluations 

are appropriate evaluation tools. Even 

if the population composition changes, 

standardized estimates can be computed.

Longitudinal or cohort samples of 

individuals surveyed repeatedly are also 

appropriate and can establish that the 

extent of change over time for individuals 

differs within the type of intervention. 

However, many longitudinal studies suffer 

from sample attrition, and the individuals 

lost may be atypical of the group as a 

whole. If loss to follow-up differs among 

the primary sampling units or intervention 

groups, and is not accounted for in the 

analysis, interpretation of the results 

can be complicated. Thus, if the rates of 

follow-up differ among groups, such as 

smokers and nonsmokers, an intervention 

may appear more or less effective than 

it really was, depending on which group 

showed the greatest attrition. For example, 

if the intervention group experienced less 

attrition, it would likely contain more 

smokers at follow-up, making it less 

probable to detect a difference. Even if the 

attrition rates are comparable, there may 

be differences in characteristics among 

those lost and those successfully followed 

within their intervention groups. Many of 

the longitudinal studies reviewed below 

attempted to establish whether differential 

attrition might be a problem.

To avoid repetition in the sections 

below that describe the controlled field 

experiments involving youth and adults, 

the studies did not specifically account for 

individual-level variability within primary 

sampling units, unless otherwise indicated. 

All studies that used longitudinal assessment 

of outcomes suffered attrition to a lesser or 

greater degree. No comment is given unless 

there was evidence of differential attrition 

or if no attrition analysis was reported. 

Furthermore, the analyses performed 

generally adjusted for at least demographic 

or other characteristics that were related to 

baseline inequalities or differential attrition. 

Only if studies did not use such methods 

is it noted. Studies using cross-sectional 

assessment generally used population-based 

random household surveys. These are simply 

referred to as population surveys in the 

tables and text. The text comments mainly 

on other important features of the study 

design, intervention, analysis, and results.

Effects on Youth

Table 12.1 summarizes the controlled field 

experiments involving youth. The columns 

of table 12.1 highlight the intervention 

and methodological characteristics of the 

various studies discussed below (see last 

paragraph of previous section). The two 
485

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

studies that did not allow for assessment of 

a media effect, either separate from or in 

addition to other intervention components, 

are discussed first (North Karelia, Minnesota 

Heart Health). The remaining studies are 

presented in more or less chronological 

order. Three of the youth studies were 

embedded within efforts primarily aimed 

at adults to improve cardiovascular health; 

these include the North Karelia Project, the 

Minnesota Heart Health Program, and the 

Stanford Five-City Project. Of the controlled 

field experiments assessing a media effect 

on youth, seven found evidence for an effect, 

and three found no evidence.

The two-year-long North Karelia Project 

in Finland began in 1978 and included 

interventions aimed at both adults 

and youth.22–24 The youth prevention 

components were school based, and the two 

intervention arms differed in the nature 

of the school social influence program: 

either peer or teacher led. North Karelia 

received both an adult mass media 

intervention (see “Effects on Adults” for 

more information on media intervention) 

and other community-based activities aimed 

at adult smoking cessation. The control 

province received no interventions. 

Three groups of students (peer-led, teacherled, and control) in the North Karelia 

Youth Project were assessed longitudinally 

multiple times up to four years after the 

program began; at least 80% of those 

surveyed at baseline participated again at 

each point. Some differences in attrition 

rates occurred among intervention groups, 

but differential attrition was not analyzed. 

The results of this study provided some 

of the earliest evidence that a combined 

school and communitywide campaign with 

a significant media component can reduce 

youth smoking. Both immediately after 

the intervention and at four years after the 

program began, smoking rates were lower in 

the intervention schools.22 At the four-year 

follow-up, when students were about 

17 years of age, 34% (peer-led) and 27% 

(teacher-led) of the boys in the intervention 

schools reported smoking at least once 

or twice a month, compared with 42% of 

those in the control schools. For girls, these 

percentages were 21% (peer-led) and 25% 

(teacher-led) in the intervention schools and 

33% in the control schools. Lower smoking 

rates in the intervention communities 

persisted at 8-year follow-up and 15-year 

follow-up, but only for baseline nonsmokers. 

At the 15-year follow-up, there was no 

evidence that youth smokers quit at higher 

rates in the intervention communities than 

in the control communities.23,24

The Minnesota Heart Health Program 

was another study that evaluated youth 

outcomes in a study aimed at reducing 

cardiovascular risk factors, including 

smoking, among adults.35 School-based 

health and smoking prevention programs 

to influence social and psychological 

factors were instituted in schools in one 

intervention community with its matched 

community serving as the control. 

The intervention community received the 

mass media campaign and the communitybased, adult-focused activities. The control 

community received neither. Thus, only the 

combined intervention could be compared 

to no intervention. All students in all 

schools in the two youth study communities 

were surveyed in 1983 when they were 

6th graders and then annually until they 

were seniors in high school. Results from 

both longitudinal and cross-sectional 

surveys showed a marked reduction (about 

40% for cross-sectional surveys) in weekly 

smoking prevalence for high school seniors 

in the intervention community compared 

with the control community.

Like the North Karelia Project and the 

Minnesota Heart Health Program, the 

Stanford Five-City Project also aimed its 

mass media primarily at adults (see “Effects 

on Adults”). However, no intervention 

was specifically for youth; the study 
486

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r Table 12.1 Summary of Reviewed Controlled Field Experiments: Youth Study Intervention description Target group Study design Assessment mode/outcomes/analysis Main results North Karelia (Youth) Vartiainen et al. 1986;22 Vartiainen et al. 1990;23 Vartiainen et al. 199824 Started in 1978. Finland C = no intervention. I1 = peer-led social influence school program plus adult-focused mass media campaign plus community activities aimed at promoting cessation among adults. 

I

2 = teacher-led social influence 

school program plus adultfocused mass media campaign plus community activities aimed at promoting cessation among adults. Lasted 2 years.

7th graders (12- to 13-year-olds) received school program for 2 years. 

Quasi-experimental: 4 schools in North Karelia (intervention province) received school program and were compared with 2 schools in a control province that did not receive it, starting in 1978. Schools selected to match for various characteristics. 

Smoking at least once or twice a month was assessed in the same cohort pre- and postintervention, with additional follow-ups later. Some differences in followup rates, not analyzed.Analysis of simple proportions smoking at each follow-up. 

At 4-year follow-up, smoking prevalence was significantly lower in both intervention groups, relative to the comparison group. At 8- and 15-year followups, smoking initiation rates were still lower for baseline nonsmokers in the intervention groups, with no difference in quit rates for baseline smokers.

Minnesota Heart Health Program (MHHP) (Youth)Perry et al. 199235Started in 1983.

C = no intervention. I = health behavior and smoking prevention school program plus mass media focused on heart health, including smoking cessation.Lasted 6 years.

6th graders in all 13 grade schools in MHHP study; community and matched control community. 

Quasi-experimental: 1 community participating in the MHHP with its 1 matched control community in South Dakota.

Weekly smoking prevalence and smoking intensity among students in all schools in each community assessed annually (longitudinally and cross-sectionally) until their senior year in high school. Intraclass correlation considered in analyses. Attrition analysis showed bias in favor of finding no effect. 

Both longitudinal and crosssectional results showed significantly less weekly smoking and lower smoking intensity for the students in the intervention community compared with the control community. Results were present early and maintained through the senior year.

Stanford Five-City Project (Youth)Fortmann et al. 1995;43Winkleby et al. 199336Started in 1979.

C = no intervention. I = media advocacy and (primarily) adultfocused antismoking advertising.Lasted 6 years.

12- to 24-year-olds Quasi-experimental: 2 pairs 

of matched communities in each condition. 

Cross-sectional population surveys assessed daily smoking prevalence before, during, and following the intervention. 

At no time (1979–90) was there a difference in daily smoking prevalence between intervention and control communities.Strong secular trend present. 
487

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 12.1 Summary of Reviewed Controlled Field Experiments: Youth (continued)

Study

Intervention 

description

Target 

group

Study 

design

Assessment 

mode/outcomes/analysis

Main 

results

Flynn et al. 1992;38Flynn et al. 1994;39Flynn et al. 199540Flynn et al. 1997;42Worden et al. 1988;37Worden et al. 199641Started in 1985.

C = school-only antismoking educational program. I = school-based education (same as C) plus television and radio antismoking media campaign.Lasted 4 years.

4th, 5th, and 6th graders

Quasi-experimental: 2 pairs of matched study communities assigned to intervention on the basis of available media markets.

Smoking behavior index, which can be interpreted as the number of cigarettes smoked per week, any smoking in the past week, or smoking yesterday. Longitudinal cohort of youth randomly selected from metropolitan statistical areas (MSAs) was surveyed at baseline and annually until 2 years postintervention. Analyzed both on an individual and community basis. Unclear whether community-level analysis accounted for individual-level variability.

At 2 years postintervention, students receiving the full intervention were significantly lower on the smoking index (41%), smoking last week (35%), or yesterday (34%) reports than those receiving only the school curriculum. The combined program appeared particularly effective in highrisk youth.

Bauman et al. 1988;44Bauman et al. 199128Started in 1985.

C = no intervention. I1 = radio antismoking messages. I

2 = same as I1 plus radio 

advertisement of a nonsmoking sweepstakes (encouraging communication with peers to discourage smoking). I

3 = same as I2 plus television 

advertisement of the sweepstakes. Lasted 15 months.

12- to 14-year-olds Prescreened standard MSAs 

were randomly allocated (2 each) to intervention and control conditions.

Longitudinal sample of adolescents in probability sample of households in MSAs assessed for a number of attitudinal and smoking behavior variables at baseline and 11 and 17 months postintervention. Individual-level variation taken into account in analysis of MSAs. 

No differences in smoking behavior detected at 11 and 17 months postintervention. Moderate effect of the radio campaign (I1 and I2) on expected consequences of smoking. 
488

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r Table 12.1 Summary of Reviewed Controlled Field Experiments: Youth (continued) Study Intervention description Target group Study design Assessment mode/outcomes/analysis Main results Television, School, and Family Smoking Prevention and Cessation Project Brannon et al. 1989;47 Flay et al. 1988;45 Flay et al. 1995;29 Sussman et al. 198946 Started in 1986. Los Angeles: C1 = no treatment. 

C2 = basic health information curriculum only. I1 = schoolbased (social-resistance) education. I2 = television media intervention. I3 = school-based education plus television media intervention. San Diego: C = no treatment. I = school-based (social-resistance) education only (no television).Lasted 4 years.

12- to 14-year-olds Schools in Los Angeles 

(35; 7 per condition) and San Diego (12; 6 per condition) randomly assigned to treatment conditions. 

Students assessed longitudinally twice in the 7th grade and once in each of grades 8 and 9. Smoking in the past week and ever smoking analyzed.Analysis accounted for individual variability within classrooms within schools.

No significant effects on smoking behavior (at 2-year follow-up). Strong, significant effects on knowledge of smoking consequences, perceived smoking prevalence, and efforts to resist trying cigarettes.

Project SixteenBiglan et al. 200030Started in 1990.

C = school intervention only. I = school intervention plus community intervention with paid antismoking media on radio.Lasted 3 years.

7th and 9th graders 8 matched pairs of small 

Oregon communities were randomly assigned to 1 of the 2 conditions. 

All 7th and 9th graders in all schools in each community surveyed annually and crosssectionally (before, 3 during, after). A composite measure of weekly smoking was evaluated. Analyses nested students within communities. 

At both project completion and 1-year follow-up, students in the school plus community intervention had significantly lower rates of past-week smoking.

Hafstad and Aaro 1997;49 Hafstad et al. 1996;48 Hafstad et al. 1997;50 Hafstad et al. 199751Started in 1992.Norway

C = no intervention. I = three consecutive waves of mass media campaigns designed to prevent adolescent smoking (newspaper advertisements, poster, television spot, and cinema spot). Each of 3 waves of media had a different message focus and was broadcast for 3 weeks once a year.Lasted 3 years. 

14- to 15-year-old students. Both males and females, but females were targeted.

Quasi-experimental: 1 pair matched counties. Unknown basis for assignment to I or C.

Daily, weekly, less than weekly, occasional, or nonsmoker status analyzed with longitudinal assessment at 6–12 months and at 3 years (1 year after 3rd campaign). Main analyses examined any current smoking with interaction effects of baseline status and gender. Attrition slightly higher in C, but differential attrition not analyzed. 

3-year follow-up: significant reduction in overall odds of being a smoker for I group compared with C group for males and females. Reduction in odds of smoking for baseline male and female smokers. Reduction in odds of smoking for baseline nonsmokers evident only for the females.
489

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 12.1 Summary of Reviewed Controlled Field Experiments: Youth (continued)

Study

Intervention 

description

Target 

group

Study 

design

Assessment 

mode/outcomes/analysis

Main 

results

Texas Tobacco Prevention Pilot InitiativeMeshack et al. 200452Started in 2000.

C = no intervention.I

1 = no program/no media.

I

2 = no program/low media.

I

3 = no program/intensive media.

I

4 = enhanced school/no media.

I

5 = enhanced school/low media.

I

6 = enhanced school/intensive 

media. I7 = multicomponent/low media. I8 = multicomponent/intensive media.Lasted 6 months.

6th graders 8 sites selected for maximum 

ethnic diversity. Random assignment of intervention level to communities contingent on having a unique media market. The largest and most ethnically diverse school in each community was selected for evaluation. In some cases, 2 schools were selected; 11 schools evaluated altogether.

Before-and-after crosssectional school surveys evaluated student attitudes and tobacco use (any in the last 30 days), and susceptibility to smoking.*Preintervention survey conducted in spring 2000. Various interventions took place during the summer and fall of 2000, with the postintervention survey of a new 6th-grade cohort taking place in late fall 2000.Analyses considered intraclass correlation within schools.

Combining the intensive or low-media campaign with the multicomponent community program (I7 or I8 ) was most effective in suppressing positive attitudes toward smoking. Combining the intensive media campaign with the multicomponent community program (condition I8) consistently reduced tobacco use, susceptibility to smoking, and prosmoking attitudes. Smoking was reduced more in I2 than in I3, but neither tested against C.

Slater et al. 200653Started in 1999.

I

1 = no intervention. I2 = no 

community media, no in-school curricula, in-school media only. I3 = community media, no in-school media, curricula. I

4 = community media, in-school 

media, curricula.Communities selected from all regions of the U.S.2-year media period staggered for communities. Study ended in 2003.

Middle and junior high school students, mean age 12.2 years.

2 schools in 8 no-media communities randomly assigned to I1 and I2, and 2 schools in 8 media communities randomly assigned to I3 and I4. Randomization constrained.

Longitudinal sample measured at preprogram, following curriculum, and twice thereafter.Four-level model included time, student, school, and community.

Study evaluated marijuana, alcohol, and smoking uptake. The community-media interventions (I3 and I4) significantly reduced uptake rates for all substances. Lowest uptake rates by 4th survey observed for condition I4. 

*Never smokers who do not rule out trying a cigarette or taking one from a friend, if offered, are susceptible to smoking. See chapter 7 for further discussion.
490

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

measured youth (aged 12–24 years) 

smoking prevalence in addition to adult 

health outcomes.36 In this study, two sets of 

matched communities received the media 

intervention and the others did not, making 

a direct assessment of mass media effects 

possible. The program began in 1977 and 

lasted for six years. Cross-sectional surveys 

before, during, and after the intervention 

did not detect a difference in youths’ daily 

smoking prevalence between the control 

and intervention communities. 

Students in two matched pairs of 

communities in Vermont and Montana 

received either a combination of media 

(television and radio) and school 

interventions, or the school intervention 

alone, over a four-year period. The school 

intervention, based on social influence 

theories, conveyed refusal skills, accurate 

social norms, positive views of nonsmoking, 

and negative views of smoking.37–42 The paid 

media intervention consisted of 15 television 

and 8 radio spots broadcast at intervals 

over the intervention period. Within each 

matched pair of communities, one was 

assigned to receive each condition. Thus, 

the media effect above and beyond the school 

intervention could be evaluated. Students 

who completed the baseline assessment 

were assessed annually over the four-year 

campaign period, with an additional followup occurring two years after completion 

of the campaign. This sustained campaign 

was associated with a reduction in youth 

smoking. Smoking rates after campaign 

completion were 34% to 41% lower among 

students exposed to both the antitobacco 

advertising campaign and the school 

programs compared with those exposed to 

the school programs alone.38 These effects 

persisted at the two-year postcampaign 

follow-up.39 Notably, these results were even 

more pronounced for high-risk students, 

particularly high-risk girls.41

Overall, this study provides strong evidence 

that a program using both mass media and 

school-based programming is more effective 

than one using school-based programming 

alone.42 The added value of the media 

campaign may be most pronounced for 

high-risk youth in the study; they were 

found to watch more television and listen 

to more radio.

In a study conducted in the southeastern 

United States, Bauman and colleagues28

compared three different strategies of 

mass media with a control group who did 

not receive any intervention. This study 

was designed to evaluate the effectiveness 

of a radio campaign about the expected 

negative consequences of smoking, along 

with television and print-media messages 

delivered by mail. These campaign 

messages were designed to provide personal 

encouragement not to smoke. The study 

occurred over a 15-month period beginning 

in 1985, with follow-up conducted two 

years after baseline, 11–17 months after the 

broadcast, and two to eight months after the 

mailed intervention.28 The media messages 

used in this campaign were rigorously 

developed on the basis of a number of 

behavioral theories and were tested during 

an extensive formative period.44

Bauman and colleagues28 used a cluster 

sampling procedure to identify a 

probability sample of households within 

standard metropolitan statistical areas 

(MSAs). They selected regionally matched 

communities. Nonetheless, baseline 

smoking rates varied substantially among 

the standardized MSAs. Analyses accounted 

for interindividual variability within 

MSAs. No significant difference in the 

change in smoking prevalence over time 

between the groups was detected. However, 

there was some evidence of a positive effect 

on expected consequences of smoking 

and peer approval of smoking. The media 

campaign was of short duration and may 

not have been sufficient to produce changes 

in smoking behavior. A further analysis54

indicated that the differences between 
491

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

communities that persisted, even after 

controlling for a wide range of demographic 

and personality covariates, limited the power 

of the study to detect change.

The Television, School, and Family 

Smoking Prevention and Cessation 

Project 29,45–47 randomly assigned schools 

in Los Angeles and San Diego, California, 

to intervention groups. The design for 

Los Angeles was more complex than for 

San Diego, which was restricted to a 

school program versus a no-intervention 

group. In Los Angeles, there were two 

control groups (no intervention and an 

attention placebo) and three intervention 

groups: school program, television, and 

both. Both the school program and the 

television spots were designed to foster 

social resistance to smoking. A cohort of 

students in 340 classes in 35 Los Angeles 

and 12 San Diego schools were assessed 

at baseline (January 1986), immediately 

postintervention (April 1986), and at one 

and two years later. The program lasted 

four years. Changes in scores at each 

assessment were analyzed separately in a 

hierarchical linear model that accounted for 

students within classrooms within schools. 

Randomization produced very comparable 

groups at baseline. No treatment condition 

was associated with smoking in the past 

week at any follow-up. However, both 

intervention types had some favorable 

effects on knowledge and on students’ 

estimates of smoking prevalence among 

youth and among adults. The authors 

attribute the lack of any intervention effect 

on smoking behavior to poorly executed 

television programming and significant 

variability in the integrity of classroom 

program delivery. Also, the program was 

of relatively short duration.

Biglan and colleagues30 matched 16 small 

Oregon communities (8 pairs) and 

randomly assigned them to receive either 

(1) a school-based prevention program, or 

(2) the school-based program in addition to 

a community program that included media 

advocacy, youth antitobacco activities, family 

communication about tobacco use, and 

policies aimed at reducing youth access to 

tobacco. The media advocacy involved paid 

advertisements and radio PSAs, newspaper 

articles, presentations to local civic groups, 

and posters. The program lasted three 

years at each site. The school curriculum 

used a social influences approach and 

was designed for students in grades 6–12. 

Cross-sectional surveys of students from 

7th grade and 9th grade were conducted 

five times from baseline until one year after 

the end of the intervention. The combined 

school and community intervention was 

associated with a significant reduction in 

prevalence one year after the intervention 

was completed, compared with the schoolonly condition.30 This study supports the 

findings of Flynn and colleagues40 and 

provides additional evidence that a mass 

media campaign (when combined with other 

components) can reduce smoking rates. 

A three-wave mass media campaign from 

Norway was designed to assess the effect of 

mass media alone.48–51 Three distinct media 

campaigns of three weeks’ duration were 

directed at adolescents in one county over a 

three-year period (1992–95). The campaign, 

designed to be provocative, was intended 

to elicit negative affective reactions and 

to stimulate communication among 

peers. It used newspaper advertisements, 

posters, and television and cinema spots. 

Two campaigns were specifically designed 

to engage girls, while the third was directed 

toward both girls and boys. A baseline survey 

of all eligible youth aged 14 and 15 years 

(longitudinal cohort) was conducted in both 

the intervention county and the control 

county before the first of three media 

campaigns. Attrition was slightly higher 

for the no-intervention group, but possible 

effects were not analyzed. At the completion 

of the final media campaign, nonsmoking 

youth at baseline were less likely to smoke 

at follow-up in the intervention county 
492

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

compared with youth in the control county. 

The overall increase in the percentage 

of daily smokers was significantly lower 

among girls in the intervention county than 

in the control county. Findings were not 

significant for boys, although the results 

appeared to be in the same direction. 

The campaign was primarily aimed at girls, 

so this finding was expected. 

A relatively short-term (six months) 

intervention study in Texas evaluated the 

effect of antitobacco media, enhanced school 

programs, and community-based programs 

on middle-school students’ smoking.52

Sites were identified on the basis of ethnic 

diversity and then randomly assigned to 

the various levels of intervention: media 

(none, low, and intensive); programs (none, 

enhanced school program based on social 

influence theory); and multicomponent 

(both school- and community-based 

programs). Two schools were selected for 

some intervention levels. Surveys were 

administered to 6th graders in spring 2000 

before the intervention at 11 schools—

selected to be the most ethnically diverse 

schools possible—and repeated on a new 

sample of 6th graders in the fall. Schools 

were the primary unit of analysis, and 

intraclass correlation within schools was 

considered in the analysis. Smoking and 

positive beliefs about smoking declined the 

most between the pre- and postintervention 

evaluations among the students at the sites 

with the highest levels of intervention. 

These schools also had the highest baseline 

smoking rates. The media-alone results were 

not consistent: the low-media condition 

showed a greater reduction in smoking than 

did intensive or no media exposure. 

Another study aimed to discern the effect 

of a communitywide media campaign on 

the initiation of marijuana, alcohol, and 

cigarette use among middle and junior 

high school students in all regions of 

the United States.53 Eight communities 

received the media program (brochures, 

press releases, advertised special events, 

posters, and radio PSAs), and eight did not. 

Within the set of eight communities that 

received media, schools were randomly 

assigned either to receive or not to receive 

an in-school media campaign consisting of 

posters, book covers, tray liners, T-shirts, 

water bottles, rulers, and lanyards. Schools 

in the no-media communities were 

randomly assigned either to no treatment 

or to the in-school media condition. 

Schools in each set of communities also 

were randomly assigned either to receive 

or not to receive an anti-substance-use 

curriculum based on social influence theory. 

The randomization process was constrained 

by using a group-matching strategy to 

reduce the potential for confounding 

from community differences. The media 

interventions lasted for two years but 

were staggered over a four-year period 

among communities. A hierarchical model 

was used to assess the uptake endpoints: 

measurement time within student, student 

within school, school within community, 

and community within media condition. 

The results showed reduced (at least 50% 

less) substance uptake over time for students 

exposed to both community and in-school 

media compared with those not exposed to 

any media. Marijuana and alcohol uptake 

appeared more reduced than was cigarette 

initiation, but the media emphasized the 

other substances more than cigarettes. 

The media effect was similar regardless of 

whether or not students participated in the 

anti-substance-use curriculum. The study 

did not examine the community media effect 

separately from the in-school media effect 

but concluded that these types of media 

together could reduce substance uptake. 

Effects on Adults

Many of the controlled field experiments 

described below were aimed at improving 

cardiovascular health, and these projects 

included intervention components to 

promote healthy eating and to increase 
493

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

exercise as well as to reduce smoking. 

Other projects were specifically designed to 

reduce smoking. As in the youth studies, 

some studies of adults allowed for the 

evaluation of media alone in influencing 

smoking behavior and others for evaluating 

only media in combination with other 

intervention components. Of the 10 studies 

reviewed concerning the promotion of 

cardiovascular health, only two allowed 

for the media component to be evaluated 

separately from all other components: the 

Stanford Three Community Study25 and 

the Coronary Risk Factor Study (CORIS).55

However, six of the eight studies specifically 

concerned with smoking cessation allowed 

for a separate evaluation of the media 

component. Table 12.2 summarizes the 

details of these studies and is organized 

into sections for general cardiovascular 

health promotion and smoking cessation, 

with results described more or less 

chronologically. Of the ten controlled field 

experiments concerning cardiovascular 

health, seven showed at least some 

evidence for an effect on reducing smoking 

behavior; of the nine field experiments 

promoting reduced smoking, eight showed 

some reduction. 

Cardiovascular Health

The Stanford Three Community Study,25

the Australian North Coast’s “Quit for 

Life” program,56 and the CORIS55 used very 

similar study designs that allowed a media 

component to be evaluated separately. 

These studies are described first, followed 

by studies for which a media component 

could not be evaluated separately.

The Stanford Three Community Study25

began in 1972 and was one of the earliest 

community-based field experiments. It used 

a quasi-experimental design in which three 

communities were randomly assigned 

to receive (1) a mass media campaign 

(radio and television programming 

and spots, weekly newspaper columns, 

newspaper advertisements, and printed 

material), (2) a mass media campaign 

and intensive face-to-face intervention, 

(3) or no intervention (control). With the 

use of a population-based longitudinal 

sample, reductions in self-reported 

cigarette consumption were examined, 

presumably among all cohort participants, 

with nonsmokers defined as smoking zero 

cigarettes per day. Thus, this measure does 

not distinguish between smokers quitting 

by follow-up or simply decreasing their 

daily consumption. Change in smoking 

prevalence within the cohort would have 

provided stronger evidence. The analyses 

were based on comparisons of unadjusted 

mean changes in consumption, and 

differential attrition was not examined. 

After two years, lower self-reported cigarette 

consumption occurred in the mass media 

and intensive face-to-face intervention 

than in the control condition (a net 

reduction of 24.1% and 2.5%, respectively). 

The group that received the mass media 

intervention alone also experienced 

a significant reduction in cigarette 

consumption, but the difference was not as 

large (7.3%). The high-risk cohort showed 

even greater reductions at two years: 

13.8% for the media-only intervention and 

42.3% for the media and intensive face-toface program versus 17.2% in the control 

community. It is likely that a portion of 

these reductions is from smokers’ quitting.

The Australian North Coast Healthy Lifestyle 

Programme included a strong component 

directed at smoking cessation: “Quit for 

Life.”56 This program was also patterned after 

the Stanford Three Community Study and 

was instituted in three small communities 

in New South Wales, Australia. The “Quit 

for Life” campaign began in 1978 and used 

a social marketing approach with an aim 

of reducing the prevalence of smoking. 

The quasi-experimental design was used 

to evaluate the effects of a mass media 

campaign alone (TV, radio, newspapers, 

posters, etc.) in one community compared 
494

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r Table 12.2 Summary of Reviewed Controlled Field Experiments: Adults Study Intervention description Target group Study design Assessment mode/outcomes/analysis Main results Cardiovascular Health Promotion Trials Stanford Three Community Study Maccoby et al. 197725 Started in 1972. C = no intervention (Tracy). 

I1 = extensive mass media campaign (Gilroy). I2 = same as above plus individual riskreduction counseling for highrisk subjects (Watsonville).Lasted 2 years.

35- to 59-year-olds. Individuals at high risk for cardiovascular disease were identified and analyzed separately.

Quasi-experimental: 2 cities as intervention sites and 1 city as the comparison. 

Longitudinal assessment with baseline data collected in 1972, immediately preceding the intervention and at follow-up at 1 and 2 years after the intervention began. Subjects reported the number of cigarettes smoked per day; presumably, nonsmokers were analyzed as smoking zero cigarettes per day.Unadjusted analysis of change.Differential attrition not analyzed.

After 2 years, the I

2 city (Watsonville) had 

a significantly lower self-reported cigarette consumption than the C city (Tracy). The reduction was not as great, but still significant for the I1 city (Gilroy). Results were similar for high-risk subjects, but with even higher net reductions in consumption, suggesting substantial quitting.

North Coast “Quit for Life” ProgrammeEgger et al. 198356Started in 1978.Australia

C = no intervention (Tamworth). I

1 = mass media program 

(Coffs Harbour). I2 = mass media program and community program (Lismore). Media and other programs aimed to alter coronary risk factors.Lasted 2 years.

18 years and older Quasi-experimental: 

2 intervention towns and a comparison town. Intervention applied to 2 towns that shared common media market. Towns not well matched.

Cross-sectional random population surveys at baseline and year 1 and year 2 were used to assess current smoking status, knowledge, and attitudinal factors. 

After 2 years, compared with C, there was a greater reduction in smoking prevalence among both men and women in I1 and I

2. The reduction was better 

sustained (year 2) in Lismore (I2). There were no significant changes in knowledge or attitudes. 
495

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 12.2 Summary of Reviewed Controlled Field Experiments: Adults (continued)

Study Intervention description Target group Study design

Assessment

mode/outcomes/analysis Main results

Coronary Risk Factor Study (CORIS)Rossouw et al. 1993;55Steenkamp et al. 1993;57 Steyn et al. 199758Started in 1979.South Africa

C = no intervention (Riversdale). I

1 = mass media (Swellenden). 

I

2 = mass media and community 

based (Robertson).Lasted 4 years.

White persons 15–64 years of age.

Quasi-experimental: 3 matched communities assigned to intervention groups. Intervention areas shared common boundary; control community was remote.

Cross-sectional surveys of entire white population conducted at baseline (1979) and follow-up (end of intervention and 12 years). Those surveyed both times were used in a cohort analysis. Surveys assessed self-reported risk factors, including current regular smoking and consumption level. 

At the 4-year follow-up, the cohort analysis showed the overall change in smoking prevalence and cigarette consumption were similar in I

1 and I2 and greater than in 

C. Effect greater for women. At the 12-year follow-up, smoking prevalence and cigarette consumption were lower in I1 but not in I2, compared to C.

North Karelia Project (Adults)Jousilahti et al. 1994;62Puska et al. 1983;21Puska et al. 1985;63Puska et al. 1985;64Puska et al. 1989;65Vartiainen et al. 1991;59Vartiainen et al. 1994;60Vartiainen et al. 199824,61Started in 1972.

C = no intervention. I = changes in community organizations, involvement of many sectors of the community, the use of mass media, screening, appropriate practical skills training, provision of social support for behavior change, environmental modifications, special training of public health nurses to provide smoking cessation advice and counseling.Lasted 5 years.

25- to 64-year-olds Quasi-experimental: 

2 matched communities. Compared cardiovascular risk factor changes in North Karelia (I) and Kuopio (C).

Cross-sectional population surveys assessed daily smoking prevalence at baseline, before the intervention, and at the end of the intervention. Changes in prevalence of regular smoking.

After 5 years, compared with Kuopio, smoking prevalence had declined significantly more among men in North Karelia, but not among women. The difference was even greater for men at 10 years, but changes thereafter were small. 
496

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r Table 12.2 Summary of Reviewed Controlled Field Experiments: Adults (continued) Study Intervention description Target group Study design Assessment mode/outcomes/analysis Main results Stanford Five-City Project (Adults) Farquhar et al. 1990;68 Fortmann et al. 1993;26 Fortmann et al. 1995;43 Fortmann & Varady 2000;66 Winkleby et al. 199667 Started in 1980. C = no intervention. I = multicomponent community program together with mass media campaign aimed at improving cardiovascular disease risk factors. Lasted 6 years. 25- to 74-year-olds Quasi-experimental: 2 pairs of matched communities, assigned to intervention on the basis of shared mass media market. Another city was observed for cardiovascular morbidity and mortality. Cross-sectional population surveys assessed smoking status, knowledge, and quitting behavior at baseline 2 years before the intervention, at alternate year intervals during the intervention, and at 2 years after the intervention. A cohort sample was embedded within the multiple cross- sectional surveys. Cross-sectional analysis: smoking prevalence fell to a comparable extent in both intervention and comparison cities. Cohort follow-up analysis: the 2 intervention cities showed greater declines in smoking prevalence than the 2 comparison cities. There were no differences in knowledge of the risks of smoking, “confident could quit,” or negative attitudes to smoking. “Intent to quit” was significantly higher in the intervention cities. Minnesota Heart Health Program (Adults) Lando et al. 1995;34 Luepker et al. 199427 Started in 1980. C = no intervention. I = multicomponent community program (including mass media). Lasted 5 years. 25- to 74-year-olds Quasi-experimental: 3 sets of matched cities, assigned to intervention on the basis of shared media market. Cross-sectional and cohort population surveys were conducted for 4 years before the interventions, annually during the intervention, and 2 years after to gain health information, including current smoking status. Cross-sectional analysis: compared with control, women in the intervention cities showed a greater decline in smoking prevalence, while men showed no difference. Cohort follow-up analysis: neither men nor women showed any differences between intervention cities and comparison cities.
497

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 12.2 Summary of Reviewed Controlled Field Experiments: Adults (continued)

Study Intervention description Target group Study design

Assessment

mode/outcomes/analysis Main results

Heartbeat WalesTudor-Smith et al. 199869Started in 1985.Wales 

C = no planned activities to promote cardiovascular health. I = planned activities related to smoking, including TV series on BBC, quit and win program, promotion of nonsmoking areas in restaurants, and worksite programs.Lasted 5 years.

18- to 64-year-olds Quasi-experimental: 

9 districts in Wales (I) compared with 4 districts in Northern England (C), chosen for similar health profiles. 

Cross-sectional population surveys pre- and postintervention (stratified by age), obtained smoking status and cigarette consumption. Individual- and community-level analyses conducted of net changes between intervention and reference communities.

Smoking prevalence and consumption declined in both intervention and control communities, and the declines were not significantly different.

Kilkenny Health ProjectShelley et al. 199570Started in 1986.Ireland

C = no intervention. I = variety of health promotion projects and events, “supported by coverage in local media” (apparently the local newspapers and a radio station).Lasted 7 years.

35- to 64-year-olds Quasi-experimental: Kilkenny 

(willing to cooperate) matched to remote control community (County Offaly).

Independent cross-sectional selections of persons from voter roles, stratified by age and sex. Visits conducted by nurses (pre- and postintervention) to obtain measures and administer questionnaire that included questions on smoking (at least 1 cigarette per day). Samples small. Net change compared between communities within gender.

Males apparently reduced their smoking more in the reference community and females more in the intervention community, but neither of these differences was significant.

Hoffmeister et al. 199671Started in 1987.Germany

C = no intervention. I = special programs targeted to each cardiovascular risk factor. For smoking, these included cessation courses, local media campaigns including an intensive poster campaign, and designation of nonsmoking areas in public places.Lasted 4 years.

25- to 69-year-olds Quasi-experimental: 

6 intervention regions were compared with a national sample (excluding the intervention regions) of areas, chosen to be representative of the former West Germany.

Representative crosssectional samples pre- and postintervention. Persons invited for a physical exam and filled out a questionnaire about smoking and other health behaviors. Samples in C and I weighted to make them comparable. Analyses accounted for intraregion variability.

From 1985 to 1991, the prevalence of smoking declined significantly more in the intervention regions than in the rest of the country.
498

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r Table 12.2 Summary of Reviewed Controlled Field Experiments: Adults (continued) Study Intervention description Target group Study design Assessment mode/outcomes/analysis Main results O’Loughlin et al. 199972 Started in 1992. Canada C = no intervention (St. Henri). 

I = multicomponent intervention, 

including videos broadcast on local TV and distributed to community groups (Centre-Sud).Lasted 4 years.

18- to 65-year-olds Quasi-experimental: 1 pair 

of matched communities of low socioeconomic status, selected and assigned to condition for logistical considerations. Communities adjacent.

Cross-sectional (before and 3 years after beginning of intervention), and longitudinal surveys (baseline and 5 years). 

No difference in change in smoking prevalence detected pre- and postintervention with either cross-sectional or longitudinal data. However, the percent of heavy smokers (≥25 cigarettes/day) showed a marginally greater decline in the intervention community.

Smoking Cessation or Reduction Trials

Sydney “Quit for Life” ProgramDwyer et al. 1986;74Pierce et al. 1986;73Pierce et al. 199075Started in 1983.Australia

C = no intervention. I = antismoking media campaign (mostly TV, but radio and newspapers as well) with some of the ads promoting a quitline and quit centre at Sydney Hospital.Lasted 7 years, but evaluated at 1 year, before program implementation in Melbourne.

16 years and older Sydney (I) compared with 

Melbourne (C).

Early results for smoking status, cigarette consumption and quitting behavior assessed longitudinally in a panel identified from a random household survey. Persons moving between cities excluded from analysis of proportions. Long-term results assessed with repeated cross-sectional surveys and a model of trends. 

Before the intervention was implemented in Melbourne, significantly more smokers in Sydney either quit or cut their cigarette consumption compared with Melbourne. Relapse and initiation rates were similar. After implementation in Melbourne, this city as well as Sydney showed declines in smoking. 

Community Intervention Trial for Smoking Cessation (COMMIT) The COMMIT Research Group 1995;76 The COMMIT Research Group 199577Started in 1989.

C = no intervention. I = 4 components: (1) public education through media and communitywide events, (2) health care providers, (3) worksites and other organizations, (4) cessation resources.Lasted 4 years.

25- to 64-year-olds Quasi-experimental: 

11 matched pairs of communities, randomly assigned to C and I.

Cross-sectional population surveys pre- and postintervention, with embedded longitudinal cohort of heavy smokers (≥25 cigarettes/day). Cohort sample weighted for attrition. 

Cohort analysis: no significant difference in quit rate observed by study end among heavy smokers in C and I communities. Effect was observed in light-tomoderate smokers.Cross-sectional analysis: no significant difference in changes in smoking prevalence, heavy smoking prevalence, daily cigarette consumption, or quit rates.
499

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 12.2 Summary of Reviewed Controlled Field Experiments: Adults (continued)

Study Intervention description Target group Study design

Assessment

mode/outcomes/analysis Main results

American Stop Smoking Intervention Study (ASSIST)NCI 2005;78 NCI 2006;79Stillman et al. 200380Started in 1993.

C = no seed money. I = seed money to build tobacco control capacity, some of which likely was spent on promoting media advocacy.Intervention phase lasted 6 years, prior to evaluation.

18 years and older 17 states selected by 

application to receive seed money. Others did not receive money.

Population surveys (1992–93, before intervention) and (1998–99) and cigarette sales data. State was the unit of analysis, with individual variability accounted for in a 2-stage analysis.

Smoking prevalence declined nationwide by 2.4% over evaluation period, but significantly greater in ASSIST states (3.0% vs. 2.1%). The decline in per capita cigarette consumption was not statistically different.

A Su SaludMcAlister et al. 199281Started in 1986.

C = no intervention (Del Rio). I1 = mass media and volunteer network (Eagle Pass). I2 = mass media and intensive contact smoking cessation program (Eagle Pass). I3 = mass media and brief contact (Piedras Negras).Lasted 4 years.

16- to 60-year-olds Quasi-experimental: 

3 matched Texas border communities. Division of intervention in Eagle Pass randomly determined. Otherwise, communities assigned to intervention conditions for logistical reasons.

Population surveys identified smokers (>9 cigarettes/day) who formed a cohort followed 1 and 2 years postintervention to assess smoking status. Data from I

1 and I2 pooled for analysis. 

Sample sizes relatively small (<200). Simple proportions of quit rates at follow-up compared.

At 2 years, cessation rates were higher in Eagle Pass (I1 and I2) than in Del Rio, but Piedras Negras (I3) was similar to C.

Mudde et al. 199582Started in 1990.Netherlands

C = no intervention. I = local television and posters; and health providers promoted a quitline and other communitybased cessation efforts.Lasted 1 year.

25- to 65-year-olds Quasi-experimental: 1 pair 

of matched communities randomly assigned to C and I.

Longitudinal panel of smokers identified from population survey, followed up during and after the intervention. 

Midpoint results showed a trend for more cessation for I, but final results showed no difference. 

Breathe EasySecker-Walker et al. 200083Started in 1989.

C = no intervention. I = community efforts, cessation assistance, videotape distributed widely through health provider offices. Lasted 4 years.

Women 18 to 64 years old

Quasi-experimental: 2 pairs of matched counties in Vermont and New Hampshire. Adjacent state border counties received interventions, and remote ones did not.

Cross-sectional population surveys conducted pre- and postintervention assessed smoking status and cigarette consumption. No differences at baseline. Simple change analyzed.

Change in smoking prevalence at postevaluation was not different between C and I; however, smokers in I reduced their consumption significantly more than those in C.
500

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r Table 12.2 Summary of Reviewed Controlled Field Experiments: Adults (continued) Study Intervention description Target group Study design Assessment mode/outcomes/analysis Main results Vietnamese-American Men Jenkins et al. 1997;85 McPhee et al. 199584 Started in 1990. C = no intervention (Houston, Texas). I1 = multimedia and community interventions (San Francisco/Alameda Counties) 39 months. I2 = similar but not identical intervention (Santa Clara County) 24 months. Vietnamese-American men, aged 18 years and older Two studies: Houston vs. San Francisco/Alameda and Houston vs. Santa Clara. Cross-sectional population surveys assessed smoking prevalence and recent quitting. Prevalence remained the same in C and I2, but in I1, it was significantly lower at follow-up. Quitting in the past 2 years also increased in I1 compared with C. Health Education Authority for England’s Anti-Smoking TV Campaign McVey and Stapleton 200086 Started in 1992. England C = no intervention. 

I

1 = television antismoking 

campaign. I2 = television campaign and locally organized antismoking campaign (Long-Term Care Network).Lasted 18 months.

16 years and older Four TV regions in central 

and northern England: One assigned to C, two to I1 and 

one to I2

.

Assigned on the basis of need for intervention, resulting in marked baseline differences in smoking rates.

Cohort of smokers and former smokers identified from population survey and followed at 6 and 18 months after program initiation.

The odds ratios for I1 and I

2, respectively, 1.53 and 

1.67, suggest an increase in nonsmokers. However, I1 and I2 are not significantly different from each other. 

Texas Regional StudyMcAlister et al. 200487Started in 2000.

C = no intervention. I1 = lowlevel media, no community-level cessation activities. I2 = highlevel media, no community-level cessation activities. I3 = I1 plus community activities. I4 = I2 plus community activities.Lasted 6 months.

18 years and older Quasi-experimental: 

19 regions in Texas assigned on the basis of media markets and other logistical considerations to interventions classified as described in left column.

Population surveys conducted at pre- and postintervention. Cohort of daily smokers identified from baseline survey and followed for cessation. Cessation of daily smoking was analyzed. Media exposures also measured.

In both cross-sectional and cohort analyses, intensity of intervention was significantly related to cessation of daily smoking. I4 showed highest cessation rates. No separate test of media-only group(s) vs. C presented. Higher level of exposures related to increased cessation in cohort sample. 
501

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

with the same mass media campaign 

combined with a variety of communitybased programs, including programs for 

smoking cessation, in a second community. 

The commercial media campaign was 

oriented toward changing several coronary 

risk factors. A third community received 

no intervention and served as the control. 

Cross-sectional population surveys showed 

that, after two years of intervention, both 

intervention communities experienced a 

reduction in smoking prevalence greater 

than that in the control community. 

Similar to results from the Stanford Three 

Community Study, these reductions were 

better sustained in the community that 

received both mass media and community 

programming.

CORIS, another cardiovascular riskreduction program patterned after the 

Stanford Three Community Study, began 

in South Africa in 1979 and also produced 

positive results.55 Like the Stanford Three 

Community Study, CORIS included 

three towns. One town received a media 

campaign, one received the media campaign 

and community-based interventions, and a 

control town received no intervention. The 

media campaign involved posters, billboards, 

mailings, and items in the local newspapers. 

Cross-sectional surveys of the entire White 

population of all three towns at baseline 

and at the end of the intervention allowed 

for both a cross-sectional assessment and a 

cohort assessment. The cohort assessment 

indicated that at the end of the four-year 

intervention, cigarette consumption and 

smoking prevalence in the two intervention 

communities were reduced by a similar 

amount overall with respect to the 

comparison community, and the effect was 

greater for women than for men. At a longterm (12 years) cross-sectional evaluation, 

overall smoking prevalence rates still 

were lower in the media-only community 

but not in the media and communityprogramming town, which had rates similar 

to the control community.58

The North Karelia Project,21,24,59–65 like 

the Stanford Three Community Study, 

was one of the earliest community-based 

intervention studies. It began in 1972 

and lasted for five years. In this study, the 

intervention consisted of both communitybased interventions and mass media; 

therefore, these interventions could not be 

evaluated separately. The media activities 

involved liaison with local newspapers and 

radio and production of printed materials 

to aid other program components and to 

publicize program activities. Population 

surveys assessed smoking prevalence 

(and other risk factors) at five-year intervals. 

After five years, the prevalence of regular 

smoking among men, but not women, 

had declined significantly more in the 

intervention community (North Karelia) 

compared with a control community 

(Kuopio). A second media program dealing 

specifically with smoking was aired 

nationally in 1978 and again a year later.88

It consisted of seven weekly programs 

depicting smokers going through the 

cessation process. At 10 years, the difference 

for men in North Karelia had become even 

more marked; prevalence had declined from 

52% to 36% in North Karelia and from 

50% to 42% in Kuopio. However, very little 

change occurred between 10 and 15 years.59

Women showed increased prevalence over 

the 15-year period, likely because diffusion 

of smoking was still occurring among 

women in Finland in this era. North Karelia 

had specifically requested the intervention, 

and some differences between the 

intervention and control communities were 

not accounted for in the analyses. 

The Stanford Five-City Project26,43,67,68,89

began in 1980 and lasted six years. In this 

quasi-experimental design to reduce 

cardiovascular risk factors, two communities 

received the interventions, two served as 

the controls, and a fifth community was 

used to monitor trends in cardiovascular 

disease data. The interventions used both 

multicomponent community programs 
502

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

and mass media interventions that 

included smoking cessation programs 

on television and radio as well as PSAs 

on television. Both cross-sectional and 

cohort analyses of the Stanford Five-City 

Project were conducted. Individual and 

community variability were accounted 

for in the analyses. Two years after the 

completion of the intervention, a significant 

decrease of 13% occurred in smoking 

prevalence in the cohort that received the 

intervention compared with the control 

cohort. Although smoking prevalence also 

decreased in the cross-sectional analyses, 

the difference between the intervention 

and control communities was inconsistent. 

The authors suggest that with the crosssectional design and a transient California 

population, people moving into intervention 

communities may not have experienced the 

full intervention. Both the cohort and crosssectional analyses demonstrated a positive 

effect on quit rates, with intervention 

communities experiencing greater quit rates 

than did the control communities.26,89

The Minnesota Heart Health Program27,34

began the same year (1980) as the Stanford 

Five-City Project and used a similar 

approach. Three matched pairs of cities 

were selected. One city from each pair 

received the intervention, while the other 

served as the control. The sites were not 

randomly assigned to these conditions. 

With respect to smoking, intervention 

efforts included smoking cessation 

programs, “quit and win” contests, 

classes, self-help materials, and in-home 

telephone and correspondence programs. 

Media messages were created that sought 

to aid the audience in understanding 

the importance of each risk factor and 

prevention strategies with respect to 

cardiovascular disease. Both crosssectional and cohort population surveys 

were used for evaluation. Results of crosssectional and cohort analyses indicate 

that while smoking prevalence fell among 

men, no significant difference was found 

between the intervention and control 

sites. For women, cross-sectional results 

pointed to a significant intervention effect. 

However, results from the cohort analyses 

showed no significant difference in smoking 

prevalence in women between intervention 

and control sites.

Several other trials in countries other than 

the United States have been patterned after 

the above cardiovascular-health projects 

and included some form of mass media as 

part of a multicomponent intervention.69–72

Table 12.2 provides details regarding these 

studies, initiated between 1985 and 1992 

and lasting between four and six years. 

In general, the media components of 

the interventions were not substantial. 

Only one study—with perhaps the largest 

media component—showed a change in 

smoking prevalence more pronounced for 

the intervention condition compared to 

the control.71

Smoking Cessation

With evidence for an effect on smoking from 

the earlier studies designed to promote 

cardiovascular health, a number of projects 

were launched specifically to alter smoking 

behavior. Some of these were targeted 

toward specific populations, such as women83

or minorities.81,84

Because smoking prevalence nationwide 

in Australia remained constant from the 

mid-1970s to the mid-1980s, the state 

health departments in New South Wales and 

Victoria decided to build on the success of 

the earlier “Quit for Life” program that was 

part of the North Coast Healthy Lifestyle 

Programme.73,74 The new “Quit. For Life” 

program would be much larger and serve 

as a demonstration project for possible 

future nationwide interventions. The new 

campaign, launched in Sydney in 1983 and 

in Melbourne in 1984, continued throughout 

the remainder of the 1980s. Television 

was the primary medium, accounting 
503

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Do “Quit and Win” Programs Work?

Chapter 11 describes media-based smoking cessation contests in which smokers abstinent for a 

required length of time are eligible to win cash or other prizes. Some studies described in this 

chapter have included “quit and win” contests as part of their community-based intervention efforts 

(e.g., Minnesota Heart Health Program, Stanford Five-City Project, Community Intervention Trial 

for Smoking Cessation [COMMIT], Heartbeat Wales). Furthermore, communities have mounted 

their own contests, either as part of state or national events (e.g., the American Cancer Society’s 

Great American Smokeout or World No-Tobacco Day sponsored by the World Health Organization) 

or as stand-alone programs. In some cases, these contests have been targeted to special populations 

such as adolescents, young adults, college students, pregnant women, mothers of young children, 

or the economically disadvantaged. 

Program evaluations using controlled field studies or comparisons of quit rates to those in the 

same (previous) or other locales (concurrent) used biochemical and/or third-party verification 

of quit status at entry, at the time of eligibility, and at subsequent follow-ups. However, in most 

programs, either the word of the smoker or a sponsor was sufficient, and only the winners 

undergo biochemical validation. The length of time smokers need to be abstinent to be eligible 

for prizes has varied, and various lengths of longer-term follow-up have shown considerable 

relapse following the contest. A review of 10 such programs found a follow-up quit rate ranging 

from 7% to 45%.a

 This review questioned whether the number of quitters from such contests was 

sufficient to detect an increase in quit rate; the authors used actual contest data from Australia to 

estimate that only 0.34% of adult smokers in the targeted population quit due to the contest. 

A 2005 reviewb found that in threec,d,e of four studiesc,d,e,f meeting rigorous criteria (followed 

quitters for at least six months and used biochemical validation at each step), longer-term quit 

rates for program participants were significantly higher than in the comparison group. 

The population effectiveness of “quit and win” programs depends on the participation rate and 

how many participants quit smoking. Participation rates can vary according to the resources 

devoted to publicizing and promoting the event. Further, it is possible that smokers more 

motivated to quit use the opportunity offered by these programs to take action, but they might 

have taken action soon anyway.a,b On the other hand, some participants might be motivated 

simply by the prize and be prone to relapse following the contest.a,b Estimates of participation 

rates vary from <0.01% to 5% of adult smokers.b

 With one-year of abstinence at follow-up as a 

criterion for successful cessation, the pooled quit rate for the three successful “quit and win” 

contests was 17.2%.b Multiplying the participation rates above by the quit rate yields an estimate 

of the percentage of the population of smokers quitting because of the contest. This result ranged 

from 0.2% to 0.9% of the population of smokers, bracketing the estimate provided earlier.a

Despite these low rates, the cost per successful quit due to “quit and win” programs is probably 

less or roughly equivalent compared with other cessation programs.b

a

Chapman, S., W. Smith, G. Mowbray, C. Hugo, and G. Egger. 1993. Quit and win smoking cessation contests: 

How should effectiveness be evaluated? Preventive Medicine 2 (3): 423–32.

b

Hey, K., and R. Perera. 2005. Quit and Win contests for smoking cessation. Cochrane Database of Systematic 

Reviews. DOI: 10.1002/14651858. (no. 2) CD004986. http://www.cochrane.org/reviews/en/ab004986.html.

c

Bains, N., W. Pickett, B. Laundry, and D. Mecredy. 2000. Predictors of smoking cessation in an incentivebased community intervention. Chronic Diseases in Canada 21 (2): 54–61. 

d

Lando, H. A., P. L. Pirie, P. G. McGovern, T. F. Pechacek, J. Swim, and B. Loken. 1991. A comparison of 

self-help approaches to smoking cessation. Addictive Behaviors 16 (5): 183–93.

e

McAlister, A. L., T. Gumina, E-L. Urjanheimo, T. Laatikainen, M. Uhanov, R. Oganov, and P. Puska. 2000. 

Promoting smoking cessation in Russian Karelia: A 1-year community-based program with quasi-experimental 

evaluation. Health Promotion International 15 (2): 109–12.

f

Hahn, E. J., M. K. Rayens, C. Chirila, C. A. Riker, T. P. Paul., and T. A. Warnick. 2004. Effectiveness of a quit 

and win contest with a low-income population. Preventive Medicine 39 (3): 543–50. 
504

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

for two-thirds of the media budget. Each 

advertisement also promoted a telephone 

quitline. A longitudinal cohort identified 

from a population cross-sectional survey 

was used to assess the immediate impact 

of the campaign.73 Proportions of smokers 

who quit, who initiated smoking, and 

who reduced their cigarette consumption 

(by ≥5 cigarettes/day) were compared for 

Sydney and Melbourne before the initiation 

of the campaign in each city. In Sydney, 

35% of smokers either quit or reduced 

their consumption compared to 18% in 

Melbourne. There were no differences in 

relapse rates or initiation rates.

Pierce and colleagues75 used cross-sectional 

data to assess the long-term impact of the 

program between 1981 and 1987 in each 

of the two cities. Their data consisted of 

multiple pre- and postcampaign years of 

population data for each city. A pre- and 

posttrend analysis estimated the prevalence 

of smoking as a function of the onset of 

Televised Smoking-Cessation Clinics

In a number of cities, mainly in the 1980s, volunteer organizations (e.g., the American Lung 

Association) worked with local television stations to provide viewers with information, tips, and 

support for smoking cessation. The rationale for these mass media projects was the reluctance of 

many smokers to attend actual smoking-cessation clinics or counseling programs. Furthermore, 

television stations were agreeable to broadcasting short messages (usually under two minutes) 

daily for 20 days (some up to six weeks) as a public service in conjunction with news programs, 

in some cases on both the early and late news. Thus, program cost was low, and potential reach 

was wide. Coordinated printed self-help materials were generally made available to anyone willing 

to obtain them.

The evaluation of the effect of such programs presented a number of challenges. The percentage 

of smokers potentially reached by a single local station and who quit as a result may not be 

high enough to detect with a reasonably sized population survey. Thus, it would be too costly to 

compare prevalence or recent quitting in communities with such a program to those in matched 

communities without any program. In reports describing these projects, smokers were asked to 

register (via the TV spots, flyers, or newspaper advertisements) and to agree to follow-up contacts 

for up to two years. Most of the reports simply present the cessation outcomes for this sample; some 

validated quit rates biochemically. However, a few studies compared registrants to random samples 

of smokers within the city.a,b,c Often, the registrants were heavier smokers and showed signs of 

being more motivated to quit (more previous attempts, poorer general health, etc.) than smokers 

in the general population. Higher motivation likely overcame the greater addiction, leading to 

cessation rates generally better for registrants than for smokers in the general population. 

Flayd reviewed a number of these televised self-help clinics and concluded that they were probably 

more cost-effective than face-to-face counseling clinics in producing sustained cessation, but the 

issues regarding participant characteristics mentioned above were noted. The literature review failed 

to identify any further reports on televised smoking-cessation clinics after 1992.c Apparently, focus 

shifted to other media efforts such as promoting telephone quitlines, discussed later in this chapter.

a

Danaher, B. G., E. Berkanovic, and B. Gerber. 1984. Mass media based health behavior change: Televised 

smoking cessation program. Addictive Behaviors 9 (3): 245–53.

b

Wewers, M. E., K. Ahijevych, and J. A. Page. 1991. Evaluation of a mass media community smoking cessation 

campaign. Addictive Behaviors 16 (5): 289–94. 

c

Warnecke, R. B., P. Langenberg, S. C. Wong, B. R. Flay, and T. D. Cook. 1992. The second Chicago televised 

smoking cessation program: A 24-month follow-up. American Journal of Public Health 82 (6): 835–40. 

d

Flay, B. R. 1987. Mass media and smoking cessation: A critical review. American Journal of Public Health

77 (2): 153–60.
505

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

the campaign. Within this model, this 

onset variable yielded estimates of the 

change in the underlying trend in smoking 

prevalence associated with the onset of 

the campaigns in Sydney and Melbourne. 

Results indicate that in the six months 

following the launch of the antismoking 

media campaigns in Sydney and Melbourne, 

smoking prevalence declined significantly 

for all people in Sydney and for men in 

Melbourne. The size of these declines was 

estimated to be 2.6 percentage points for 

all people in Sydney and 2.9 percentage 

points for men in Melbourne. In separate 

analyses by sex, the authors also found 

that for men in both cities, the campaigns 

were associated with a continued decline in 

smoking prevalence of 1.5 percentage points 

per year, but women did not show a decline.

The Community Intervention Trial for 

Smoking Cessation (COMMIT) was a 

large demonstration project focusing 

on smoking cessation among heavy 

smokers (≥25 cigarettes/day).76,77 COMMIT 

selected 22 matched communities (20 in 

the United States and 2 in Canada) and 

randomly assigned one of each pair to 

receive the multicomponent intervention 

and the other to serve as a control. 

The communities were matched on the 

basis of geographic location, size, and 

socioeconomic factors. For four years 

(1989–92), intervention communities 

received the intervention, which may or 

may not have included some mass media 

elements. Community board members 

were provided media advocacy training 

that included building a press strategy, 

identifying and training spokespeople, 

analyzing available media resources, 

learning about smoking prevention and 

cessation campaign design, planning 

strategies for countering tobacco industry 

promotions, and using role models. The 

objectives of the media effort were to 

implement and publicize events (e.g., “quit 

and win” contests), publicize local action 

plans and activities, and enhance local 

coverage of national and regional tobaccorelated news. Communities could optionally 

elect to mount antitobacco media campaigns 

with donated or purchased time or 

space.90 Some states where the COMMIT 

communities were located (e.g., California) 

initiated antitobacco media campaigns 

during this time. COMMIT was evaluated 

both longitudinally and cross-sectionally. 

Analyses adjusted for individual variability 

within community but did not show a 

greater cessation rate for heavy smokers in 

the intervention communities compared 

with the controls.77 Cross-sectional analyses 

also did not find a difference in changes 

in smoking behavior for the two groups.76

However, an increase in cessation was found 

among light to moderate smokers.77

The American Stop Smoking Intervention 

Study (ASSIST) was a large-scale 

demonstration project for which the 

National Cancer Institute provided seed 

money of about $1 million per year to 

selected states to build tobacco control 

capacity.78–80 Chapter 9 gives more 

information on the media efforts promoted 

by this project. The ASSIST intervention 

involved much more than media. Its net 

effect was evaluated by population surveys 

before (1992–93) and during (1998–99) 

the project as well as tobacco sales data 

before and during the intervention period. 

The analysis used the state as the unit 

of evaluation; for smoking prevalence, 

individual variation within each state 

was taken into account with a two-stage 

analytical approach.79,80 The decline in 

prevalence over the evaluation period 

was significantly greater in ASSIST states 

compared to non-ASSIST states, even after 

controlling for tobacco control efforts 

funded by states in either group. However, 

no significant difference was found for per 

capita cigarette consumption according 

to cigarette sales data. In contrast to the 

Sydney “Quit for Life” study, women in 

ASSIST states appeared to account for 

much of the reduced smoking prevalence.
506

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

A study of smokers in three Texas border 

towns used television programming in 

Spanish and English to promote general 

health, with smoking cessation as the main 

focus.87 The study began in 1986, lasted 

four years, and involved three matched 

towns. One served as a control (Del Rio), 

sections of another (Eagle Pass) were 

randomly assigned by residential block to 

receive either volunteer network activities 

or an intensive cessation intervention, 

and the third community (Piedras Negras) 

received a media intervention and a brief 

smoking-cessation intervention. By means 

of a population survey, a cohort of smokers 

consuming at least 10 cigarettes per day 

was identified and followed up during and 

at the end of the program. The cohort 

sample sizes were small (<200 people) 

per group. While the groups appeared 

comparable at baseline, no attrition 

analysis was presented. An analysis of 

the proportion who quit at each followup showed little difference within the 

Analyses of Media Effects in COMMIT Communities

Two analyses relying on population data from the COMMIT communities are relevant to the role 

of media in influencing smoking behavior.a,b These analyses could have been presented in the 

following section on “Population-Based Studies” because they do not compare intervention and 

control conditions; however, they involve communities rather than nations, regions, or states.

The first study analyzed data from school surveys of 9th graders in 21 of the 22 COMMIT 

communities.a The goal of this analysis was to examine the role of tobacco media exposures 

and tobacco control policies on smoking (any in the last 30 days) and susceptibility to smoking 

among nonsmokers. Cigarette price, strength of youth access laws, and recall of school-based 

tobacco education were negatively associated with both smoking and susceptibility to smoking. 

Smoke-free policies for public places and schools appeared to be unrelated to either. Frequency 

of reported exposure to protobacco advertisements was marginally positively associated with 

smoking and susceptibility to smoking. Perhaps due to selective recall bias, a positive relationship 

was also observed for frequency of exposure to antitobacco advertisements.

 Although mass media were not a major component of the COMMIT study design, a 2006 

follow-up study permitted an assessment of the influence of mass media on smoking cessation.b

In 2001, smokers in the evaluation cohort were surveyed again (53% follow-up rate). An analysis 

was conducted of smokers living in 15 of the U.S. communities located in a major television 

media market who were smokers at the time of the 1993 evaluation and still lived in the same 

community (n = 2,061).b Nielsen gross-rating-point data for state-sponsored antitobacco media 

aired in these communities from 1999 to 2000 were correlated with the observed quit rates for 

participants in the 15 communities, with significant results (p = 0.047). Higher rating points 

correlated with a higher quit rate. The effect was greater when the analysis was restricted to 

individuals who believed that media information had increased significantly between 1999 and 

2000. It was estimated that quitting increased 10% for every 5,000 additional rating points 

(or about two additional exposures per month). Media messages may or may not have emphasized 

smoking cessation. Some of the communities were in states with other tobacco control initiatives 

(increased excise taxes, clean indoor air laws) in place during this period. The group who believed 

media had increased significantly may have been those more disposed to quit smoking and thus 

more likely to remember the messages. 

a

Lewit, E. M., A. Hyland, N. Kerrebrock, and K. M. Cummings. 1997. Price, public policy, and smoking in 

young people. Tobacco Control 6 Suppl 2: S17–S24.

b

Hyland, A., M. Wakefield, C. Higbee, G. Szczypka, and K. M. Cummings. 2006. Anti-tobacco television 

advertising and indicators of smoking cessation in adults: A cohort study. Health Education Research 21 (2): 

296–302.
507

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

two groups of Eagle Pass residents, but 

together, the quit rate for this community 

was significantly higher than for Del Rio, 

the control community. Piedras Negras 

smokers showed quit rates similar to the 

control community. 

A study from the Netherlands involved two 

matched communities in which local mass 

media and health providers promoted a 

quitline.82 A longitudinal panel of smokers 

identified from a population survey were 

evaluated again at mid- and postcampaign. 

No differences were found, although 

somewhat more quitting occurred in the 

intervention communities at the midpoint 

evaluation. The authors note that a national 

media campaign mandating and reinforcing 

smoking bans in public buildings was 

introduced about midway through the 

intervention period and could have 

contaminated the results.

A study initiated in 1989 and lasting four 

years focused on smoking cessation among 

women in rural communities.83 Two pairs 

of matched communities were identified in 

rural Vermont and New Hampshire. The two 

communities close in proximity received 

the intervention; their remote matches 

served as comparisons. The intervention 

consisted of community efforts, cessation 

assistance, and the distribution through the 

offices of health professionals of a videotape 

that showed four women going through 

the smoking-cessation process. Analyses 

of data from cross-sectional population 

surveys showed good baseline comparability, 

so simple change analyses were performed. 

These analyses failed to find a difference 

in the change in prevalence between the 

groups, but smokers in the intervention 

communities appeared to reduce their 

cigarette consumption to a significantly 

greater extent than did those in the 

control group.

Two related projects concerned male 

Vietnamese Americans and used a mass 

media intervention that focused on 

changing smoking behavior. One project 

targeted Vietnamese-American men living 

in San Francisco and Alameda Counties in 

California.85 The other targeted VietnameseAmerican men living in Santa Clara 

County, California.84 A single comparison 

community, Vietnamese-American men 

living in Houston, Texas, was used for 

both projects. In the San Francisco and 

Alameda project, an antitobacco media 

campaign lasting more than one year 

immediately preceded the communitybased intervention, including cessation 

assistance, which lasted an additional 

24 months. The total intervention time 

was 39 months for San Francisco and 

Alameda and 24 months for Santa Clara. 

The San Francisco and Alameda project 

had an additional component that targeted 

students and their families. The media 

campaign extensively used Vietnameselanguage messages in newspapers, 

billboards, posters, other materials, and 

a video shown twice on local Vietnameselanguage television. Cross-sectional 

population surveys pre- and postintervention 

were used to evaluate the projects. At the 

completion of the intervention, the odds of 

being a smoker were lower, and the odds 

of quitting smoking sometime in the past 

two years were higher in San Francisco 

and Alameda Counties than in Houston. 

The Santa Clara project did not demonstrate 

any significant reduction in smoking 

prevalence compared with Houston. 

The antismoking media campaign conducted 

before the intervention in San Francisco 

and Alameda Counties may have primed 

the target audience for the intervention 

messages, thus improving the efficacy of 

the community-based interventions. 

McVey and Stapleton86 evaluated the 

effectiveness of an antismoking television 

campaign conducted in England. 

Two regions in England received an 

intensive television-based mass media 

campaign to provide motivation, support, 
508

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

and confidence for quitting, as well as an 

understanding of the difficulties associated 

with it. All spots were tagged with a 

telephone number for a quitline. Another 

region received the television campaign 

and a locally organized antitobacco 

program encompassing a wide array of 

antismoking activities, including policy 

advocacy. A fourth region served as the 

control (no intervention). These regions 

were selected to receive their respective 

treatments because of practical issues, 

including the need for intervention, as 

expressed by higher smoking rates, and 

the existence of a strong, preexisting 

antitobacco infrastructure. The regions 

were therefore, by design, significantly 

different at baseline. After 18 months, the 

odds of not smoking in the intervention 

regions were significantly higher than in 

the control region. No evidence indicated 

that adding community-based antismoking 

programming significantly increased the 

effectiveness of the mass media campaign in 

reducing smoking prevalence. 

In 2000, McAlister and colleagues87

used a mass media campaign (including 

television, radio, newspaper, and billboard 

advertisements) and community-based 

efforts to provide cessation assistance in 

Texas. Spots were tagged with the telephone 

number for the American Cancer Society 

quitline. A cohort was identified from a 

cross-sectional population survey at baseline. 

The cohort was resurveyed six months 

later, along with another cross-sectional 

survey. The authors found in both the crosssectional and longitudinal analyses that 

treatment areas receiving both high-level 

(high-exposure) mass media campaigns 

along with cessation activities (including 

both clinical and community-based cessation 

programs) had the highest rate of reduction 

in daily smoking, with a significant doseresponse effect over the various levels of 

intervention. The media-alone interventions 

were not analyzed separately against the 

no-intervention condition. 

Summary of Experimental 

Studies

The studies discussed above mainly used 

quasi-experimental designs to assess the 

effects of mass media campaigns on youth 

and adult smoking behavior. The media 

intervention studies had wide variability 

in scope, duration, and quality. Some 

studies considered the effect of media alone; 

in others, media were only one part of a 

multicomponent intervention.

The majority (seven of ten) of the youth 

studies provided evidence that media can 

play an important role in affecting smoking 

behavior. Although one of the studies that 

evaluated the effect of media alone (versus 

no intervention) found evidence for an 

effect,50 three did not,29,44,68 and one did not 

test the effect.52 In studies comparing media 

combined with a school-based intervention 

to a school-based intervention alone,30,40

or to no intervention,22,29,35 all but one29

found evidence for an effect. These findings 

suggest that for maximal effect on youth 

smoking, media need to be combined 

with other smoking prevention efforts. 

Supporting this is another controlled field 

experiment, the Midwestern Prevention 

Project, not reviewed above because media 

were present in both the intervention 

and control communities. This project 

compared media alone (control condition) 

with media together with school and other 

programs (intervention condition) by using 

longitudinal cohorts.91 The study found 

that the intervention condition was more 

effective in curbing youth smoking uptake 

than was the media-alone condition. 

The results for the role of media in 

influencing adult smoking behavior are 

also mixed. Among studies concerned 

with promoting cardiovascular health, 

which had many other media messages 

besides those related to smoking cessation, 

seven of ten found at least some evidence 

of an effect on adult smoking prevalence 
509

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

or quitting.24,27,55,56,66,71,72 Among those 

concerned with smoking cessation, eight 

of nine found such evidence.75,76,80,81,83,85–87

However, if strong and consistent evidence 

of an effect is the criterion (uniformly 

decreased smoking prevalence or increased 

quitting), only five of the studies concerning 

cardiovascular health and six of those for 

smoking cessation would meet this standard. 

Whether media alone are as effective as 

media combined with other program 

components in promoting quitting 

is difficult to discern. Of the six 

studies25,55,56,75,86,87 with designs allowing 

for a comparison of media alone versus 

no intervention, one did not make the 

comparison (only analyzed dose-response 

of intervention intensity87), and all of the 

others showed at least some evidence for 

an effect. Of those studies with a mediaalone condition, five also included a 

condition for media combined with other 

program components. Often, there appeared 

to be a greater effect for the combined 

intervention, but only one study86 provided 

a direct comparison of these two conditions, 

and that study did not find them to be 

significantly different. Although results are 

less clear than for youth, it is likely that 

multicomponent interventions that include 

media will have a greater chance of having 

an impact than will media-only or othermodes-only interventions.

Each of the studies reviewed had unique 

strengths and weaknesses. However, 

some limitations deserve mention as 

consistent across a number of these 

studies. Most notably, many studies 

focused on the individual as the unit of 

analysis, despite allocating intervention 

treatments at the community (or regional) 

level. As discussed earlier, this approach 

can lead to biased results because it fails 

to account for the between-community 

differences associated with hierarchical 

or nested designs. Preexisting differences 

between communities, aside from those 

explicitly measured and controlled for in 

the analyses, can obscure or be mistaken for 

intervention effects. Differential attrition in 

longitudinal studies can also be a problem 

if not examined closely for potential 

effects on the results. Furthermore, few of 

these studies included measures of prior 

secular trends, which might have obscured 

intervention effects.

Population-Based 

Studies

Overview 

The first study of a media campaign aimed 

at influencing populations’ smoking 

behavior was the natural experiment 

provided by the Federal Communications 

Commission’s (FCC’s) Fairness Doctrine. 

This campaign and its consequences 

are described in more detail later in this 

section. Here it is important to note that 

it preceded all of the controlled field 

experiments described above and all of the 

other population studies described in this 

section. The campaign may have provided 

impetus to investigators to undertake 

controlled studies using media to influence 

health behaviors, including smoking. 

Evidence of efficacy from the controlled field 

experiments and demonstration projects 

in turn paved the way for governmental 

agencies charged with improving public 

health to take action. One example is 

Australia’s National Tobacco Campaign of 

1997–2003, which built on the success of 

the earlier experimental (“Quit for Life”)56

and demonstration “Quit. For Life” media 

campaigns.73 The effectiveness of such 

efforts is discussed below. In some cases, 

funding for population interventions 

was obtained from existing public health 

budgets, and in other cases, public health 

advocates worked to pass ballot measures to 

increase tobacco excise taxes (chapter 14) to 

pay for tobacco control efforts that included 
510

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

media campaigns. Some U.S. states have also 

used funds from the 1998 Master Settlement 

Agreement to fund or augment funding for 

tobacco control programs. 

Many of these U.S. state-sponsored 

campaigns in California, Florida, 

Massachusetts, Minnesota, and elsewhere 

described later in this chapter have 

included media campaigns as part of a 

multicomponent tobacco control program 

to reduce tobacco use. Other components of 

these programs have included school- and 

community-based programs, telephone 

quitlines and other smoking-cessation 

efforts, efforts to manage the chronic disease 

burden of smoking, the implementation 

of new laws restricting smoking in 

public places and workplaces, increased 

enforcement of laws restricting youth 

access to tobacco, and increases in tobacco 

excise taxes. A comprehensive program 

includes all of these components as well 

as provision for program administration 

and evaluation.92 Because many of these 

program components are often initiated 

simultaneously, isolating the effects that can 

be attributed to a mass media campaign is 

generally not possible. However, this isolation 

of effect was also not possible in some of the 

controlled field experiments described in the 

previous section for the same reason. 

Typical Study Designs and 

Methodological Issues

Researchers have used a variety of analytic 

approaches to evaluate the results of 

population-based studies. Typically, studies

n Relate individual recall of mass media 

campaigns to changes in tobacco use 

outcomes by using pre-post cohort 

designs.

n Compare pre-post changes in tobacco 

use outcomes in a state with a tobacco 

control program with states without one 

and use cross-sectional data.

n Correlate levels of aggregate exposure 

across geographic areas with changes in 

tobacco use outcomes for the same areas.

The first type of design described above 

falls under the general heading of 

longitudinal designs. The other two are 

considered cross-sectional designs. Some 

of the advantages and shortcomings of 

these types of evaluation strategies have 

already been touched upon in the section 

“Methodological Issues” for the controlled 

field experiments, and this section provides 

more relevant details. Separate sections on 

“Longitudinal Designs: State and National 

Mass Media Campaigns” and “CrossSectional Evaluations” describe individual 

studies. However, some studies used 

both types of designs and are, therefore, 

mentioned more than once. 

Longitudinal Designs

Population-based longitudinal designs 

can attribute effects to a campaign by 

relating self-reported exposure at baseline 

to changes in behavior in subsequent 

measurements. However, the strength of 

the observed association is influenced by 

the extent of control variables available 

to assess confounding and issues related 

to sample attrition. Careful attention to 

potential confounding is critical in such 

designs to account for the possibility that 

study participants who recall campaign 

messages may differ from those who do not. 

For example, if youth who are susceptible to 

smoking are more likely to recall campaign 

messages than are nonsusceptible youth 

(selective attention bias), then failure to 

control for baseline susceptibility to smoking 

could bias the results. For instance, because 

youth who are susceptible to smoking are 

more likely to become smokers in the future, 

failure to account for this in the analysis 

could lead to a positive correlation between 

message recall and smoking initiation.

A second potential limitation of longitudinal 

designs relates to the extent of sample 
511

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

attrition over time. Invariably, some 

study participants are lost at follow-up. 

Random attrition hinders the power of the 

study to detect an effect but does not bias 

the observed effects. However, if sample 

attrition is systematic (nonrandom), it can 

lead to bias. For example, if at-risk youth 

who are susceptible to smoking are more 

likely to move and be lost to follow-up, they 

will not be adequately represented, possibly 

resulting in fewer transitions to smoking, 

which will bias the results. For population 

samples, this effect can be accounted for 

with sampling weights that make the 

sample followed look more like the original 

representative sample.

Post-Only Cross-Sectional Design

With this design, a single measurement 

is obtained following an intervention 

for groups exposed and unexposed to 

the intervention. The following example 

illustrates the problems that can arise. 

It is possible that the level of smoking 

among individuals more likely to be 

exposed to an antismoking media campaign 

(e.g., urban dwellers)93,94 is lower than 

among those unexposed (e.g., rural people) 

simply because of where they live and the 

differing smoking prevalence in those areas 

(typically higher in rural areas). Thus, any 

difference or lack of difference in smoking 

rates between intervention conditions 

(which may have different distributions of 

urban and rural residents) may be due to 

underlying smoking rates and not to the 

intervention. Selective attention can also 

cloud interpretation from cross-sectional 

studies; for example, if youth nonsmokers 

recall a specific antitobacco advertisement 

more than do smokers, the association of 

recall and smoking status may only mean 

that the advertisement was more salient 

to nonsmokers, not that it prevented them 

from smoking. Hornik10 outlines a number 

of questions that, if answered appropriately, 

provide some confidence that a campaign 

evaluated with a post-only design had 

an effect:

n Does a substantial proportion of the 

target audience report a high level of 

exposure to the campaign?

n Is the targeted outcome of campaign 

exposure negatively associated with 

smoking?

n Does this relationship continue to hold 

after statistically controlling for known 

predictors of smoking?

n Is there a dose-response relationship 

between exposure and smoking? 

As exposure increases, does the rate of 

smoking decrease accordingly?

n Do the attitudes targeted by the campaign 

change in the expected direction?

Pre-Post Cross-Sectional Design

With measurements before and after a media 

campaign, change can be measured, and 

the analysis can control for the preexisting 

level of the outcome being measured 

(likely different for different geographical 

areas, see example above). Again, adjusting 

for other pre-campaign covariates would 

be important. However, if there are no 

comparison areas not receiving the media, 

it still would be unknown whether the 

change observed was part of a secular trend, 

or because of other events, or because of the 

program. There also is the potential that 

some of the intervention will “leak” into 

comparison areas, again making it more 

difficult to establish that the program was 

responsible for a desired outcome.

A more rigorous methodology would provide 

for two (or more) precampaign measures 

to establish the secular trend and take a 

postcampaign measurement and perhaps 

some measurements during the campaign as 

well. Assuming all else in the environment 

remained constant (not always the case), 

it would be expected that comparison areas 

would continue on the same trajectory as 

observed during the precampaign period. 

This method would ensure that any change 

during the program period in the areas 
512

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

receiving the intervention would be due to 

the campaign. If other factors were operative 

during the campaign period, the multiple 

precampaign measures would at least enable 

some estimation of this unplanned effect. 

An advantage of cross-sectional measures is 

that they often are obtained from random 

samples of the population, and population 

estimates can be made with appropriate 

weighting. However, if the demographic 

composition of the population has 

changed over time, it would be desirable 

to standardize these estimates to the 

composition of the population at a fixed 

time. Some longitudinal baseline samples 

are selected from a random population 

study as well; to the extent that they are 

appropriately weighted for nonparticipation 

at baseline and for attrition, the samples 

can provide population estimates. 

Various population-based studies are 

discussed below under the general headings 

of longitudinal and cross-sectional designs. 

However, a number of the populationbased studies were evaluated by means 

of both longitudinal and cross-sectional 

studies reported separately. Therefore, the 

individual studies are mentioned under each 

of the main headings below. Again, to the 

extent possible, results for youth and adults 

are presented separately.

Longitudinal Designs

State Mass Media Campaigns

Three population-based longitudinal 

studies have assessed the effectiveness 

of two statewide mass media campaigns 

(Massachusetts and Florida). These studies 

examined the association between youth 

smoking and individual recall of media 

campaign advertisements in the context 

of statewide tobacco control programs. 

Additionally, an oral cancer prevention 

campaign in India and Australia’s 

National Tobacco Campaign were assessed 

longitudinally in adults.

Massachusetts, Youth

Siegel and Biener95 assessed the impact 

of Massachusetts’s statewide mass media 

campaign on smoking initiation among 

youth aged 12–15 years. A baseline 

population survey was conducted in 

October 1993 to March 1994 to identify 

a cohort of youth to follow and to obtain 

baseline measures. A four-year follow-up 

survey assessed whether youth initiated 

smoking, defined as smoking 100 or more 

cigarettes in their lifetimes. A cigarette 

excise tax increase went into effect in 

January 1993. The media campaign, begun 

in October 1993, consisted of television 

and radio spots and billboards for the 

youth-focused media. Approximately 

80% of the media expenditures were 

for television. The campaign primarily 

focused on reaching a general audience, 

not youth specifically. This study found 

that youth aged 12–13 years who recalled 

campaign messages at baseline were less 

likely (odds ratio = 0.49; 95% confidence 

interval, 0.26–0.93) to become smokers 

than were those who did not recall 

messages. No statistically significant effects 

were found for youth 14–15 years old. 

Among all youth, there was no association 

between recall of media on seven of the 

eight knowledge and attitude outcomes. 

The observed association between media 

recall and smoking among 12- and 

13-year-old youth is strengthened by the 

extensive set of baseline control variables 

included in the analysis. One of the 

key controls was a measure of baseline 

smoking status defined as susceptible 

nonsmokers, nonsusceptible nonsmokers, 

and experimenters. The researchers 

also demonstrated that recall of media 

messages at baseline was not associated 

with smoking status. The primary limitation 

of this study is that the authors did not 

adjust for nonresponse at the follow-up 
513

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

survey either with appropriate weights or 

analytic techniques. 

Florida, Youth

Two other studies with longitudinal designs 

involve the evaluation of the Florida 

“truth” campaign. Florida’s campaign, 

begun in April 1998, targeted youth aged 

12–17 years with messages that “attacked 

the [tobacco] industry and portrayed its 

executives as predatory, profit hungry, 

and manipulative.”96(p.333) 

The first longitudinal study to examine 

the effectiveness of the Florida “truth” 

campaign surveyed youth in February 1999, 

5–10 months after a stratified, representative 

baseline survey (vendor provided sampling 

frame) conducted within 6 months of the 

campaign launch. This survey included 

1,820 youths, but the study limited the 

sample to 1,480 who were nonsmokers at 

baseline. The study examined two measures 

of smoking initiation: (1) whether a 

youth smoked at all in the past 30 days at 

follow-up, and (2) whether a youth was an 

“established” smoker at follow-up, defined 

as smoking on six or more days in the past 

month and more than five cigarettes per 

day. Campaign exposure was measured 

Typical Measures of Media Exposure

For studies that rely on individual measures of exposure to mass media campaigns, researchers have 

used a number of methods to operationalize exposure. For clarity, commonly used measures are 

described and labeled below. Many studies described below used more than one of these measures.

● Unaided Recall of Campaign Messages. Reports of campaign messages overall and/or 

by medium (e.g., television, radio, billboard, print) that respondents recall seeing 

without prompting for specific message content.

● Aided Recall of Campaign Messages. Reports of campaign messages overall and/or by 

medium (e.g., television, radio, billboard, print) that respondents recall seeing after 

being provided a brief description of the advertisement. Some studies confirm the 

accuracy of recall with follow-up questions about the message content.a,b

● Aided and Unaided Campaign or Brand Awareness. The ability to recall the campaign 

slogan or brand (with or without prompting). In some studies, recall is confirmed with 

follow-up questions regarding details or meaning of a specific advertisement.

● Message Receptivity. Several studies measure audience reaction to campaign messages 

with a series of questions (e.g., did the advertisement grab your attention? did you talk 

to friends about the advertisement?).

● Aggregate Measures of Campaign Exposure. In addition to individual-level measures 

of campaign awareness, several studies have estimated exposure to campaigns by 

using aggregate data on campaign advertising such as gross rating points (defined 

as the percentage of the target population reached by a campaign [reach] multiplied 

by the frequency at which the target population is exposed). Therefore, if a campaign 

advertisement reaches 50% of the target audience three times in a week, the gross 

rating points equal 150. Aided recall appears to correlate well with gross rating points.c

a

Sly, D. F., G. R. Heald, and S. Ray. 2001. The Florida “truth” anti-tobacco media evaluation: Design, first year 

results, and implications for planning future state media evaluations. Tobacco Control 10 (1): 9–15.

b

Farrelly M. C., C. G. Healton, K. C. Davis, P. Messeri, J. C. Hersey, and M. L. Haviland. 2002. Getting to the 

truth: Evaluating national countermarketing campaigns. American Journal of Public Health 92 (6): 901–7. 

c

Niederdeppe, J., M. C. Farrelly, and M. L. Haviland. 2004. Confirming “truth”: More evidence of a successful 

tobacco countermarketing campaign in Florida. American Journal of Public Health 94 (2): 255–57.
514

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

with a complex index that combined three 

different measures: (1) recall of up to two 

campaign advertisements, (2) cognitive 

reactions to these advertisements, and 

(3) agreement with a campaign-related 

belief—“you feel tobacco companies are just 

trying to use you.” The index equaled zero 

if the youth could not confirm awareness 

of any advertisements. It equaled two 

if the respondent confirmed awareness 

of two advertisements, said that both 

advertisements made him or her “stop and 

think about whether or not they should 

smoke,” and responded “some” or “a lot” 

in response to the belief described above. 

It equaled one for all other respondents. 

These values were determined from the 

follow-up survey measures.

The analysis consisted of two separate 

logistic regressions of smoking initiation 

(to either smoking or established smoking) 

as a function of the exposure index. 

It controlled for month of the baseline 

survey, age, gender, whether the respondent 

had at least one friend who smoked, and 

whether the youth had a parent who 

smoked. These analyses indicated that those 

who scored higher on the exposure index 

were less likely to become smokers and 

established smokers. 

A limitation of this study is that the measure 

of campaign exposure relied on recall at 

follow-up. This process can bias the observed 

findings in favor of finding an effect if 

nonsmokers at follow-up are more likely 

to recall or process campaign messages. 

In addition, the combination of campaign 

recall with an intermediate outcome 

(i.e., agreement with a key belief question) 

that is on the causal pathway between 

campaign exposure and smoking initiation 

is a questionable measure of campaign 

exposure. If nonsmokers are more likely 

to hold this belief compared with smokers, 

then combining recall with agreement with 

this belief will bias the analysis in favor of 

finding an effect. 

A second longitudinal study of the 

effectiveness of the Florida “truth” 

campaign, by Sly and colleagues,97 takes 

a somewhat different approach from the 

study described above.96 In the later study, 

another follow-up survey was conducted of 

adolescents who responded to the earlier 

surveys. Those who were nonsmokers 

(1,805) at their baseline interview were 

included in this analysis. The outcome 

measures are identical to those of Sly and 

colleagues96 for current smoking and 

established smoking. The measure of 

campaign exposure is constructed differently 

from the measure in the earlier study. 

Youth were asked at the new followup survey if they had seen any of the 

11 advertisements that had aired since 

the inception of the campaign.

Youth were given a short description 

of the beginning of each advertisement 

and then asked to confirm their 

awareness by describing what happened 

in the advertisement. Exposure to these 

advertisements was categorized into three 

levels: zero, one to three, and four or more 

advertisements. A separate measure was 

constructed to capture the influence of 

the campaign message theme on smoking 

initiation on the basis of agreement with 

a key campaign belief (“You feel tobacco 

companies are just trying to use you”). 

Responses to this statement were grouped 

into “a lot,” “some or a little,” and “not at 

all.” A third measure was summed across 

nine attitude and belief statements to test the 

influence of tobacco industry attitudes and 

beliefs on smoking initiation. The authors 

estimated two logistic regressions of 

initiating smoking and established smoking 

as a function of number of advertisements 

recalled, agreement with a key campaign 

message theme, and the index of industry 

attitudes. The latter three constructs were 

tested individually and jointly. Other controls 

included age, gender, and how many of the 

respondent’s best friends smoked at baseline. 

Unlike the previous study, there was no 
515

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

control for parental smoking or the timing of 

the baseline survey.

The results indicated that the number of 

advertisements recalled, agreement with 

the key campaign message, and the industry 

attitude index all were associated with 

decreased smoking initiation. The analyses 

also suggested that exposure to the 

campaign works indirectly through changing 

attitudes and beliefs, which in turn influence 

smoking uptake. This finding is consistent 

with the theory of planned behavior.98

National Mass Media Campaigns

India, Adults

To determine whether the rate of oral cancer 

in India could potentially be reduced, an 

intensive, ongoing, media-based educational 

program (films, posters, folk theater, radio 

broadcasts, and newspaper articles) to 

discourage all forms of tobacco use was 

undertaken in three districts of the country. 

The intervention period began in 1979 and 

lasted at least five years.99,100 A cohort of 

tobacco users (identified from all adults 

screened in randomly selected villages 

in each district) was interviewed in their 

homes by dentists and followed annually for 

five years. The dentists advised participants 

of any precancerous conditions discovered; 

these individuals were not included in the 

analyses. These and all other tobacco users 

were advised of the dangers and encouraged 

to quit at each follow-up. A comparison 

cohort was obtained from a similar inhome surveillance effort that took place a 

decade earlier in the same districts, with the 

baseline interview in 1966–67. This earlier 

cohort was not exposed to the media 

campaign. Cessation of all forms of tobacco 

use was increased in the intervention cohort 

in two of the three districts; in the third 

district, the increase was slight and not 

significant. Chewing tobacco cessation rates 

were higher than for other forms of tobacco 

(bidis and clay pipes; cigarette smoking 

was rare). Many more in the intervention 

cohort also reported reducing consumption. 

Whether or not tobacco use was declining 

in other districts during the media 

intervention phase was not reported. 

Five-year follow-up examinations by the 

dentist interviewers showed the age-adjusted 

rate of occurrence of precancerous conditions 

to be reduced to nearly one-quarter of that 

observed in the earlier control cohort in 

two of the regions, but it increased in the 

third (the same region with no significant 

reduction in prevalence). A 10-year 

evaluation of one of the districts that the 

authors considered most representative 

of India showed that tobacco users in the 

intervention cohort continued to quit, 

but quit rates in the control cohort remained 

stable.100 At 10 years, the incidence of 

precancerous lesions in the intervention 

cohort was 40% of the incidence in the 

control cohort. Because oral cancer is usually 

preceded by precancerous conditions, the 

authors concluded the media program likely 

would reduce the incidence of oral cancer. 

Australia, Adults

Smoking rates declined steadily in Australia 

during the 1980s and early 1990s. However, 

these declines stalled during the mid-1990s, 

raising concerns in the public health 

community.101 Encouraged by the earlier 

“Quit for Life” campaigns,56,73 the federal 

government of Australia subsequently 

committed an initial A$7 million to an 

additional cessation-focused campaign to 

target adult smokers aged 18–40 years.

Launched in June 1997, the National 

Tobacco Campaign (NTC) was the largest 

and most intense antismoking media 

campaign ever implemented in Australia. 

The central communications element 

of the campaign consisted of television 

advertisements designed to convey 

information about the relatively certain 

effects of smoking. The campaign slogan 

was “every cigarette is doing you damage” 

and focused on the continuing damage 
516

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

that results from smoking, rather than on 

long-term health risks. The campaign used 

three television advertisements—Artery, 

Lung, and Tumor—to launch the campaign. 

These advertisements used highly realistic 

and graphic images to portray the deadly 

pathology of what happens inside the 

arteries, lungs, and brain as cigarette smoke 

enters the body. These advertisements 

were supplemented by a series of similar 

radio advertisements that reinforced the 

campaign’s messages, and in later years, 

by television ads about the effects of 

smoking on damage to the brain and eyes 

and a further ad on damage to the lungs. 

For a full description of the NTC and its 

implementation, see Hill and Carroll.101

Borland and Balmford102 conducted a 

longitudinal analysis to explore the shortterm impact of Australia’s NTC on thoughts 

about quitting smoking and progression 

toward cessation. A random sample of 

the electronic white pages identified 

1,000 current smokers, aged 18–40 years, 

who lived in Sydney, Melbourne, Brisbane, 

and Adelaide. A total of 250 baseline 

interviews were conducted in each of 

the four cities, with 119 of the original 

1,000 interviewees lost to follow-up 

for the survey two weeks after baseline 

(88% retention). Primary outcome measures 

included the frequency of various thoughts 

about smoking and the tobacco industry, 

concerns about passive smoking, and the 

prequitting stage of change. They also 

included a measure of self-reported quitting 

activity that was based on a survey question 

to assess whether participants had changed 

or thought about changing their smoking 

behavior in the past two weeks. This study 

also included measures of exposure to the 

NTC on the basis of survey questions that 

assessed unprompted and prompted recall 

of NTC advertisements from the “every 

cigarette is doing you damage” campaign.

Between the baseline and follow-up surveys, 

33% of smokers progressed toward cessation 

after the onset of the campaign. Recall of 

the NTC also was found to be significantly 

associated with greater self-reported 

quitting activity and an increase in negative 

thoughts about smoking. These results 

suggest that the NTC may have had a shortterm impact on smokers’ preparedness to 

quit smoking. Study limitations noted by 

the authors included lack of a control and 

selective attention. Also, the analysis did 

not adjust for the potentially confounding 

factors in a multivariable model.

Cross-Sectional Evaluations

A number of studies have assessed the 

effectiveness of state and national mass 

media campaigns in preventing youths’ 

smoking and in promoting smoking 

cessation in the United States and abroad. 

The next two subsections review studies 

concerning national campaigns and discuss 

the evidence from state-based media 

campaigns in the United States. The last 

subsection discusses the efficacy of media 

advertisements for quitlines.

National Antitobacco Media 

Campaigns

United States Fairness Doctrine, Adults 

and Youth

The earliest opportunity for evaluation of 

antismoking media campaigns occurred 

with the 1967 FCC ruling that the Fairness 

Doctrine applied to cigarette commercials, 

requiring broadcasters to air antismoking 

commercials in proportion to cigarette 

commercials. This balance was defined as 

a ratio of one free antismoking advertisement 

on television or radio for every three cigarette 

commercials.103 The first evaluations of the 

natural experiment provided by the Fairness 

Doctrine were simple models of cigarette 

demand, using time-series data on annual 

per capita cigarette consumption.103–105 These 

studies provided convincing evidence that the 

Fairness Doctrine had a significant impact on 
517

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

smoking during the late 1960s. Antismoking 

advertisements aired from 1967 through 

early 1971 when cigarette advertising was 

banned in the broadcast media.

Studies by Lewit and colleagues106 and 

Warner and Murt107 add to the evidence 

base on the effectiveness of the Fairness 

Doctrine. Warner and Murt107 evaluated the 

Fairness Doctrine by using a time series of 

cross-sectional data from the 1978 National 

Health Interview Survey (NHIS). These 

surveys contain self-reported smoking rates 

in the United States for each year from 1901 

through 1978 for six 10-year birth cohorts 

of males and females. The 1901–10 cohort 

is the eldest, and the 1951–60 cohort is 

the youngest. To assess the effect of the 

campaign on smoking rates, the authors 

estimated what smoking rates would have 

been between 1964 and 1978 in the absence 

of the campaign. They then compared those 

estimates with the actual self-reported 

smoking rates in NHIS data.

In estimating the rates of smoking that 

would have occurred for each cohort, in each 

year of the antismoking campaign, Warner 

and Murt used assumptions that, without 

the campaign, secular trends in smoking 

would have persisted through the 1960s and 

1970s. To estimate these rates, the authors 

added or subtracted the earlier cohorts’ 

average percentage point changes for the 

relevant ages to the 1963 base smoking rate 

for the cohort in question. This process was 

repeated for the 1964–78 estimates.

Warner and Murt’s107 time-series analysis 

indicated that self-reported smoking rates 

in NHIS data would have been significantly 

higher through 1978 in the absence of the 

antismoking campaign. This analysis suggests 

that the campaign had a measurable effect 

on U.S. smoking rates. More specifically, 

these researchers found that the campaign 

may have been more effective at encouraging 

males to quit smoking or not to start. Males 

in the youngest cohort were projected to have 

a 61% smoking prevalence by 1978 without 

the campaign, a difference of 22 percentage 

points from that cohort’s actual reported rate 

of 39%. Although the largest effects appeared 

to be within male cohorts, the campaign had 

a significant impact on most female cohorts 

as well.

The primary limitation of Warner and 

Murt’s107 analysis is that it used a number 

of unverifiable assumptions to calculate 

estimated smoking rates in the absence of 

the campaign and did not control for possible 

confounding influences, such as cigarette 

prices, that may have affected smoking rates 

during the campaign. Also, these estimated 

rates were not based on model predictions 

that could have accounted for a number 

of influences. Nonetheless, to check the 

overall validity of their assumptions, Warner 

and Murt converted the cohort estimates 

of smoking prevalence into estimates of 

cigarette consumption and compared them 

with consumption estimates produced by 

Warner104,105 from cigarette production and 

sales data. The similarity of these estimates, 

they argued, provided reasonable support for 

the validity of their assumptions. 

Lewit and colleagues106 conducted a more 

traditional analysis of the effects of the 

antismoking campaign that aired under 

the Fairness Doctrine. They used a crosssectional sample from Cycle III of the 

National Health Examination Survey to 

estimate demand functions for cigarette 

smoking by adolescents. Their analysis 

used a large sample of youth (N = 6,768), 

aged 12–17 years and data collected 

between March 1966 and March 1970. 

These researchers estimated self-reported 

smoking behavior as a function of various 

measures of exposure to antismoking 

advertisements. Unlike previous studies, 

the analysis by Lewit and colleagues 

controlled for an extensive set of potential 

confounding influences that included 

cigarette prices, family income, family 

size, employment status, family structure, 
518

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

parents’ education, age, gender, race, and 

exposure to prosmoking messages.

The analysis by Lewit and colleagues106 used 

two measures of smoking behavior as the 

dependent variables in regression models: 

(1) whether the youth was a current smoker 

and (2) the number of packs of cigarettes 

smoked per day. Youth exposure to the 

antismoking commercials aired under the 

Fairness Doctrine was captured with a series 

of dichotomous and interaction variables. 

The simplest measure was a dichotomous 

variable that distinguished youth who were 

interviewed during the Fairness Doctrine 

period. Alternative measures were used to 

capture the possibility that youth who watch 

more television would be more likely to see 

antismoking campaign commercials. To do 

so, the authors used two variables consisting 

of youths’ daily hours of television and 

an interaction between daily television 

and an indicator for Fairness Doctrine 

periods. The final specification of campaign 

exposure by Lewit and colleagues consisted 

of a proxy for the number of antismoking 

commercials that youth viewed. This proxy 

was defined as the product of the number 

of antismoking commercials that aired in a 

given year and the number of hours per day 

that each youth spent watching television. 

The study by Lewit and colleagues also 

included a squared term for this variable 

to capture the possibility that the impact 

of antismoking commercials is subject to 

diminishing returns.

The regression analyses by Lewit and 

colleagues106 indicated that smoking 

prevalence among youth was between 3.0 

and 3.4 percentage points lower during the 

Fairness Doctrine than during the previous 

16 months. Consistent with their hypotheses, 

they also found that the interaction between 

television watching and the Fairness Doctrine 

periods had a negative and statistically 

significant impact on the probability of 

smoking, suggesting that youth who watched 

more television during the Fairness Doctrine 

era of antismoking commercials were 

less likely to smoke cigarettes. Lewit and 

colleagues further found that their proxy for 

the number of advertisements youths saw 

was negatively and statistically associated 

with a lower probability of smoking. However, 

the squared term for this proxy had a positive 

and significant effect on smoking. These 

results suggest that the Fairness Doctrine 

had a significant negative impact on 

smoking by youth and that this impact was 

subject to diminishing returns. None of the 

specifications estimated by the Lewit study 

found a significant impact of the campaign 

on the number of cigarettes smoked per day. 

This finding is not surprising, as many youth 

are not yet regular or addicted smokers.

Lewit and colleagues106 made significant 

improvements in estimating the effects of 

Fairness Doctrine antismoking commercials. 

They did so by estimating youth smoking 

behaviors as a function of proxies for 

exposure to the antismoking campaign while 

controlling for a broad set of potentially 

confounding influences. This study made 

significant strides in using more complex 

measures of exposure to the campaign. As in 

other studies that rely on aggregate rather 

than self-reported individual exposure, 

the measures were of potential rather than 

actual exposure.

Despite their limitations, these crosssectional studies provided fairly convincing 

evidence of the impact of the Fairness 

Doctrine and were consistent with previous 

time-series analyses of cigarette sales and 

consumption data.103,104 As noted by Flay,1

these findings were further validated by 

other analyses and studies showing that 

cigarette consumption increased after 

antismoking commercials were no longer 

broadcast, following a ban of cigarette 

advertising on television and radio. Thus, the 

Fairness Doctrine advertisements appeared 

to be more effective in deterring cigarette 

consumption than were the cigarette 

commercials in encouraging consumption, 
519

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

even though the latter outnumbered the 

former. The Fairness Doctrine and ensuing 

evaluations showed that antismoking 

advertising on television and radio, when 

implemented with sufficient intensity and 

reach, could produce behavioral changes 

in smoking. As such, these studies laid 

groundwork for further investigation and 

eventually for antismoking media campaigns 

to become one of the preeminent tools 

used by governments and private health 

organizations for curbing youth and adult 

smoking in the United States.

Australia’s NTC, Adults

The details of this campaign were described 

above in “Longitudinal Designs, National 

Mass Media Campaigns.” In addition, 

Wakefield and colleagues8 used a national 

cross-sectional population telephone 

survey method, involving a baseline survey 

of adults and cross-sectional follow-up 

surveys in subsequent years. The surveys 

measured unprompted recall of the NTC, 

recognition of advertising, campaignattributed encouragement to become or 

remain a quitter, and beliefs and attitudes 

about smoking and health. Overall, 88% 

of Australian adults had confirmed recall 

of the NTC in 2000. In addition, roughly 

one-half of the smokers who had seen 

the NTC believed that it made them more 

likely to quit smoking cigarettes. Specific 

changes between surveys—in unprompted 

awareness of health effects caused by 

smoking, and new learning about smoking 

and health—were observed in relation to 

the main messages of the advertisements, 

which were time sensitive, according 

to the year of launch of each of the ads. 

This analysis relied on a basic descriptive 

analytic strategy and specifically did not 

link self-reported measures of awareness of 

the NTC to outcomes of interest because of 

the problem of selective recall bias.

Australia’s NTC, Youth

Other studies have used cross-sectional data 

to assess whether the NTC, which focused on 

adults, had an impact on youth in Australia. 

White and colleagues108 used two crosssectional surveys of youth (one telephone 

and one school based; both postintervention 

only) to examine youth awareness of the 

“every cigarette is doing you damage” 

campaign and whether the campaign had 

any measurable impact on tobacco-related 

attitudes and behaviors among youth. The 

national telephone survey targeted youths 

aged 14–17 years. The school survey included 

secondary school students aged 12–17 years 

in Victoria. The telephone survey assessed 

youth awareness of campaign messages, 

attitudes about smoking, intentions to 

smoke, and quitting behaviors. The school 

survey also assessed youth awareness 

of campaign messages and whether the 

students took any actions as a result of 

seeing the campaign advertisements.

Again, the primary analytic strategy of 

White and colleagues108 consisted of 

simple descriptive analyses rather than 

multivariate analyses that adjusted for 

potential confounding factors. Analyses 

were conducted separately for smokers 

and nonsmokers and summarized youth 

awareness of the campaign and responses 

to various questions about tobacco-related 

attitudes and quitting behaviors. Results 

from both the telephone and school surveys 

show that recognition of the NTC’s tagline 

was extremely high (90% or greater) 

among Australian youth. Analyses from 

the telephone survey indicate that a high 

proportion of smoking and nonsmoking 

youth agreed with statements about 

campaign-related beliefs. A high proportion 

of youth also indicated beliefs that the 

campaign was relevant to primary students, 

secondary students, and young smokers.

Students in the Victoria school survey were 

asked questions about whether they took 

any action in response to the campaign. 

Students were allowed to indicate any one 

of a number of possible actions, such as 

quitting smoking, reducing their cigarette 
520

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

consumption, and telling someone else 

to quit smoking. Compared with never 

smokers, a significantly higher proportion of 

youth who had smoked at least once in their 

lifetime indicated taking at least one action 

in response to the campaign. Among current 

established smokers, for example, 27% said 

they cut down the number of cigarettes 

they smoked in response to the campaign, 

26% indicated they thought about quitting, 

and 18% said the campaign made them try 

to quit smoking. However, 42% did nothing 

in response to the campaign.

These data suggest that, although the 

NTC was aimed at adult smokers and had 

a strong cessation message, the campaign 

had at least some impact on youth in 

Australia. Awareness of NTC advertisements 

was assessed in both surveys used in this 

study, but the authors did not estimate the 

direct statistical relationships between selfreported awareness of the campaign and 

the attitudinal and behavioral outcomes 

assessed in the study. 

American Legacy Foundation’s National 

“truth” Campaign Aimed at Youth

Cross-sectional studies also have been used 

extensively to evaluate high-profile, national 

antismoking campaigns aimed at curbing 

youth smoking in the United States, such as 

the American Legacy Foundation’s (Legacy’s) 

national “truth” campaign. When launched 

in 2000, the “truth” campaign differed 

from other national smoking prevention 

campaigns in being marketed as a popular 

youth brand and delivering blunt facts 

and messages about the tobacco industry 

(such as industry efforts to obscure the 

health effects of tobacco). The campaign’s 

messages were delivered in a variety of 

television advertisements that featured risktaking adolescents and were designed to 

avoid making directive statements that tell 

youth not to smoke.

The Legacy “truth” campaign strategy is 

generally consistent with modern theories 

of persuasion. These theories hold that, 

for a message to have an effect on desired 

outcomes, it must not only be viewed and 

remembered but also must be understood 

and perceived as credible and relevant. 

The Legacy “truth” campaign’s general 

approach contrasts with other national 

campaigns, such as Philip Morris’s “Think. 

Don’t Smoke” campaign, the second-largest 

national antismoking campaign to air 

during the early years of the Legacy “truth” 

campaign. The “Think. Don’t Smoke” 

campaign, which aired between 1998 and 

2002, featured role models displaying firm 

decisions not to smoke and explaining their 

reasons for not smoking.

The first cross-sectional studies on the 

effectiveness of the Legacy “truth” campaign 

provide fairly convincing evidence that 

the campaign had a significant impact 

on tobacco industry-related attitudes, 

beliefs, and other behavioral precursors, 

as well as a significant impact on youth 

smoking prevalence in the United States. 

Farrelly and colleagues109 used a nationally 

representative sample of 12- to 17-year-olds 

from the Legacy Media Tracking Survey. 

Data were from two waves: a baseline period 

during the months before the campaign’s 

launch, and approximately 10 months 

afterward. This study included self-reported 

measures of confirmed recall of Legacy 

“truth” advertisements, multiple measures 

of campaign-related attitudes and beliefs, 

and a comprehensive set of individual 

background characteristics.

The study indicated that 10 months 

subsequent to the campaign’s launch, a 

high percentage of youth (75%) had seen at 

least one specific campaign advertisement. 

Using multivariable logistic regressions, 

the authors also showed that awareness 

of specific campaign advertisements was 

significantly associated with greater antitobacco-industry attitudes and with beliefs 

that were targeted by the campaign.109

A subsequent study, using six waves of 
521

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

the same survey, examined antitobacco 

attitudes over time in groups of states: 

(1) tobacco-producing states, (2) nontobacco-producing states with low tobacco 

control funding, (3) non-tobacco-producing 

states with relatively high tobacco control 

funding, and (4) non-tobacco-producing 

states with well-funded media programs. 

The authors found no significant difference 

in how antitobacco attitudes changed over 

time among the state groups and concluded 

that response to the Legacy “truth” 

campaign was not influenced by residence 

in a tobacco-producing state.110

For the earlier study,109 findings also showed 

that the Legacy “truth” campaign was 

associated with a significant reduction in 

youths’ intentions to smoke in the future. 

Interestingly, this study also found that 

youth awareness of Philip Morris’s “Think. 

Don’t Smoke” campaign was associated with 

a lower level of several anti-tobacco-industry 

attitudes as well as increased intentions to 

smoke. As with all cross-sectional studies, 

the primary limitation of this study is the 

potential for bias in selective attention, 

which precludes strong causal inferences.

A subsequent cross-sectional study, 

published in 2005, examined effects of 

the Legacy “truth” campaign on smoking 

behavior of youth.93 This study used a 

large national sample of 8th-, 10th-, and 

12th-grade students from the Monitoring 

the Future survey. Multivariable logistic 

regression models estimated youth smoking 

prevalence as a function of the Legacy “truth” 

campaign’s intensity measured at the media 

market level. The media market measure 

of “truth” campaign exposure was based on 

gross-ratings-point data provided by the 

campaign’s media contractor. These data 

captured the relative reach of and frequency 

of exposure to the campaign among its target 

audience of 12- to 17-year-olds within each 

of 210 media markets in the United States. 

Because gross rating points varied greatly 

across U.S. media markets, these data allowed 

the formation of multiple natural comparison 

groups and provided an alternative analysis 

approach in the absence of true experimental 

implementation of the campaign. This study 

also controlled for a wide range of individual 

demographic characteristics as well as 

preexisting levels of smoking in each of the 

210 U.S. media markets. 

Findings from this study associate the 

Legacy “truth” campaign with a significant 

decline in youth smoking, resulting 

in approximately 300,000 fewer youth 

smokers in the United States. The authors 

showed that smoking prevalence among 

students in 8th, 10th, and 12th grades 

combined declined from 25.8% to 18.0% 

between 2000 and 2002. The Legacy “truth” 

campaign accounted for approximately 

22% of this decline. Although the Legacy 

“truth” campaign had no effect on youth 

smoking after only a few months of 

the campaign in 2000, the effects were 

statistically significant in 2001 and 2002. 

These findings suggest that the association 

between the Legacy “truth” campaign and 

youth smoking strengthened over time 

and, as expected, had little effect in the 

early months after the campaign’s launch. 

Furthermore, Thrasher and colleagues110

found that the effect on smoking was similar 

among high- and low-risk adolescents, when 

high risk was defined in multiple ways.

The above studies, like all other population 

studies, relied on self-reported measures 

of youth smoking. These measures may 

be subject to social desirability bias; that 

is, youth are less likely to report smoking 

in media markets that received high 

levels of exposure to the campaign. This 

would lead to an overstatement of the 

campaign’s effects. However, in a study 

published in 2007,111 biochemically validated 

smoking status in a school-setting survey 

(5,511 students from 48 high schools) 

showed that only 1.3% of respondents 

underreported smoking via self-report, and 

recall of “truth” advertisements was not 
522

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

related to underreporting. The campaign’s 

effects could have resulted from other 

youth-focused prevention programs, such as 

the national antidrug campaign by the Office 

of National Drug Control Policy.20 However, 

in similar models, the authors found no 

associations between Legacy “truth” gross 

rating points and heavy drinking among 

youth, which may be influenced by the 

Office of National Drug Control Policy 

campaign and other drug and alcohol 

prevention initiatives. These findings help 

rule out the possibility that the correlation 

between Legacy “truth” gross rating points 

and youth smoking was spurious. 

Tobacco Industry-Sponsored Media 

Campaigns Aimed at Youth and Parents

In contrast to the Legacy “truth” 

campaign, Philip Morris’s “Think. Don’t 

Smoke” campaign was associated with 

lower levels of antitobacco attitudes and 

higher intentions to smoke.109 Another 

analysis of this campaign by Wakefield 

and colleagues examined its association 

with smoking behavior as well as attitudes 

and intentions.112 This study also included 

Lorillard’s “Tobacco Is Whacko if You’re 

a Teen” and a Philip Morris media 

campaign aimed at parents, “Talk. They’ll 

Listen.” The study used Monitoring the 

Future school survey data (8th, 10th, and 

12th graders) from tens of thousands of 

students and related the data to grossrating-point data for the four months 

preceding the surveys in the media markets 

where the schools were located. Models 

for the variables associated with behavior, 

attitude, and intention controlled for 

demographic and other personal data, 

region, the real price of cigarettes, a 

smoke-free air index, and exposure to 

state tobacco control program media. 

Additional models for smoking behavior 

also controlled for frequency of television 

watching, with consistent outcomes. 

The analyses discerned no association 

between smoking in the past month with 

the youth-directed media campaigns as 

measured by gross rating points. However, 

exposure to the tobacco industry’s 

youth-directed campaign advertising 

was associated with an intent to smoke 

in the next five years for 8th graders. 

In contrast, greater exposure to the rating 

point variable for media directed toward 

parents was associated with a higher 

likelihood of smoking in the past month 

for 10th and 12th graders, increased intent 

to smoke for all grades, and lower levels of 

a few antitobacco attitudes. Wakefield and 

colleagues112 cite theories in developmental 

psychology to explain these findings. 

As adolescents mature, they consider 

themselves more independent and less 

reliant on their parents. Thus, messages 

aimed at parents as authority figures invite 

rejection by older adolescents. The nature 

of the media buy for the campaign directed 

toward parents was unlikely to result in 

more rating points in areas with higher 

adolescent smoking rates. Sensitivity 

analyses explored the effect of removing 

some of the key control variables (cigarette 

price, smoke-free air index, exposure 

to public health-sponsored antitobacco 

campaigns) from the model; however, the 

results were basically unchanged. 

Cross-Sectional Results from Other 

Countries for Adults

In addition to the studies described above, 

several national antismoking media 

campaigns in other countries have been 

evaluated with cross-sectional data and have 

shown similar results. In March through 

May 1977, Norway conducted a mass media 

campaign to inform its population about 

the health consequences of smoking, 

with no other tobacco control measures 

mentioned.113 The publicly controlled 

media ran six large advertisements in 

170 newspapers and magazines, and the 

state-owned television station twice aired 

the British documentary film Dying for a 

Fag. The first showing was followed by a 

call-in radio program for viewers to discuss 
523

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

their reactions to the film. An in-home 

population survey, conducted in June 1977 

to evaluate the effect of this campaign, 

found that 86% of the population had seen 

a newspaper advertisement, 62% had seen a 

magazine advertisement, and 66% had seen 

one of the showings of the film on television. 

Compared with surveys conducted before the 

campaign, daily smoking prevalence among 

men dropped from 53% to 45%. It had been 

close to 53% since 1971, after declining 

from the mid-1950s. Daily smoking 

prevalence among women had been steadily 

increasing from the mid-1950s through 

1973, declined through 1976, but remained 

even between 1976 and 1977. Per capita 

cigarette consumption declined 4.3% in the 

12-month period from July 1976 through 

July 1977 compared to the preceding 

12-month period. Gredler and Kunze,114

using a pre-post design, suggested that a 

large-scale antismoking campaign that aired 

in Austria for eight weeks at the end of 1980 

and the beginning of 1981 was responsible 

for a significant reduction in the prevalence 

of smoking in Austria between 1979 and 

1981. Using multiple cross-sectional 

surveys, Doxiadis and colleagues115 found 

that an intensive antismoking campaign in 

Greece that consisted of radio and television 

advertisements virtually eliminated annual 

percentage increases in smoking between 

1979 and 1980. Doxiadis and colleagues 

also found that when this campaign ceased, 

cigarette consumption again rose to 

precampaign rates. These findings suggest 

that a media campaign that reaches a high 

proportion of the population can influence 

smoking behavior, even without other 

tobacco control efforts in place. 

Statewide Antitobacco Media 

Campaigns 

Comparative Cross-Sectional Evaluation 

Among States of Effects on Youth

A study by Emery and colleagues116 published 

in 2005 provides compelling evidence 

from a correlational analysis that youth 

exposure to state-sponsored antismoking 

commercials within the United States is 

associated with stronger intentions not 

to smoke in the future and with a lower 

probability of being a smoker. This study 

used cross-sectional data for two years (1999 

and 2000) on 8th-, 10th-, and 12th-grade 

students from the Monitoring the Future 

survey to link exposure to state antismoking 

commercials to youth smoking outcomes. 

Their analysis was similar to that of Farrelly 

and colleagues,93 using commercial ratings 

data from Nielsen Media Research to 

calculate a measure of audience exposure 

to antismoking advertising across the 

75 largest media markets for the years 1999 

through 2000. These data enabled Emery 

and colleagues to measure exposure to state 

antismoking advertisements across the 

75 media markets separately from exposure 

to antismoking advertisements sponsored 

by the tobacco industry and advertisements 

for smoking-cessation aids sponsored by the 

pharmaceutical industry. These measures 

were incorporated as independent variables 

in a series of multivariable logistic 

regressions that estimated outcomes related 

to smoking as a function of exposure 

to advertising. This study was the first 

to examine the impact of state-funded 

antismoking campaigns on youth smoking 

while controlling for other tobacco-related 

advertisements. The analyses controlled for a 

comprehensive set of potential confounding 

influences—such as demographics, family 

structure, parents’ education, average state 

cigarette prices, clean indoor air laws, 

and secular trends—to account for potential 

influences they were unable to model 

(e.g., such as Legacy’s “truth” campaign).

The results from these analyses indicate 

that exposure to at least one state-funded 

antismoking advertisement in the prior four 

months is associated with lower perceived 

rates of friends’ smoking, greater perceived 

harm of smoking, stronger intentions not 

to smoke in the future, and lower likelihood 
524

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

of being a smoker. These findings are 

particularly compelling because the models 

consistently yield significant associations 

between exposure to state antismoking 

campaigns and youth smoking-related 

outcomes. This association occurred even 

though state campaigns, as captured by the 

awareness measures used by Emery and 

colleagues, varied dramatically in the number 

and frequency of advertisements aired.

A limitation of this study was that the 

authors could not control for preexisting 

correlations between levels of smoking in 

the media markets and the number and 

frequency of advertisements aired in each 

market. As Farrelly and colleagues93 noted, 

markets with low media exposure tend 

to have populations that are more rural, 

white, and less educated, and lower in 

income than do markets with high exposure. 

These factors are all associated with higher 

levels of smoking. Thus, failing to control 

for these potential preexisting correlations 

could lead to a spurious negative correlation 

between antismoking advertising and 

youth smoking rates. In subsequent 

analysis, the same methods applied to five 

years of advertising exposure and youth 

smoking outcome data, and controlling for 

preexisting youth smoking rates in 1995–96, 

found the same pattern of results, linking 

greater advertising exposure to reductions 

in youth smoking.117

Minnesota, Youth

In 1985, Minnesota was the first state to 

mount a statewide antismoking campaign 

aimed at youth. The campaign used paid 

and donated spots on television and radio 

as well as newspaper and billboard ads, 

particularly in connection with sports and 

other events attracting large adolescent 

audiences. Murray and colleagues118

evaluated the effects of this campaign during 

1986–90 on youth attitudes toward tobacco 

and smoking by contrasting change over 

time among Minnesota youth relative to 

youth in Wisconsin. They demonstrated a 

small but statistically significant increase in 

exposure to antismoking messages but no 

changes in attitudes or smoking behavior. 

Given the relatively low level of spending 

for the campaign and only a small increase 

in exposure to antismoking messages, 

it is possible that the campaign’s reach 

was not sufficient to lead to change in 

smoking behaviors. 

Another cross-sectional study examined the 

effects of Minnesota’s Target Market youth 

media campaign. This campaign, launched 

in the spring of 2000 and continued for 

three years, was phased out after state 

budget cuts. To evaluate the campaign, four 

cross-sectional surveys of approximately 

1,100 12- to 17-year-olds were conducted 

between summer 2002 and winter 2003.119

The last survey was conducted five 

months after the last advertisement aired. 

The authors used several measures to test 

whether or not ending the campaign had 

a negative impact on outcomes: awareness 

of Target Market; smoking susceptibility 

(“if someone you thought was cool offered 

you a cigarette, would you smoke it?” and 

“would you wear a shirt, hat, or sunglasses 

with a tobacco company logo on it?”); 

intention to smoke in the next year; and 

three attitudinal scales. One scale measured 

attitudes toward the tobacco industry (central 

to the campaign), one included traditional 

normative attitudes and beliefs, and the third 

reflected antitobacco empowerment.

The results show that awareness of the 

advertising dropped from 59% to 50%, 

and awareness of the Target Market brand 

dropped from 85% to 57%. By the last 

survey, the two measures of smoking 

susceptibility increased, as did intentions 

to smoke in the next year. Finally, scores 

on all three attitudinal scales decreased. 

These results may provide evidence of 

the effectiveness of Minnesota’s media 

campaign by showing that the absence of 

the campaign led to adverse changes in 

key tobacco outcomes. However, without a 
525

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

comparison sample, it is difficult to know 

if the trends in Minnesota reflected, in part, 

a national trend.

California, Youth and Adults

Popham and colleagues120 conducted a 

before-and-after cross-sectional design 

to assess the effectiveness of California’s 

1990–91 mass media campaign among 

youth and adult smokers. This assessment 

occurred before the implementation of 

most other statewide tobacco control 

activities and after an increase of 25 cents 

per pack in the state cigarette excise tax. 

The pre- and posttest surveys of youth in 

grades 4–12 were conducted in schools; 

the adult smoker survey was conducted 

by telephone. For youth, posttest surveys 

were conducted 3, 7, and 12 months after 

baseline and 2, 6, and 11 months after the 

campaign launch. The authors used t-tests 

to evaluate differences between surveys 

and in the final survey and differences 

between those exposed and unexposed 

(self-report) to the media messages. 

The results indicate positive changes in 

tobacco attitudes, intentions, and use. 

However, these differences appear between 

the baseline and first posttest survey 

only after two months of exposure to the 

campaign. For example, smoking prevalence 

declined from 12.8% to 10.3% over this 

period and was 10.9% in the 12-month 

survey. A similar pattern was found for 

attitudes and intentions. In addition, the 

statistically significant differences were of 

modest magnitude. When authors analyzed 

outcomes in the 12-month survey for those 

who reported awareness of the campaign 

versus those who did not, they found 

conflicting results: those exposed to the 

campaign showed significantly more healthenhancing attitudes, but more nonsmokers 

indicated they were thinking about starting 

to smoke. The authors suggest that their 

measure for “thinking about starting” may 

not have been valid. Selective attention 

among nonsmokers susceptible to smoking 

may also explain this result.

The results for the adult smoker surveys 

show an increase in awareness of campaign 

messages between the baseline and 

12-month surveys, a modest but statistically 

significant decrease in antitobacco attitudes, 

and no difference in intentions to quit. 

No meaningful differences were found in 

the final survey between those reporting 

and those not reporting awareness of 

the campaign. Given the relatively short 

timeframe for the study and analyses that 

did not control for potentially confounding 

influences among those either reporting or 

not reporting exposure, it is not surprising 

that this study had mixed results.

One other study attempted to assess 

indirectly the impact of California’s 

media campaign on tax-paid cigarette 

sales. Hu and colleagues121 conducted a 

regression analysis of quarterly cigarette 

sales between 1980 and 1992 and mass 

media campaign expenditures, controlling 

for cigarette price excluding cigarette 

excise taxes, the amount of cigarette 

excise taxes, and time. They found a 

significant association between expenditures 

on mass media campaigns and declines in 

cigarette sales.

Florida, Youth

In addition to the evidence of effectiveness 

for the Florida “truth” campaign noted 

earlier in this chapter from longitudinal 

evaluations,96,97 Sly and colleagues96

used a before-and-after design with a 

comparison group to assess the effectiveness 

of the Florida “truth” campaign in the 

first year of the campaign. The central 

comparisons in this study are between 

independent cross-sectional samples of 

12- to 17-year-olds in Florida and the rest 

of the United States (excluding Arizona, 

California, Massachusetts, and Oregon, 

which had preexisting campaigns) in 

April 1998 and May 1999. Key outcome 

measures included campaign-targeted 

beliefs and attitudes, smoking susceptibility, 

and behavior. Target sample sizes were 
526

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

1,800 and 1,000 for the Florida and national 

population samples, respectively.

One year after the campaign was launched, 

89% of Florida youth sampled reported 

seeing at least one of the Florida “truth” 

advertisements. At baseline, the level of 

agreement with beliefs and attitudes was 

similar between Florida and national youth 

for 9 of the 11 items. By the May 1999 

survey, youth in Florida had more favorable 

beliefs and attitudes than did the national 

sample for 9 of the 11 items. Between 

the baseline and the May 1999 surveys, 

statistically significant decreases occurred 

in the percentage of youth who had ever 

tried a cigarette and the percentage of 

nonsmoking youth who were open to 

smoking. In addition, rates of change in 

ever trying a cigarette, currently smoking, 

and being open to smoking among 

nonsmokers over the one-year period 

compared favorably in Florida with the 

national sample. For example, current 

smoking declined by 8.9% in relative 

terms in Florida and increased by 11.9% 

nationally. These results are consistent 

with the longitudinal studies by Sly and 

colleagues.96,97 They indicate that the Florida 

“truth” campaign reached a significant 

proportion of all Florida youth in its first 

year and had a positive impact on beliefs, 

attitudes, and intentions to smoke.

Using an approach similar to that of 

Sly and colleagues,96 Niederdeppe and 

colleagues122 compared 12- to 17-year-old 

youths in Florida (N = 1,097) and nationally 

(N = 6,381, excluding youth in states with 

large-scale media campaigns in Arizona, 

California, Massachusetts, Mississippi, 

and Oregon) with cross-sectional surveys 

conducted between fall 2000 and spring 

2001. Key measures included current and 

lifetime smoking, smoking intentions, 

awareness of tobacco control activities, and 

agreement with four belief items about 

cigarette companies that are central to the 

Florida “truth” and the Legacy national 

“truth” campaigns as well as eight other 

beliefs about the social and physical effects 

of tobacco use.

The results indicate that Florida adolescents 

were less likely than youth nationally 

to have smoked in the past 30 days, 

to have ever tried smoking, and to be 

open to smoking in the future (among 

never smokers). Florida adolescents also 

had higher awareness of “truth” and 

community antitobacco organizations 

(e.g., Florida’s Students Working Against 

Tobacco) but similar levels of exposure to 

school-based tobacco prevention education. 

Florida youth had less-favorable beliefs 

about cigarette companies (all four items 

were statistically significant) compared 

with youth nationally, but all other beliefs 

surveyed were similar.

Another evaluation of Florida’s campaign 

relied on the cross-sectional Florida Youth 

Tobacco Surveys (more than 20,000 students 

in more than 240 middle and high schools 

each year) conducted in 1998 (preprogram) 

and in both 1999 and 2000 (postprogram).123

No comparison group in other states was 

presented. However, over the two-year 

period, both experimentation and current 

smoking declined markedly for both 

middle school and high school students. 

Experimentation declined from 21.4% to 

16.2% among middle school students and 

from 32.8% to 28.2% for high school 

students. The corresponding percentages for 

current smoking were 18.5% to 11.1% and 

27.4% to 22.6% for middle and high school 

students, respectively. In addition, among 

never smokers, there were significant 

increases in the percentages committed to 

never smoking: 67.4% to 76.9% for middle 

school students and 73.7% to 79.3% for 

high school students. Furthermore, the 

percentage of experimenters who said they 

would not try smoking again went from 

67.4% to 76.8% for middle school students 

and from 44.4% to 51.0% for high school 

students. This study documented very 
527

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

encouraging trends in Florida over the 

course of the campaign. 

British Columbia, Canada, Adults

Gagne124 described the short-term results of 

a provincewide media campaign conducted 

in two waves—four weeks in early 2005 

and four weeks in early 2006—but 

postcampaign data were available only for 

the 2005 segment. The media campaign 

consisted of television and radio spots, 

together with a poster campaign, and 

focused on the short- and long-term 

benefits of quitting. Cross-sectional national 

population surveys conducted before 

(from 1999) and after (to 2005) the first 

segment provided trend data on smoking 

behavior for analysis. Smoking prevalence 

is lower in British Columbia than in the 

rest of Canada, so deviations from expected 

trends for prevalence or self-reported 

cigarette consumption among smokers for 

British Columbia and the rest of Canada were 

computed. Both prevalence and smokers’ 

daily cigarette consumption increased in 

the rest of Canada, but they continued a 

downward trend in British Columbia. Lowconsumption smokers in British Columbia 

showed a greater decline in consumption 

than expected, but those in the rest of 

Canada continued on trend. Higher 

consumption smokers in British Columbia 

remained on trend, but those in the rest of 

Canada increased consumption beyond that 

expected from the preexisting trend. These 

results suggest that the media campaign 

helped British Columbia residents curb 

their smoking, while smoking increased in 

the rest of Canada. 

State and National Tobacco Control 

Programs with Antitobacco Media 

Components 

As the study by Emery and colleagues116

described above indicates, a number of 

statewide mass media campaigns have aimed 

at curbing youth and/or adult smoking in 

the United States. A central challenge in 

assessing these efforts’ effectiveness is that 

these campaigns often take place within 

the context of a comprehensive approach 

to tobacco control that includes tobacco 

prevention education in schools, community 

mobilization efforts to change policy and 

educate the public, smoking cessation 

telephone quitlines, and policy initiatives 

(e.g., banning smoking in public places, 

raising excise taxes, subsidizing smoking 

cessation therapy, restricting youth access 

to cigarettes). Reviews of multicomponent 

tobacco use prevention and control 

programs have shown them to be effective 

in reducing both smoking by youth and 

adults and cigarette sales.6,7,125–129

The population studies described earlier 

in this chapter (national and state 

programs, evaluated longitudinally and 

cross-sectionally) mostly concerned 

the media campaign component of a 

multicomponent program; in general, 

other tobacco control measures were also 

operative. These evaluation studies generally 

related behavior and attitudes directly to 

some measure of exposure to the media 

campaigns. This section looks at programs 

regarded as multicomponent or even 

comprehensive tobacco control programs.92

Although antitobacco media campaigns are 

an important component of these programs, 

other components may have played at least 

as great a role in discouraging smoking. 

It is difficult to determine the separate 

effectiveness of campaign components. 

Furthermore, the programs are generally 

directed at the entire population, not just 

youth. The studies described below concern 

the net effect of all program components 

together for two national, four statewide, 

and one citywide campaign. Although other 

U.S. states have also mounted tobacco 

control programs, peer-reviewed, published 

results are insufficient to include them in 

this summary. Results from state reports 

and other sources are summarized, however, 

in a 2005 review.128
528

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

Singapore

This city-state appeared to be among the 

first countries to undertake a concerted and 

coordinated tobacco control program, in 

1986, that sought to denormalize tobacco 

use with its theme, “Towards a Nation 

of Non-Smokers.”130 The program aimed 

to prevent youth smoking, encourage 

smokers to quit, and protect the rights of 

nonsmokers. Tobacco control measures 

included restriction of smoking in public 

places and workplaces, restriction of 

tobacco advertising, increased excise duties 

on imported cigarettes, and provision of 

cessation assistance. Educational programs 

in schools, clubs, worksites, and within 

the community also were undertaken, 

and written materials were part of this 

effort. Emmanuel and colleagues130 noted 

that all these educational programs “were 

complemented by intensive mass media 

coverage.” It is not known whether these 

media efforts were paid announcements 

by the government or provided as news 

coverage (perhaps requested by the agency 

running the campaign). Cross-sectional, 

population-based surveys indicated that 

smoking prevalence (aged 15 and older) 

fell from 19.0% in 1984 to 13.6% in 1987, 

or a 28% decrease. Per capita tobacco 

consumption decreased 26% over this 

period, while youth (15–19 years old) 

smoking prevalence decreased from 5.1% 

to 2.9%. Declines were observed for both 

genders and all age and ethnic groups. 

Smoking prevalence had been declining 

in Singapore before this tobacco control 

effort, but the rate of decline increased 

during the campaign. 

New Zealand

From 1985 to 1998, New Zealand undertook 

an extensive tobacco control program that 

included restrictions on tobacco advertising 

and sponsorships, increased taxation of 

tobacco products, regulation of nicotine and 

tar yields in manufactured cigarette brands, 

stronger warnings on cigarette packaging, 

increased but not total smoking restrictions 

in enclosed public places and workplaces, 

school-based education programs, a ban 

on the sale of tobacco products to those 

under age 16, and public education through 

both paid advertising campaigns and news 

items.131 However, the paid advertisements 

were limited because of cost. The campaign 

effect was evaluated by annual crosssectional population surveys (1985 through 

1995), and data were compared to available 

published data from other Organisation for 

Economic Co-operation and Development 

(mostly European) countries. Adult smoking 

prevalence fell from 30% in 1985 to 

25% in 1998, and was then the eighth 

lowest among 21 comparison countries. 

Youth (15–24 years old) smoking prevalence 

decreased from 35% to 28% over this 

period. Among the 17 comparison countries 

with data for this age group, New Zealand 

ranked third in the rate of decline. 

The decline was also observed among the 

Maori population, which was an important 

program goal. In general, the declines were 

greater among those with more education. 

Between 1975 and 1985, adult per capita 

tobacco consumption fell 23%; the decline 

nearly doubled to 45% from 1985 to 1998. 

The adult per capita consumption level in 

1995 was second lowest behind Sweden 

among the comparison countries.

California

California was the first U.S. state to fund a 

tobacco control program from the revenues 

of a voter-approved cigarette excise tax 

hike, Proposition 99. The initiative passed 

in 1989, boosting the tax by 25 cents per 

pack, with 20% of the new revenue to be 

devoted to a comprehensive tobacco control 

program. California’s program featured an 

antitobacco media campaign that began in 

late 1990. Shortly thereafter, community 

and school programs were initiated. 

Activists instrumental in the passage of 

Proposition 99 worked for local and then 

statewide bans on smoking in workplaces. 

The state ban became law in 1995 and 

was extended to bars and clubs in 1998. 
529

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Increased efforts began in 1996 to enforce 

laws banning the sale of cigarettes to 

minors. In 1998, voters approved a further 

increase of 50 cents per pack in the cigarette 

excise tax; the increase took effect in 1999.

Further evaluation efforts documented a 

decline in per capita cigarette consumption 

(sales).121,132,133 Later studies compared both 

per capita cigarette consumption and adult 

smoking prevalence in California with 

similar data for the rest of the United States 

and found greater declines in California than 

in any other state.95,134 Comparisons were 

from state-specific sales data and national 

cross-sectional surveys as well as the 

cross-sectional California Tobacco Surveys, 

conducted approximately every three 

years as part of the program evaluation. 

Pierce and colleagues134 presented evidence 

of a halting of favorable downward trends 

coincident with severely reduced funding for 

the program, including the media campaign, 

in 1993–96. Program funding was restored 

in late 1996. 

Evaluations of the California Tobacco 

Program’s effect on cigarette 

consumption135,136 and adult smoking 

cessation137 provide additional evidence of 

program success. Between 1988 and 2002, 

per capita consumption (sales data) declined 

by 60% in California compared to 40% in 

the rest of the United States.135 During the 

early part of the program, analyses of selfreported consumption (from California 

Tobacco Surveys) indicated that most of the 

decline could be attributed to California 

smokers’ smoking less. However, between 

1996 and 2002, a significant proportion 

of the decline was because of smokers’ 

quitting. Self-reported consumption by 

non-Hispanic, white, daily smokers between 

the ages of 35 and 64 years responding 

to national cross-sectional surveys 

(U.S. Census Bureau Current Population 

Surveys) declined faster in California, 

with its comprehensive tobacco control 

program, than in smokers of similar ages 

in (1) New York and New Jersey, with 

cigarette prices similar to those in California 

and no program, and (2) in tobacco-growing 

states (Kentucky, Tennessee, North Carolina, 

South Carolina, Virginia, and Georgia), 

with low cigarette prices and no program.136

Although consumption among daily 

smokers was lower in California among 

younger, non-Hispanic, white smokers 

aged 20–34 years than in the other state 

groups, all groups showed similar rates of 

decline. In contrast, successful cessation 

increased among this younger age group of 

California smokers faster than in the other 

state groups.137 Faster increases in quitting 

for California smokers were also observed 

for the age group of 35–49 years, but not 

for those 50–64 years old. An analysis of 

trends in the prevalence of daily smoking 

among African Americans in these state 

groups (above) showed no program or tax 

effect;138 the levels and trends for all state 

groups were virtually the same. All these 

analyses adjusted for demographic factors 

and estimated the trends from general linear 

models that accounted for variability within 

state groups.

Youth outcomes have also been 

investigated.139–141 Trends in unstandardized 

measures of several adolescent (12–17 years 

old) smoking behaviors (ever puffed, ever 

smoked a whole cigarette, and smoked at 

least 100 cigarettes in lifetime) from the 

California Tobacco Surveys showed overall 

declines from 1990 to 2002.139 However, while 

the decline in ever puffing was apparent 

after 1990 in the youngest age group (12 and 

13 years), it became apparent after 1993 

for adolescents aged 14 and 15 years, and 

after 1996 for those aged 16 and 17 years. 

The declines in the other measures did not 

begin until after 1996 for all age groups. 

The prevalence of smoking in the past 

30 days for all adolescents remained constant 

from 1990 to 1992 (approximately 9%), 

increased to 12% in 1996, declined below 

1990 levels to about 7% in 1999, and declined 

further to about 5% in 2002. The California 
530

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

Tobacco Surveys also showed a decline 

(standardized) in prevalence of young adults’ 

(aged 18–24 years) ever smoking over this 

period, and national survey data (Current 

Population Surveys, again standardized) 

indicate that while young adults’ smoking 

prevalence remained level in the rest 

of the United States, a marked decline 

occurred between 1998–99 and 2001–02 in 

California. These results suggest that fewer 

of California’s adolescents are moving to 

young adulthood as smokers. 

Two longitudinal population surveys 

of adolescents aged 12–17 years were 

conducted: (1) at baseline in 1993, followed 

in 1996; and (2) at baseline in 1996, 

followed in 1999; and transition rates were 

examined.140 Adjusted analyses indicate 

that transitions from being a committed 

never smoker at baseline to any smoking 

by follow-up, from being a susceptible 

never smoker to any smoking, and from 

being an experimenter to becoming an 

established smoker were significantly lower 

in the second survey compared to the first 

for those aged 12–14 years. Only the first 

transition was significantly less likely for 

those aged 15–17 years in the second cohort. 

Although the other transition rates were 

lower in the second cohort compared with 

the first, they were not significantly lower.

An analysis by Chen and colleagues141 used 

age-period cohort analyses of the California 

Tobacco Surveys and California Youth 

Tobacco Surveys (similar surveys, but the 

latter are smaller and conducted continually) 

to examine the prevalence of never smoking 

from 1990 to 1999. They concluded that the 

California Tobacco Control Program affected 

only those born after 1978 who would have 

been 12 years of age or younger when the 

California Tobacco Program began.

Taken together, these studies suggest that 

an environment of tobacco control and the 

denormalization of tobacco use decrease 

smoking initiation. 

Massachusetts

Koh and colleagues present a thorough 

review of the history of tobacco control in 

Massachusetts.142 Following California’s 

example, Massachusetts voters approved 

a ballot initiative in 1992 that raised 

the excise tax on cigarettes by 25 cents 

per pack, with a portion of the revenues 

(initially about 30%, but less later) dedicated 

to funding a tobacco control program. 

The program was implemented in 1994. 

It included a mass media campaign, 

community-based programs to promote 

change at the local level (including the 

adoption of smoking restrictions), the 

passage and enforcement of laws restricting 

youth access to cigarettes, school-based 

prevention programs, and efforts to help 

smokers quit (including a quitline). 

First evaluations of the program examined 

per capita cigarette sales data and adult 

smoking prevalence.143 Taking into 

account cross-border sales, Harris and 

colleagues143 found a 17% reduction in 

sales for Massachusetts from 1992 to 1996, 

compared to a decline of 6% nationally. Using 

Behavioral Risk Factor Surveillance System 

(population survey) data, they found that 

adult prevalence declined 9.4% from 1990–92 

(before the program) to 1993–95 (after the 

program), but declined only 2.9% during 

this period in all other 41 states surveyed 

(excluding California). A subsequent analysis 

of per capita consumption data indicated 

an annual decline of 4% for Massachusetts 

compared to only 1% in the rest of the 

United States (excluding California) from 

1993 to 1999.144 Unadjusted adult prevalence 

rates from the Behavioral Risk Factor 

Surveillance System, together with the 

random, population-based Massachusetts 

Tobacco Surveys, showed an annual decline 

of 0.43 percentage points for Massachusetts 

compared to no change in the other states 

from 1992 to 1999. Prevalence trends 

through 1999 were examined again later by 

using the Behavioral Risk Factor Surveillance 

System data,145 with the addition of regression 
531

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

models that adjusted for demographics. 

On the basis of the model estimates, 

prevalence declined 22% (or 2.4% per year 

on average for nine years) from 1990 to 1999 

in Massachusetts but only 5% nationally 

(<0.5%per year) during this period. 

Surveys of students in secondary schools 

and colleges have shown a decline in youth 

tobacco use.146,147 Triennial school surveys 

of students in randomly selected classes of 

randomly selected schools showed a decline 

from 1996 to 1999 in current smoking (in last 

30 days) from 21.0% to 12.6% for students 

in grades 7 to 9, and from 35.6% to 29.9% 

for students in grades 9 to 12.146 Data were 

weighted to account for any changes in 

population demographics. The greater relative 

decline for younger students compared to 

older students (67% vs. 16%) supports the 

California results;139,141 that is, children who 

grow up in an environment that denormalizes 

tobacco use may be more likely to remain 

never smokers. Rigotti and colleagues147

examined smoking prevalence (last 30 days) 

among young adult college students, using 

the 1999 Massachusetts College Alcohol 

Survey administered to 11 public colleges 

and universities in Massachusetts. Current 

smoking was lower among public college 

students who had attended high school in 

Massachusetts compared with out-of-state 

students: 35.5% versus 42.6%, respectively. 

Adjusting for demographic factors including 

age, sex, race, parental education, and college 

residence found the in-state students were 

only 67% as likely to be smokers as the outof-state students.

Arizona

Arizona’s comprehensive program began 

in 1995, following a 1994 voter-approved 

initiative raising the excise tax on 

cigarettes by 40 cents per pack, with 23% 

of this new revenue devoted to tobacco 

control.148 The resulting program included 

all nine components of a comprehensive 

tobacco control program subsequently 

recommended by the Centers for Disease 

Control and Prevention.92 Cross-sectional 

surveys conducted in 1996 and 1999 

assessed changes in adult smoking 

prevalence with standardization to 1996 

state demographics for comparability. 

Although the 1996 survey was not a true 

preprogram survey, the changes between 

the two surveys were notable. Overall, 

adult smoking prevalence decreased from 

23.1% to 18.3%, and significant decreases 

were observed for important population 

subgroups, including Hispanics, low-income 

households, and low-education groups. 

Whether the decline in prevalence was due 

to national or regional influences rather 

than to the state tobacco control program 

could not be established without data from 

a comparison group of states.

Ross and colleagues149 report that youth 

smoking in Tucson, Arizona, declined 

between 1996 and 2001 coincident with 

the city’s Full Court Press (FCP) project, a 

comprehensive, community-based program 

for prevention of adolescent tobacco use. 

Factoring out the expected decline from 

increases in cigarette prices during this 

period, the percentage decline in 30-day 

smoking prevalence attributable to the 

FCP was 13.8% for 7th and 8th graders, 

10.9% for 9th and 10th graders, and 

8.8% for 11th and 12th graders. However, 

because the FCP supplemented the state’s 

tobacco control program and students were, 

therefore, exposed to multiple programs, 

the resultant decline would represent the 

combined program effects and does not 

factor in national or regional secular trends.

Oregon

Voters in Oregon also approved an initiative 

increasing the excise tax on cigarettes.150

This increase occurred in 1996, and 10% 

of the revenue generated was allocated to 

the development and implementation of a 

comprehensive tobacco control program 

that became operational in 1997. Oregon’s 

Tobacco Prevention and Education Program 

included community-based tobacco use 
532

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

prevention coalitions in every county, 

a statewide media-based public awareness 

and education campaign, comprehensive 

school-based programs, tribal tobacco 

use prevention programs, multicultural 

outreach and education, a quitters’ help 

line providing smoking cessation support, 

and projects evaluating new approaches to 

prevent and reduce tobacco use. Cigarette 

sales data from Oregon were compared with 

the United States as a whole, excluding 

California, Massachusetts, and Arizona. 

In the baseline period before program onset, 

per capita cigarette sales decreased 2.2% in 

Oregon compared to 0.6% in the rest of 

the United States. During the program 

(1996–98), per capita consumption declined 

by 11.3% in Oregon compared to 1.0% in 

the other states. Adult smoking prevalence, 

as estimated from the cross-sectional 

Behavioral Risk Factor Surveillance System, 

indicated a decline of 6.4%. How this decline 

in prevalence compared with other states 

was not described.

New York City

Although New York City is not a state, its 

population is larger than that of many 

U.S. states. Between 2002 and 2003, 

the city undertook a number of tobacco 

control activities, including a large 

increase ($1.42 per pack) in the excise 

tax on cigarettes, an indoor air smokefree policy that covered all workplaces 

including restaurants and bars, an emphasis 

on the treatment of nicotine dependence 

with distribution of nicotine patches in 

conjunction with brief telephone counseling 

for heavy smokers, and educational 

publications and advertisements in broadcast 

and print media that emphasized the health 

risks of secondhand smoke and the benefits 

of quitting.151 Cross-sectional population 

surveys show that adult smoking prevalence 

remained remarkably stable from 1993 

to 2002 (between 21.5% and 21.7%) but 

dropped 11% (to 19.2%) between 2002 

and 2003. Subgroups showing the greatest 

declines (>15%) were smokers aged 

18–24 years, those residing in the Bronx, 

those with some college, U.S.-born African 

Americans, and those who smoked more 

than 10 cigarettes per day. Many smokers, 

especially those with lower incomes, reported 

that they had tried to quit or had cut down 

the number of cigarettes they smoked per 

day. Furthermore, nearly half the population 

reported reduced exposure to secondhand 

smoke. Although the proportion of cigarettes 

reportedly purchased outside the city 

increased by nearly one-third, city tax 

revenue increased by a factor of 10. However, 

tax avoidance practices such as city residents 

purchasing outside the city, or nonresidents 

bringing cigarettes into the city instead of 

purchasing them while there, meant that 

the reported average price paid per pack 

increased just 20% instead of the 32% 

expected in the absence of such behavior. 

Although declines may have occurred in 

other metropolitan areas between 2002 and 

2003, the stable prevalence rate leading 

up to the city’s tobacco control program 

suggests that the program was responsible 

for at least some of the decline in smoking.

Because the decline in smoking prevalence 

in New York City appeared to level off by 

2005, an intensive mass media campaign 

was planned to augment a statewide media 

campaign planned for January through 

October of 2006.152 The city campaign 

aimed to increase smokers’ motivation to 

quit; the statewide campaign had the same 

theme but also focused on the effects of 

secondhand smoke on children. No new 

additional tobacco control efforts were 

undertaken either by the state or by the 

city during this period. Adult smoking 

prevalence declined from 18.9% in 2005 

to 17.5% in late 2006, and the decline was 

observed particularly among males and 

Hispanics. Unless statewide or nationwide 

secular trends show a decline of similar 

magnitude during this period (data not yet 

available), this study suggests that a wellfunded, intensive antitobacco mass media 

campaign can have an effect in the setting 
533

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

of an ongoing, multicomponent tobacco 

control program.

Media and Calls to Cessation 

Information Centers and Quitlines

Mass media messages have sometimes been 

“tagged” with phone numbers for interested 

viewers to call for information about 

cessation services or to get cessation help 

directly. It can be argued that prompting a 

smoker to make a call for information or 

help is a behavioral outcome for a media 

campaign. Quitlines can be an effective mode 

for the delivery of cessation services for a 

number of reasons, including accessibility 

and convenience to the smoker.153 The studies 

described below indicate that tagged media 

can increase call volume to informational 

services and quitlines.

For five years, from 1985 through 1989, 

the U.S. Department of Health and Human 

Services, through its Public Health Service, 

Centers for Disease Control and Prevention, 

Office on Smoking and Health, conducted 

a media campaign through PSAs to 

encourage smokers to inform themselves 

about smoking cessation. During three 

months (August 1983, January 1985, and 

January 1987), the PSAs were tagged with 

a telephone number staffed by the Cancer 

Information Service (CIS) of the National 

Cancer Institute. The numbers of calls to 

the information and referral service related 

to smoking cessation were much higher 

(approximately 20% of total calls) during the 

months when the PSAs were tagged (three 

spots) with the service center number154

than in months when no cessation-related 

messages, or cessation-related messages 

(nine spots) not tagged with the telephone 

number, were shown (approximately 8% of 

total calls). This campaign appeared to be 

effective in prompting smokers who possibly 

already were motivated to take an action 

that might help them quit. An estimated 

63% of the television-viewing audience 

saw a tagged announcement, but no 

indication of a noticeable change in smoking 

prevalence was found during this period.155

Another study involving the CIS used 

strategically placed media spots to encourage 

African Americans to call for help with 

quitting.156 Fourteen communities were 

selected for similar demographic profiles, 

including race, to form seven matched 

pairs. One community of each pair was 

then randomly assigned (to the extent 

possible, as determined by media markets) 

to the intervention condition. Within the 

intervention communities, newly designed 

radio and television spots were placed 

on stations with predominantly AfricanAmerican adult audiences. Copies of these 

spots were also disseminated through 

community-based organizations. Call 

records that obtained demographics, address, 

smoking status, and how the caller heard 

about the CIS were the basis for evaluating 

campaign effectiveness. During the campaign, 

African Americans made 82% of the calls 

in the intervention communities but only 

26% of the calls in the control communities. 

Before the campaign, African Americans in 

all communities averaged only 1.6 calls per 

week; during the first wave of the campaign, 

however, the average was 86 calls per week. 

Call volume for African Americans fell to near 

baseline levels just before the second wave of 

the campaign, but during the second wave, 

call volume for African Americans increased 

to 40.3 per week. Slightly more of the African 

Americans said their calls were prompted by 

radio spots than by television. 

One of the first smokers’ quitlines was part 

of the Sydney, Australia, “Quit. For Life” 

antismoking campaign.73 Call volume 

increased markedly during the first week of 

airing of commercials with the theme: “I’ve 

had enough.” The commercials depicted 

social reasons for not smoking and smokers 

unhappy with their smoking, as well as 

including the suggestion that smokers call 

the quitline. Enrollment in Quit Centre 

programs at Sydney Hospital also was higher 
534

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

during the part of the media campaign that 

emphasized the “I’ve had enough” theme. 

Other media-promoted quitlines157–163 also 

saw increases in call volume coinciding with 

the airing of tagged messages. Since 1994, 

the Health Education Authority for England 

has funded a mass media campaign aimed 

at getting smokers to quit.164 The campaign 

advertisements urge smokers to call a 

quitline. Although the quitline receives 

about one-half million calls per year, more 

than 70% of calls occurred during the three 

months of the advertising campaign. In 2004, 

quitline call volume increased fourfold 

compared with the average, coincident 

with the media blitz associated with the 

United Kingdom No Smoking Day.162

The California Smokers’ Helpline appears 

to reach a fairly representative sample of 

California smokers, as the demographic 

characteristics of helpline callers are similar 

to those of the general population.165 During 

the first period when media messages were 

tagged with the helpline phone number, 

call volume increased more than three times 

compared with that observed for a period of 

similar length before the media campaign.157

Furthermore, a greater proportion of callers 

during the first and subsequent periods of 

intense, tagged media messages indicated 

the spots as the reason they had called. 

In periods when media use was minimal, 

a higher proportion of callers cited other 

sources of referral to the helpline. 

As in previous campaigns, some media 

messages for Australia’s NTC were tagged 

with a telephone number for the Australian 

National Quitline Service.159,166 Quitline call 

volume was higher when media messages 

were present. Overall, the NTC quitline 

call volume was significantly related to 

television target rating points for the tagged 

advertisements. However, calls from people 

making counseling requests occurred more 

when rating points were lower; counseling 

was not suggested proactively during times 

of high call volume. Some of the callers 

during lower call-volume periods may have 

been specifically referred.159 Carroll and 

Rock166 found that certain of the campaign 

ads, especially those that showed someone 

calling the quitline, and placement in low 

involvement programs tended to yield 

greater quitline activity. 

In contrast to the egalitarian reach of the 

California quitline, a study in Victoria, 

Australia, found lower response in low 

socioeconomic areas;163 however, the 

increase in quitline call volume161 coincident 

with increased media messages was the 

same regardless of socioeconomic area.163

Furthermore, the Maori population, a 

minority group in New Zealand, called a 

national quitline at higher rates during an 

intense media campaign.160

Summary of Population-Based 

Studies

The earliest evidence that mass media 

could affect smoking behavior was discerned 

from events surrounding the natural 

experiment created by the Fairness Doctrine. 

This evidence provided the impetus to 

investigate further the effects of well-defined 

media interventions aimed at national and 

statewide populations. Often, the evaluation 

of these media campaigns has taken place 

within the framework of a multicomponent 

tobacco control program. In many instances 

it is not possible to separate the effects 

of the media component from the other 

components of the tobacco control program.

When studies have related various measures 

of exposure to media from these campaigns 

to behavioral outcomes, the evidence has 

been very consistent. The findings described 

above suggest that antismoking media 

campaigns can influence attitudes toward 

tobacco within a short period, followed by 

longer-term effects on smoking behavior. 

Moreover, these studies highlight the 

validity of modern health behavior change 
535

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

theories that predict that health-marketing 

campaigns bring about behavior changes by 

first influencing behavior-related attitudes, 

beliefs, and intentions. This evidence also 

highlights the importance of identifying 

in the formative stages of campaign 

development the attitudinal constructs 

that health marketing advertisements are 

likely to influence, and then using those 

constructs to inform and enhance the 

evaluation of health marketing campaigns. 

As in the controlled experimental studies, 

methodological issues (similar and unique) 

related to population studies deserve 

attention. Particular care to separate 

program effects from secular trends is 

essential. Repeated cross-sectional surveys 

to establish preexisting secular trends and 

track progress during the program need 

to take into account changing population 

demographics. Longitudinal surveys need to 

investigate the possible effects of differential 

attrition. Selection of a comparison group 

for evaluating a state-level program is 

complicated by spillover of media and other 

program elements from other states and 

programs, however modest, within the 

comparison states. 

Summary

Controlled Field Experiments

A large number of field experiments 

have assessed the efficacy of mass media 

campaigns in the United States and in 

other countries. Taken as a whole, these 

experimental studies provide evidence 

that antismoking media campaigns can 

affect smoking-related attitudes, smoking 

initiation, and smoking cessation. However, 

these findings are not uniformly positive.

Early, longitudinal, community-based 

studies such as the North Karelia Project 

and the Stanford Three Community 

Study used multicomponent approaches, 

including mass media, to reduce risk factors, 

including smoking, for cardiovascular 

disease. These studies provide some initial 

evidence of efficacy that such approaches 

can alter health behaviors.

A second wave of large-scale studies 

(e.g., the Stanford Five-City Project and 

the Minnesota Heart Health Program), 

using approaches similar to those in the 

North Karelia Project and the Stanford 

Three Community Study, also documented 

declines in cardiovascular disease risk 

factors. However, interpretation of these 

later studies was complicated by favorable 

secular trends that occurred simultaneously 

with the study, possibly obscuring the 

results in the intervention communities. 

Overall, these studies provide only modest 

evidence of intervention effects over time.

Although most of the large-scale 

cardiovascular disease prevention studies 

examined outcomes related to adults, 

several also assessed their effect on youth 

(North Karelia Project, Stanford FiveCity Project, and Minnesota Heart Health 

Program). A number of controlled field 

experiments also were aimed specifically 

at preventing smoking in youth or at 

encouraging smoking cessation among 

adults. Several cited studies focused solely 

on evaluating mass media campaigns, while 

others, like the seminal community-based 

cardiovascular disease prevention studies 

mentioned above, observed the role of media 

as part of a comprehensive approach. Again, 

results from the prevention and cessation 

studies have been mixed. Nevertheless, 

evidence exists for the potential effectiveness 

of intensive, well-planned, and coordinated 

mass media campaigns, together with 

school- and community-based programs, 

to reduce youth smoking and support adult 

smoking cessation.

Intrinsic in controlled field experiments 

are a number of considerations that 

may cloud intervention effects or lead to 
536

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

inaccurate conclusions, possibly explaining 

some of the variation in findings from the 

studies reviewed. Common issues, such as 

insufficient control for baseline community 

characteristics, smoking-related risk factors, 

and prior and concurrent secular trends, 

along with small sample sizes, can result in 

reduced statistical power. In most studies, 

only a few communities are included. 

Appropriate analyses of field experiments 

should account for the fact that individuals 

“nested” within schools, organizations, 

and communities tend to share similar 

characteristics. Failure to account for the 

homogeneity among individuals within 

communities, if present, can result in a 

type I error (p-values that are too small). 

Analyses that account for these similarities 

among individuals within communities are 

more precise but at the cost of significantly 

reducing statistical power (p-values that 

are too large). Differential attrition in 

longitudinal samples also can either mask 

or contribute to observed effects. Differences 

in how researchers treat these issues likely 

account for some of the inconsistency in 

study findings.

Population Studies

Population research regarding the effect 

of mass media on smoking behavior 

began with the evaluation of the Fairness 

Doctrine. The results of the Fairness 

Doctrine natural experiment, evaluated by 

cross-sectional studies, provided impetus 

for much that followed. Since then, a 

number of longitudinal and cross-sectional 

studies evaluated the effectiveness of 

novel, large-scale national and state-level 

campaigns aimed at youth and/or the 

general population in the United States and 

Australia and smaller-scale campaigns in 

other countries. In most of these studies, 

mass media was a major component of a 

multicomponent tobacco control program. 

A number of population-based, crosssectional studies and a few longitudinal 

studies have validated the findings from 

the controlled field experiments. All of 

these population studies showed evidence 

of effectiveness. Three longitudinal studies 

examined two state campaigns to investigate 

how mass media campaigns curb smoking 

initiation among youth. Although both 

campaigns were conducted in states that 

implemented other tobacco use prevention 

and control interventions, all three studies 

found an association of recall of campaign 

messages with decreased initiation. None of 

these studies addressed how attrition from 

the longitudinal sample may have influenced 

the findings, but all three studies provide 

evidence of effectiveness. One longitudinal 

study of smoking cessation indicated 

that exposure to mass media messages is 

associated with increased thoughts about 

quitting and negative thoughts about 

smoking. However, the study did not control 

for potentially confounding influences.

Cross-sectional studies of Legacy’s national 

“truth” campaign, which featured hardhitting messages that highlight tobacco 

industry practices and stark facts about 

the deadly effects of tobacco (similar to 

the successful Florida “truth” campaign), 

found that the campaign was associated 

with stronger antitobacco attitudes and 

reduced smoking. Philip Morris’s “Think. 

Don’t Smoke” campaign, which takes a 

“just say no” approach and lacks hardhitting messages and facts about tobacco, 

has not been shown to be effective, however. 

In addition, the company’s “Talk. They’ll 

Listen” campaign directed to parents may 

encourage prosmoking beliefs and attitudes 

among older adolescents. On the other 

hand, evaluations of state tobacco control 

programs with significant media components 

have shown encouraging results.

Conclusions

1. Several evaluations of the antismoking 

public service announcements required 
537

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

under the Fairness Doctrine between 

1967 and 1970, the first large-scale 

U.S. national mass media campaign, 

indicate that there were discernible 

reductions in tobacco consumption, 

smoking prevalence, and smoking 

initiation. This natural experiment 

spurred research into the use of media 

to influence health behaviors.

2. Evidence from controlled field 

experiments suggests that antitobacco 

mass media campaigns conducted in 

conjunction with school- or communitybased programming can be effective in 

curbing smoking initiation in youth and 

promoting smoking cessation in adults. 

This evidence has provided the impetus 

for antitobacco mass media campaigns 

to become important components of 

tobacco control programs. 

3. The few population-based studies of 

antitobacco mass media campaigns, in 

which the media campaign was the only 

antitobacco program, demonstrate that 

the media campaigns were effective in 

reducing smoking in the youth and adult 

target populations.

4. Population-based studies of antitobacco 

mass media campaigns that were only one 

component of multicomponent tobacco 

control programs provide considerable 

evidence for reduced use of tobacco 

by youth and adults. The antitobacco 

mass media campaign and the other 

program components together may have 

reduced smoking more than did any 

single component alone. The relative 

contributions of various components 

to program effectiveness are difficult to 

determine, but some of the controlled 

field experiments showed a dose-response 

relationship between reduced smoking 

and an increased number of program 

components.

5. Evidence from controlled field 

experiments and population studies 

conducted by many investigators in 

many countries shows that antitobacco 

mass media campaigns can reduce 

tobacco use.
538

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

References

1. Flay, B. R. 1987. Mass media and smoking 

cessation: A critical review. American 

Journal of Public Health 77 (2): 153–60. 

2. Pechmann, C. 1997. Does antismoking 

advertising combat underage smoking? 

A review of past practices and research. 

In Social marketing: Theoretical and 

practical perspectives, ed. M. E. Goldberg, 

M. Fishbein, and S. E. Middlestadt, 189–216. 

Mahwah, NJ: Lawrence Erlbaum.

3. Pechmann, C. 2001. Changing adolescent 

smoking prevalence: Impact of advertising 

interventions. In Changing adolescent 

smoking prevalence (Smoking and tobacco 

control monograph no. 14, NIH publication 

no. 02-5086), 171–81. Bethesda, MD: National 

Cancer Institute. http://cancercontrol.cancer

.gov/tcrb/monographs/14/index.html.

4. Pechmann, C., and E. T. Reibling. 2000. Antismoking advertising campaigns targeting 

youth: Case studies from USA and Canada. 

Tobacco Control 9 Suppl. 2: II18–II31. 

5. Friend, K., and D. T. Levy. 2002. Reductions 

in smoking prevalence and cigarette 

consumption associated with mass-media 

campaigns. Health Education Research

17 (1): 85–98. 

6. Farrelly, M. C., J. Niederdeppe, and 

J. Yarsevich. 2003. Youth tobacco prevention 

mass media campaigns: Past, present, 

and future directions. Tobacco Control

12 Suppl. 1: i35–i47. 

7. Siegel, M. 2002. The effectiveness of statelevel tobacco control interventions: A review 

of program implementation and behavioral 

outcomes. Annual Review of Public Health 

23:45–71. 

8. Wakefield, M., B. Flay, M. Nichter, and 

G. Giovino. 2003. Effects of anti-smoking 

advertising on youth smoking: A review. 

Journal of Health Communication 8 (3): 

229–47. 

9. Derzon, J. H., and M. W. Lipsey. 2002. 

A meta-analysis of the effectiveness of masscommunication for changing substanceuse knowledge, attitudes, and behavior. In 

Mass media and drug prevention: Classic 

and contemporary theories and research, 

ed. W. D. Crano and M. Burgoon, 231–58. 

Mahwah, NJ: Lawrence Erlbaum.

10. Hornik, R. C., ed. 2002. Public health 

communication: Evidence for behavior 

change. Mahwah, NJ: Lawrence Erlbaum.

11. Gordon, R., L. McDermott, M. Stead, 

and K. Angus. 2006. The effectiveness of 

social marketing interventions for health 

improvement: What’s the evidence? Public 

Health 120 (12): 1133–39. 

12. Snyder, L. B., M. A. Hamilton, E. W. Mitchell, 

J. Kiwanuka-Tondo, F. Fleming-Milici, and 

D. Proctor. 2004. A meta-analysis of the 

effect of mediated health communication 

campaigns on behavior change in the United 

States. Journal of Health Communication 

9 Suppl. 1: 71–96. 

13. Hornik, R. C. 2002. Introduction. Public 

health communication: Making sense of 

contradictory evidence. In Public health 

communication: Evidence for behavior 

change, ed. R. C. Hornik, 1–20. Mahwah, 

NJ: Lawrence Erlbaum.

14. Aguirre-Molina, M., and D. M. Gorman. 

1996. Community-based approaches for the 

prevention of alcohol, tobacco, and other 

drug use. Annual Review of Public Health 

17: 337–58. 

15. Pechmann, C., and E. T. Reibling. 2000. 

Planning an effective anti-smoking mass 

media campaign targeting adolescents. 

Journal of Public Health Management and 

Practice 6 (3): 80–94. 

16. McKenna, J., K. Gutierrez, and K. McCall. 

2000. Strategies for an effective 

youth counter-marketing program: 

Recommendations from commercial 

marketing experts. Journal of Public Health 

Management and Practice 6 (3): 7–13. 

17. Hopkins, D. P., C. G. Husten, J. E. Fielding, 

J. N. Rosenquist, and L. L. Westphal. 2001. 

Evidence reviews and recommendations 

on interventions to reduce tobacco use and 

exposure to environmental tobacco smoke: 

A summary of selected guidelines. American 

Journal of Preventive Medicine 20 Suppl. 2: 

67–87. 

18. Randolph, W., and K. Viswanath. 2004. 

Lessons learned from public health mass 

media campaigns: Marketing health in a 

crowded media world. Annual Review of 

Public Health 25:419–37. 

19. Schar, E., K. Gutierrez, R. Murphy-Hoefer, 

and D. E. Nelson. 2006. Tobacco use 

prevention media campaigns: Lessons 

learned from youth in nine countries. 

Atlanta: U.S. Department of Health and 

Human Services, Centers for Disease 

Control and Prevention. http://www.cdc

.gov/tobacco/youth/00_pdfs/youthmedia

.pdf.
539

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

20. Schwartz, B. 2004. Introduction and 

overview: Lessons learned and the sharing 

of applicable insights. Social Marketing 

Quarterly 10 (2): 4–5. 

21. Puska, P., J. Salonen, A. Nissinen, and 

J. Tuomilehto. 1983. The North Karelia 

Project. Preventive Medicine 12 (1): 191–95. 

22. Vartiainen, E., U. Pallonen, A. McAlister, 

K. Koskela, and P. Puska. 1986. Four-year 

follow-up results of the smoking prevention 

program in the North Karelia Youth Project. 

Preventive Medicine 15 (6): 692–98. 

23. Vartiainen, E., U. Pallonen, A. L. McAlister, 

and P. Puska. 1990. Eight-year follow-up 

results of an adolescent smoking prevention 

program: The North Karelia Youth Project. 

American Journal of Public Health 80 (1): 

78–79. 

24. Vartiainen, E., H. J. Korhonen, P. Pietinen, 

J. Tuomilehto, L. Kartovaara, A. Nissinen, 

and P. Puska. 1998. 15-year follow-up of 

smoking prevention effects in the North 

Karelia Youth Project. American Journal of 

Public Health 88 (1): 81–85. 

25. Maccoby, N., J. W. Farquhar, P. D. Wood, 

and J. Alexander. 1977. Reducing the risk 

of cardiovascular disease: Effects of a 

community-based campaign on knowledge 

and behavior. Journal of Community Health

3 (2): 100–114. 

26. Fortmann, S. P., C. B. Taylor, J. A. Flora, 

and D. E. Jatulis. 1993. Changes in adult 

cigarette smoking prevalence after 5 years of 

community health education: The Stanford 

Five-City Project. American Journal of 

Epidemiology 137 (1): 82–96. 

27. Luepker, R. V., D. M. Murray, D. R. Jacobs Jr., 

M. B. Mittelmark, N. Bracht, R. Carlaw, 

R. Crow, et al. 1994. Community education 

for cardiovascular disease prevention: 

Risk factor changes in the Minnesota Heart 

Health Program. American Journal of 

Public Health 84 (9): 1383–93. 

28. Bauman, K. E., J. LaPrelle, J. D. Brown, 

G. G. Koch, and C. A. Padgett. 1991. The 

influence of three mass media campaigns 

on variables related to adolescent cigarette 

smoking: Results of a field experiment. 

American Journal of Public Health 81 (5): 

597–604. 

29. Flay, B. R., T. Q. Miller, D. Hedeker, 

O. Siddiqui, C. F. Britton, B. R. Brannon, 

C. A. Johnson, W. B. Hansen, S. Sussman, 

and C. Dent. 1995. The television, school, 

and family smoking prevention and 

cessation project: 8. Student outcomes and 

mediating variables. Preventive Medicine

24 (1): 29–40. 

30. Biglan, A., D. V. Ary, K. Smolkowski, 

T. Duncan, and C. Black. 2000. A randomized 

controlled trial of a community intervention 

to prevent adolescent tobacco use. Tobacco 

Control 9 (1): 24–32. 

31. Atienza, A. A., and A. C. King. 2002. 

Community-based health intervention 

trials: An overview of methodological issues. 

Epidemiology Review 24 (1): 72–79. 

32. Murray, D. M. 1998. Design and analysis of 

group-randomized trials. New York: Oxford 

Univ. Press.

33. Bryk, A. S., and S. W. Raudenbush. 1992. 

Hierarchical linear models: Applications 

and data analysis methods. Thousand Oaks, 

CA: Sage.

34. Lando, H. A., T. F. Pechacek, P. L. Pirie, 

D. M. Murray, M. B. Mittelmark, 

E. Lichtenstein, F. Nothwehr, and C. Gray. 

1995. Changes in adult cigarette smoking 

in the Minnesota Heart Health Program. 

American Journal of Public Health 85 (2): 

201–8. 

35. Perry, C. L., S. H. Kelder, D. M. Murray, and 

K. I. Klepp. 1992. Communitywide smoking 

prevention: Long-term outcomes of the 

Minnesota Heart Health Program and the 

Class of 1989 Study. American Journal of 

Public Health 82 (9): 1210–16. 

36. Winkleby, M. A., S. P. Fortmanm, and 

B. Rockhill. 1993. Cigarette smoking 

trends in adolescents and young adults: 

The Stanford Five-City Project. Preventive 

Medicine 22 (3): 325–34. 

37. Worden, J. K., B. S. Flynn, B. M. Geller, 

M. Chen, L. G. Shelton, R. H. Secker-Walker, 

D. S. Solomon, L. J. Solomon, S. Couchey, 

and M. C. Costanza. 1988. Development of 

a smoking prevention mass media program 

using diagnostic and formative research. 

Preventive Medicine 17 (5): 531–58. 

38. Flynn, B. S., J. K. Worden, R. H. SeckerWalker, G. J. Badger, B. M. Geller, and 

M. C. Costanza. 1992. Prevention of cigarette 

smoking through mass media intervention 

and school programs. American Journal of 

Public Health 82 (6): 827–34. 

39. Flynn, B. S., J. K. Worden, R. H. SeckerWalker, P. L. Pirie, G. J. Badger, 

J. H. Carpenter, and B. M. Geller. 1994. Mass 

media and school interventions for cigarette 

smoking prevention: Effects 2 years after 
540

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

completion. American Journal of Public 

Health 84 (7): 1148–50. 

40. Flynn, B. S., J. K. Worden, R. H. SeckerWalker, G. J. Badger, and B. M. Geller. 

1995. Cigarette smoking prevention effects 

of mass media and school interventions 

targeted to gender and age groups. Journal 

of Health Education 26 (2): 45–51. 

41. Worden, J. K., B. S. Flynn, L. J. Solomon, 

R. H. Secker-Walker, G. J. Badger, and 

J. H. Carpenter. 1996. Using mass media to 

prevent cigarette smoking among adolescent 

girls. Health Education Quarterly 23 (4): 

453–68. 

42. Flynn, B. S., J. K. Worden, R. H. SeckerWalker, P. L. Pirie, G. J. Badger, and 

J. H. Carpenter. 1997. Long-term responses 

of higher and lower risk youths to smoking 

prevention interventions. Preventive 

Medicine 26 (3): 389–94. 

43. Fortmann, S. P., J. A. Flora, M. A. Winkleby, 

C. Schooler, C. B. Taylor, and J. W. Farquhar. 

1995. Community intervention trials: 

Reflections on the Stanford Five-City 

Project experience. American Journal of 

Epidemiology 142 (6): 576–86. 

44. Bauman, K. E., J. D. Brown, E. S. Bryan, 

L. A. Fisher, C. A. Padgett, and J. M. Sweeney. 

1988. Three mass media campaigns to 

prevent adolescent cigarette smoking. 

Preventive Medicine 17 (5): 510–30. 

45. Flay, B. R., B. R. Brannon, C. A. Johnson, 

W. B. Hansen, A. L. Ulene, D. A. WhitneySaltiel, L. R. Gleason, et al. 1988. The 

television, school, and family smoking 

prevention and cessation project. 1. 

Theoretical basis and program development. 

Preventive Medicine 17 (5): 585–607. 

46. Sussman, S., C. W. Dent, B. R. Brannon, 

K. Glowacz, L. R. Gleason, S. Ullery, 

W. B. Hansen, C. A. Johnson, and B. R. Flay. 

1989. The television, school, and family 

smoking prevention/cessation project: 4. 

Controlling for program success expectancies 

across experimental and control conditions. 

Addictive Behaviors 14 (6): 601–10. 

47. Brannon, B. R., C. W. Dent, B. R. Flay, 

G. Smith, S. Sussman, M. A. Pentz, 

C. A. Johnson, and W. B. Hansen. 1989. 

The television, school, and family project: 5. 

The impact of curriculum delivery format 

on program acceptance. Preventive Medicine

18 (4): 492–502. 

48. Hafstad, A., L. E. Aaro, and F. Langmark. 

1996. Evaluation of an anti-smoking mass 

media campaign targeting adolescents: 

The role of affective responses and 

interpersonal communication. Health 

Education Research 11 (1): 29–38. 

49. Hafstad, A., and L. E. Aaro. 1997. Activating 

interpersonal influence through provocative 

appeals: Evaluation of a mass mediabased antismoking campaign targeting 

adolescents. Health Communication 9 (3): 

253–72. 

50. Hafstad, A., B. Stray-Pedersen, and 

F. Langmark. 1997. Use of provocative 

emotional appeals in a mass media 

campaign designed to prevent smoking 

among adolescents. European Journal of 

Public Health 7 (2): 122–27. 

51. Hafstad, A., L. E. Aaro, A. Engeland, 

A. Andersen, F. Langmark, and B. StrayPedersen. 1997. Provocative appeals in antismoking mass media campaigns targeting 

adolescents—The accumulated effect of 

multiple exposures. Health Education 

Research 12 (2): 227–36. 

52. Meshack, A. F., S. Hu, U. E. Pallonen, 

A. L. McAlister, N. Gottlieb, and P. Huang. 

2004. Texas Tobacco Prevention Pilot 

Initiative: Processes and effects. Health 

Education Research 19 (6): 657–68. 

53. Slater, M. D., K. J. Kelly, R. W. Edwards, 

P. J. Thurman, B. A. Plested, T. J. Keefe, 

F. R. Lawrence, and K. L. Henry. 2006. 

Combining in-school and community-based 

media efforts: Reducing marijuana and 

alcohol uptake among younger adolescents. 

Health Education Research 21 (1): 157–67. 

54. LaPrelle, J., K. E. Bauman, and G. G. Koch. 

1992. High intercommunity variation 

in adolescent cigarette smoking in a 10-

community field experiment. Evaluation 

Review 16 (2): 115–30. 

55. Rossouw, J. E., P. L. Jooste, D. O. Chalton, 

E. R. Jordaan, M. L. Langenhoven, 

P. C. Jordaan, M. Steyn, A. S. Swanepoel, 

and L. J. Rossouw. 1993. Community-based 

intervention: The Coronary Risk Factor 

Study (CORIS). International Journal of 

Epidemiology 22 (3): 428–38. 

56. Egger, G., W. Fitzgerald, G. Frape, 

A. Monaem, P. Rubinstein, C. Tyler, and 

B. McKay. 1983. Results of large scale media 

antismoking campaign in Australia: North 

Coast “Quit for Life” programme. British 

Medical Journal (Clinical Research and 

Education) 287 (6399): 1125–28. 

57. Steenkamp, H. J., P. L. Jooste, 

P. C. Jordaan, A. S. Swanepoel, and 

J. E. Rossouw. 1991. Changes in smoking 
541

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

during a community-based cardiovascular 

disease intervention programme. The 

Coronary Risk Factor Study. South African 

Medical Journal 79 (5): 250–53. 

58. Steyn, K., M. Steyn, A. S. Swanepoel, 

P. C. Jordaan, P. L. Jooste, J. M. Fourie, and 

J. E. Rossouw. 1997. Twelve-year results of 

the Coronary Risk Factor Study (CORIS). 

International Journal of Epidemiology

26 (5): 964–71. 

59. Vartiainen, E., H. J. Korhonen, P. Pietinen, 

J. Tuomilehto, L. Kartovaara, A. Nissinen, 

and P. Puska. 1991. Fifteen-year trends in 

coronary risk factors in Finland, with special 

reference to North Karelia. International 

Journal of Epidemiology 20 (3): 651–62. 

60. Vartiainen, E., P. Puska, P. Jousilahti, 

H. J. Korhonen, J. Tuomilehto, and 

A. Nissinen. 1994. Twenty-year trends in 

coronary risk factors in north Karelia and 

in other areas of Finland. International 

Journal of Epidemiology 23 (3): 495–504. 

61. Vartiainen, E., H. J. Korhonen, K. Koskela, 

and P. Puska. 1998. Twenty years smoking 

trends in a community-based cardiovascular 

diseases prevention programme: Results 

from the North Karelia Project. European 

Journal of Public Health 8 (2): 154–59. 

62. Jousilahti, P., J. Tuomilehto, H. J. Korhonen, 

E. Vartiainen, P. Puska, and A. Nissinen. 

1994. Trends in cardiovascular disease risk 

factor clustering in eastern Finland: Results 

of 15-year follow-up of the North Karelia 

Project. Preventive Medicine 23 (1): 6–14. 

63. Puska, P., A. Nissinen, J. Tuomilehto, 

J. T. Salonen, K. Koskela, A. McAlister, 

T. E. Kottke, N. Maccoby, and J. W. Farquhar. 

1985. The community-based strategy to 

prevent coronary heart disease: Conclusions 

from the ten years of the North Karelia 

Project. Annual Review of Public Health

6:147–93. 

64. Puska, P., J. Tuomilehto, A. Nissinen, and 

J. Salonen. 1985. Ten years of the North 

Karelia Project. Acta Anaesthesiologica 

Scandinavica Supplement 701:66–71. 

65. Puska, P., J. Tuomilehto, A. Nissinen, 

J. T. Salonen, E. Vartiainen, P. Pietinen, 

K. Koskela, and H. J. Korhonen. 1989. 

The North Karelia Project: 15 years of 

community-based prevention of coronary 

heart disease. Annals of Medicine 21 (3): 

169–73. 

66. Fortmann, S. P., and A. N. Varady. 2000. 

Effects of a community-wide health 

education program on cardiovascular 

disease morbidity and mortality: The 

Stanford Five-City Project. American 

Journal of Epidemiology 152 (4): 316–23. 

67. Winkleby, M. A., C. B. Taylor, D. Jatulis, and 

S. P. Fortmann. 1996. The long-term effects 

of a cardiovascular disease prevention trial: 

The Stanford Five-City Project. American 

Journal of Public Health 86 (12): 1773–79. 

68. Farquhar, J. W., S. P. Fortmann, J. A. Flora, 

C. B. Taylor, W. L. Haskell, P. T. Williams, 

N. Maccoby, and P. D. Wood. 1990. 

Effects of communitywide education 

on cardiovascular disease risk factors. 

The Stanford Five-City Project. JAMA: 

The Journal of the American Medical 

Association 264 (3): 359–65. 

69. Tudor-Smith, C., D. Nutbeam, L. Moore, and 

J. Catford. 1998. Effects of the Heartbeat 

Wales programme over five years on 

behavioural risks for cardiovascular disease: 

Quasi-experimental comparison of results 

from Wales and a matched reference area. 

British Medical Journal 316 (7134): 818–22. 

70. Shelley, E., L. Daly, C. Collins, M. Christie, 

R. Conroy, M. Gibney, N. Hickey, et al. 1995. 

Cardiovascular risk factor changes in the 

Kilkenny Health Project. A community 

health promotion programme. European 

Heart Journal 16 (6): 752–60. 

71. Hoffmeister, H., G. B. Mensink, 

H. Stolzenberg, J. Hoeltz, H. Kreuter, 

U. Laaser, E. Nussel, K. D. Hullemann, and 

J. V. Troschke. 1996. Reduction of coronary 

heart disease risk factors in the German 

cardiovascular prevention study. Preventive 

Medicine 25 (2): 135–45. 

72. O’Loughlin, J. L., G. Paradis, K. GrayDonald, and L. Renaud. 1999. The impact of 

a community-based heart disease prevention 

program in a low-income, inner-city 

neighborhood. American Journal of Public 

Health 89 (12): 1819–26. 

73. Pierce, J. P., T. Dwyer, G. Frape, S. Chapman, 

A. Chamberlain, and N. Burke. 1986. 

Evaluation of the Sydney “Quit. For 

Life” anti-smoking campaign. Part 1. 

Achievement of intermediate goals. Medical 

Journal of Australia 144 (7): 341–44. 

74. Dwyer, T., J. P. Pierce, C. D. Hannam, and 

N. Burke. 1986. Evaluation of the Sydney 

“Quit. For Life” anti-smoking campaign. 

Part 2. Changes in smoking prevalence. 

Medical Journal of Australia 144 (7): 344–7. 

75. Pierce, J. P., P. Macaskill, and D. Hill. 1990. 

Long-term effectiveness of mass media 

led antismoking campaigns in Australia. 
542

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

American Journal of Public Health 80 (5): 

565–69. 

76. American Journal of Public Health. 1995. 

Community Intervention Trial for Smoking 

Cessation (COMMIT): 1. Cohort results 

from a four-year community intervention. 

American Journal of Public Health 85 (2): 

183–92. 

77. American Journal of Public Health. 1995. 

Community Intervention Trial for Smoking 

Cessation (COMMIT): 2. Changes in adult 

cigarette smoking prevalence. American 

Journal of Public Health 85 (2): 193–200. 

78. National Cancer Institute. 2005. ASSIST: 

Shaping the future of tobacco prevention 

and control (Tobacco control monograph 

no. 16, NIH publication no. 05-5645). 

Bethesda, MD: National Cancer Institute. 

http://cancercontrol.cancer.gov/tcrb/

monographs/16/index.html.

79. National Cancer Institute. 2006. Evaluating 

ASSIST: A blueprint for understanding 

state-level tobacco control (Tobacco 

control monograph no. 17, NIH publication 

no. 06-6058). Bethesda, MD: National 

Cancer Institute. http://cancercontrol

.cancer.gov/tcrb/monographs/17/index.html.

80. Stillman, F. A., A. M. Hartman, 

B. I. Graubard, E. A. Gilpin, D. M. Murray, 

and J. T. Gibson. 2003. Evaluation of the 

American Stop Smoking Intervention Study 

(ASSIST): A report of outcomes. Journal 

of the National Cancer Institute 95 (22): 

1681–91. 

81. McAlister, A., A. Ramirez, C. Amezcua, 

L. Pulley, M. Stern, and S. Mercado. 1992. 

Smoking cessation in Texas–Mexico 

border communities: A quasi-experimental 

panel study. American Journal of Health 

Promotion 6 (4): 274–79. 

82. Mudde, A. N., H. de Vries, and M. G. Dolders. 

1995. Evaluation of a Dutch communitybased smoking cessation intervention. 

Preventive Medicine 24 (1): 61–70. 

83. Secker-Walker, R. H., B. S. Flynn, 

L. J. Solomon, J. M. Skelly, A. L. Dorwaldt, 

and T. Ashikaga. 2000. Helping women 

quit smoking: Results of a community 

intervention program. American Journal of 

Public Health 90 (6): 940–46. 

84. McPhee, S. J., C. N. H. Jenkins, C. Wong, 

D. Fordham, K. Q. Lai, J. A. Bird, and 

J. M. Moskowitz. 1995. Smoking cessation 

intervention among Vietnamese Americans: 

A controlled trial. Tobacco Control

4 Suppl. 1: S16–S24. 

85. Jenkins, C. N., S. J. McPhee, A. Le, 

G. Q. Pham, N. T. Ha, and S. Stewart. 1997. 

The effectiveness of a media-led intervention 

to reduce smoking among VietnameseAmerican men. American Journal of Public 

Health 87 (6): 1031–34. 

86. McVey, D., and J. Stapleton. 2000. Can 

anti-smoking television advertising affect 

smoking behaviour? Controlled trial of the 

Health Education Authority for England’s 

anti-smoking TV campaign. Tobacco Control

9 (3): 273–82. 

87. McAlister, A., T. C. Morrison, S. Hu, 

A. F. Meshack, A. Ramirez, K. Gallion, 

V. Rabius, and P. Huang. 2004. Media and 

community campaign effects on adult 

tobacco use in Texas. Journal of Health 

Communication 9 (2): 95–109. 

88. Puska, P., K. Koskela, A. McAlister, 

U. Pallonen, E. Vartiainen, and K. Homan. 

1979. A comprehensive television smoking 

cessation program in Finland. International 

Journal of Health Education 22 Suppl. 4: 

1–28. 

89. Williams, E. L., M. A. Winkleby, and 

S. P. Fortmann. 1993. Changes in coronary 

heart disease risk factors in the 1980s: 

Evidence of a male-female crossover effect 

with age. American Journal of Epidemiology

137 (10): 1056–67. 

90. Wallack, L., and R. Sciandra. 1991–1992. 

Media advocacy and public education in the 

Community Intervention Trial to reduce 

heavy smoking (COMMIT). International 

Quarterly of Community Health Education 

11 (3): 205–22. 

91. Pentz, M. A., D. P. MacKinnon, J. H. Dwyer, 

E. Y. Wang, W. B. Hansen, B. R. Flay, and 

C. A. Johnson. 1989. Longitudinal effects of 

the midwestern prevention project on regular 

and experimental smoking in adolescents. 

Preventive Medicine 18 (2): 304–21. 

92. Centers for Disease Control and Prevention. 

2007. Best practices for comprehensive 

tobacco control programs, October 2007.

Atlanta: U.S. Department of Health and 

Human Services, Centers for Disease 

Control and Prevention, National Center 

for Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health. 

http://www.cdc.gov/tobacco/tobacco_control

_programs/stateandcommunity/best

_practices/index.htm.

93. Farrelly, M. C., K. C. Davis, M. L. Haviland, 

P. Messeri, and C. G. Healton. 2005. 

Evidence of a dose-response relationship 
543

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

between “truth” antismoking ads and youth 

smoking prevalence. American Journal of 

Public Health 95 (3): 425–31. 

94. Zollinger, T. W., R. M. Saywell Jr., 

A. D. Overgaard, M. J. Przybylski, and 

M. Dutta-Bergman. 2006. Antitobacco 

media awareness of rural youth compared 

to suburban and urban youth in Indiana. 

Journal of Rural Health 22 (2): 119–23. 

95. Siegel, M., and L. Biener. 2000. The impact 

of an antismoking media campaign on 

progression to established smoking: Results 

of a longitudinal youth study. American 

Journal of Public Health 90 (3): 380–86. 

96. Sly, D. F., G. R. Heald, and S. Ray. 2001. 

The Florida “truth” anti-tobacco media 

evaluation: Design, first year results, and 

implications for planning future state 

media evaluations. Tobacco Control 10 (1): 

9–15. 

97. Sly, D. F., E. Trapido, and S. Ray. 2002. 

Evidence of the dose effects of an 

antitobacco counteradvertising campaign. 

Preventive Medicine 35 (5): 511–18. 

98. Ajzen, I. 1971. Attitudinal vs. normative 

messages: An investigation of the differential 

effects of persuasive communications on 

behavior. Sociometry 34 (2): 263–80. 

99. Gupta, P. C., F. S. Mehta, J. J. Pindborg, 

M. B. Aghi, R. B. Bhonsle, D. K. Daftary, 

P. R. Murti, H. T. Shah, and P. N. Sinor. 1986. 

Intervention study for primary prevention 

of oral cancer among 36,000 Indian tobacco 

users. Lancet 1 (8492): 1235–39. 

100. Gupta, P. C., F. S. Mehta, J. J. Pindborg, 

R. B. Bhonsle, P. R. Murti, D. K. Daftary, and 

M. B. Aghi. 1992. Primary prevention trial 

of oral cancer in India: A 10-year follow-up 

study. Journal of Oral Pathology & Medicine 

21 (10): 433–39. 

101. Hill, D., and T. Carroll. 2003. Australia’s 

National Tobacco Campaign. Tobacco 

Control 12 Suppl. 2: ii9–ii14. 

102. Borland, R., and J. Balmford. 2003. 

Understanding how mass media campaigns 

impact on smokers. Tobacco Control

12 Suppl. 2: ii45–ii52. 

103. Hamilton, J. L. 1972. The demand for 

cigarettes: Advertising, the health scare, 

and the cigarette advertising ban. Review of 

Economics and Statistics 54 (4): 401–11. 

104. Warner, K. E. 1977. The effects of the 

anti-smoking campaign on cigarette 

consumption. American Journal of Public 

Health 67 (7): 645–50. 

105. Warner, K. E. 1981. Cigarette smoking in 

the 1970’s: The impact of the antismoking 

campaign on consumption. Science 211 

(4483): 729–31. 

106. Lewit, E. M., D. Coate, and M. Grossman. 

1981. Effects of government regulation 

on teenage smoking. Journal of Law and 

Economics 24:545–73. 

107. Warner, K. E., and H. A. Murt. 1982. Impact 

of the antismoking campaign on smoking 

prevalence: A cohort analysis. Journal of 

Public Health Policy 3 (4): 374–90. 

108. White, V., N. Tan, M. Wakefield, and D. Hill. 

2003. Do adult focused anti-smoking 

campaigns have an impact on adolescents? 

The case of the Australian National Tobacco 

Campaign. Tobacco Control 12 Suppl. 2: 

ii23–ii29. 

109. Farrelly, M. C., C. G. Healton, K. C. Davis, 

P. Messeri, J. C. Hersey, and M. L. Haviland. 

2002. Getting to the truth: Evaluating 

national tobacco countermarketing 

campaigns. American Journal of Public 

Health 92 (6): 901–7. 

110. Thrasher, J. F., J. Niederdeppe, M. C. Farrelly, 

K. C. Davis, K. M. Ribisl, and M. L. Haviland. 

2004. The impact of anti-tobacco industry 

prevention messages in tobacco producing 

regions: Evidence from the US truth 

campaign. Tobacco Control 13 (3): 283–88. 

111. Messeri, P. A., J. A. Allen, P. D. Mowery, 

C. G. Healton, M. L. Haviland, J. M. Gable, 

and S. D. Pedrazzani. 2007. Do tobacco 

countermarketing campaigns increase 

adolescent under-reporting of smoking? 

Addictive Behaviors 32 (7): 1532–36. 

112. Wakefield, M., Y. Terry-McElrath, S. Emery, 

H. Saffer, F. Chaloupka, G. Szczypka, B. Flay, 

P. O. O’Malley, and L. Johnston. 2006. 

Effect of televised, tobacco company-funded 

smoking prevention advertising on youth 

smoking-related beliefs, intentions, and 

behavior. American Journal of Public Health

96 (12): 2154–60. 

113. Hauknes, A. 1981. Results from an 

evaluation of a special smoking and health 

information campaign in Norwegian 

newspapers and on television in 1977, 

seen against the background of the general 

situation as regards smoking and as regards 

the media. In Health education and the 

media: Proceedings of an international 

conference organized jointly by the Scottish 

Health Education Group, eds. D. W. Leathar, 

G. B. Hastings, and J. K. Davies, 425–39. 

New York: Pergamon Press.
544

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

114. Gredler, B., and M. Kunze. 1981. Impact of a 

national campaign on smoking attitudes and 

patterns in Austria. International Journal of 

Health Education 24 (4): 271–79. 

115. Doxiadis, S. A., D. V. Trihopoulos, and 

H. D. Phylactou. 1985. Impact of a 

nationwide anti-smoking campaign. Lancet

2 (8457): 712–13. 

116. Emery, S., M. A. Wakefield, Y. Terry-McElrath, 

H. Saffer, G. Szczypka, P. M. O’Malley, 

L. D. Johnston, F. J. Chaloupka, and B. Flay. 

2005. Televised state-sponsored antitobacco 

advertising and youth smoking beliefs and 

behavior in the United States, 1999–2000. 

Archives of Pediatrics and Adolescent 

Medicine 159 (7): 639–45. 

117. Terry-McElrath, Y. M., M. A. Wakefield, 

S. Emery, H. Saffer, G. M. Szczypka, 

P. O’Malley, L. D. Johnston, F. J. Chaloupka, 

and B. R. Flay. 2007. State anti-tobacco 

advertising and smoking outcomes by 

gender and race/ethnicity. Ethnicity and 

Health 12 (4): 339–62. 

118. Murray, D. M., A. V. Prokhorov, and 

K. C. Harty. 1994. Effects of a statewide 

antismoking campaign on mass media 

messages and smoking beliefs. Preventive 

Medicine 23 (1): 54–60. 

119. Sly, D. F., K. Arheart, N. Dietz, E. J. Trapido, 

D. Nelson, R. Rodriguez, J. McKenna, and 

D. Lee. 2005. The outcome consequences of 

defunding the Minnesota youth tobacco-use 

prevention program. Preventive Medicine

41 (2): 503–10. 

120. Popham, W. J., L. D. Potter, M. A. Hetrick, 

L. K. Muthen, J. M. Duerr, and M. D. Johnson. 

1994. Effectiveness of the California 1990–

1991 tobacco education media campaign. 

American Journal of Preventive Medicine

10 (6): 319–26. 

121. Hu, T. W., H. Y. Sung, and T. E. Keeler. 

1995. Reducing cigarette consumption 

in California: Tobacco taxes vs an antismoking media campaign. American 

Journal of Public Health 85 (9): 1218–22. 

122. Niederdeppe, J., M. C. Farrelly, and 

M. L. Haviland. 2004. Confirming “truth”: 

More evidence of a successful tobacco 

countermarketing campaign in Florida. 

American Journal of Public Health 94 (2): 

255–57. 

123. Bauer, U. E., T. M. Johnson, R. S. Hopkins, 

and R. G. Brooks. 2002. Changes in youth 

cigarette use and intentions following 

implementation of a tobacco control 

program: Findings from the Florida 

Youth Tobacco Survey, 1998–2000. JAMA: 

The Journal of the American Medical 

Association 284 (6): 723–28. 

124. Gagne, L. 2007. The 2005 British Columbia 

Smoking Cessation Mass Media Campaign 

and short-term changes in smoking. Journal 

of Public Health Management and Practice

13 (3): 296–306. 

125. Wakefield, M., and F. Chaloupka. 2000. 

Effectiveness of comprehensive tobacco 

control programmes in reducing teenage 

smoking in the USA. Tobacco Control 

9 (2): 177–86. 

126. National Cancer Policy Board. 2000. 

State programs can reduce tobacco use. 

Washington, DC: National Academies Press.

127. Tauras, J. A., F. J. Chaloupka, M. C. Farrelly, 

G. A. Giovino, M. Wakefield, L. D. Johnston, 

P. M. O’Malley, D. D. Kloska, and 

T. F. Pechacek. 2005. State tobacco control 

spending and youth smoking. American 

Journal of Public Health 95 (2): 338–44. 

128. Kuiper, N. M., D. E. Nelson, and 

M. Schooley. 2005. Evidence of effectiveness: 

A summary of state tobacco control 

program evaluation literature. Atlanta: 

U.S. Department of Health and Human 

Services, Centers for Disease Control and 

Prevention, National Center for Chronic 

Disease Prevention and Health Promotion, 

Office on Smoking and Health. http://www

.cdc.gov/tobacco/tobacco_control_programs/

stateandcommunity/sustainingstates/00

_pdfs/lit_review.pdf.

129. U.S. Department of Health and Human 

Services. 2000. Reducing tobacco use: 

A report of the Surgeon General. Atlanta: 

U.S. Department of Health and Human 

Services, Centers for Disease Control and 

Prevention, National Center for Chronic 

Disease Prevention and Health Promotion, 

Office on Smoking and Health. http://www

.cdc.gov/tobacco/data_statistics/sgr/sgr

_2000/index.htm

130. Emmanuel, S. C., A. Phe, and A. J. Chen. 

1988. The impact of the anti-smoking 

campaign in Singapore. Singapore Medical 

Journal 29 (3): 233–39. 

131. Laugesen, M., and B. Swinburn. 2000. 

New Zealand’s tobacco control programme 

1985–1998. Tobacco Control 9 (2): 155–62. 

132. Pierce, J. P., D. M. Burns, C. Berry, 

B. Rosbrook, J. Goodman, E. Gilpin, 

D. Winn, and D. Bal. 1991. Reducing tobacco 

consumption in California: Proposition 99 

seems to work. JAMA: The Journal of the 
545

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

American Medical Association 265 (10): 

1257–58. 

133. Glantz, S. A. 1993. Changes in cigarette 

consumption, prices, and tobacco industry 

revenues associated with California. Tobacco 

Control 2 (4): 311–14. 

134. Pierce, J. P., E. A. Gilpin, S. L. Emery, 

M. M. White, B. Rosbrook, C. C. Berry, 

and A. J. Farkas. 1998. Has the California 

Tobacco Control Program reduced smoking? 

JAMA: The Journal of the American Medical 

Association 280 (10): 893–39. 

135. Gilpin, E. A., K. Messer, M. M. White, 

and J. P. Pierce. 2006. What contributed 

to the major decline in per capita 

cigarette consumption during California’s 

comprehensive tobacco control programme? 

Tobacco Control 15 (4): 308–16. 

136. Al-Delaimy, W. K., J. P. Pierce, K. Messer, 

M. M. White, D. R. Trinidad, and E. A. Gilpin. 

2007. The California Tobacco Control 

Program’s effect on adult smokers: (2) Daily 

cigarette consumption levels. Tobacco 

Control 16 (2): 91–95. 

137. Messer, K., J. P. Pierce, S. H. Zhu, 

A. M. Hartman, W. K. Al-Delaimy, 

D. R. Trinidad, and E. A. Gilpin. 2007. 

The California Tobacco Control Program’s 

effect on adult smokers: (1) Smoking 

cessation. Tobacco Control 16 (2): 85–90. 

138. Trinidad, D. R., K. Messer, E. A. Gilpin, 

W. K. Al-Delaimy, M. M. White, and 

J. P. Pierce. 2007. The California Tobacco 

Control Program’s effect on adult smokers: 

(3) Similar effects for African Americans 

across states. Tobacco Control 16 (2): 

96–100. 

139. Pierce, J. P., M. M. White, and E. A. Gilpin. 

2005. Adolescent smoking decline during 

California’s Tobacco Control programme. 

Tobacco Control 14 (3): 207–12. 

140. Gilpin, E. A., S. Emery, M. M. White, and 

J. P. Pierce. 2003. Changes in youth smoking 

participation in California in the 1990s. 

Cancer Causes & Control 14 (10): 985–93. 

141. Chen, X., G. Li, J. B. Unger, X. Liu, and 

C. A. Johnson. 2003. Secular trends in 

adolescent never smoking from 1990 to 

1999 in California: An age-period-cohort 

analysis. American Journal of Public Health

93 (12): 2099–104. 

142. Koh, H. K., C. M. Judge, H. Robbins, 

C. C. Celebucki, D. K. Walker, and 

G. N. Connolly. 2005. The first decade of the 

Massachusetts Tobacco Control Program. 

Public Health Reports 120 (5): 482–95. 

143. Harris, J. E., G. N. Connolly, D. Brooks, and 

B. Davis. 1996. Cigarette smoking before 

and after an excise tax increase and an 

antismoking campaign—Massachusetts, 

1990–1996. Morbidity and Mortality Weekly 

Report 45 (44): 966–70. 

144. Biener, L., J. E. Harris, and W. Hamilton. 

2000. Impact of the Massachusetts tobacco 

control programme: Population based trend 

analysis. British Medical Journal 321 (7257): 

351–54. 

145. Weintraub, J. M., and W. L. Hamilton. 2002. 

Trends in prevalence of current smoking, 

Massachusetts and states without tobacco 

control programmes, 1990 to 1999. Tobacco 

Control 11 Suppl. 2: ii8–ii13. 

146. Soldz, S., T. W. Clark, E. Stewart, 

C. Celebucki, and D. Klein Walker. 

2002. Decreased youth tobacco use in 

Massachusetts 1996 to 1999: Evidence of 

tobacco control effectiveness. Tobacco 

Control 11 Suppl. 2: ii14–ii19. 

147. Rigotti, N. A., N. E. Majchrzak, J. R. Knight, 

and H. Wechsler. 2002. Tobacco use by 

Massachusetts public college students: 

Long term effect of the Massachusetts 

Tobacco Control Program. Tobacco Control

11 Suppl. II: ii20–ii24. 

148. Porter, R. S., V. R. Gowda, K. Kotchou, 

K. Nodora, and R. Leischow. 2001. Tobacco 

use among adults: Arizona, 1996 and 1999. 

Morbidity and Mortality Weekly Report

50 (20): 402–6. 

149. Ross, H., L. M. Powell, J. E. Bauer, 

D. T. Levy, R. M. Peck, and H. R. Lee. 2006. 

Community-based youth tobacco control 

interventions: Cost effectiveness of the 

Full Court Press project. Applied Health 

Economics and Health Policy 5 (3): 167–76. 

150. Centers for Disease Control and 

Prevention. 1999. Decline in cigarette 

consumption following implementation of 

a comprehensive tobacco prevention and 

education program—Oregon, 1996–1998. 

Morbidity and Mortality Weekly Report

48 (7): 140–43. 

151. Frieden, T. R., F. Mostashari, B. D. Kerker, 

N. Miller, A. Hajat, and M. Frankel. 2005. 

Adult tobacco use levels after intensive 

tobacco control measures: New York City, 

2002–2003. American Journal of Public 

Health 95 (6): 1016–23. 

152. Centers for Disease Control and Prevention. 

2007. Decline in smoking prevalence—

New York City, 2002–2006. Morbidity and 

Mortality Weekly Report 56 (24): 604–8. 
546

1 2 . E f f e c t i v e n e s s o f M e d i a i n D i s c o u r a g i n g S m o k i n g B e h a v i o r

153. Zhu, S.-H., V. Stretch, M. Balabanis, 

B. Rosbrook, G. Sadler, and J. P. Pierce. 

1996. Telephone counseling for smoking 

cessation: Effects of single-session and 

multiple-session interventions. Journal of 

Consulting and Clinical Psychology 64 (1): 

202–11. 

154. Pierce, J. P., D. M. Anderson, R. M. Romano, 

H. I. Meissner, and J. C. Odenkirchen. 

1992. Promoting smoking cessation in 

the United States: Effect of public service 

announcements on the Cancer Information 

Service telephone line. Journal of the 

National Cancer Institute 84 (9): 677–83. 

155. U.S. Department of Health and Human 

Services. 1989. Reducing the health 

consequences of smoking: 25 years of 

progress. A report of the Surgeon General 

(DHHS publication no. [CDC] 89-8411). 

Rockville, MD: U.S. Department of Health 

and Human Services, Public Health Service, 

Centers for Disease Control, National Center 

for Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health. 

http://profiles.nlm.nih.gov/NN/B/B/X/S/.

156. Boyd, N. R., C. Sutton, C. T. Orleans, 

M. W. McClatchey, R. Bingler, L. Fleisher, 

D. Heller, S. Baum, C. Graves, and 

J. A. Ward. 1998. Quit Today! A targeted 

communications campaign to increase use 

of the cancer information service by African 

American smokers. Preventive Medicine

27 (5 Pt. 2): S50–S60. 

157. Pierce, J. P., E. A. Gilpin, S. L. Emery, 

A. J. Farkas, S. H. Zhu, W. S. Choi, 

C. C. Berry, et al. 1998. Tobacco control 

in California: Who’s winning the war? 

An evaluation of the Tobacco Control

Program, 1989–1996. La Jolla: Univ. of 

California, San Diego, Cancer Prevention 

and Control Program.

158. Owen, L., and G. Lafferty. 1999. Quitline: 

An audit of the national helpline for 

smokers 1995–1998. London: Health 

Education Authority. http://www.nice.org

.uk/aboutnice/whoweare/aboutthehda/

hdapublications/quitline_an_audit_of_the

_national_helpline_for_smokers_19951998

.jsp.

159. Miller, C. L., M. Wakefield, and L. Roberts. 

2003. Uptake and effectiveness of the 

Australian telephone Quitline service in 

the context of a mass media campaign. 

Tobacco Control 12 Suppl. 2: ii53–ii58. 

160. Wilson, N., M. Grigg, L. Graham, and 

G. Cameron. 2005. The effectiveness 

of television advertising campaigns on 

generating calls to a national Quitline by 

Maori. Tobacco Control 14 (4): 284–86. 

161. Erbas, B., Q. Bui, R. Huggins, T. Harper, 

and V. White. 2006. Investigating the 

relation between placement of Quit 

antismoking advertisements and 

number of telephone calls to Quitline: 

A semiparametric modelling approach. 

Journal of Epidemiology and Community 

Health 60 (2): 180–82. 

162. Owen, L., and B. Youdan. 2006. 22 years 

on: The impact and relevance of the UK 

No Smoking Day. Tobacco Control 15 (1): 

19–25. 

163. Siahpush, M., M. Wakefield, M. Spittal, and 

S. Durkin. 2007. Antismoking television 

advertising and socioeconomic variations in 

calls to Quitline. Journal of Epidemiology 

and Community Health 61 (4): 298–301. 

164. Owen, L. 2000. Impact of a telephone 

helpline for smokers who called during a 

mass media campaign. Tobacco Control

9 (2): 148–54. 

165. Zhu, S. H., B. Rosbrook, C. Anderson, 

E. A. Gilpin, G. Sadler, and J. P. Pierce. 

1995. The demographics of help-seeking 

for smoking cessation in California 

and the role of the California Smoker’s 

Helpline. Tobacco Control 4 Suppl. 1: 

S9–S15. 

166. Carroll, T., and B. Rock. 2003. Generating 

Quitline calls during Australia’s National 

Tobacco Campaign: Effects of television 

advertisement execution and programme 

placement. Tobacco Control 12 Suppl. 2: 

ii40–ii44. 
547

Media, Tobacco Control 

Interventions, and Tobacco 

Industry Mitigation Efforts

Part

5

Tobacco use is exacerbated by the efforts of a profit-making industry. This part explores 

two areas in which tobacco industry efforts against tobacco control and interventions 

involve the media. The first chapter reviews state-level tobacco control media programs in 

Minnesota, California, Arizona, and Florida as examples of industry attempts to prevent 

or limit the scope of antitobacco media campaigns through political advocacy, claims 

of fiscal crisis, negotiated restrictions, or legal challenges.

The second chapter addresses the use of media in attempting to defeat state tobacco 

control initiatives and referenda, looking at results from several state-level propositions. 

Television, radio, print, and billboard advertising have been used to portray tobacco 

tax initiatives as unfair taxation, limitation of personal choice, or wasteful government 

spending with mixed levels of success. By understanding how tobacco control efforts 

can be blunted by protobacco media interventions, public health stakeholders can more 

effectively plan efforts to reduce tobacco use in their states and communities.

549

13

Tobacco Industry Efforts 

to Influence Tobacco Control 

Media Interventions

Tobacco control media interventions often face opposition from the tobacco industry at 

both the state and national levels. This chapter examines how tobacco industry interests 

and their allies work to inhibit antitobacco media efforts, including examples from 

specific media campaigns:

n	 Minnesota Plan for Nonsmoking and Health, one of the first state-level tobacco 

control efforts to include a large-scale media campaign

n	 California Tobacco Control Program, a voter-approved initiative under 

Proposition 99 that targeted tobacco industry practices and social norms 

regarding smoking

n	 Arizona’s efforts toward tobacco prevention and education programs under 

Proposition 200

n	 Florida’s Tobacco Pilot Program, which led to the successful state “truth” media 

campaign designed by young people for their peers, and to the American Legacy 

Foundation’s national rollout of a similar program

Tobacco industry strategies to counter or weaken these programs include efforts to divert 

funding away from tobacco control media campaigns, lobbying and financial support of 

elected officials, negotiated settlement restrictions, and legal challenges.
550

1 3 . To b a c c o I n d u s t r y E f f o r t s t o I n f l u e n c e To b a c c o C o n t r o l M e d i a

Introduction

Tobacco control media campaigns can 

be an effective means to reduce cigarette 

consumption (see chapter 12). Such efforts 

clearly have the potential to affect tobacco 

sales, while advertisements that educate the 

population about the industry’s practices 

can influence perceptions about tobacco 

companies. This chapter examines how the 

tobacco industry works, at times through 

intermediaries, to prevent or limit the 

effectiveness of these campaigns. Readers 

may also refer to the National Cancer 

Institute’s Tobacco Control Monograph 16 

for a description of tobacco industry 

attempts to counter the American Stop 

Smoking Intervention Study (ASSIST),1

which included media campaigns in some 

states (such as Massachusetts). 

This chapter provides some historical 

context for the development of antismoking 

and anti-industry advertisements, beginning 

with the Fairness Doctrine messages in 

the 1960s, and outlines the corresponding 

tobacco use behaviors that result from 

changes in regulation of tobacco industry 

advertising. Second, this chapter reviews 

published information on selected state 

tobacco control media campaigns as they 

developed over time from Minnesota to 

California to Arizona and Florida. It also 

reviews the American Legacy Foundation’s 

(Legacy’s) tobacco control media activities 

at the national level and its adoption of 

Florida’s “truth” campaign. The chapter 

concludes by identifying four specific 

approaches the tobacco industry uses 

against tobacco control media campaigns.

Fairness Doctrine

One of the first examples of a large-scale 

tobacco control advertising campaign 

came in 1966, when Action on Smoking 

and Health (ASH) approached a New York 

television station for free air time to respond 

to cigarette advertisements and was denied.2

After this denial, ASH filed a complaint 

with the Federal Communications 

Commission (FCC) under its Fairness 

Doctrine. The doctrine required television 

and radio stations to air both sides of 

“controversial issues,” even though doing 

so required the provision of free air time to 

one side of the “controversy.”2

The Fairness Doctrine was created in 

1949 as a result of the FCC’s decision that 

licensed stations were obligated to provide a 

reasonable opportunity for interested parties 

to present both sides of a controversial 

issue. The doctrine was designed to ensure 

that all sides of controversial issues would 

be given access to the airwaves, even if 

one side could not pay for access.3 In 1967, 

when the FCC declared cigarette advertising 

“controversial,” it opened up the broadcast 

airwaves to large-scale antitobacco 

advertising for the first time. (Before then, 

free public service announcements were 

rare and generally were not placed in 

prime time.) While there was no specific 

formula, the common practice was to 

provide approximately one antismoking 

advertisement for every three advertisements 

that the tobacco industry placed.2 Nearly 

$200 million in free air time (in 1970 dollars) 

was donated for antismoking messages 

between 1967 and 19714 (or $341 million 

in 2006 dollars) (see chapter 11). The effect 

was dramatic, with an immediate drop in 

cigarette consumption. The antismoking 

messages that aired slowed cigarette 

consumption by 531 cigarettes per person 

per year, while tobacco company advertising 

increased consumption by only 95 cigarettes 

per person per year5 (figure 13.1). 

Subsequent to this decrease in consumption, 

Congress banned cigarette advertising on 

television and radio, effective January 2, 1971. 

Between 1970 and 1971, cigarette advertising 

decreased by 20%–30%, thereby also 

decreasing the number of antismoking 
551

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

messages, resulting in an increase in 

cigarette consumption.5 Public health 

authorities viewed the legislation ending 

broadcast cigarette advertising as a step 

forward. However, by removing cigarette 

commercials from television and radio, 

the broadcast advertising ban removed the 

requirement for antitobacco advertisements 

as well. This eliminated the most effective 

antismoking campaign at that time. While 

losing direct broadcast advertising, the 

tobacco industry was able to compensate by 

increasing its advertising and promotional 

expenditures elsewhere.6 The public health 

community did not have the resources to buy 

advertising to counter the increased cigarette 

advertising appearing on billboards, in 

magazines, and in other venues. In addition, 

the industry continued to effectively use 

sports sponsorship, advertising in baseball 

and other stadiums, and event sponsorship 

to ensure that its logos and images remained 

prominently displayed on television. The 

result was that rates of tobacco consumption 

began to increase again.5

After the Fairness Doctrine antismoking 

messages ended, there was no systematic 

tobacco control advertising at the national 

level for 30 years, until 2000. That year, 

Legacy (created as part of the Master 

Settlement Agreement [MSA] between 

46 state attorneys general and the tobacco 

industry)7 began its national “truth” 

campaign.

With the elimination of tobacco control 

advertisements at the national level in 

1970, the focus shifted to the state level. 

In the mid-1980s, states began to establish 

tobacco control programs, including 

paid media campaigns. Several states, 

beginning with Minnesota, developed and 

implemented significant media campaigns, 

which were met by tobacco industry efforts 

to curtail the effectiveness of such media 

campaigns. This chapter presents case studies 

to illustrate efforts that helped eliminate 

antitobacco campaigns in Minnesota and 

Florida, limited the scope of the campaigns in 

California and Arizona, and impeded progress 

on campaigns such as that of Legacy.

Minnesota

Minnesota was the first state to create 

a statewide paid tobacco control media 

Figure 13.1 Adult Per Capita Cigarette Consumption and Major Smoking-and-Health Events

5,000

4,000

3,000

2,000

1,000

0

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000

Number of cigarettes per year, per capita

U.S. entry

into WWII

End of WWII

First Surgeon General’s Report

Broadcast ad ban

Great Depression

States settle

lawsuits against

tobacco industry

Broad public

awareness of link

between smoking

and cancer

States begin suing tobacco industry

Federal cigarette

tax doubles

Nonsmokers’ rights

movement begins

Fairness Doctrine

messages on

TV and radio

California Tobacco

Control Program begins;

other states follow

Year

Note. Adapted from Glantz, S. A. 2003. Tobacco: Biology and politics. Waco, Texas: WRS HealthEdCo.
552

1 3 . To b a c c o I n d u s t r y E f f o r t s t o I n f l u e n c e To b a c c o C o n t r o l M e d i a

campaign. In 1982, Minnesota commissioner 

of health Sister Mary Madonna Ashton 

convened the Technical Advisory Committee 

on Nonsmoking and Health (TACNH) to 

formulate recommendations to promote 

nonsmoking and health for individuals. 

On September 14, 1984, the TACNH 

released its report, The Minnesota Plan for 

Nonsmoking and Health (Minnesota Plan). 

The document proposed “a coordinated 

statewide program to prevent young people 

from starting to smoke, to encourage and 

assist smokers to quit, and to promote 

clean indoor air.”8(Bates no. 680581560) The 

Minnesota Plan made recommendations 

for the creation of multiple components 

of a program, including promotion of 

nonsmoking through marketing and 

communication techniques.8

As a first step, the advisory committee 

reviewed the pertinent literature on 

the tobacco industry’s marketing 

techniques, which had become available 

in the early 1980s through a subpoena 

by the Federal Trade Commission. The 

committee discovered that the tobacco 

industry planned to “associate particular 

brands with a lifestyle that is ‘masculine, 

contemporary, confident/self-assured, 

daring/adventurous, mature’”9(Bates no. 505774507)

and to stress that smoking was an initiation 

into the adult world.9 In response to 

the tobacco industry’s strategies, the 

committee reasoned that a strategy for 

marketing nonsmoking should be based 

on the “problems which are to be solved by 

the nonsmoking product.”8(Bates no. 680581671)

These problems include social isolation, 

knowing the health effects of smoking, 

the cost of cigarettes and their health 

effects, and self-image. In addition, an 

information component would provide 

regularly to the news media and other 

communication channels scientific data on 

smoking and nonsmoking. This strategy 

was based on the belief that information 

played a significant role in the promotion 

of nonsmoking.

The campaign primarily targeted young 

Minnesota women aged 20–29 years. 

In the early 1980s, this group was the 

largest single block of smokers (141,000 of 

812,000 total smokers) in Minnesota. 

Men aged 20–29 years were the second 

largest block of smokers (110,000) in the 

state. Overall, among people aged 20–

79 years, 390,000 women and 422,000 men 

were smokers in Minnesota.8(Bates no. 680581674)

Tobacco Industry’s Initial 

Response to the Minnesota Plan

The Tobacco Institute, the tobacco 

industry’s then-existing lobbying 

arm based in Washington, DC, 

characterized the Minnesota Plan as 

“a revolutionary attack on our industry.”10

The Tobacco Institute described the 

plan as “unnecessary, expensive and 

impractical”11(Bates no. TIMN0140515) and claimed 

that “much of the underlying research for 

the plan is inaccurate.”11(Bates no. TIMN0140510)

The Institute used estimates from 

advertising and public relations firms to 

support its position that the Minnesota 

Department of Health’s estimated 

costs for the campaign were too low 

and far more taxpayer dollars would 

be needed to implement the plan’s 

recommendations. These cost estimates 

also were promulgated by Minnesota 

business and labor coalitions.11

Finally, the tobacco industry sought 

to “identify and remove as supporters 

of the plan representatives from those 

groups with whom we have developed 

working relationships.”11(Bates no. TIMN0140511)

The tobacco industry mobilized its Tobacco 

Industry Labor Management Committee 

to identify contacts with major Minnesota 

labor unions and its lobbyists to persuade 

organized labor groups to withdraw their 

support of the Minnesota Plan.11

The tobacco industry anticipated that 

the Minnesota Plan could have national 
553

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

repercussions12 because antismoking 

advertising would compete with nationwide 

industry advertisements to discourage 

youth from smoking.11,13 Therefore, the 

industry introduced its own youth education 

campaign (“Helping Youth Decide” [HYD]) 

to draw attention away from the Minnesota 

campaign.13 This approach was to be 

implemented in four ways:

n Mailing copies of HYD brochures 

through the Tobacco Institute and the 

National Association of State Boards of 

Education (NASBE) to “state legislators, 

educators, and allies,”11(Bates no. TIMN0140512)

along with having the Tobacco Institute 

make field operation and lobbyist visits 

to those receiving HYD pamphlets

n Seeking the endorsement of the HYD 

program from state legislators and 

educators

n Arranging to have Tobacco Institute 

and NASBE spokespersons describe the 

merits of the HYD to state and local 

education organizations

n Publicizing “reaction to the program 

via ads in state and local media, 

including endorsements by Minnesotans, 

labor unions, national educators, 

etc.”11(Bates no. TIMN0140513)

Implementing the Public 

Education Media Campaign

In May 1985, the Minnesota state legislature 

passed the Omnibus Nonsmoking and 

Disease Act (Omnibus Act), which outlined 

funding and administrative responsibilities 

to implement the activities detailed in the 

Minnesota Plan. The Omnibus Act included 

a 5¢ cigarette tax increase to fund both 

sewer construction (4¢) and public health 

programs (1¢), including tobacco control 

programs (1/4¢).14,15 It also authorized the 

commissioner of health to run a long-term 

public communications campaign to 

promote nonsmoking in Minnesota.16

The 1985 Omnibus Act generated about 

$1.6 million/year (or 37¢ per capita/year) 

for nonsmoking programs during the first 

five years. A major objective of these funds 

was to reduce smoking among Minnesota 

youth by roughly a third, from 18% in 1986 

to 13% in 1990.14,16,17

Between 1985 and 1990, the Minnesota 

Department of Health ran a media campaign 

to promote nonsmoking among youth aged 

8–18 years.14,16 In addition to television 

advertisements that aired during the first 

three years of the campaign, the Minnesota 

Department of Health expanded the campaign 

Shifting the Focus from Tobacco

The tobacco industry questioned the financial planning for the Minnesota Plan and worked 

to shift the debate away from health to “areas in which we have the most credible arguments, 

e.g., economics, government intervention, etc.”a

 The industrya held roundtable discussions with 

representatives from Minnesota businesses and labor, education, and police groups to

1. Determine the negative consequences of a plan such as the Minnesota campaign,

2. Mobilize voters to demonstrate that members of the public do not want further 

government intrusion in their lives,

3. Create an information campaign to convince Minnesota taxpayers that numerous 

national programs already addressed this issue (i.e., nonsmoking among youth), and

4. Indicate “that local efforts are duplicative, a waste of taxpayers’ money and unnecessary.”

a

Tobacco Institute. [Public relations strategies to address the Minnesota Plan for nonsmoking and health]. 

Sep 1984. Tobacco Institute. Bates No. TIMN0140510/0525. http://legacy.library.ucsf.edu/tid/nia92f00.
554

1 3 . To b a c c o I n d u s t r y E f f o r t s t o I n f l u e n c e To b a c c o C o n t r o l M e d i a

and began to run radio advertisements during 

the 1988–89 biennium.17 However, during 

the 1991 fiscal year, the media budget was 

cut from its 1990 allocation of $1.5 million 

to $1 million. This decrease in funding 

translated to a 42% reduction in Minnesota 

Department of Health media placements. 

As a result, several target groups and venues 

were eliminated, including boys at risk for 

using smokeless tobacco and cable television 

advertisements targeting women and high 

school sport sponsorships.17

Long-Term Efforts Against the 

First Media Campaign

Beginning in 1988, the tobacco industry 

recruited new allies from several Minnesota 

business and labor organizations within 

specific legislative districts to build 

grassroots political opposition to the 

Minnesota Plan and its antismoking media 

campaign.18 Michael F. Brozek, Tobacco 

Institute regional vice president, reported

Our increasingly successful relationship 

with the Minnesota Grocers Association 

and our efforts in working with 

community groups (Iron Range Food 

Shelf Charities) are two new areas of real 

potential for the 1988 legislative year.

Never before has the tobacco industry 

embarked on such a detailed labor 

effort in the state of Minnesota. We 

have already met with officials of the 

Minnesota Teamsters Union, Minnesota 

AFSCME [American Federation of State, 

County and Municipal Employees] 

Organization and parties extremely close 

to leadership in the entire Minnesota 

labor movement and are receiving a 

positive response particularly in the 

areas of smoking restrictions and their 

effect on the collective bargaining 

process.18(Bates no. TIMN457503–7504)

In pursuing this strategy, the tobacco 

industry was neutralizing many of the 

constituencies that the original TACNH 

was designed to recruit. Neither the 

Minnesota Department of Health nor 

tobacco control advocates were able to 

hold these constituencies after the tobacco 

industry pursued them. With these new 

allies, the tobacco industry targeted 

legislative districts of specific House and 

Senate leaders. According to Brozek, the 

allies used several strategies specifically 

targeting legislative districts “with an 

emphasis on business, social, labor and 

civic groups. Labor related interactions ... 

in legislators’ home districts.... Serious 

and accountable interaction with nonindustry persons ‘aggrieved’ by punitive 

or restrictive actions on their working 

conditions.”18(Bates no. TIMN457499) Using these 

allies and continuing to frame tobacco 

control issues primarily as tax issues, the 

industry had a substantial impact on the 

long-term implementation of the Minnesota 

Plan and its media campaign.

Beyond outreach to allies, the tobacco 

industry strengthened its campaign 

contributions and lobbying budget after the 

start of the first media campaign in 1986.19

For example, it contributed $21,815 to 

Governor Rudolph G. Perpich’s (D) reelection 

campaign during 1989–90, the largest 

contribution to the campaign (1990 was an 

election year in Minnesota).19 It previously 

contributed $20,905 in 1987–88. On average, 

the tobacco industry spent about $63,000 per 

year for lobbying during 1980–85 and more 

than three times as much while the first 

media campaign was in full swing (1987–92), 

averaging about $230,000 annually.19

Tobacco Industry’s Success: 

Budget Cuts

The tobacco industry’s increased campaign 

contributions and lobbying expenditures 

appeared to have an effect in 1990 under 

Governor Perpich, when the legislature 

cut the tobacco control program’s 

budget from $1.5 million to $1 million.17
555

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

The governor used the state health 

department’s successes in reducing the 

rate of smoking to recommend the cut 

to “meet the state budget shortfall and to 

pay for drug-prevention efforts.”20 In 1991, 

Governor Perpich cut the program’s 

budget by nearly one-half million dollars. 

Assistant health commissioner Mick Finn 

responded to criticism by arguing that the 

state still would “spend $1.1 million next 

year (i.e., 1991) on nonsmoking programs 

even if the $473,000 cut goes through” and 

argued that “under budget circumstances it 

makes sense.”20 Governor Perpich’s budget 

reduction for the tobacco control program21 

turned out to be a precursor to further 

action against it.

During the 1990 gubernatorial race, 

Republican Arne H. Carlson defeated 

Democrat Perpich. From the 1989–90 

biennium election cycle to the 1993–94 

biennium election cycle, Carlson’s campaign 

committee received nearly $5,000 from 

tobacco industry contributions.19 During 

the 1993–94 election cycle, at least three 

Tobacco Institute contract lobbyists 

(Ronald A. Jerich, Thomas A. Kelm, and 

Allen M. Shofe) became fundraisers for 

Carlson’s reelection campaign committee,22

and Kelm alone expected to raise at least 

$10,000.22 In addition, in 1993, the tobacco 

industry spent more than $250,000 lobbying 

against tobacco control measures in 

Minnesota. In 1994, Tom and Doug Kelm’s 

firm, the chief tobacco industry contract 

lobbyists in Minnesota, received at least 

$100,000.23

Three years after his election, Governor 

Carlson eliminated the antismoking 

media campaign on the grounds that the 

state faced a fiscal crisis,19 although the 

Republican Governor Carlson and the 

Democratic Party–controlled legislature 

were debating the size of the state’s 

reserve fund and possible tax rebates. 

A Minneapolis, Minnesota, Star Tribune

article suggested that

Even by the Carlson administration’s own 

calculations, the state will be sitting on a 

sizable nest egg at the end of the two-year 

budget cycle that runs until June 1995.... 

The more Carlson cuts DFL [Democratic 

Farm Labor Party] spending and diverts 

the money into the reserve, the larger 

the political weapon he would have at his 

disposal in 1994.24

Health Advocates’ Failure to 

Respond Effectively

From 1986 to 1989, while the tobacco 

control program was fully funded, the adult 

smoking prevalence rate in Minnesota 

dropped by a relative amount of 16.3%, 

while the rest of the United States 

experienced a relative decrease of 8.7%.21

The Centers for Disease Control and 

Prevention (CDC) concluded that while 

the Minnesota Plan, including the first 

state antismoking media campaign, was 

in place (1985–92), “the state’s per capita 

tobacco consumption declined 26 percent, a 

steeper decline than the national average.”25

By comparison, after the program 

was dismantled (1993–97), per capita 

consumption in Minnesota increased 3.1%, 

while the national rate decreased.25

Despite such correlations between 

the Minnesota Plan and lower rates of 

smoking, health groups appeared to 

lose confidence in justifying the first 

antismoking media campaign in the face 

of the fiscal crisis claims.26,27 According 

to Tsoukalas and colleagues,19 health 

advocates did not challenge the claim 

of a fiscal crisis. Rather, antitobacco 

interests felt that belief in a fiscal crisis 

was strong enough to preclude sufficient 

sympathetic support in the legislature 

to save the antismoking campaign.26,27

Tsoukalas and colleagues19 concluded that 

the campaign also had a very low priority 

in the Minnesota Department of Health, 

which seemed unwilling to fight for it in 

either the legislature or the administration, 
556

1 3 . To b a c c o I n d u s t r y E f f o r t s t o I n f l u e n c e To b a c c o C o n t r o l M e d i a

and that health groups did little to press 

the department to give the program a 

higher priority. These factors enabled 

Governor Carlson and the legislature 

to eliminate the funds dedicated to the 

antismoking media campaign.

California

The California Tobacco Control Program 

was created in 1988 as a result of 

Proposition 99. This proposition was a voter 

initiative that increased the state excise 

tax on cigarettes by 25¢/pack and allocated 

20% of the revenues to programs to reduce 

smoking.28,29 (The remainder of the money 

went to medical care, research on diseases 

related to tobacco, and environmental 

protection.)29 The California Department of 

Health Services’ Tobacco Control Section 

administered the program’s media campaign 

with “the goal of reducing tobacco use 

in California by promoting a social norm 

of not accepting tobacco.”30 The media 

campaign included television, radio, print, 

billboard, and transit venue messages about 

the tobacco industry, secondhand smoke, 

addiction, smoking cessation, cigarette 

additives, smokeless tobacco, general health, 

pregnancy, and prevention among youth.31

In the early years of the program, under 

Republican Governor George Deukmejian, 

the media campaign was highly productive, 

with 113 advertisements produced in 

the first year. Importantly, in a radical 

departure from messages used in earlier 

media campaigns, substantial resources 

were invested in publicizing the tobacco 

industry’s encouragement of smoking 

among the public and actions within 

the policymaking process to create an 

environment that would support the 

industry’s ability to continue marketing 

its products with minimal interference 

by health authorities. The antitobacco 

campaign also was directed at nonsmokers 

to reinforce the nonsmoking position 

with many messages about secondhand 

smoke. Cessation messages represented 

a small fraction of the total campaign.31

The campaign focused on the general 

population rather than only youth.32

The media campaign’s early success came 

as a result of several favorable conditions. 

These included toleration from the 

governor and active and enthusiastic 

support from the director of health 

services, Kenneth W. Kizer. First, although 

Governor Deukmejian had campaigned 

against Proposition 99, he believed that 

after the voters passed it, the proposition 

should be implemented.33 Second, 

Governor Deukmejian delegated authority 

to administer the media campaign to 

Kizer and did not play any role in message 

development or advertising approval. 

Within the California Department of Health 

Services, Kizer was a strong supporter of 

the media campaign and was eager to see it 

make a significant difference in California.33

He emphasized that the tobacco control 

program and the media campaign were a 

high priority of the department and worked 

to clear bureaucratic impediments to 

issuing contracts necessary to implement 

the campaign.33

As a result, 59 days after Governor 

Deukmejian signed the implementing 

legislation for Proposition 99 (Assembly 

Bill [AB] 75), the California Department 

of Health Services released a request 

for proposals from advertising agencies 

seeking to create the media campaign 

(December 1, 1989). The proposals were 

due six weeks later, on January 10, 1990, 

and on January 26, 1990, the California 

Department of Health Services selected 

a Los Angeles advertising firm to develop 

the media campaign. The first antitobacco 

advertisements aired on April 10, 1990, only 

65 days after the contract was signed.29

In addition to the speed with which 

the media campaign was launched, the 
557

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

content of the first advertisement also 

was important. Rather than conveying a 

health message, the advertising agency 

decided to directly address tobacco 

company practices. Paul Keye, the 

advertising agency principal, explained

The cigarette companies were never 

in any of our original thoughts or 

conversations with one another. 

You can’t find the topic in our first 

work.... What happened was that—

as we dug into each topic—there, 

right in the middle of everything were 

the Smokefolk, making their quaint, 

nonsensical, fraudulent arguments 

and—by sheer weight of wealth and 

power and privilege—getting away 

with it.... Frankly, the tobacco industry 

[angered us]. They insulted our 

intelligence.34(Bates no. 520697106)

The first antitobacco advertisement 

aired was called “Industry Spokesman.”35

It portrayed a smoke-filled boardroom filled 

with tobacco industry executives and the 

leader saying

Gentlemen, gentlemen. The tobacco 

industry has a very serious multibilliondollar problem. We need more cigarette 

smokers. Pure and simple. Every day, 

2,000 Americans stop smoking and another 

1,110 also quit. Actually, technically 

they die.

That means that this business needs 

3,000 fresh new volunteers every day. 

So, forget about all that cancer, heart 

disease, stroke stuff.

We’re not in this for our health (script, 

as recorded).35

The tobacco industry reacted quickly. 

On April 18, 1990, eight days after “Industry 

Spokesman” first aired, Kurt L. Malmgren, 

senior vice president of state activities 

for the Tobacco Institute, wrote to 

Samuel D. Chilcote Jr., president of the 

Tobacco Institute, as follows

As previously reported, [the Tobacco 

Institute’s national legal counsel] 

Covington & Burling and California legal 

counsel have been reviewing possible 

grounds for a legal attack on the ad 

program. Among the possible bases for 

suit that have been reviewed are that the 

ad campaign is an improper expenditure 

of funds under Prop 99 and AB 75, that 

it is defamatory, that it is deceptive 

advertising, and presents First Amendment 

concerns. Aside from tactical questions 

as to the desirability of pursuing any 

legal action, the considered judgment 

of counsel here and on the ground in 

California is that there is no basis for a 

suit which would have a realistic chance 

of success.

It is also our considered opinion that 

the industry should not attempt a 

‘dollar-for-dollar’ response in the media. 

Our goal is to keep the advertisements—

not the tobacco industry—at the center of 

the controversy. If the industry attempts 

to meet the Department of Health Services 

head on in the media, the controversy is 

likely to shift from the advertisements to 

the industry.36(Bates no. 87700743) 

The tobacco industry realized that a direct 

public attack on the media campaign would 

be counterproductive. One month later, 

in a memorandum to Roger L. Mozingo in 

the State Government Relations Division 

From “Industry Spokesman” television advertisement.
558

1 3 . To b a c c o I n d u s t r y E f f o r t s t o I n f l u e n c e To b a c c o C o n t r o l M e d i a

of R.J. Reynolds, Terry Eagan from the 

Government Affairs Division of Philip Morris 

wrote

California’s growing fiscal crisis has 

created funding problems that have 

caused both the Governor’s office and 

the Legislature to scramble for money to 

maintain existing programs. The estimated 

revenue shortfall is now $3.6 billion....

The tobacco industry has decided that 

the timing is excellent for an attempt to 

divert money from the anti-smoking media 

campaign into other programs that are 

doomed to suffer because of the current 

fiscal crisis....

Strategy sessions on this issue resulted 

in the conclusion that it is important 

that the tobacco industry not be 

identified as an instigator of any attempt 

to encourage special interests to seek 

re-direction of the media money to other 

programs. It is agreed that under no 

circumstances can we visibly participate 

in this process. The press, however, 

will assume, as they always do, that 

the industry is behind any ‘conspiracy’ 

to change existing funding patterns. 

We should be prepared for this.

Currently a host of groups interested in 

chasing the media money have surfaced. 

These groups include: the counties 

(from both urban and rural perspectives), 

the Black Health Network (walk-in clinics), 

the California Health Federation (clinics), 

the Department of Education (defending 

their existing tobacco revenue sources), 

the doctors, the hospitals, the dentists, 

and the ambulance operators. Literally 

dozens of other interest groups can be 

expected to surface when the money goes 

into play.37(Bates no. 507640368–0369)

The tobacco industry would portray the 

state’s fiscal crisis as an opportunity for 

third parties to pursue funds previously 

earmarked for the media campaign, an 

approach that was used successfully in 

Minnesota in 1990.19

Although the tobacco industry was unable 

to remove funding for the media campaign, 

productivity declined from 113 campaign 

advertisements in 1990 to 6 in 1991.31

The media campaign then received an 

almost $2 million increase in funding, from 

$14.3 million in 1990–91 to $16.0 million in 

1991–92.30 In contrast to the earlier removal 

of bureaucratic impediments to developing 

and implementing the media campaign, 

newly elected Republican Governor 

Pete Wilson hindered the campaign. Text 

in an April 1990 memorandum between 

two Philip Morris lobbyists in Washington, 

DC, specifically identified Governor Wilson 

(previously a U.S. Senator) as an ally. This 

was apparent despite the fact that Wilson 

had returned a campaign contribution check 

from tobacco industry executives:

Wilson is only sending about 16K of the 

100K he collected. This 16K includes 

checks he received from either a tobacco 

company or anyone working directly for 

a tobacco company, i.e., Hamish Maxwell 

[President of Philip Morris], Mrs. Ehud, 

Bill Murray [Member of Philip Morris’ 

Board of Directors 1987–1989].

Apparently, he has also done this with 

other “controversial” industries such 

as lumber, chemical and others. The 

decision to do this was Wilson’s alone, 

and in the response to a wave of negative 

campaigning in California that not only 

attacks the candidates, but those who 

give to them as well.

You will be pleased to know that Pete 

[Wilson] called Hamish [Maxwell] to 

explain that he was doing this to protect 

Hamish as well as himself. You will 

also be pleased to know that Pete is still 

“pro-tobacco.” 38(Bates no. 2072914862)
559

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Health advocates, including the American 

Heart Association (AHA) and the American 

Nonsmokers’ Rights Foundation, 

revealed this memorandum in a full-page 

advertisement as part of an aggressive public 

campaign to defend the California Tobacco 

Control Program. The advertisement ran 

in the New York Times on April 16, 1996, 

and later in the Sacramento Bee and the 

Los Angeles Times.29

Governor Wilson’s first attempt to 

eliminate the media campaign occurred on 

January 10, 1992, when he introduced his 

fiscal year (FY) 1992–93 budget in which 

current and future funding for the media 

campaign was suspended. Governor Wilson 

said the media campaign was of “secondary” 

significance39 and had not been proven 

effective. Four days after the budget was 

introduced, results from the California 

Tobacco Survey conducted by the University 

of California, San Diego, were made available. 

The survey findings indicated a 17% relative 

decrease in the percentage of adult smokers 

in California since Proposition 99.40

Governor Wilson’s efforts to halt the media 

campaign continued. After the California 

Department of Health submitted the media 

contract for rebidding in 1991, the Wilson 

administration declined to sign the contract 

(personal communication from C. Stevens, 

head of Tobacco Education Media Campaign, 

to J. Ibrahim, 2002). On February 21, 1992, 

the American Lung Association (ALA) 

countered by filing a lawsuit against 

Governor Wilson and the director of the 

California Department of Health Services, 

Molly Coye. The lawsuit claimed that by 

preventing the advertising contract from 

being signed, Wilson and Coye were violating 

Proposition 99, which stated that the state 

would run an antitobacco media campaign.29

On April 24, 1992, Judge James T. Ford of 

the Sacramento Superior Court ruled that 

Governor Wilson did not have the authority 

to take funds appropriated for one purpose 

and use them for another.29 Following this 

decision, the California Department of Health 

Services contracted with the advertising 

agency on May 29, 1992.29 In addition, the 

authorizing legislation, AB 75, required 

the advertising contract to be rebid every 

other year. Because the bidding process 

was delayed, the media campaign contract 

lapsed for six to nine months, during which 

time no new advertisements were produced 

(personal communication from C. Stevens to 

J. Ibrahim, 2002).

Governor Wilson also implemented a formal 

review process for the media campaign 

by the Health and Welfare Agency (which 

includes the California Department of 

Health Services) and the governor’s 

office, further slowing the process. Once 

the campaign was reestablished, the 

program produced only 20 advertisements 

each year from the fall of 1992 through 

1995 (figure 13.2).31 By the mid-1990s, 

the tobacco industry denormalization 

advertisements were disappearing.

In summer 1996, the California Department 

of Health Services, under the Wilson 

administration, prohibited the media 

campaign from using the following four terms 

in antitobacco messages: “tobacco industry,” 

“profit,” “nicotine addiction,” and “lies.”29(p. 340)

This new constraint on terminology coupled 

with new contract startup time resulted in 

the production of one advertisement in 1996, 

which focused on youth access to tobacco 

products (personal communication from 

C. Stevens to J. Ibrahim, 2002). The number 

of advertisements increased somewhat in 

the following two years and included several 

anti-industry advertisements.31

The weakening of the media campaign 

under Governor Wilson was seen by 

some as reaching beyond the number of 

advertisements to the number of cigarettes 

smoked. The reduced size and aggressiveness 

of the campaign was associated with a 

decrease in the rate of decline in cigarette 
560

1 3 . To b a c c o I n d u s t r y E f f o r t s t o I n f l u e n c e To b a c c o C o n t r o l M e d i a

consumption (and a reduction in the 

rate of decline in associated deaths from 

heart disease).41 As noted in chapter 12, 

this reduction in effectiveness after 1994 

was associated with 840 million packs of 

cigarettes (worth about $1.2 billion) smoked 

between 1994 and 1998 and an additional 

15,000 deaths from heart disease. Potentially, 

the 840 million packs of cigarettes smoked 

and the 15,000 deaths could have been 

avoided if the program had remained as 

effective as it was between 1989 and 1994.29,41

The results of a 1998 independent evaluation 

indicate that the media campaign increased 

young people’s belief that the tobacco 

industry was working to make youth 

addicted to cigarettes. The Independent 

Evaluation Consortium recommended that 

the media campaign “should continue to 

educate the public, including youth, about 

the negative influence of tobacco advertising 

and promotions.”42(p.xv) A second evaluation 

found that almost all youth and adults were 

exposed to the media campaign in 1998, 

when funding was $31.9 million, and that 

the exposure was significantly greater than 

in 1996,43 when funding was $12.2 million.44

In 1998, exposure to campaign messages 

was associated with more negative attitudes 

toward the tobacco industry and more 

support among youth for policies restricting 

tobacco marketing.42 Youth had more beliefs 

about the negative consequences of smoking 

and fewer beliefs about the benefits of 

smoking.42 Despite funding cuts and toneddown messages, California’s media campaign 

continued to positively influence youth, but 

not as effectively as in its initial years.

Governor Wilson’s efforts to eliminate or 

scale down the media campaign continued 

until his last days in office, in the summer 

of 1998. At that time, he did not approve 

placement of produced advertisements, 

leaving them to newly elected Democratic 

Governor Gray Davis, who took office in 

January 1999 (personal communication from 

C. Stevens to J. Ibrahim, 2002). Following 

complaints from health advocates, Davis 

nominally reversed Wilson’s ban on attacks 

on the tobacco industry. Nonetheless, only a 

few advertisements focused on the tobacco 

industry’s actions, and Governor Davis 

let stand Wilson’s process for approving 

advertisements.45

Figure 13.2 Total Number and Type of Advertisements for the California Tobacco Control 

Media Campaign, 1990–2006

0

25

50

75

100

125

Number of Advertisements

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

6

27

40

56

33

42

1

41

11

32 36

22 24

16

5

27

113

Outdoor

Print

Radio

TV

Year

Note. From California Department of Health Services, Tobacco Control.
561

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

The media campaign’s budget decreased from 

$23.3 million in 1998–99 to $19.6 million in 

1999–2000, due in part to declining revenues 

from Proposition 99 associated with lower 

cigarette consumption. Governor Davis did 

not attempt to cut revenues allocated to the 

media campaign, but he refused to use funds 

from the $500 million the state received 

annually from the tobacco industry through 

the MSA to compensate for the declining 

purchasing power of the funds from the 

Proposition 99 tax on cigarettes. (The tax 

had been set in 1988 and was not indexed to 

inflation.) Figure 13.3 illustrates the trend 

in funding for the media campaign with 

annual budgets using adjusted 2003 dollars 

to compensate for inflation and allowing 

comparisons across time.

In March 2001, the AHA and Americans 

for Nonsmokers’ Rights launched a 

lobbying and newspaper campaign to 

strengthen the California Tobacco Control 

Program, specifically the media campaign, 

to counter the effects of the tobacco 

industry’s marketing and promotion. 

Governor Davis increased the media 

campaign’s funding to $45.3 million 

for FY 2000–2001 and FY 2001–2002, 

by releasing funds that had been tied up 

in litigation due to challenges brought by 

health groups against the diversion of funds 

from health education during the Wilson 

administration.46,47

The augmented funding dwindled as 

Governor Davis withdrew the additional 

support in his 2002–2003 budget,48 reducing 

the media campaign’s budget allocation 

to $21.1 million. As a result of declining 

revenue from Proposition 99 and no 

new dedication of funds, the governor’s 

Keeping a Strong Message Off the Air

In 1994, an advertisement called “Nicotine 

Soundbites” used footage of tobacco industry 

executives testifying in April 1994 at congressional 

hearings conducted by Rep. Henry Waxman 

(D-CA), stating that they did not believe nicotine 

was addictive. The industry reacted negatively. 

Legal counsel for R.J. Reynolds stated that the 

advertisement represented defamation of the 

executives and threatened to sue the California 

Department of Health Services.a,b Initially, 

several television stations refused to run the 

advertisement because of its controversial nature. 

However, the advertisement aired in fall 1994, 

and California Department of Health Services director Kimberly Belshé publicly defended it. The 

television stations backed down and ran the advertisement.b

Ultimately, however, the Wilson administration removed “Nicotine Soundbites” from television 

amid requests to keep it on the air from health advocates and the California Tobacco Education and 

Research Oversight Committee.b The latter is the state-mandated independent oversight committee 

for the program. This reaction from television stations and the governor indicates the effectiveness 

of tobacco companies’ influence in limiting the broadcast of strong antitobacco messages.

a

Balbach, E. D., and S. A. Glantz. 1998. Tobacco control advocates must demand high-quality media campaigns: 

The California experience. Tobacco Control 7 (4): 397–408 

b

Glantz, S. A., and E. D. Balbach. 2000. Tobacco war: Inside the California battles. Berkeley: Univ. of California 

Press. 
562

1 3 . To b a c c o I n d u s t r y E f f o r t s t o I n f l u e n c e To b a c c o C o n t r o l M e d i a

2003–2004 budget proposal reduced the 

media campaign budget to $16.7 million.49

After losing several lawsuits brought by ill 

smokers in California, R.J. Reynolds and 

Lorillard sued the state on April 1, 2003. 

The lawsuit claimed that the media 

campaign had violated the companies’ 

First Amendment rights, interfered with 

their right to a fair trial, and tarnished their 

reputations.50,51 The case was dismissed on 

July 22, 2003. R.J. Reynolds and Lorillard 

appealed the ruling, and health groups 

responded. On February 12, 2004, attorneys 

for the AHA, the ALA, and the American 

Cancer Society (ACS) filed an amicus curiae

brief (a brief filed with a court by someone 

who is not a party in the case) in support 

of the state. On September 28, 2004, the 

Ninth Circuit Court of Appeals rejected the 

tobacco companies’ argument. The court 

stated, “A mere link between an excise tax 

and a government-sponsored advertising 

campaign, absent a claim that either the 

tax or the advertising is unconstitutional, 

does not violate the First Amendment.”52(p.5)

The tobacco companies’ other arguments 

were rejected as well.

In summary, strong and repeated political 

and legal interventions by health advocates 

in California were required to keep the 

program effective. This was true even though 

voters’ enactment of Proposition 99, which 

created the health education account and 

the media campaign, nominally protected 

the California Tobacco Control Program. 

These political and legal steps involved 

monitoring the budget process in both the 

administration and legislature and working 

to press the administration to produce 

high-quality advertisements in a timely 

manner. As in Minnesota, claims of budget 

limitations were the purported reasons 

for cutting or eliminating the program 

in California. Health groups successfully 

defended the program by rejecting these 

explanations and learning that they needed 

to monitor the bureaucratic procedures 

surrounding advertising message 

development and execution.

Arizona

Arizona provides an example of tobacco 

industry efforts to limit the scope of 

tobacco control from program inception. 

Encouraged by the experiences in California 

(1988) and Massachusetts (1992), voters 

in Arizona passed Proposition 200 on 

November 8, 1994, to increase the cigarette 

Figure 13.3 Budget Allocations for the California Tobacco Control Media Program, 1989–2003

$14.7

$21.2

$20.0

$21.5

$20.1

$16.4

$15.1

$29.2 $26.2

$36.4

$21.6

$48.1 $46.8

$21.5

$0

$5

$10

$15

$20

$25

$30

$35

$40

$45

$50

2003 Dollars (in millions)

1989–

90

1990–

91

1991–

92

1992–

93

1993–

94

1994–

95

1995–

96

1996–

97

1997–

98

1998–

99

1999–

00

2000–

01

2001–

02

2002–

03

Fiscal Years

Note. From California Department of Health Services, Tobacco Control.
563

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

excise tax by 40¢/pack and dedicate 23% of 

the new revenues to a health education 

account for tobacco prevention and 

education programs.53 Republican Governor 

John Fife Symington III and Senate 

President John Greene (R-Phoenix) were 

two main opponents to the creation of the 

Arizona Tobacco Education and Prevention 

Program (AzTEPP).53

After passage of Proposition 200 but 

before program implementation, both the 

governor and the senate president expressed 

their opinions that the initiative process 

The Massachusetts Tobacco Control Program

The Massachusetts Tobacco Control Program (MTCP) began after a 1992 ballot initiative raised the 

cigarette excise tax by 25¢ per pack to fund the program.a,b The comprehensive tobacco control 

program, launched in October 1993, included a media campaign, workplace and community 

programs, cessation services, school-based education programs, and health professional education 

and assistance for tobacco intervention. For almost a decade, the MTCP was associated with a drop 

in per-capita adult cigarette consumption and smoking prevalence. From 1993 onward, per-capita 

consumption in Massachusetts showed a consistent annual decline of more than 4%, while in 

other U.S. states (except California), the downturn leveled off, decreasing by less than 1% a year. 

From 1992 to 1999, the prevalence of adult smoking in Massachusetts declined significantly 

each year (by 0.43 percentage points) compared with virtually no change in the comparison 

states (see chapter 12).b,c,d In 2002, the program’s funding was severely cut, a decision attributed 

to state budget crises. Although the MTCP was active, its funding was appropriated to fund other 

programs, so the program did not achieve the intended amount of funding.a

The tobacco industry was working in Massachusetts to divert funding away from the program, 

but its response was less aggressive than that observed in California.e Among attempts to divert 

tobacco tax money, the most public was Acting Governor Jane Swift’s invocation of unilateral 

emergency “9C” powers in early 2002 to cut the MTCP by $22 million. When she defended these 

cuts as necessary in the face of a state deficit, tobacco control advocates sued, arguing that the 

administration’s action was unconstitutional in the context of a program with a dedicated revenue 

source.f In the spring of 2002, the court ruled in favor of the Swift administration, ultimately 

leading to the removal of almost all MTCP funding. The 2005 fiscal year program budget was 

$3.2 million, a 93% decrease from $48 million at the start of 2002.b

 Long-term tobacco industry 

lobbying ($690,000 spent in Massachusetts in 2002),g

 the budget crisis, lukewarm legislative 

support in the face of severe fiscal constraints, and the loss of the lawsuit against the Swift 

administration all appear to have contributed to the de-funding of the program. The state’s 

innovative policy measures, such as the ban on tobacco advertising near schools and playgrounds 

and the tobacco product disclosure law, were legally challenged by the tobacco industry.b

a

Ritch, W. A., and M. E. Begay. 2001 Smoke and mirrors: How Massachusetts diverted millions in tobacco tax 

revenues. Tobacco Control 10 (4): 309–16.

b

Koh, H. K., C. M. Judge, H. Robbins, C. C. Celebucki, D. K. Walker, and G. N. Connolly. 2005. The first decade 

of the Massachusetts Tobacco Control Program. Public Health Reports 120 (5): 482–95. 

c

Biener, L., J. E. Harris, and W. Hamilton. 2000. Impact of the Massachusetts tobacco control programme: 

Population based trend analysis. British Medical Journal 321 (7257): 351–54. 

d

Smith, S. 2002. Tobacco foes hit cuts in budget. Boston Globe, October 12. 

e

Siegel, M., and L. Biener. 1997. Evaluating the impact of statewide anti-tobacco campaigns: The Massachusetts 

and California Tobacco Control Programs. Journal of Social Issues 53 (1): 147–68. 

f

Associated Press. 2002 SJC backs Swift cut in antismoking programs. Boston Globe, June 15. 

g

Massachusetts Secretary of the Commonwealth. Massachusetts Lobbyist and Employer Search System 

Database. http://db.state.ma.us/sec/pre/search.asp.
564

1 3 . To b a c c o I n d u s t r y E f f o r t s t o I n f l u e n c e To b a c c o C o n t r o l M e d i a

should not override public policymaking 

and that the legislature, not the public, 

should handle fiscal issues such as the 

tax proposed by Proposition 200.54 In an 

April 1994 meeting with health advocates, 

Governor Symington and Senator Greene 

threatened retaliation by removing 

the groups’ nonprofit status and by 

blocking future legislation proposed by 

the health advocates who spearheaded 

Proposition 200.55–57 These groups included 

the ACS, the AHA, the ALA, and the Arizona 

for a Healthy Future Coalition.

After failing to defeat Proposition 200, 

Governor Symington and Senator Greene 

worked to weaken AzTEPP through 

membership on the Tobacco Use Prevention 

Advisory Committee (TUPAC), the 

state commission overseeing Arizona’s 

tobacco control program. House Bill 

(HB) 2275, the implementing legislation 

for Proposition 200,58 required that the 

TUPAC be composed of the director of the 

Arizona Department of Health Services, 

two individuals appointed by the governor, 

four individuals appointed by the president 

of the senate, and four individuals appointed 

by the speaker of the house.

Four of the 11 TUPAC members had 

clear ties with the tobacco industry. 

Governor Symington’s appointees were 

from the Arizona Retailers Association and 

Golden Eagle Distributors.54 Senator Greene 

appointed Senator Gus Arzberger (D) 

and Senator Janice K. Brewer (R), both 

of whom were known among health 

advocates as supporters of the tobacco 

industry.53 However, Speaker of the House 

Mark Killian (R-Mesa) was an ally of health 

advocates and had worked against bills 

containing preemption language related to 

tobacco control.59,60 Representative Killian 

selected Representatives Andrew W. Nichols 

(D-Summerhaven) and Sue Gerard 

(R-Phoenix). While Representative Gerard 

was a friend of Philip Morris lobbyist 

Rip Wilson, she was known within the public 

health community as an ally of tobacco 

control efforts.53 Representative Killian 

followed the recommendation of the 

Coalition for Tobacco-Free Arizona in 

selecting the two nonelected appointees 

to the TUPAC.54

The legislature used HB 227558 as the 

vehicle to adjust the funding levels for 

AzTEPP from the estimated $27 million 

and $29 million in tobacco tax revenues 

for FY 1996 and FY 1997, respectively, to 

$10 million for FY 1996 and $15 million 

for FY 1997.54 The remaining $37 million 

intended for antitobacco education 

remained in a reserve account that could 

be used after July 1, 1997. The FY 1996 and 

FY 1997 spending caps were to remain 

in place for two years, at which point the 

program would receive the intended 23% of 

the tobacco tax revenues. Representative 

Gerard introduced several pieces of 

legislation to remove the caps. In April 1997, 

she successfully removed the caps and 

backfilled the missing funds for FY 1996 and 

FY 1997.54 Also in 1997, Governor Symington 

waged an unsuccessful campaign to divert 

$34.7 million from the tobacco control 

program.54

The media campaign was implemented 

in December 1995. Under HB 2275,58 the 

Arizona Department of Health Services was 

charged with authority for the campaign, 

which it significantly limited both in 

audience and message. The health services 

department determined that the media 

campaign should not address nicotine 

addiction and that the “target population 

of the media program during the first year 

of the contract shall be pre-adolescents 

and adolescents, pregnant women and 

their partners.”61(p.5-1)

This focus was not the most efficient use 

of funds for influencing populationwide 

smoking as only a small fraction of the 

Arizona population is pregnant at any given 

time (about 104 women per 1,000 women 
565

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

according to U.S. data),62 and youth-focused 

advertising is unlikely to influence the 

majority of smokers who are adults.63

Targeting adolescents and lacking discussion 

of nicotine addiction compromised the media 

campaign’s effectiveness from the onset, 

in contrast with the California campaign’s 

approach a few years earlier.

The first tobacco control expenditures 

were for contracts with the Phoenix Suns, 

a professional basketball team, and the 

Arizona Cardinals, a professional football 

team, to promote antitobacco education 

through players, team mascots, radio and 

television spots, and stadium billboards. 

After contract approval, attorney Steve Duffy 

represented the Tobacco Institute in filing a 

memorandum claiming that the contracts 

violated state policymaking and were illegal.54

Protobacco members of the TUPAC said they 

had not been consulted on the contracts 

before signing. These issues slowed down the 

program and encouraged it to be cautious.

In 1998, under the administration of 

Governor Jane Dee Hull (R), the media 

campaign broadened its scope, particularly 

by addressing adult cessation in addition to 

pregnant women and children, in response 

to smokers’ complaints that their taxes 

were not paying for services to help them.53

Despite the early narrow focus of the 

campaign, Proposition 200 was associated 

with a decline in Arizona’s tobacco use 

prevalence from an estimated 23.1% in 

1996 to 18.3% in 1999,64 although no data 

were available to compare that trend to 

other states not subject to the campaign.

In summary, the tobacco industry 

worked to weaken the media campaign 

by influencing the placement of tobaccofriendly representatives on TUPAC.54 Hence, 

the efforts of health advocates in Arizona to 

create a tobacco control media campaign 

took place in an environment in which the 

tobacco industry made numerous attempts 

to prevent such progress.

Florida

In 1995, the attorney general of Florida, 

following the lead of the Minnesota 

attorney general, filed a lawsuit against 

the tobacco industry to cover the costs of 

treating Florida’s Medicaid patients for 

illnesses related to tobacco, fund smoking 

cessation programs, restrict tobacco 

marketing, and fund an antitobacco 

education program.65 The case was settled 

on August 25, 1997 (before the MSA). The 

tobacco industry agreed to pay $11.3 billion 

to the state of Florida over 25 years and to 

provide $200 million for a two-year Tobacco 

Pilot Program, “the elements of which shall 

be aimed specifically at the reduction of the 

use of Tobacco Products by persons under 

the age of 18 years.”66

Having learned a lesson in California, 

the tobacco industry sought to limit the 

scope of the tobacco control campaign 

aimed at youth by including language in 

the settlement stating, “The $200 million 

amount payable by Settling Defendants in 

support of the Pilot Program shall be used 

only after approval by the Court and at 

the rate of approximately $100 million per 

12-month period for general enforcement, 

media, educational and other programs 

directed to the underage users or potential 

underage users of Tobacco Products.”66

The industry sought to prevent the tobacco 

control media campaign from negatively 

characterizing tobacco companies by 

including a “vilification clause” that stated 

that funds “shall not be directed against the 

tobacco companies or any particular tobacco 

company or companies or any particular 

brand of Tobacco Products.”66

Governor Lawton Chiles (D), who 

enthusiastically supported the lawsuit 

against the tobacco industry,67 worked to 

create a Tobacco Pilot Program within the 

governor’s office in 1998 in an effort to 

deter efforts by the tobacco companies or 
566

1 3 . To b a c c o I n d u s t r y E f f o r t s t o I n f l u e n c e To b a c c o C o n t r o l M e d i a

other protobacco interests to undermine 

such an initiative.47 As in the initial 

California program, this high priority in 

the administration cleared the bureaucratic 

way for quickly establishing an aggressive 

program.

The first step in the program’s creation 

was the Governor’s Teen Summit on 

Tobacco Education, attended by more than 

600 youth. The result was the approval of 

four goals for the Tobacco Pilot Program: 

changing youth attitudes about tobacco 

use, empowering youth to work in their 

communities against tobacco use, reducing 

the availability of tobacco products to youth, 

and reducing youth exposure to secondhand 

smoke.47 In June 1998, representatives of 

a newly formed group, Students Working 

Against Tobacco (SWAT), along with 

four at-large representatives from the 

community, met in St. Petersburg, Florida, 

to discuss the means of implementing 

the Tobacco Pilot Program. Following 

the four guidelines created at the 

governor’s summit, the group decided 

on five program components: youth 

programs and community partnerships, 

education and training, marketing and 

communications, enforcement, and 

research and evaluation.47

The marketing component was to focus on 

maintaining tobacco-free youth, informing 

youth of the risks of secondhand smoke and 

the addictive nature of tobacco, creating 

awareness of the Tobacco Pilot Program, 

linking popular athletes and teams with 

antitobacco messages, deglamorizing 

tobacco use, developing a communications 

network on the Internet, and demonstrating 

that peer pressure to use tobacco can be 

effectively countered.47 An advertising firm 

in Miami, Florida, worked with youth to 

develop a campaign that would effectively 

speak to youth. The result was that youth 

clearly stated that they wanted the truth and 

facts and did not want to be manipulated by 

marketing by the tobacco industry.68

Although prohibited by the vilification 

clause from directly attacking the tobacco 

industry,66 the campaign adopted “truth” 

as its theme with the tagline “Their brand 

is lies. Our brand is Truth.”47 Who “they” 

were was purposefully left vague. Moreover, 

the campaign featured telephone calls 

asking tobacco industry spokespersons 

questions intended to embarrass them and 

directly attacked the tobacco industry’s 

network, including advertising agencies 

and scientists who supported the tobacco 

industry.47

The vilification clause was lifted in 

September 1998 when Texas settled its 

lawsuit against the tobacco industry 

without such restrictive language.69

The Florida settlement contained a “most 

favored nation” clause indicating that 

more favorable terms in subsequent 

settlements would apply retroactively to 

Florida: “The terms of this Settlement 

Agreement will be revised so that the State 

of Florida will obtain treatment at least as 

relatively favorable as any such non-federal 

governmental entity.”66 Therefore, the 

vilification clause was removed from the 

Florida settlement.

Florida’s “truth” campaign began in 

April 1998 with print and broadcast 

advertisements and expanded in 

June 1998 with billboard advertisements. 

In July 1998, the “Truth Train,” filled with 

youth, toured the state for 13 days to build 

awareness of the campaign and to recruit 

new members for SWAT as well as to call for 

Hollywood to refuse to glamorize tobacco 

in the movies.67 In September 1998, Florida 

State University released the results of a 

survey assessing youth awareness of the 

Florida “truth” campaign. Since the Florida 

“truth” campaign began, 57% of youth who 

were surveyed reported being aware of the 

campaign, 87% reported being aware of 

specific messages, and 47% believed that 

tobacco companies used deceptive practices 

in their advertising.70
567

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

From 1988 to 1999, current smoking 

dropped from 18.5% to 15.0% among 

middle school students and from 27.4% 

to 25.2% among high school students.71,72

Over two years, prevalence among middle 

school students dropped further to 11.1% 

and among high school students dropped 

to 22.6%.73

Despite this strong initial sign of success, 

Florida House General Appropriations 

Committee chair James E. King Jr. 

(R-Jacksonville) called for reduced program 

funding.74 (King was among the top 25 

recipients of tobacco industry campaign 

contributions during the 1997–98 election 

cycle.)47 Claims of ineffectiveness were made 

despite the September evaluation70 reporting 

broad exposure and awareness among youth 

and a spread of the belief that tobacco 

industry advertising was deceptive.

On December 11, 1998, Governor Chiles 

died suddenly of a heart attack, removing the 

Tobacco Pilot Program’s primary champion. 

In January 1999, Jeb Bush (R) was sworn 

in as governor. Despite the program’s 

success and popularity,73,75–77 Governor Bush 

proposed cutting its funding. His budget 

submitted to the legislature included 

$61.5 million as opposed to the $70.5 million 

allocated the previous year.78 The Senate 

Budget Subcommittee on Health and Human 

Services proposed cutting the program to 

$50 million.79 The House Health and Human 

Services’ budget panel for appropriations 

proposed eliminating the program, claiming 

that it was not working.80 As noted earlier, 

the tobacco industry supported such funding 

cuts in Minnesota in the early 1990s.20

Health advocates accepted Governor Bush’s 

budget proposal.67 However, the American 

Nonsmokers’ Rights Foundation responded 

by running a newspaper campaign urging the 

public to hold Governor Bush accountable 

for “truth” campaign budget cuts.

In April 1999, the House and Senate agreed to 

give the Tobacco Pilot Program $45.2 million 

for 1999–2000, a 36% reduction from the 

previous year’s $70.5 million. In May 1999, 

Governor Jeb Bush cut the program 

further to $38.7 million.67 The Jeb Bush 

administration then disassembled the 

program by laying off staff members 

and youth workers and reassigning 

responsibilities to spread the program over 

several different administrative divisions. 

In essence, this was the end of the program.

In summary, the tobacco industry found 

some success in the limitations placed 

on the Florida media campaign from its 

inception. The antivilification clause was 

lifted in Florida when Texas settled its 

lawsuit with the tobacco companies,69

but the Florida program’s restriction 

to target only youth under 18 years66

remained in place. Health advocates and 

officials effectively responded to this 

limitation by creating the cutting-edge 

“truth” campaign. Despite the campaign’s 

documented success in reducing youth 

smoking,71–73 its funding was severely 

cut. In their analysis of events leading 

up to and during the Florida campaign, 

Glantz and colleagues concluded that the 

tobacco industry’s efforts also benefited 

from financial donations to political allies 

who criticized the campaign’s value, thus 

contributing to its eventual demise.47,67

American Legacy 

Foundation

On November 23, 1998, attorneys general 

for the remaining 46 states, the District 

of Columbia, and five territories that had 

sued the tobacco industry over Medicaid 

costs related to smoking and other 

issues announced the Master Settlement 

Agreement.7 The MSA resolved the 

remaining state litigation against the 

tobacco industry, providing the states 

with money in perpetuity based on their 

estimated Medicaid costs due to smoking, 

cigarette sales, and inflation and imposing 
568

1 3 . To b a c c o I n d u s t r y E f f o r t s t o I n f l u e n c e To b a c c o C o n t r o l M e d i a

Print advertisement from the American Nonsmokers’ Rights Foundation urging the public to hold Governor Jeb Bush 

accountable for “truth” budget cuts.
569

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

some limitations on tobacco industry 

advertising to youth. A national public 

health foundation, later named the American 

Legacy Foundation, was established with 

$250 million paid over 10 years. A national 

public education campaign was established 

with $1.45 billion over the next five years. 

The attorneys general who negotiated the 

payments to the education fund agreed to 

a clause stating that the settling tobacco 

companies could end their payments to the 

public education fund if their aggregate 

market share dropped below 99.05% of the 

total domestic cigarette market, potentially 

ending funding for a substantial national 

tobacco control campaign after five years.7

The American Legacy Foundation’s purposes 

were “to support (1) the study of and 

programs to reduce Youth Tobacco Product 

usage and Youth substance abuse in the 

States and (2) the study of and educational 

programs to prevent diseases associated 

with the use of Tobacco Products in the 

States.”7 The tobacco industry pursued, 

and the attorneys general granted, several 

important restrictions in the MSA on 

Legacy’s activities. These included no 

“political activities or lobbying, including, 

but not limited to, support of or opposition 

to candidates, ballot initiatives, referenda 

or other similar activities.”7 This restriction 

was significant because it barred Legacy 

from supporting public advocacy for 

smokefree and other tobacco control policies 

that otherwise would have been permitted 

by a private foundation. As public policy 

interventions are the most effective way to 

reduce cigarette consumption,81,82 tobacco 

industry interests benefited from Legacy’s 

restriction from pursuing them.

Equally important, the attorneys general 

agreed that funds from the education 

account would be used only for “public 

education and advertising regarding the 

addictiveness, health effects, and social 

costs related to the use of tobacco products 

and shall not be used for any personal 

attack on, or vilification of, any person ... 

company, or governmental agency, whether 

individually or collectively.”7 This broad 

vilification clause constrained Legacy’s 

use of advertising portraying the tobacco 

industry as deceptive. Even so, Legacy acted 

aggressively in adopting Florida’s successful 

“truth” campaign. Although Florida’s 

“truth” media campaign was waning because 

of decreased funding under the Jeb Bush 

administration,67 Legacy turned the strategy 

into a national campaign. Continuing the 

course set in Florida, the national “truth” 

campaign effectively reduced smoking 

among teens77,83 and increased antitobacco 

attitudes and beliefs.84 Between 1999 and 

2002, youth smoking prevalence decreased 

from 25.3% to 18.0%, and 22% of this 

decline was attributed to the Legacy “truth” 

campaign.83 (See chapter 12.)

Although Legacy was established as part of 

the national settlement with the tobacco 

companies, it is not exempt from actions 

brought by tobacco companies, particularly 

in areas subject to the MSA vilification 

clause.51 For example, on January 18, 2002, 

Lorillard gave Legacy 30-day notice 

(required under the terms of the MSA) that 

it would file suit against the foundation 

in Wake County, North Carolina, alleging 

that the Legacy “truth” antismoking 

advertising campaign violated the terms 

of the MSA through personal attacks and 

vilification of the company.51 In response, 

Legacy filed a preemptive suit against 

Lorillard in New Castle County, Delaware, 

on February 13, 2002,85 arguing that, 

because it was not itself as an organization a 

signatory to the MSA, the terms of the MSA 

did not apply, and the 30-day notice was 

unnecessary.85 With knowledge of the nature 

of Lorillard’s complaints, Legacy asked the 

court for a declaratory judgment.

On January 31, 2003, after reviewing 

documents from both parties, the Delaware 

Chancery Court denied Legacy’s motion 

for summary judgment, moving the case to 
570

1 3 . To b a c c o I n d u s t r y E f f o r t s t o I n f l u e n c e To b a c c o C o n t r o l M e d i a

trial.47 The court stated that Lorillard had the 

right to pursue legal action against Legacy to 

enforce the provisions of the MSA. The court 

ruled in favor of Legacy, finding that simply 

criticizing the tobacco industry did not 

amount to vilification. It also provided a clear 

definition of the term vilification, allowing 

Legacy to continue its “truth” campaign 

by ensuring that it continued to avoid the 

now-defined practice of vilification. Lorillard 

appealed to the Delaware Supreme Court, 

which upheld the lower court decision.86

On March 21, 2003, Lorillard announced 

that it would place its share of MSA 

payments in escrow to prevent the 

funds from going to Legacy.87 Following 

correspondence between Vermont Attorney 

General William H. Sorrell, chair of 

the Tobacco Committee of the National 

Association of Attorneys General, and 

Lorillard, the tobacco company reversed its 

decision and made its annual payments on 

time on March 31, 2003.88 However, Lorillard 

also revised its initial claim for damages 

against Legacy from $1 to a complete return 

of the MSA payments made by Lorillard 

since 1999.87 The implications of such action 

by Lorillard in the decision in the case 

against Legacy were significant. If Lorillard 

won, the decision could serve as a precedent 

for other tobacco company signatories to 

the MSA to collect their payments as well, 

thereby leading to Legacy’s financial demise.

In June 2004, Lorillard dropped the claim 

that it was unjustly accused of adding 

urea to its cigarettes (the use of urea as 

a cigarette additive was the subject of a 

Legacy advertisement), stating, “We are not 

complaining that they [Legacy’s “truth” 

campaign] are saying urea is in cigarettes. 

What we are complaining about is the 

implication that Lorillard puts the equivalent 

of dog urine in cigarettes or that Lorillard 

would consider doing something like that.” 

(Personal communication from E. Vargyas, 

General Counsel, American Legacy 

The Tobacco Industry and the Youth Smoking Message

While the American Legacy Foundation’s media efforts were under way, the tobacco industry 

launched its own updated youth smoking prevention programs, which in the past had been 

thought to displace more effective tobacco control efforts.a As noted earlier, in Minnesota in 

the mid-1980s, the tobacco industry introduced its youth campaign, “Helping Youth Decide,” 

considered by some to be an attempt to delegitimize the utility and significance of the Minnesota 

Plan for Nonsmoking and Health.a,b Similarly, in 1998 Philip Morris introduced its national 

“Think. Don’t Smoke.” campaign, later shown to be associated with an increase in youths’ 

intention to smoke within the next year.c This program was discontinued in 2002.d From 1999, 

however, Philip Morris developed and ran a media campaign directed at parents, encouraging 

them to talk to their children about smoking.d Lorillard also launched a youth smoking 

prevention program in 1999 called “Tobacco Is Whacko if You’re a Teen.” Chapter 12 discusses 

studies that have evaluated these campaigns.

a

Landman, A., P. M. Ling, and S. A. Glantz. 2002. Tobacco industry youth smoking prevention programs: 

Protecting the industry and hurting tobacco control. American Journal of Public Health 92 (6): 917–30. 

b

Mozingo, R. Confidential information on new TI program. 13 Aug 1984. Tobacco Institute. Bates No. 

TIMN0150840. http://legacy.library.ucsf.edu/tid/poy82f00. 

c

Farrelly, M. C., C. G. Healton, K. C. Davis, P. Messeri, J. C. Hersey, and M. L. Haviland. 2002. Getting to the 

truth: Evaluating national tobacco countermarketing campaigns. American Journal of Public Health 92 (6): 

901–7. 

d

Farrelly, M. C., J. Niederdeppe, and J. Yarsevich. 2003. Youth tobacco prevention mass media campaigns: 

Past, present, and future directions. Tobacco Control 12 Suppl. 1: i35–i47.
571

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Foundation, to J. Ibrahim, 2004). Counsel 

for Lorillard indicated that the company had 

no intention of challenging the credibility of 

the comments about adding urea and that its 

focus was to challenge the vilification clause 

(personal communication from E. Vargyas 

to J. Ibrahim, 2004). On August 22, 2005, 

Judge Stephen P. Lamb ruled against 

Lorillard, stating that Legacy’s “truth” 

advertisements did not violate the MSA.51

Summary

In the past, the tobacco industry has 

worked to influence tobacco control media 

campaigns and diminish their impact.37,89

This chapter examined four primary 

strategies employed by the tobacco industry: 

preventing the creation of media campaigns, 

de-funding media campaigns through efforts 

such as claims of a fiscal crisis, weakening 

the message or limiting the audience of a 

campaign, and claiming that tobacco control 

efforts duplicate the tobacco industry’s own 

youth smoking prevention programs.

Tobacco industry strategies constantly 

evolve and adapt, as discussed further in 

chapter 6, making it more difficult for the 

public to differentiate between goodwill 

efforts from the tobacco companies to 

prevent smoking by youth and diversionary 

tactics to prevent meaningful efforts to 

reduce tobacco consumption. The benefits 

of tobacco control media campaigns can be 

reinforced among the public and elected 

officials where supported by the evidence, 

and health advocates can anticipate 

the nature of the above-mentioned 

counterefforts that could diminish the 

effectiveness of their campaigns.

Conclusions

1. Tobacco industry efforts to impede 

tobacco control media campaigns 

include attempts to prevent or reduce 

their funding. Examples include 

opposition to a tobacco tax increase 

intended to fund media campaigns in 

California and claims that a “budget 

crisis” precluded spending on tobacco 

control media campaigns in Minnesota. 

2. Efforts to weaken the messages or 

reduce the size of the target audience 

in tobacco control media campaigns 

include restricting the scope of 

Arizona’s Proposition 200 initiative to 

address specific topics such as nicotine 

addiction and to target only children and 

pregnant women and, in the American 

Legacy Foundation’s “truth” campaign, 

disallowing public policy advocacy and 

vilification of the tobacco industry. 

3. The tobacco industry has cited its 

own media campaigns—such as 

“Helping Youth Decide,” “Think. 

Don’t Smoke,” and “Tobacco Is 

Whacko if You’re a Teen”—to argue 

that government-funded campaigns 

duplicate these efforts and waste 

taxpayer dollars. This strategy was seen 

first in Minnesota and leading up to 

and following the 1998 signing of the 

Master Settlement Agreement.

4. Increasing consumer awareness of 

tobacco industry activities to counteract 

public-health-sponsored campaigns 

designed to reduce tobacco use can be 

an important component of effective 

media interventions. 
572

1 3 . To b a c c o I n d u s t r y E f f o r t s t o I n f l u e n c e To b a c c o C o n t r o l M e d i a

References 

1. National Cancer Institute. 2005. ASSIST: 

Shaping the future of tobacco prevention 

and control (Tobacco control monograph 

no. 16, NIH publication no. 05-5645). 

Bethesda, MD: National Cancer Institute. 

http://cancercontrol.cancer.gov/tcrb/

monographs/16/index.html.

2. Action on Smoking and Health. 1999. How 

Banzhaf’s successful antismoking crusade 

began. Washington, DC: Action on Smoking 

and Health. http://www.no-smoking.org/

nov99/11-18-99-1.html.

3. Limburg, V. E. 2005. Fairness doctrine: U.S. 

broadcasting policy. http://www.museum

.tv/archives/etv/F/htmlF/fairnessdoct/

fairnessdoct.htm.

4. Warner, K. E. 1979. Clearing the airwaves: 

The cigarette ad ban revisited. Policy 

Analysis 5 (4): 435–50. 

5. Hamilton, J. L. 1972. The demand for 

cigarettes: Advertising, the health scare, 

and the cigarette advertising ban. Review 

of Economics and Statistics 54 (4): 401–11. 

6. Federal Trade Commission. 2003. Federal 

Trade Commission cigarette report for 

2001. http://www.ftc.gov/os/2003/06/

2001cigreport.pdf.

7. National Association of Attorneys General. 

1998. Multistate settlement with the tobacco 

industry. http://library.ucsf.edu/tobacco/

litigation/msa.pdf.

8. Minnesota Department of Health. The 

Minnesota plan for nonsmoking and 

health. Sep 1984. Tobacco Institute. Bates 

No. 680581549/1755. http://legacy.library

.ucsf.edu/tid/lcg04f00.

9. R.J. Reynolds. Salem 1977 annual 

marketing plan. 1977. R. J. Reynolds. Bates 

No. 505774500/4514. http://legacy.library

.ucsf.edu/tid/ofs05d00.

10. Brozek, M. F. Memorandum to Roger 

Mozingo regarding Minnesota legislative 

status. 11 Apr 1985. Brown & Williamson. 

Bates No. 680581757/1765. http://legacy

.library.ucsf.edu/tid/ncg04f00.

11. Tobacco Institute. [Public relations 

strategies to address the Minnesota plan 

for nonsmoking and health]. Sep 1984.

 Tobacco Institute. Bates No. TIMN0140510/

0525. http://legacy.library.ucsf.edu/tid/

nia92f00.

12. Brozek, M. F. Memorandum to Michael J.

Kerrigan regarding the Minnesota Technical 

Advisory Committee on Nonsmoking and 

Health. 27 Sep 1984. Brown & Williamson. 

Bates No. TIMN0458234/8237. http://

legacy.library.ucsf.edu/tfid/ess42f00.

13. Landman, A., P. M. Ling, and S. A. Glantz. 

2002. Tobacco industry youth smoking 

prevention programs: Protecting the industry 

and hurting tobacco control. American 

Journal of Public Health 92 (6): 917–30. 

14. Minnesota Department of Health. 1989. 

The Minnesota Tobacco-Use Prevention 

Initiative, 1987–1988: A report to the 

1989 legislature. Saint Paul: Minnesota 

Department of Health.

15. U.S. Department of Health and Human 

Services. 1989. Reducing the health 

consequences of smoking: 25 years of 

progress. A report of the Surgeon General 

(DHHS publication no. [CDC] 89-8411). 

Rockville, MD: U.S. Department of Health 

and Human Services, Public Health Service, 

Centers for Disease Control, National Center 

for Chronic Disease Prevention and Health 

Promotion, Office on Smoking and Health. 

http://profiles.nlm.nih.gov/NN/B/B/X/S/.

16. Minnesota Department of Health. 1987. 

The Minnesota nonsmoking initiative, 

June, 1985–December, 1986: A report to 

the 1987 legislature. Saint Paul: Minnesota 

Department of Health.

17. Minnesota Department of Health. 1991. 

Minnesota Tobacco-Use Prevention 

Initiative, 1989–1990: A report to the 

1991 legislature. Saint Paul: Minnesota 

Department of Health.

18. Brozek, M. F., and D. C. Nelson. 

Memorandum to William A. Cannell 

regarding Minnesota plan/status report. 

6 Jan 1988. Brown & Williamson. Bates 

No. TIMN0457497/7504. http://legacy

.library.ucsf.edu/tid/ddt42f00.

19. Tsoukalas, T. H., J. K. Ibrahim, and 

S. A. Glantz. 2003. Shifting tides: Minnesota 

tobacco politics. San Francisco: Univ. of 

California, Institute for Health Policy 

Studies, Center for Tobacco Control 

Research and Education. http://repositories

.cdlib.org/cgi/viewcontent.cgi?article=1039

&context=ctcre. 

20. Parker, W., and St. Paul Pioneer Press.

Anti-smoking budget cut one-third. 

18 Apr 1990. Tobacco Institute. Bates 

No. TIMN0459012. http://legacy.library.ucsf

.edu/tid/bsr42f00.
573

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

21. Centers for Disease Control and Prevention. 

1991. Smoking prevalence among selected 

adult demographic groups in participating 

states: Behavioral risk surveillance system, 

1986–1990. Morbidity and Mortality Weekly 

Report 40 (SS-4): 13. 

22. Ragsdale, J. 1994. Fund-raiser has foes 

fuming: Tobacco lobbyists among sponsors 

of Carlson event. St. Paul Pioneer Press, 

October 4.

23. Tobacco Institute. 1993. 1994 proposed 

budget. Tobacco Institute. http://www

.tobaccodocuments.org//lor/91082882-2938

.html.

24. McGrath, D. J. 1993. Behind the budget 

fight: Politics and prudence. Minneapolis 

Star Tribune, May 23.

25. Gordon, G., and T. Hamburger. 1999. 

Minnesota no longer leads the pack: Health 

experts cite decline in antismoking efforts. 

Minneapolis Star Tribune, May 23.

26. Tsoukalas, T. H. 2000. Interview by J. Knapp. 

May 10.

27. Tsoukalas, T. H. 2000. Interview by 

J. Weigum. May 9.

28. Anderson, S. J., R. W. Pollay, and 

P. M. Ling. 2006. Taking ad-Vantage of 

lax advertising regulation in the USA 

and Canada: Reassuring and distracting 

health-concerned smokers. Social Science 

and Medicine 63 (8): 1973–85. 

29. Glantz, S. A., and E. D. Balbach. 2000. 

Tobacco war: Inside the California battles. 

Berkeley: Univ. of California Press.

30. California Department of Health Services. 

2000. California’s Tobacco Education 

Media Campaign. Sacramento: California 

Department of Health Services, Tobacco 

Control Section. http://www.dhs.ca.gov/

tobacco/documents/pubs/FSMediaCamp.pdf.

31. California Department of Health Services. 

2002. California’s Tobacco Education Media 

Campaign scripts. Sacramento: California 

Department of Health Services, Tobacco 

Control Section. 

32. California Department of Health Services. 

1998. A model for change: The California 

experience in tobacco control. Paper 

presented at the National Tobacco Conference, 

Saint Paul. http://web.archive.org/web/

20000925170524/http://www.dhs.ca.gov/

tobacco/documents/modelforchange.pdf.

33. Glantz, S. A. 1999. Tobacco biology and 

politics: An exposé of fraud and deception. 

Waco, TX: HEALTH EDCO.

34. Keye, P. F. What don’t we know, and when 

haven’t we known it? Speech presented 

at Health Communications Day, Johns 

Hopkins Univ., Baltimore. 13 Oct 1993. 

R.J. Reynolds. Bates No. 520697096/7109. 

http://legacy.library.ucsf.edu/tid/llm97c00.

35. Keye/Donna/Pearlstein. 1990. Industry 

spokesman. Video advertisement. 

Los Angeles: Keye/Donna/Pearlstein.

36. Malmgren, K. L. Memo to Samuel D. 

Chilcote, Jr. 18 Apr 1990. Tobacco Institute. 

Bates No. 87700741/0744. http://legacy

.library.ucsf.edu/tid/xbo21e00.

37. Eagan, J. Prop 99 Anti-Smoking Media 

Campaign. 30 May 1990. R.J. Reynolds. 

Bates No. 507640367/0370. http://legacy

.library.ucsf.edu/tid/qxd24d00.

38. Philip Morris. Pete Wilson. Memorandum. 

24 Apr 1990. Philip Morris. Bates No. 

2072914850/4893. http://legacy.library.ucsf

.edu/tid/fqo95c00.

39. State of California. 1992. Governor’s budget 

1992–93. Sacramento: State of California, 

Office of the Governor.

40. Pierce, J. P. 1992. Evaluating Proposition 99 

in California. Speech at the American Heart 

Association, Nineteenth Science Writers 

Forum.

41. Fichtenberg, C. M., and S. A. Glantz. 2000. 

Association of the California Tobacco 

Control Program with declines in cigarette 

consumption and mortality from heart 

disease. New England Journal of Medicine 

343 (24): 1772–77. 

42. Independent Evaluation Consortium. 1998. 

Final report of the independent evaluation 

of the California Tobacco Control 

Prevention and Education Program: 

Wave 1 data, 1996–1997. Rockville, MD: 

Gallup Organization.

43. Independent Evaluation Consortium. 1998. 

Interim report. Independent evaluation of 

the California Tobacco Control Prevention 

and Education Program: Wave 2 data, 

1998; Wave 1 and wave 2 data comparisons, 

1996–1998. Rockville, MD: Gallup 

Organization.

44. California Department of Health Services. 

2003. Proposition 99 health education 

account, TCS funding, and tobacco 

settlement fund budget appropriation 

summary. Sacramento: California 

Department of Health Services.

45. Givel, M. S., J. Dearlove, and S. A. Glantz. 

2001. Tobacco policy making in 
574

1 3 . To b a c c o I n d u s t r y E f f o r t s t o I n f l u e n c e To b a c c o C o n t r o l M e d i a

California 1999–2001: Stalled and adrift. 

San Francisco: Univ. of California, Institute 

for Health Policy Studies. http://www.library

.ucsf.edu/tobacco/ca2001. 

46. Givel, M. S., and S. A. Glantz. 2001. Tobacco 

lobby political influence on US state 

legislatures in the 1990s. Tobacco Control 

10 (2): 124–34. 

47. Givel, M. S., and S. A. Glantz. 1999. Tobacco 

industry political power and influence in 

Florida from 1979 to 1999. San Francisco: 

Univ. of California, Institute for Health 

Policy Studies. http://repositories.cdlib.org/

cgi/viewcontent.cgi?article=1006&context

=ctcre. 

48. State of California. 2001. Governor’s budget, 

2002–2003. Sacramento: State of California, 

Office of the Governor.

49. State of California. 2002. Governor’s budget, 

2003–2004. Sacramento: State of California, 

Office of the Governor.

50. R.J. Reynolds Tobacco Co. v. Bonta, 272 F 

Supp. 2d 1085 (2003).

51. Ibrahim, J. K., and S. A. Glantz. 2006. 

Tobacco industry litigation strategies to 

oppose tobacco control media campaigns. 

Tobacco Control 15 (1): 50–58. 

52. R.J. Reynolds Tobacco Co. v. Shewry, 

No. 03-16535 (E.D. Cal., filed Sept. 28, 

2004). http://www.publichealthlaw.net/

Reader/docs/Shewry.pdf.

53. Bialous, A. S., and S. A. Glantz. 1997. 

Tobacco control in Arizona, 1973–1997. 

San Francisco: Univ. of California, Institute 

for Health Policy Studies, Center for 

Tobacco Control Research and Education. 

http://repositories.cdlib.org/cgi/viewcontent

.cgi?article=1000&context=ctcre.

54. Bialous, S. A., and S. A. Glantz. 1999. 

Arizona’s tobacco control initiative illustrates 

the need for continuing oversight by tobacco 

control advocates. Tobacco Control 8 (2): 

141–51. 

55. Cannella, D. 1994. Cigarette-tax backers 

assail Symington. Arizona Republic, May 4.

56. Bush, C. 1994. Senate president speaks 

out against tobacco tax initiative. Arizona 

Capitol Times, January 7.

57. Bush, C. 1994. Tobacco tax promoters 

publicize allegations of industry conspiracy. 

Arizona Capitol Times, May 6.

58. Arizona Revised Statutes. Laws of 1995, 

Chapter 275, tobacco tax.

59. Fischer, H. 1995. Back from the dead. Tempe 

Daily News Tribune, April 10.

60. Fischer, H. 1995. Lawmakers OK state 

liquor panel to regulate product sales. 

Arizona Daily Star, April 6.

61. Arizona Department of Health Services. 

1995. Solicitation Number H6-001: Media 

services. Phoenix: Arizona Department 

of Health Services, Administrative and 

Financial Services, Procurement Office.

62. Ventura, S. J., W. D. Mosher, S. C. Curtin, 

J. C. Abma, and S. Henshaw. 2001. Trends 

in pregnancy rates for the United States, 

1976–97: An update. National Vital 

Statistics Reports 49 (4): 1–9. 

63. Hill, D. 1999. Why we should tackle adult 

smoking first. Tobacco Control 8 (3): 

333–35. 

64. Porter, R. S., V. R. Gowda, K. Kotchou, 

K. Nodora, and R. Leischow. 2001. Tobacco 

use among adults: Arizona, 1996 and 1999. 

Morbidity and Mortality Weekly Report

50 (20): 402–6. 

65. Florida v. American Tobacco Co.,

No. 951466AO (Fla., Palm Beach Cty. 1995), 

cited in 10.1 TPLR 3.1 (1995).

66. Florida v. American Tobacco Co., C.A. 

95-1466 AH (Fla., Palm Beach Cty. 1997) 

(Settlement Agreement).

67. Givel, M. S., and S. A. Glantz. 2000. Failure 

to defend a successful state tobacco control 

program: Policy lessons from Florida. 

American Journal of Public Health 90 (5): 

762–67. 

68. Hicks, J. J. 2001. The strategy behind 

Florida’s “Truth” campaign. Tobacco Control 

10 (1): 3–5. 

69. Texas v. American Tobacco Co., 5-96CV-9 

(U.S. D.C. E.D. Tex., Texarkana Div. 1998). 

http://legacy.library.ucsf.edu/tid/ojm61c00.

70. Florida State University. 1998. Florida 

anti-tobacco media evaluation: Report on 

September 1998 survey results. Tallahassee: 

Florida State Univ.

71. University of Michigan. Institute for Social 

Research. 2004. Monitoring the Future: 

1999 data from in-school surveys of 8th, 

10th, 12th grade students. Rockville, MD: 

U.S. Department of Health and Human 

Services, National Institutes of Health, 

National Institute on Drug Abuse.

72. Friend, K., and D. T. Levy. 2002. Reductions 

in smoking prevalence and cigarette 

consumption associated with mass-media 

campaigns. Health Education Research 

17 (1): 85–98. 
575

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

73. Bauer, U. E., T. M. Johnson, R. S. Hopkins, 

and R. G. Brooks. 2002. Changes in youth 

cigarette use and intentions following 

implementation of a tobacco control 

program: Findings from the Florida 

Youth Tobacco Survey, 1998–2000. JAMA: 

The Journal of the American Medical 

Association 284 (6): 723–28. 

74. McKinnon, J. 1998. Lawmaker questions 

the effectiveness of anti-smoking ads. 

Wall Street Journal, November 11.

75. Sly, D. F., G. R. Heald, and S. Ray. 2001. 

The Florida “Truth” anti-tobacco media 

evaluation: Design, first year results, and 

implications for planning future state media 

evaluations. Tobacco Control 10 (1): 9–15. 

76. Sly, D. F., E. Trapido, and S. Ray. 2002. 

Evidence of the dose effects of an 

antitobacco counteradvertising campaign. 

Preventive Medicine 35 (5): 511–18. 

77. Niederdeppe, J., M. C. Farrelly, and 

M. L. Haviland. 2004. Confirming “Truth”: 

More evidence of a successful tobacco 

countermarketing campaign in Florida. 

American Journal of Public Health 94 (2): 

255–57. 

78. Tallahassee Democrat. 1999. Florida’s key 

legislative issues for 1999. Tallahassee 

Democrat, February 28.

79. Kennedy, J. 1999. “Truth” drive director 

is ousted. http://pqasb.pqarchiver.com/

orlandosentinel/results.html?st=basic

&QryTxt=drive+director+is+ousted.

80. Kennedy, J., and R. Perez. 1999. Tobacco: ad 

fight is not our doing: Some lawmakers don’t 

think the anti-smoking campaign aimed at 

teens is effective and are threatening to cut 

funds. Orlando Sentinel, March 12.

81. Aguinaga, S., and S. A. Glantz. 1995. The 

use of public records acts to interfere with 

tobacco control. Tobacco Control 4 (3): 

222–30. 

82. White, J., and L. A. Bero. 2004. Public 

health under attack: The American Stop 

Smoking Intervention Study (ASSIST) and 

the tobacco industry. American Journal of 

Public Health 94 (2): 240–50. 

83. Farrelly, M. C., K. C. Davis, M. L. Haviland, 

P. Messeri, and C. G. Healton. 2005. 

Evidence of a dose-response relationship 

between “Truth” antismoking ads and youth 

smoking prevalence. American Journal of 

Public Health 95 (3): 425–31. 

84. Farrelly, M. C., C. G. Healton, K. C. Davis, 

P. Messeri, J. C. Hersey, and M. L. Haviland. 

2002. Getting to the truth: Evaluating 

national tobacco countermarketing 

campaigns. American Journal of Public 

Health 92 (6): 901–7. 

85. American Legacy Foundation v. Lorillard 

Tobacco Co., 2002 WL 927383, at *2.3 

(Del. Ch. Apr. 29, 2002).

86. Ibrahim, J. K., and S. A. Glantz. 2007. 

The rise and fall of tobacco control media 

campaigns, 1967–2006. American Journal 

of Public Health 97 (8): 1383–96. 

87. Cartwright, J. 2003. American Legacy 

Foundation calls Lorillard plan to tie up 

funding unwarranted and harmful: NAAG 

tobacco committee chairman says MSA 

does not permit Lorillard action and warns 

of “enforcement proceedings” against the 

company. Press release. Washington, DC: 

American Legacy Foundation. http://www

.americanlegacy.org/977.aspx.

88. Cartwright, J. 2003. American Legacy 

Foundation receives last major tobacco 

settlement payment: Foundation challenges 

tobacco industry to continue funding 

lifesaving programs. Press release. 

Washington, DC: American Legacy 

Foundation. http://www.americanlegacy

.org/959.aspx.

89. Balbach, E. D., and S. A. Glantz. 1998. 

Tobacco control advocates must demand 

high-quality media campaigns: The 

California experience. Tobacco Control 7 (4): 

397–408. 

577

14

Tobacco Industry Media Efforts 

to Defeat State Tobacco Control 

Ballot Initiatives and Referenda

Ballot initiatives that allow voters to enact new legislation, and referenda that allow 

voters to approve or disapprove legislation enacted by legislatures, are effective means of 

promulgating tobacco control legislation. This chapter examines the tobacco industry’s 

use of media to counter these ballot measures in a sample of the 42 state-level tobacco 

measures voted on from 1988 to 2006. An analysis of selected tobacco industry media 

campaigns demonstrated several primary themes—that these measures would create 

unfair tax increases or divert funds from intended objectives, impinge on personal choice, 

or constitute wasteful government spending. Despite these efforts, voters ultimately passed 

28 tobacco control initiatives and referenda and defeated 4 tobacco industry-sponsored 

initiatives, yielding a 76% success rate for tobacco control advocates. The following 

campaigns are discussed:

n	 California’s Proposition 99, a 1988 initiative increasing the tobacco tax by 

25¢ per pack to fund antitobacco health education, research, health care, 

and related programs

n	 Massachusetts’s Question 1, a 1999 initiative to increase tobacco taxes by 

25¢ per pack for a health protection fund to pay for tobacco education, cessation, 

and prevention programs

n	 Oklahoma’s State Question 713, a 2004 referendum to increase the tobacco tax 

by 4¢ per cigarette to fund health care and tobacco cessation programs

n	 Montana’s Initiative 149, a 2004 ballot measure increasing a variety of tobacco 

taxes to fund health care, prescription drug, nursing home, and other programs

n	 Colorado’s Amendment 35, a 2004 initiative to raise cigarette taxes by 64¢ a pack 

to fund health care and tobacco education and cessation programs

n	 California’s Proposition 86, a 2006 initiative to raise cigarette taxes by $2.60 a 

pack to fund health programs, children’s health insurance coverage, and tobacco 

use prevention programs

n	 Missouri’s Amendment 3, a 2006 initiative to raise taxes by 4¢ per cigarette 

and 20% on all other tobacco products to fund health care and tobacco use 

prevention programs
578

1 4 . To b a c c o I n d u s t r y M e d i a E f f o r t s

Introduction

This chapter examines the use of initiatives 

and referenda to pass antitobacco legislation 

by direct vote. It focuses on state initiatives 

and referenda in which voters were voting 

only on a tobacco tax increase. It also 

explores the tobacco industry’s use of media 

in its attempts to prevent such legislation, 

covering ballot measures taking place from 

1988 to 2006. The years 1988 to 2006 were 

chosen for this study because they provide 

a suitable duration of time to counter any 

potential bias caused by short-term changes 

in an examination of modern state tobacco 

initiative and referendum trends that started 

in 1988 with California’s groundbreaking 

Proposition 99.

Initiatives are a direct vote by the people on 

legislation, while referenda refer to direct 

votes by the people to approve or disapprove 

legislation enacted by legislatures.1

Both represent means for tobacco 

control advocates to bypass protobacco 

constituencies in state legislatures and enact 

legislation directly by popular support.

In the latter part of the 19th century, a 

very strong agrarian and labor populist 

movement, particularly so in the American 

Midwest and the South, arose to challenge 

the concentrated political power and abusive 

practices of monopolistic corporations in a 

variety of economic sectors.2–7 The populist 

movement proposed several significant 

reforms such as a progressive income tax, 

public ownership of railroads, and direct 

votes of the people to approve or disapprove 

legislation.4,8,9 The preamble to the 1892 

Omaha Platform of the Populist Party 

clearly stated the primary reason for these 

proposals (including the call for a direct 

vote by the people):

The conditions which surround us best 

justify our cooperation: we meet in the 

midst of a nation brought to the verge 

of moral, political, and material ruin. 

Corruption dominates the ballot-box, the

legislatures, the Congress, and touches even 

the ermine of the bench. The people are 

demoralized; most of the States have been 

compelled to isolate the voters at the polling 

places to prevent universal intimidation 

and bribery. The newspapers are largely 

subsidized or muzzled, public opinion 

silenced, business prostrated, homes covered 

with mortgages, labor impoverished, and 

the land concentrating in the hands of the 

capitalists. The urban workmen are denied 

the right to organization for self-protection, 

imported pauperized labor beats down 

their wages, a hireling standing army, 

unrecognized by our laws, is established 

to shoot them down, and they are rapidly 

degenerating into European conditions. 

The fruits of the toil of millions are badly 

stolen to build up colossal fortunes for a few, 

unprecedented in the history of mankind; 

and the possessors of these, in turn, despise 

the Republic and endanger liberty.8

Although this strong current of agrarian 

and labor protest subsided by 1896, the 

movement continued to promote direct 

votes by the people.1 Entrenched large 

corporations opposed legislation allowing a 

direct vote by the people. However, in 1898, 

South Dakota became the first state to enact 

initiative legislation (table 14.1),9

 quickly 

followed by 19 mostly western and southern 

states from 1900 to 1918. Since 1918, only 

four states have enacted some form of state 

initiative and/or referendum. In 2005, 

18 states allowed voters to enact by initiative 

a constitutional amendment, 21 allowed 

enactment via a state statute, and 27 states 

allowed some form of initiative and/or 

referendum (tables 14.1 and 14.2).

The populists’ call for a direct vote of 

the people—to bypass the stranglehold 

of powerful corporate interests, such as 

the oil and railroad industries, over state 

legislatures—is as salient today as it was more 

than a century ago.9–11 From 1988 to 2006, 

direct referendum and initiative votes by the 

people for state antitobacco legislation—

which would bypass the influence of the 
579

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

tobacco industry in state legislatures—

occurred 42 times in 17 states (including four 

protobacco industry-sponsored initiatives) 

(table 14.3).12,13 Tobacco industry interests 

frequently used media channels to attempt 

to sway public opinion against these ballot 

measures. Despite these efforts, the success of 

many of these initiatives demonstrates how, 

through direct votes, antitobacco advocates 

can undertake initiative and referendum 

efforts to bypass state legislatures and enact 

vigorous antitobacco programs.

Criticisms of State 

Initiatives and 

Referenda

Critics argue that direct votes of the people 

in policy areas (such as state antitobacco 

legislation) violate a founding principle in 

the establishment of the U.S. Constitution 

that the United States is a republican form 

of government.14,15 Rather than governance 

Table 14.1 U.S. States in 2005 with Statewide Initiatives and Referenda

State Date adopted Initiative Referenda

South Dakota 1898/1972/1988 Yes Yes

Utah 1900/1917 Yes Yes

Oregon 1902 Yes Yes

Nevada 1908 Yes Yes

Montana 1904/1972 Yes No

Oklahoma 1907 Yes Yes

Missouri 1908 Yes Yes

Michigan 1908 Yes Yes

Maine 1908 Yes Yes

Arkansas 1910 Yes Yes

Kentucky 1910 No Yes

Arizona 1911 Yes Yes

California 1911 Yes Yes

New Mexico 1911 No Yes

Idaho 1912 Yes Yes

Colorado 1912 Yes Yes

Nebraska 1912 Yes Yes

Washington 1912 Yes Yes

Ohio 1912 Yes Yes

Mississippi 1914/1992 Yes No

North Dakota 1914 Yes Yes

Maryland 1915 No Yes

Massachusetts 1918 Yes Yes

Alaska 1956 Yes Yes

Wyoming 1968 Yes Yes

Illinois 1970 Yes No

Florida 1972 Yes No

Total 24 23

Note. NA = not applicable. From University of Southern California. Initiative and Referendum Institute. 2004. States with direct and 

indirect initiative amendments: Direct and indirect initiative statutes and popular referendum. http://www.iandrinstitute.org.
580

1 4 . To b a c c o I n d u s t r y M e d i a E f f o r t s

by the people through direct votes on 

legislation, a republican form of government 

means that representatives chosen through 

elections govern the people.

In addition, critics of direct votes by the 

people often indicate that initiatives and 

referenda are poorly written.14,15 This 

argument overlaps the first argument 

because the job of elected officials in a 

republican form of government is to write 

intelligent and effective legislation for the 

public good. This often does not occur with 

ad hoc initiatives and referenda. Moreover, 

critics charge that if the initiatives 

or referenda are “locked in” as a state 

constitutional amendment, then such poorly 

written legislation diminishes the public 

Table 14.2 U.S. States in 2005 by Type of Initiative Allowed

State Date adopted

Initiative to adopt 

state constitutional 

amendment

Initiative to adopt 

state statute

South Dakota 1898/1972/1988 Yes Yes

Utah 1900/1917 No Yes

Oregon 1902 Yes Yes

Nevada 1908 Yes Yes

Montana 1904/1972 Yes Yes

Oklahoma 1907 Yes Yes

Missouri 1908 Yes Yes

Michigan 1908 Yes Yes

Maine 1908 No Yes

Arkansas 1910 Yes Yes

Kentucky NA No No

Arizona 1911 Yes Yes

California 1911 Yes Yes

New Mexico NA No No

Idaho 1912 No Yes

Colorado 1912 Yes Yes

Nebraska 1912 Yes Yes

Washington 1912 No Yes

Ohio 1912 Yes Yes

Mississippi 1914/1992 Yes No

North Dakota 1914 Yes Yes

Maryland NA No No

Massachusetts 1918 Yes Yes

Alaska 1956 No Yes

Wyoming 1968 No Yes

Illinois 1970 Yes No

Florida 1972 Yes No

Total 18 21

Note. NA = not applicable. From University of Southern California. Initiative and Referendum Institute. 2004. States with direct and 

indirect initiative amendments: Direct and indirect initiative statutes and popular referendum. http://www.iandrinstitute.org.
581

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Table 14.3 Tobacco Control State Initiatives and Referenda from 1988 to 2006

State Year Measure type Measure number Subject matter Passed?

California 1988 Initiative Proposition 99 Tax increase Yes

Montana 1990 Initiative I-115 Tax increase No

Massachusetts 1992 Initiative Question 1 Tax increase Yes

Arizona 1994 Initiative Proposition 200 Tax increase Yes

California 1994 Initiative Proposition 186 Tax increase No

Californiaa 1994 Initiative Proposition 188 Preemption of local clean 

indoor air regulations

No

Colorado 1994 Initiative Amendment 1 Tax increase No

Michigan 1994 Referendum Proposal A General tax increase that 

included tobacco tax increase

Yes

Arizona 1996 Initiative Proposition 200 Tax increase Yes

Oregon 1996 Initiative Measure 44 Tax increase Yes

California 1998 Initiative Proposition 10 Tax increase Yes

Arizona 2000 Initiative Proposition 200 Tax increase Yes

Arizona 2000 Initiative Proposition 204 MSA funding for health care Yes

Arkansas 2000 Initiative Act 1 MSA funding for university 

facilities

Yes

Montana 2000 Referendum C-35 MSA funding for health care 

and tobacco control

Yes

Oklahoma 2000 Referendum State Question 692 Creates tobacco settlement 

trust fund

Yes

Oregon 2000 Initiative Measure 4 MSA funding for health care No

Oregon 2000 Referendum Measure 89 MSA funding for health, 

housing, and transportation

No

Utah 2000 Referendum Proposition 2 Creates tobacco settlement 

trust fund

Yes

Washington 2001 Initiative Measure 773 Tax increase Yes

Arizona 2002 Referendum Proposition 303 Tax increase Yes

Florida 2002 Initiative Amendment 6 Smoke-free worksites and 

public places

Yes

Michigan 2002 Initiative Proposal 02-4 MSA funding for health care 

and tobacco control

No

Missouri 2002 Initiative Proposition A Tax increase No

Montana 2002 Initiative I-146 MSA funding for state 

tobacco prevention program

Yes

Oklahoma 2002 Referendum State Question 701 Modifies tobacco trust fund 

expenditures

No

Oregon 2002 Referendum Measure 15 Bonds for public education 

and earthquake repairs paid 

by tobacco settlement funds

Yes

Oregon 2002 Referendum Measure 16 Bonds for emergency services 

and earthquake repairs paid 

by tobacco settlement funds

Yes

Colorado 2004 Initiative Amendment 35 Tax increase Yes

Oklahoma 2004 Referendum State Question 713 Tax increase Yes
582

1 4 . To b a c c o I n d u s t r y M e d i a E f f o r t s

good. This is particularly true, as many 

critics argue, if voters are not “competent” 

to make informed decisions regarding 

complicated public policy issues.14,15

Yet another criticism of direct voting by the 

people is that initiatives and referenda have 

become a tool of well-financed and powerful 

special interests, and these special interests 

dominate the process.14,15 Syndicated 

columnist David Broder strongly argued 

for this position in Democracy Derailed: 

The Initiative Movement and the Power of 

Money.14 This trend, according to critics 

such as Broder, is contrary to the original 

intent of populist reformers—to bypass 

special-interest-dominated state legislatures 

and directly enact needed reforms that 

benefit average citizens.

These debates are particularly relevant 

to tobacco-tax initiatives and referenda 

in which tobacco control advocates, and 

in some cases the tobacco companies, 

attempted to bypass opposing interests 

in the legislatures and sought direct 

mandate from the voters. This chapter 

focuses on how the tobacco industry, 

using various forms of often expensive 

media communication approaches (most 

campaigns now are media based), has 

attempted since 1988 to frame campaigns 

to defeat state initiatives and referenda 

run by health and antitobacco reformers.16

The remainder of this chapter will explore 

this question using seven case studies of 

initiatives and referenda to increase tobacco 

taxes among the 20 tobacco tax initiatives 

introduced between 1988 and 2006.

Table 14.3 Tobacco Control State Initiatives and Referenda from 1988 to 2006 (continued)

State Year Measure type Measure number Subject matter Passed?

Montana 2004 Initiative I-149 Tax increase Yes

Arizona 2006 Initiative Proposition 201 Smoke-free worksites and 

public places

Yes

Arizona 2006 Initiative Proposition 203 Tax increase Yes

Arizonaa 2006 Initiative Proposition 206 Smoke-free worksite and 

public places

No

Florida 2006 Initiative Amendment 4 MSA funding for state 

tobacco prevention and 

cessation programs

Yes

Nevadaa 2006 Initiative Question 4 Smoke-free worksites and 

public places

No

Nevada 2006 Initiative Question 5 Smoke-free worksites and 

public places

Yes

Ohioa 2006 Initiative Issue 4 Smoke-free worksites and 

public places

No

Ohio 2006 Initiative Issue 5 Smoke-free worksites and 

public places

Yes

South Dakota 2006 Initiative Measure 2 Tax increase Yes

California 2006 Initiative Proposition 86 Tax increase No

Missouri 2006 Initiative Amendment 3 Tax increase No

Note: MSA = Master Settlement Agreement. From National Conference of State Legislatures. 2004. Initiatives and referenda: Tobacco. 

http://www.ncsl.org/ncsldb/elect98/irsrch.cfm. University of Southern California. Initiative and Referendum Institute. 2007. States with 

direct and indirect initiative amendments: Direct and indirect initiative statutes and popular referendum. http://www.iandrinstitute.org.

a

In these four states, voters rejected tobacco industry–sponsored ballot initiatives that were much weaker than legislation supported 

by health groups: Proposition 188 in California, Proposition 206 in Arizona, Question 4 in Arizona, Question 4 in Nevada, and Issue 4 

in Ohio.
583

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

General Role of Media 

in State Initiatives and 

Referenda

Support can be mobilized through framing 

(a way to define a problem and suggest a 

solution17) a message for or against state 

initiatives and referenda, such as those for 

tobacco tax increases. As some scholars 

have argued, the side that can purchase 

more media exposure in key markets can 

significantly influence the outcome of these 

elections.9 The use of media messages is a 

very important avenue to potentially reach 

and sway large numbers of voters.9

Opinion polls and focus groups are 

conducted in the beginning stage of 

many modern and professionally run 

direct democracy campaigns, often even 

before the language of the proposal has 

been written.18 This is done to identify 

which media themes might undermine 

the appeal of an initiative or referendum 

to voters and which media themes might 

enhance voters’ support for the initiative 

or referendum.18

These polls and focus group findings 

also are an important research tool in 

crafting the language of the initiative or 

referendum.18 Opponents of initiatives or 

referenda, particularly wealthy ones such 

as the tobacco industry, almost always 

conduct their own polls and focus groups 

to develop media themes to sway voters 

to oppose tobacco control initiatives or 

referenda.10,19 As the direct democracy 

campaign nears the actual election, many 

groups also use tracking polls to gauge 

Tobacco Control Initiatives: A Theoretical Perspective

In 1960, Schattschneidera provided an early examination in the field of political science and 

public policy of the connection between political mobilization of bias by groups and the public 

framing of an issue to effectively oppose or support public policies. This occurs, for instance, 

when the tobacco industry engages in media advertising to influence state tobacco tax initiative 

and referendum votes in its favor. Schattschneider argued that powerful interests, such as the 

tobacco industry, usually prefer to conduct policymaking in private because less public exposure 

means their policy goals usually are approved with the least political resistance. At the same 

time, an open and public struggle, as can occur with state initiatives and referenda, by ordinary 

citizens and organizations such as health groups with fewer political resources often can make 

the political process more competitive.

Theories expanding on Schattschneider’s mobilization of bias theory, such as Stone’s theory of 

causal stories in the policy process, have analyzed the function of political symbols and images in 

depicting problems and causal stories that are enacted into public policies.b,c,d According to Stone 

and others, symbols and images (including numerical) through media messages and arguments 

tell a particular story of what an interest group, such as the tobacco industry, supports in a 

manner that resonates with and can be easily understood by other people.b,c,d,e

a

Schattschneider, E. E. 1960. The semisovereign people. New York: Holt, Rinehart, and Winston. 

b

Stone, D. 1989. Causal stories and the formation of policy agendas. Political Science Quarterly 104 (2): 281–300.

c

Cobb, R., and M. H. Ross. 1997. Agenda setting and the denial of agenda access: Key concepts. In Cultural 

strategies of agenda denial: Avoidance, attack, and redefinition, ed. R. Cobb and M. H. Ross. Lawrence: 

Univ. of Kansas Press.

d

Stone, D. 1997. Policy paradox: The art of political decision making. New York: W. W. Norton.

e

Birkland, T. 2001. An introduction to the policy process. Armonk, NY: M. E. Sharpe.
584

1 4 . To b a c c o I n d u s t r y M e d i a E f f o r t s

sentiment for or against the measure and 

to determine if particular media arguments 

should be changed to sway key groups 

of voters. The remainder of this chapter 

analyzes this conflict between health 

advocates and the tobacco industry over 

causal stories to frame the debate about 

state tobacco initiatives and referenda from 

1988 to 2006.

Methods

This section examines the general success 

of the tobacco industry in all state tobacco 

initiatives and referenda, descriptively 

analyzing and tallying which state direct 

votes were in favor of tobacco control and 

which favored the tobacco industry from 

1988 to 2006. It also provides specific 

and detailed analyses of how the tobacco 

industry mobilized against initiatives and 

referenda that solely raised tobacco taxes on 

statewide ballots during the same period.

A total of 42 state tobacco control 

initiatives and referenda were held from 

1988 to 2006 (including four tobacco 

industry–sponsored initiatives in four states) 

(table 14.3). These initiatives and referenda 

occurred in 16 states, with Arizona (8), 

California (5), Oregon (5), Montana (4), 

and Oklahoma (3) accounting for 25 (60%) 

of the 42 campaigns. 

Measures dealing only with tobacco taxes 

represented 20 (48%) of the 42 state 

tobacco control initiatives and referenda 

held from 1988 to 2006 (table 14.3). This 

large number of tobacco tax measures 

provides sufficient experience to document 

how the tobacco industry used media to 

mobilize voters in initiatives and referenda 

promoting tobacco control or weakening 

tobacco control. Eight initiatives and 

referenda (19%) centered on Master 

Settlement Agreement (MSA) funding 

allocations for health care, tobacco control, 

and university facilities. Eight initiatives 

(19%) proposed limits on smoking in 

worksites and public places, two referenda 

(4.8%) focused on bonds for public works 

repaid with tobacco settlement funds, two 

referenda (4.8%) created tobacco settlement 

trust funds, one referendum (2.4%) aimed 

to modify tobacco trust fund expenditures, 

and one referendum (2.4%) imposed tax 

increases from various revenue sources. 

Four of the smoking restriction initiatives 

(9.5%)—California’s 1994 Proposition 188, 

Arizona’s 2006 Proposition 206, Nevada’s 

2006 Question 4, and Ohio’s 2006 Issue 4—

were weak tobacco industry measures 

defeated by the voters.20

The 18-year time span from 1988 to 

2006 provides a sufficiently long period 

to observe general and ongoing tobacco 

industry arguments against state tobacco 

tax initiatives and referenda. In addition 

to examining general trends, this chapter 

provides in-depth discussions of some 

state initiatives and referenda from 

earlier and later portions of this 18-year 

period. These discussions demonstrate the 

consistency of the arguments generated 

in the context of state campaigns on 

increasing tobacco taxes. Two of the 

earliest case examples presented are 

tobacco tax increase initiatives in 1988 in 

California (Proposition 99) and in 1992 

in Massachusetts (Question 1). These 

cases are contrasted with five later state 

tobacco tax initiatives and referenda to 

understand if the tobacco industry changed 

its media themes over time. The three 

direct votes in 2004 were two initiatives in 

Colorado (Amendment 35) and Montana 

(Initiative 149) and one referendum 

in Oklahoma (State Question 713). 

In 2006, direct tobacco tax votes in 

which media were used took place in 

California (Proposition 86) and Missouri 

(Amendment 3). In 2006, the industry did 

not run a statewide media campaign in 

South Dakota (e-mail communication from 

Jennifer Staley, American Cancer Society in 

South Dakota to M. Givel, 2007).
585

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

In the analysis presented below, the term 

media includes all known electronic media 

and print political advertising sources that 

the tobacco industry and its surrogates 

used to try to defeat tobacco tax–increase 

initiatives and referenda. All known media 

spots were examined, analyzed, and coded 

by summarizing the type of media used 

and the major theme(s) used in each media 

spot. All media advertisements were analyzed 

and themes were identified on the basis 

of careful examination by Michael Givel. 

These themes then were analyzed, as a 

whole, to determine if the tobacco industry 

had a consistent general argument or 

causal story against tobacco tax increases. 

State, rather than local, initiatives and 

referenda were examined because of the 

broader impact of these measures on all 

citizens of a state. This chapter treats each 

state and each advertisement as equivalent 

for the purposes of ascertaining and 

comparing the degree to which a theme 

appears in the campaign advertisements. 

The chapter does not review whether certain 

advertisements were shown repeatedly 

in highly visible venues (and thus viewed 

by large audiences).

State Tobacco 

Control Initiatives 

and Referenda*

As mentioned above, from 1988 to 2006 there 

were 42 state tobacco control initiatives 

(including 4 tobacco industry initiatives) 

and referenda (table 14.3). Voters in states 

that allow initiatives and referenda voted 

to enact 28 tobacco control initiatives 

and referenda and to defeat 4 protobacco 

initiatives. In sum, voters during this period 

voted for protobacco control measures and 

against the tobacco industry in 32 (76%) of 

42 initiatives and referenda. Clearly, tobacco 

control advocates have been quite successful 

when it comes to statewide tobacco-related 

initiatives and referenda that have bypassed 

state legislatures.19,21,22

Tobacco Industry 

Opposition to State 

Tobacco Tax Initiatives 

and Referenda

California’s Proposition 99

One of the earliest state tobacco tax direct 

democracy measures, Proposition 99, 

was voted on in 1988 in California. 

Proposition 99 was an initiative that 

increased the tobacco tax by 25¢ per pack 

to fund antitobacco health education, 

indigent hospital care, environmental 

and conservation programs, antitobacco 

research, and an unallocated account to 

consist of 25% of the funding that the 

legislature could distribute for any of 

the other programs.19 The voters enacted 

Proposition 99, which the tobacco industry 

vigorously opposed, by a margin of 58% 

to 42%.19 The tobacco industry viewed 

Proposition 99 as a huge threat to its sales 

and profits in the large California market 

and devoted significant political and 

media resources to defeat the initiative.19

By election day, the tobacco industry had 

spent $21.4 million to defeat Proposition 99 

compared with $1.6 million spent by 

health and environmental advocates to 

enact the initiative.19

The tobacco industry’s media campaign 

to defeat Proposition 99 included six 

*

Editors’ note: Michigan’s Proposal A (1994) was materially different from the other 41 initiatives and 

referenda, which focused exclusively on tobacco. Michigan’s Proposal A affected many types of taxes, 

including tobacco excise taxes, sales taxes, income taxes, and business-related taxes. A summary of 

Proposal A appears as an appendix to this monograph.
586

1 4 . To b a c c o I n d u s t r y M e d i a E f f o r t s

radio and television advertisements in 

1988 (table 14.4). The primary themes of 

the industry’s advertisements opposing 

Proposition 99 included arguments 

that the funds would go to promoters 

of the proposition rather than to health 

care, the tax would be unfair to working 

families, and the tax would increase 

crime and smuggling in California. 

However, the combined effect of the 

increase in tobacco prices due to the 

tax and the antitobacco program associated 

with Proposition 99 has led to a significant 

decline in mortality from heart and lung 

diseases in California.23,24

Massachusetts’s Question 1

Another early state tobacco initiative 

to increase tobacco taxes modeled after 

California’s Proposition 99 was voted on 

in 1992 in Massachusetts.21 Question 1 

proposed to increase the state tobacco 

tax by 25¢ per pack to fund a Health 

Protection Fund to pay for tobacco 

education, cessation, and prevention 

programs.13,21 The measure, vigorously 

opposed by the tobacco industry, passed, 

with 54.4% voting yes and 45.6% 

voting no.13 By the time of the election, 

the tobacco industry had spent $7.1 million 

to defeat Question 1 compared with 

$1.0 million spent by health advocates to 

enact the initiative.25,26

The tobacco industry’s media campaign to 

defeat Question 1 included five television 

advertisements in 1992 (table 14.5). The 

campaign’s primary themes suggested that 

the measure would restrict personal choice 

to smoke, discriminate against smokers, 

provide funding that would not be spent 

primarily on health care programs, reduce 

economic growth, and impose an unfair 

tax increase.

Oklahoma’s State Question 713

State Question 713, voted on in 2004, was 

an Oklahoma referendum to increase the 

tobacco tax by 4¢ per cigarette to fund 

health care and tobacco use cessation 

programs.13,27,28 The measure passed, with 

53.4% voting yes and 46.6% voting no.29

Despite early widespread public support 

for the measure, the tobacco industry 

engaged in a significant mobilization effort 

to defeat the measure.28 By election day, 

the tobacco industry had spent $1.7 million 

to defeat State Question 713 compared 

with $809,000 spent by health advocates to 

enact the referendum.30

The tobacco industry’s campaign to defeat 

State Question 713 included two television 

advertisements and a direct mailer in 

2004 (table 14.6). The campaign’s primary 

themes were that the measure would create 

an unfair tax increase, be a tax cut for the 

Table 14.4 1988 Tobacco Industry Advertisements Opposing California’s Proposition 99

Media Titles Anti-Proposition 99 advertisement themes

Radio Driving Woman Health research funding would be diverted to promoters of proposition 

and unfair tax 

Radio Morning Couple Health research funding would be diverted to promoters of proposition 

and unfair tax 

Radio Elderly Man Health research funding would be diverted to promoters of proposition 

Radio Golf Clubs Funding would be diverted to doctors and medical industry who promote 

the proposition 

Television Do You Realize? Would divert millions of dollars to doctors and medical industry and 

unfair tax 

Television State By State Would increase crime and smuggling
587

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

rich, create higher taxes for the poor, and 

not pay for health care, with funding being 

diverted to Native Americans in the form of 

a “kickback” and to other projects.

Montana’s Initiative 149

In 2004, Montana’s Initiative 149 proposed 

to raise tobacco taxes from 70¢ to $1.70 per 

pack of cigarettes, from 35¢ to 85¢ per 

ounce for moist snuff, and from 25% to 

50% of the wholesale price for all other 

tobacco products. The tax increase was 

proposed to fund health care, a prescription 

drug program, nursing homes, and other 

general state government programs.13

The measure passed, with 63.3% voting 

yes and 36.7% voting no.31 Given the early 

and large public support for the measure, 

the tobacco industry decided not to devote 

significant political and media resources to 

sway voter opinion against the initiative. 

By the day of the election, the tobacco 

industry had spent $104,000 to defeat 

Initiative 149 compared with $414,000 spent 

by health advocates to enact the initiative 

(e-mail communication from M. Jackson, 

Program & Data Technician, Office of 

Political Practices, State of Montana, to 

M. Givel, 2005).

The tobacco industry’s campaign to 

defeat Initiative 149 included a direct 

mailer and a newspaper advertisement 

in 2004. This media approach was lower 

profile than the high-profile ongoing 

television advertisements used in 

California, Massachusetts, and Oklahoma. 

The primary themes of the tobacco 

industry’s media campaign (table 14.7) 

to defeat Initiative 149 were that the 

measure would increase “big government,” 

significantly increase taxes, unfairly 

discriminate against smokers, cause illegal 

smuggling and crime, and would not 

solve Montana’s budget problems.

Colorado’s Amendment 35

Also in 2004, Colorado’s Amendment 35 

proposed to raise tobacco taxes on 

cigarettes by 64¢ a pack to fund health 

care and tobacco education and cessation 

programs.13 The initiative passed, with 

61.4% voting yes and 38.6% voting no.32

Because of early and large public support for 

Table 14.5 1992 Tobacco Industry Advertisements Opposing Massachusetts’s Question 1

Media Titles Anti-Question 1 advertisement themes

Television Tolerance Would restrict personal choice and discriminates against smokers 

Television 501 Warning Health care funding would be diverted and unfair tax 

Television Look at the 

Language

Health care funding would be diverted and unfair tax 

Television Flood 2 Health care funding would be diverted, unfair tax, and would not 

support economic growth 

Television Closely Health care funding would be diverted 

Table 14.6 2004 Tobacco Industry Advertisements Opposing Oklahoma’s State Question 713

Media Titles Anti-State Question 713 advertisement themes

Television 200 Million Tax 

Increase

Health care money would be diverted, unfair tax increase, and tax cut 

for rich 

Television Old Tricks Health care money would be diverted, unfair tax increase, and tax cut 

for rich 

Mailer What Else Aren’t 

They Telling Us?

Health care money would be diverted to Native Americans in form of 

“kickback” and unfair tax increase 
588

1 4 . To b a c c o I n d u s t r y M e d i a E f f o r t s

the measure, the tobacco industry decided 

not to oppose the initiative. By election day, 

the tobacco industry had spent $112,000 

to defeat Amendment 35 compared with 

$2.03 million spent by health advocates to 

enact the initiative.33

The tobacco industry’s campaign to defeat 

Amendment 35 included two direct mailers 

in 2004. This media approach, again, 

was lower profile than the high-profile 

television advertisements used in 2004 in 

California, Massachusetts, and Oklahoma. 

The primary themes of the media campaign 

to defeat Amendment 35 were that the 

measure would create an unfair tax increase, 

discriminate against smokers, lead to 

wasteful government spending, and cause 

economic hardship (table 14.8).

California’s Proposition 86

In 2006, California’s Proposition 86 proposed 

to increase tobacco taxes on cigarettes 

by $2.60 per pack to fund new health 

services, health insurance for children, and 

Advertisement from the Oklahoma Vote No on Question 713 campaign

Advertisement from Montana veterans, taxpayers, and tobacco retailers, wholesalers, 

and manufacturers against Initiative 149 campaign
589

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

expanded tobacco prevention programs.34

The initiative failed, with 48% voting yes 

and 52% voting no.34 By election day, the 

tobacco industry had spent $66.3 million 

to defeat Proposition 86 compared with 

$16.2 million spent by health groups to 

enact the initiative.35 The tobacco industry’s 

campaign to defeat Proposition 86 included 

12 television advertisements. The primary 

themes of the media campaign were that the 

measure would create an unfair tax increase, 

lead to wasteful government spending, 

divert tobacco control funding to hospital 

interests, cause crime and smuggling, 

and allow hospitals to waive antitrust laws 

and escape civil and criminal penalties 

(table 14.9).

Missouri’s Amendment 3

In 2006, Missouri’s Amendment 3 proposed 

to increase tobacco taxes on cigarettes 

by 4¢ each and 20% of a manufacturer’s 

invoice price, before discounts, to fund 

new health services and expand tobacco 

prevention programs.36 The initiative failed, 

with 49% voting yes and 51% voting no.37

By election day, the tobacco industry had 

spent $5.3 million to defeat Amendment 3 

compared with $6.7 million spent by health 

groups to enact the initiative.38

The tobacco industry’s campaign to defeat 

Amendment 3 included two television and 

two radio advertisements. The primary 

themes of the media campaign were 

that the measure would create an unfair 

tax increase and divert funding to state 

programs not related to tobacco control 

(table 14.10).

Results

Table 14.11 tallies the numbers of times 

a tobacco industry theme appeared in the 

early initiatives in California in 1988 and 

Massachusetts in 1992 to defeat tobacco 

tax measures. The most widely used 

themes were that the measures would 

divert funds from the stated purpose 

of the proposal such as health care or 

antitobacco programs and would impose 

an unfair tax increase. These were followed 

by several other themes, including that 

the measure would discriminate against 

smokers, increase crime and smuggling, 

hurt economic growth, and restrict adults’ 

personal choice to use tobacco. When 

assessed as a whole, these themes formed 

two major parts of an overall frame of 

the campaign. The first part of the frame 

was that the government had no right 

Table 14.7 2004 Tobacco Industry Advertisements Opposing Montana’s Initiative 149

Media Titles Anti-Initiative 149 advertisement themes

Mailer Vote No on 

Initiative 149

Would create big government and an unfair tax increase and 

discriminate against smokers

Newspaper 

advertisement

Another Tobacco 

Tax Hike? Consider 

the Consequences

Unfair tax, would cause crime and smuggling, discriminates against 

smokers, and would not solve state budget problems

Table 14.8 2004 Tobacco Industry Advertisements Opposing Colorado’s Amendment 35

Media Titles Anti-Amendment 35 advertisement themes

Mailer The Facts on 

Constitutional 

Amendment 35

Unfair tax, would discriminate against smokers, lead to wasteful 

government spending, and cause economic hardship 

Mailer Vote No on 

Constitutional 

Amendment 35

Unfair tax, would discriminate against smokers, lead to wasteful 

government spending, and cause economic hardship 
590

1 4 . To b a c c o I n d u s t r y M e d i a E f f o r t s

Table 14.9 2006 Tobacco Industry Advertisements Opposing California’s Proposition 86

Media Titles Anti-Proposition 86 advertisement themes

Television LaDonna White Unfair tax, tobacco control money would be diverted, and lead to 

wasteful government spending

Television Mark Kogan Unfair tax, tobacco control money would be diverted, and lead to 

wasteful government spending

Television Ralph Di Libero Tobacco control money would be diverted and would cause crime and 

smuggling

Television A Lot Tobacco control money would be diverted and lead to wasteful 

government spending

Television Woman in Car Tobacco control money would be diverted and lead to wasteful 

government spending

Television Newspapers Say Tobacco control money would be diverted to hospital interests and 

would allow hospitals to waive anti-trust laws

Television Patricia Austin Unfair tax and tobacco control money would be diverted to hospital 

interests

Television I Thought Unfair tax, tobacco control money would be diverted to hospital 

interests, and lead to wasteful government spending

Television At First Unfair tax and tobacco control money would be diverted to hospital 

interests

Television I Liked The Idea Tobacco control money would be diverted to hospital interests and 

would allow hospitals to waive anti-trust laws

Television No Why Tobacco control money would be diverted to hospital interests, would 

allow hospitals to waive anti-trust laws, and would allow hospitals to 

escape civil and criminal penalties

Television Two Billion Unfair tax and tobacco control money would be diverted to hospital 

interests

Table 14.10 2006 Tobacco Industry Advertisements Opposing Missouri’s Amendment 3

Media Titles Anti-Amendment 35 advertisement themes

Radio Follow the Money Unfair tax and would divert funds to politicians

Radio Experienced Unfair tax and would divert funds to politicians

Television Lockbox Diverts funds to politicians

Television Settlement Player Diverts funds to politicians

Table 14.11 Number of Times Tobacco Industry Advertising Themes 

Were Used to Oppose California and Massachusetts 

Tobacco Tax Initiatives in 1988 and 1992

Advertisement themes Totals

Would divert funds from stated purpose of the program 9

Unfair tax increase 6

Would discriminates against smokers 1

Would hurt economic growth 1

Would increase crime, including smuggling 1

Would restrict personal choice by adults to use tobacco 1
591

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

to “unfairly” target smokers. The second 

part was that tobacco tax initiatives were 

inappropriate because the government 

is unable (compared with the market) to 

solve societal problems.

A numerical summary of the three ballot 

measures in Colorado, Montana, and 

Oklahoma in 2004 and in California and 

Missouri in 2006 indicates the predominant 

themes were that these measures would 

divert funds from the stated purpose of 

the measure and impose an unfair tax 

increase (table 14.12). This was followed 

by a subtheme that the measure would 

increase big and wasteful government. 

Less numerous themes included that these 

measures would discriminate against 

smokers, increase crime, be a tax cut for the 

rich, and impede economic growth. Again, 

when assessed as a whole, these themes in 

the later campaigns were identical to the 

themes used in the early state tobacco tax 

initiatives. The tobacco industry’s frame 

to oppose the initiative was that state 

governments had no right to “unfairly” 

target smokers with tobacco tax initiatives 

and the initiatives were inappropriate 

because of the government’s inability to 

solve societal problems.

Summary

State initiatives and referenda are an 

effective way to implement tobacco control 

legislation in general and tobacco tax 

increases in particular. State initiatives 

and referenda, such as California’s 

Proposition 99, also have significantly 

decreased tobacco use.24 The success of 

these measures makes them an important 

tool for tobacco control advocates in states 

that permit them. This is particularly 

true for legislation that cannot be 

effectively passed by using the regular 

state legislative process.

Despite the tobacco industry’s media 

campaigns, its efforts have failed for 32 (76%) 

of 42 state initiatives and referenda from 1988 

to 2006. The industry’s media campaigns 

and the frames used in the campaigns 

generally are ineffective regardless of which 

theme is used. The range of ballot measures 

profiled here shows that media efforts and 

expenditures by the tobacco industry vary 

and are influenced by perceptions of the 

level of popular support for the measures. 

Moreover, state tobacco tax initiatives and 

referenda frequently have succeeded, even 

Table 14.12 Number of Times Tobacco Industry Advertising Themes 

Were Used to Oppose 2004 Colorado, Montana, and 

Oklahoma Initiatives and Referenda and 2006 California 

and Missouri Initiatives

Advertisement themes Totals

Would divert funds from stated purpose of the program 19

Unfair tax increase 15

Would increase big and wasteful government 7

Would discriminate against smokers 4

Would increase crime, including smuggling 3

Tax cut for the rich 2

Would hurt economic growth 2

Would not solve state budget problems 1

Would restrict personal choice to use tobacco 1

Would waive anti-trust laws 1
592

1 4 . To b a c c o I n d u s t r y M e d i a E f f o r t s

in situations in which the tobacco industry 

spent considerably more than initiative 

proponents. These results indicate that the 

fundamental frames that the tobacco industry 

uses have had limited success in connecting 

with voters, compared with the benefits 

conveyed by these measures.

Conclusions

1. Within those states that allow these 

processes, ballot initiatives and referenda 

have served as an effective tool for 

enacting tobacco control legislation by 

direct vote. Tobacco industry interests 

frequently have used media channels 

(such as radio, television, print media, 

and direct mail) to defeat these ballot 

measures.

2. Despite the tobacco industry’s media 

efforts, it has generally not prevailed, 

losing in 32 (76%) of 42 state initiatives 

and referenda from 1988 to 2006. 

Given the industry’s lack of success in 

defeating tobacco control state initiatives 

and referenda at the state level, holding 

tobacco control initiatives or referenda is 

an important, though expensive, option 

if a state legislature has blocked tobacco 

control legislation.

3. The tobacco industry consistently has 

used several primary themes to defeat 

state tobacco tax increase initiatives. 

These include suggestions that the 

measures would impose unfair taxes 

and that tax revenues would not be 

spent on health care or tobacco control 

programs as intended. Secondary 

themes used consistently over an 18-year 

time span include that the measures 

would increase “big government” and 

wasteful spending, discriminate against 

smokers, and increase crime and 

smuggling. Other, less frequent themes 

were that the measures would be a 

tax cut for the rich, impede economic 

growth, fail to solve state budget 

problems, restrict personal choice, 

and violate antitrust laws.
593

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

References

1. Schmidt, D. D. 1989. Citizen lawmakers: 

The ballot initiative revolution. Philadelphia: 

Temple Univ. Press.

2. Hicks, J. D. 1931. The populist revolt: 

A history of the Farmers’ Alliance and 

the Peoples’ Party. Minneapolis: Univ. of 

Minnesota Press.

3. Pollack, N. 1967. The populist mind.

American Heritage Series. New York: 

MacMillan.

4. Beals, C. 1970. The great revolt and its 

leaders: The history of popular American 

uprisings in the 1980’s. London: AbelardSchuman. (Orig. pub. 1968).

5. Pollack, N. 1976. The populist response to 

industrial America. Cambridge, MA: Harvard 

Univ. Press.

6. Goodwyn, L. 1978. The populist movement: 

A short history of the agrarian revolt in 

America. New York: Oxford Univ. Press.

7. Givel, M. S., and S. A. Glantz. 2000. Tobacco 

control and direct democracy in Dade 

County, Florida: Future implications for 

health advocates. Journal of Public Health 

Policy 21 (3): 268–95. 

8. Populist Party. 1892. Populist Party platform: 

The Omaha platform. Preamble. Omaha, NE: 

Populist Party. http://historymatters.gmu

.edu/d/5361/.

9. Cronin, T. E. 1989. Direct democracy: The 

politics of initiative, referendum, and recall.

Twentieth Century Fund Books. Cambridge, 

MA: Harvard Univ. Press.

10. Givel, M. S., and S. A. Glantz. 2001. Tobacco 

lobby political influence on US state 

legislatures in the 1990s. Tobacco Control

10 (2): 124–34. 

11. Morley, C. P., K. M. Cummings, A. Hyland, 

G. A. Giovino, and J. K. Horan. 2002. 

Tobacco Institute lobbying at the state and 

local levels of government in the 1990s. 

Tobacco Control 11 Suppl. 1: I102–I109. 

12. Initiative and Referendum Institute. 

2004. States with direct and indirect 

initiative amendments: Direct and 

indirect initiative statutes. Los Angeles: 

Univ. of Southern California, School of 

Law, Institute and Referendum Institute. 

http://iandrinstitute.org.

13. National Conference of State Legislatures. 

2004. Initiatives, referendum, and recall. 

http://www.ncsl.org/programs/legman/elect/

initiat.htm.

14. Broder, D. S. 2000. Democracy derailed: 

The initiative movement and the power of 

money. San Diego: Harcourt.

15. Donovan, T., and S. Bowler. 2004. Reforming 

the republic: Democratic institutions for 

the new America. Upper Saddle River, NJ: 

Pearson-Prentice Hall.

16. Miroff, B., R. Seidleman, and T. Swanstrom. 

2002. The democratic debate: An 

introduction to American politics. 3rd ed. 

Boston: Houghton Mifflin.

17. Entman, R. M. 1993. Framing: Toward 

clarification of a fractured paradigm. 

Journal of Communication 43 (4): 51–58. 

18. Donovan, T., S. Bowler, and D. McCuan. 

2001. Political consultants and the 

initiative industrial complex. In Dangerous 

democracy? The battle over ballot initiatives 

in America, ed. L. J. Sabato, H. R. Ernst, 

and B. A. Larson, 101–34. Lanham, MD: 

Rowman and Littlefield.

19. Glantz, S. A., and E. D. Balbach. 2000. 

Tobacco war: Inside the California battles.

Berkeley: Univ. of California Press.

20. Crary, D. 2006. Big Tobacco counters bans 

with less-strict proposals; Ballots show 

choice: Limit smoking a lot or limit it a 

little. Washington Post, October 22: A7. 

21. Begay, M. E., and S. A. Glantz. 1995. 

Question 1 tobacco education outlays: From 

the 1994 fiscal year to the 1996 fiscal year. 

Tobacco control policy making: United 

States, Paper MA1995. San Francisco: Univ. 

of California, Center for Tobacco Control 

Research and Education. http://repositories

.cdlib.org/cgi/viewcontent.cgi?article=1023

&context=ctcre.

22. National Cancer Policy Board. 2000. 

State programs can reduce tobacco use.

Washington, DC: National Academies Press.

23. Centers for Disease Control and Prevention. 

2000. Declines in lung cancer rates—

California, 1988–1997. Morbidity and 

Mortality Weekly Report 49 (47): 1066–69. 

24. Fichtenberg, C. M., and S. A. Glantz. 2000. 

Association of the California Tobacco 

Control Program with declines in cigarette 

consumption and mortality from heart 

disease. New England Journal of Medicine

343 (24): 1772–77. 

25. O’Reilly, J. 1993. More than $16 million 

spent on statewide ballot questions. Boston: 
594

1 4 . To b a c c o I n d u s t r y M e d i a E f f o r t s

Commonwealth of Massachusetts, Office of 

Campaign and Political Finance.

26. Heiser, P. F., and M. E. Begay. 1997. The 

campaign to raise the tobacco tax in 

Massachusetts. American Journal of Public 

Health 87 (6): 968–73. 

27. Cooper, S. 2004. Smokin’ and other state 

questions. Oklahoma Gazette, October 20.

28. Spivak, A., and M. S. Givel. 2004. Tobacco 

industry lobbying and smoking regulation in 

Oklahoma. Paper presented at the American 

Public Health Association, Washington, 

DC. http://apha.confex.com/apha/132am/

techprogram/paper_87539.htm.

29. Oklahoma State Election Board. 2004. State 

Question 713, Legislative Referendum 336: 

General election, November 2, 2004. http://

www.ok.gov/~elections/04gen.html.

30. Spivak, A., and M. Givel. 2005. From 

industry dominance to legislative progress: 

The political and public health struggle 

of tobacco control in Oklahoma. Tobacco 

Control: Reports on industry activity from 

outside UCSF. Paper OKLA. San Francisco: 

Univ. of California, Center for Tobacco 

Control Research and Education. http://

repositories.cdlib.org/tc/reports/OKLA. 

31. Montana Secretary of State. 2004. 2004 

statewide general election results. http://

www.sos.state.mt.us/elb/archives/2004/

2004-genstate.pdf.

32. Colorado Secretary of State. 2004. Official 

publication of the abstract of votes cast 

for the 2003 coordinated, 2004 primary, 

2004 general. http://www.elections

.colorado.gov/www/default/prior%20years%

20election%20information/2004abstract%

202003%202004%20082305%late%

20pm-5.pdf.

33. Colorado Secretary of State. 2005. Campaign 

finance home. http://www.elections

.colorado.gov/ddefault.aspx?tid=85.

34. League of Women Voters of California 

Education Fund. 2006. Proposition 86: 

Tax on cigarettes, state of California. http://

www.smartvoter.org/2006/11/07/ca/state/

prop/86.

35. California HealthCare Foundation. 2007. 

Tobacco tax: MoneyWatch. http://www

.healthvote.org/index.php/moneywatch/

C37/#2.

36. Missouri Secretary of State. 2007. 2006 

ballot measures. http://www.sos.mo.gov/

elections/2006ballot/.

37. Missouri Secretary of State. 2006. 2006 

Ballot issues. http://www.sos.mo.gov/

enrweb/ballotissueresults.asp?eid=189.

38. Missouri Ethics Commission. 2006. Report 

summary: Missourians against tax abuse. 

http://www.moethics.mo.gov/Ethics/

CampaignFinance/CFCommitteeInfo1

.aspx?MECID=C061536&Year=2006.
595

Future Directions

Part

6

Most formal research into media and tobacco dates back little more than four decades, 

and numerous areas remain open for further study. This final part explores possible 

directions for future studies of the relationships among the media, tobacco industry 

interests, and tobacco control efforts and their interaction as components of a system.

This part first outlines forward trends in tobacco promotion, including point-of-sale 

marketing, packaging, entertainment media, and public relations, and examines the 

future of tobacco control efforts from the perspectives of news and media advocacy and 

media interventions. Calling for more research on how tobacco-related disparities related 

to socioeconomic and other factors may be exacerbated or mitigated by communications 

for and against tobacco, this monograph can serve as a foundation for progressive 

research and tobacco control practice in years to come as efforts continue to address 

the major cause of preventable death in the United States.

597

15

Future Directions

Mass media have been used both to encourage the growth of tobacco use over past 

decades and to contribute to tobacco control efforts, and today the media remain a key 

factor in reducing the public health burden of tobacco. This concluding chapter examines 

areas for future research and action based on the findings of this monograph across two 

fundamental areas of interest:

n	 The role of media in tobacco promotion, including marketing practices such 

as price discounting, point-of-purchase displays, and cigarette packaging; 

depictions of tobacco use in entertainment media; and the public relations efforts 

of the tobacco industry, as well as measures to counteract tobacco promotion

n	 The impact of media as a vehicle for tobacco control efforts, including media 

advocacy, understanding the effects of tobacco-related news coverage, paid 

promotional campaigns for prevention and cessation, corrective advertising 

designed to counter tobacco industry claims, and the potential for better use of 

alternative channels such as online media, as well as measures to counteract 

tobacco promotion, such as the World Health Organization’s Framework 

Convention on Tobacco Control

To further inform tobacco control policy and program decisions, more research attention 

should be paid to the inherently dynamic interplay between the forces driving tobacco 

promotion and tobacco control.
598

1 5 . F u t u r e D i r e c t i o n s

Introduction

During the past four decades, great 

strides have been made in understanding 

how tobacco promotion increases the 

likelihood of tobacco use and how tobacco 

control media interventions can reduce 

tobacco use. A fundamental theme of the 

work reviewed here is the great agility 

of tobacco companies in using a variety 

of communication channels, strategies, 

and rhetorical devices to continue to sell 

tobacco products, frame the public debate 

on effects of tobacco use, and influence key 

stakeholders. These stakeholders include the 

media, policymakers, activists, scientists, 

and other opinion leaders. The evidence 

presented in this volume illustrates the 

ability of tobacco companies to anticipate, 

or at least keep in step with, tobacco control 

policies and limits on tobacco promotion 

and evolve their strategies accordingly. 

When one channel has closed or become 

limited, tobacco companies have nimbly 

switched to different channels to promote 

tobacco products and protobacco ideas. 

This volume offers important lessons 

in how the media could be harnessed to 

further reduce tobacco use in the United 

States, and these lessons have implications 

for other nations seeking to achieve the 

same aim. Despite this extensive body of 

work, a considerable amount of research 

remains to be done, partly because the 

relationship between tobacco promotion 

and tobacco control is dynamic: Action 

in one area produces change in another. 

As long as tobacco companies are able to 

develop new tobacco marketing strategies to 

circumvent tobacco control measures, the 

need for monitoring, research, and policy 

advisement continues.

More broadly, the need for research 

continues as the communications 

environment becomes ever more complex. 

A growing range of communication 

channels and information-delivery 

systems provides increasing opportunities 

for tobacco companies to target 

communications to consumers, sometimes 

with little oversight from policymakers, 

regulators, or those working in tobacco 

control. The fragmentation of audiences 

across this proliferation of channels also 

means that those working to stem tobacco 

use must consider a bewildering number 

and variety of communication channels 

to run campaigns and deliver antitobacco 

messages. Limited funds and resources are 

further strained, and efforts to monitor 

tobacco promotion become more complex.

The growing socioeconomic disparity in 

tobacco use is another important trend with 

implications for study of tobacco-related 

media communications. In general, tobacco 

users are more likely to be among the 

groups that are disproportionately deprived 

in social and economic areas.1 At the same 

time, increasing globalization, proliferation 

of communication channels, and movement 

across global borders mean that nations with 

weaker tobacco control efforts, usually lowincome countries, are most susceptible to 

the effects of tobacco marketing.

A more vigorous, systematic, and empirical 

research agenda can further understanding 

of how mass communications contribute 

to tobacco promotion and tobacco control. 

Against this background, this final chapter 

discusses future directions for such media 

and communications research. 

Future Directions 

to Address Tobacco 

Promotion

A major conclusion of this volume is that 

cigarettes are one of the most heavily 

promoted products in the United States. 

Expenditures in 2005 were $13.5 billion 

(in 2006 dollars) ($37 million per day 
599

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

on average) for cigarette advertising and 

promotion. The information on tobacco 

marketing in the chapters of this volume 

plainly demonstrates the evolution of these 

practices in response to imposed tobacco 

marketing restrictions. In general, there is 

abundant evidence that tobacco companies 

failed to adhere to voluntary agreements on 

tobacco marketing (see chapter 3). However, 

once one avenue for tobacco marketing 

is closed by an imposed restriction, the 

attention of the tobacco companies shifts 

to alternative media to generate exposure 

to tobacco brands. For this reason, partial 

restrictions on tobacco marketing have 

limited effectiveness in reducing tobacco 

use and consumption (see chapter 7). Only 

comprehensive restrictions can achieve 

this aim. 

Because restrictions were imposed on 

tobacco marketing through television, 

radio, and billboard advertising, alternative 

avenues for tobacco marketing have 

emerged in the United States. First, the 

tobacco industry has seen a huge shift in 

marketing expenditures toward the point 

of purchase (POP, see chapter 4). Second, 

cigarette packaging has assumed a more 

significant role in communicating the brand 

image of tobacco products (see chapter 4). 

Third, sponsorship of events by tobacco 

companies, to promote both tobacco 

brands and corporate image, has increased 

substantially (see chapters 4 and 6). 

Depiction of smoking in movies, including 

use of cigarette brands, has also become 

more prevalent and is a risk factor for youth 

smoking (see chapter 10).

Price Discounts

More than 70% of tobacco industry 

expenditures on advertising and promotions 

are used to provide price discounts 

(see chapter 4). Research is needed to 

increase understanding of the ways in which 

these price discounts interact with other 

promotional strategies to influence tobacco 

use. Research has provided convincing 

evidence that the tobacco industry has 

modified marketing strategies in step with 

the extent of tobacco control. For example, 

cigarette sales promoting price discounts to 

add value (e.g., “Buy one pack, get one pack 

free”) are more likely in states with higher 

amounts of tobacco control funding and 

higher cigarette taxes.2 To the extent that 

such marketing strategies undermine the 

benefits of tobacco control programs and 

policies such as cigarette tax increases, these 

findings are considerable cause for concern 

and underline the importance of developing 

effective policy limits on tobacco marketing. 

Point-of-Purchase Tobacco 

Marketing

At the POP, in addition to tobacco 

promotions, the tobacco industry also relies 

on optimal placement of cigarettes near 

the cash register for maximum exposure. 

As detailed in chapters 4 and 7, research 

demonstrates that the placement of tobacco 

in convenience stores beside candy and 

everyday consumer goods increases the 

sense of “friendly familiarity” with tobacco, 

increases youth perceptions of high smoking 

prevalence, and may increase the likelihood 

that youth will initiate smoking.

In countries where restrictions on tobacco 

marketing are more extensive than in the 

United States, the POP environment has seen 

the emergence of ever-larger advertising 

signage and huge power walls of cigarettepackaging displays provided by tobacco 

companies (see chapter 3). These kinds of 

POP strategies have yet to fully evolve in the 

United States. In countries such as Australia 

and Canada where POP tobacco advertising 

and promotions were eliminated, policies 

to remove tobacco from the line of sight are 

beginning to be implemented.3

Research on the POP environment that 

could further inform the field includes 

studies on the relationship between exposure 
600

1 5 . F u t u r e D i r e c t i o n s

to POP tobacco promotions and advertising 

and youth smoking attitudes and behavior. 

Especially important are studies with 

longitudinal or time-series designs. Studies 

that use eye-tracking methods4 could help to 

ascertain what kinds of POP advertising and 

display configurations are most attractive 

to youth. In addition, studies could assess 

the effect of POP advertising and packaging 

displays on the urge to buy cigarettes 

among adults attempting to quit smoking 

and among recent quitters. Exit surveys 

of store customers, population surveys, 

self-completion diary studies, qualitative 

studies, and experimental studies of the urge 

to smoke in smokers randomly assigned to 

view photographs of POP displays might 

further examine (1) the extent to which 

POP strategies influence regular smokers 

or persons experimenting with smoking or 

(2) whether some subgroups, such as lowincome smokers or young adults, may be 

most responsive to POP marketing practices 

for tobacco sales, as suggested in a crosssectional study by White and colleagues.5

Brain-imaging studies may also be helpful 

to gauge the levels of neurological arousal 

evoked by various POP configurations 

(see “Need for Emotionally Evocative 

Advertising” later in this chapter). 

Beyond individual outcomes, more studies 

are needed on POP marketing strategies, 

restrictions on them, and cigarette sales 

data, which primarily reflect adult smoking. 

Studies of cigarette sales data might analyze 

sales volume data from convenience store or 

supermarket scanners. Only one relatively 

small-scale study of cigarette sales data at 

the retail level has been performed.6

Cigarette Packaging

The tobacco industry has placed a much 

greater reliance on cigarette packaging as a 

form of marketing as traditional avenues for 

promoting tobacco use became unavailable 

(see chapter 4). Cigarette packaging is 

designed to create and reinforce brand 

imagery and, because of the increasing 

importance of the POP in tobacco marketing, 

to promote greater salience of the brand 

family in POP retail displays. Cigarette 

packaging is all the more important because, 

unlike other consumer-product packaging 

that is discarded after purchase, cigarette 

packs are taken out and may be displayed 

whenever a cigarette is smoked.

Research on perceptions about popular 

cigarettes, including those that appear to 

communicate reduced harm, could provide 

helpful information on youth perceptions 

and misperceptions of particular brands. 

Youth-oriented education and advocacy 

that have sought to publicize tobacco 

industry marketing approaches might 

focus on how tobacco companies use 

packaging to entice young consumers to 

their brands. Adult smokers might also 

benefit by better understanding how tobacco 

companies seek to reassure them about 

health concerns through clever cigarette 

packaging (see “Corrective Advertising 

About Tobacco Industry Product Claims” 

later in this chapter). 

Additional areas for future research include 

the following:

n Exploring how packaging and price 

work in concert to drive brand selection, 

especially among low-income consumers

n Studying the extent to which the design 

of cigarette packs elicits physiological 

responses that may lead to cognitive, 

affective, and attitudinal outcomes

n Understanding how tobacco companies 

have worked to design packaging that 

obscures or minimizes required health 

warnings or labeling information about 

the constituents of tobacco products or 

cigarette smoke

n Examining the effectiveness of tobacco 

company statements about health or 

packaged messages such as Philip Morris’s 

“onserts”7 in communicating health risks
601

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

The United States lags behind nations 

that have introduced graphic pictorial 

health warnings on tobacco products.8

Government-mandated pictorial warnings 

have been shown to garner greater attention 

and to communicate risks more effectively 

than do written health warnings.9–12 Studies 

comparing U.S. health-warning statements 

on cigarette packs with those in other 

countries would add to the evidence base 

for stronger warnings for U.S. smokers.

Entertainment Media

Youth are frequently exposed to depictions 

of smoking in entertainment media 

(see chapter 10). The prevalence of 

smoking is overrepresented in movies, 

and identifiable cigarette brands appear 

in about one-third of movies. Smokers 

in movies are more likely than smokers 

in real life to be affluent and white. 

Experimental studies demonstrate that 

depiction of smoking in movies enhances 

the perception that smoking is normal 

and desirable and increases intentions to 

smoke. The association between exposure 

to depiction of smoking in movies and 

youth smoking initiation lends weight 

to the justification for efforts to reduce 

movie depictions of cigarette smoking and 

youth exposure to them (see chapter 10). 

Proposals for action have focused on the 

individual, family, and societal levels, 

including improving the media literacy 

of youth; encouraging greater parental 

responsibility for restricting youth viewing 

of R-rated movies, which depict smoking 

more commonly; and placing an R rating 

on movies featuring tobacco use. 

Although clear and consistent evidence 

indicates that exposure to smoking in 

movies increases the likelihood of youth 

smoking initiation, research has yet to 

determine the role smoking in movies plays 

(1) in the transition from experimental 

to regular smoking in youth and young 

adults, (2) in prompting relapse among 

former smokers, or (3) in making it more 

difficult for smokers to quit. Descriptive 

studies suggest that the effects of adolescent 

exposure to smoking in movies can be 

decreased (1) by motivating parents 

to restrict access to such movies or 

(2) by teaching adolescents to evaluate 

smoking in movies with more skepticism 

through training in media literacy.13

However, no published intervention studies 

have evaluated these hypotheses. 

Tobacco exposure in online media remains 

an area for further study (see chapters 4 

and 10). YouTube,14 the free video-sharing 

Internet site, has hosted advertisements by 

the Office of National Drug Control Policy15

as well as protobacco material.16 The extent 

to which tobacco is promoted on other Web 

sites for social networking is also a topic for 

future research.

Video games are emerging as a prime 

medium for marketing products to 

youth.17 Only limited research has assessed 

the extent and effects of tobacco use in 

video games (see chapters 4 and 10).18

More research attention could be paid 

to (1) tracking tobacco involvement in 

video games over time, (2) the reasons for 

tobacco involvement (e.g., paid promotions 

or tobacco use by game designers), and 

(3) the effects of video-game tobacco use 

and cigarette brand identification on 

smoking-related attitudes, intentions, 

and behaviors of consumers.

Tobacco Company Public 

Relations Strategies

Because of the tobacco industry’s history 

of concerns about corporate image and 

the investment of significant resources to 

remedy those concerns (see chapter 6), 

its use of the media for public relations 

warrants scrutiny. This issue is particularly 

important because corporate-image 

and industry-sponsored campaigns to 

prevent youth smoking may engender 
602

1 5 . F u t u r e D i r e c t i o n s

sympathy for tobacco companies,19,20 and 

favorable attitudes toward the tobacco 

industry are related to increased likelihood 

of youth smoking initiation.21 These 

industry campaigns could also dampen 

motivation to quit smoking or undermine 

support for tobacco control policies. One 

possible direction is for the Federal Trade 

Commission (FTC) or another governmental 

agency to monitor the tobacco companies’ 

annual expenditures for advertising and 

promoting corporate brands as the FTC 

does for cigarette and smokeless tobacco 

advertising and promotion. 

Future research could measure public 

opinion about tobacco companies, public 

support for tobacco control policies, 

and their relationship with exposure to 

corporate advertising, including tobacco 

company-sponsored ads for prevention of 

youth smoking and Web-based messages 

on smoking cessation from tobacco 

manufacturers. Research could also examine 

the link between exposure to corporateimage campaigns and adult smokers’ 

intentions and behaviors related to quitting 

smoking. Evidence indicates that shaping 

a positive or negative corporate reputation 

directly affects consumers’ responses to a 

company’s brand advertising.22,23 Research 

is needed to assess more directly the role 

of corporate-image advertising in opposing 

more restrictive laws and regulations as well 

as possible intermediate effects. For example, 

researchers might study the views of leaders 

of societal opinion or media gatekeepers 

(e.g., newspaper editors or columnists) and 

relate corporate-image campaigns to these 

gatekeepers’ attitudes about the tobacco 

industry and strength of support for tobacco 

control policies and tobacco control funding. 

Media campaigns for prevention of 

youth smoking that are sponsored by 

tobacco companies have a face-value 

message that tobacco companies do 

not want youth to smoke. Statements 

against self-interest tend to increase the 

perceived trustworthiness of the source 

of the statement.24 Thus, these media 

campaigns serve as a highly effective public 

relations tool for the tobacco industry. 

Because peer-reviewed, population-based 

research has convincingly demonstrated 

that these campaigns have negligible or 

adverse outcomes on youth smoking,20,25

tobacco company-sponsored media 

campaigns on preventing smoking or 

promoting smoking cessation require 

careful scrutiny. As part of a broader 

approach to media literacy, tobacco control 

programs might create ads that highlight 

the ineffectiveness of the industry’s ads in 

prevention of youth smoking and emphasize 

their public relations value to the industry 

in an effort to educate the community about 

the purpose of public relations.

Additional research is needed to understand 

for which audiences and under what 

circumstances exposure to such messages 

dilutes or undermines the demonstrated 

beneficial effects of media campaigns 

sponsored by the public health community. 

For example, population subgroups with 

lower socioeconomic status (SES), which 

have the highest prevalence of smoking in 

industrialized countries, may have more 

difficulty sorting through complex health 

messages26 and reconciling conflicting 

messages. Research is needed to assess 

the effects of corporate-image campaigns 

and tobacco company-sponsored smoking 

prevention campaigns on smoking-related 

attitudes and behaviors among adults in 

different SES subgroups. States with high 

levels of exposure to media campaigns on 

tobacco control, especially ads featuring 

the manipulative nature of tobacco 

companies, may be more protected from 

the adverse effects of campaigns sponsored 

by the tobacco industry. A cross-sectional 

study by Hersey and colleagues27 suggests 

this conclusion, but longitudinal research 

and time-series studies could be undertaken 

to more thoroughly examine this 

important question. 
603

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

The global impact of these types of public 

relations activities is another important 

area for future study. In the United States, 

the extent of mass-media advertising paid 

for by tobacco companies is far greater 

than in any other country. This advertising 

has introduced a unique aspect to the ever 

more cluttered media environment that 

is not present to the same extent in any 

other country, so lessons learned in the 

United States may not apply worldwide. 

Future research could examine how 

multinational tobacco companies use 

public relations advertising to manage 

corporate image in other markets and could 

compare the behaviors and reputations of 

the tobacco industry in the United States 

with those in other countries.

Issues in Cross-National Tobacco 

Promotion and Tobacco Control

The World Health Organization’s 

Framework Convention on Tobacco Control 

(FCTC)28 directs countries to undertake 

a comprehensive ban on all tobacco 

advertising, promotion, and sponsorship. 

Article 13 of the FCTC recognizes 

that some countries may be unable to 

impose a comprehensive ban because 

of constitutional principles and should 

therefore apply restrictions to tobacco 

marketing practices that are consistent 

with their legal environments (see sidebar 

on the FCTC in chapter 8).

However, Article 13 also includes several 

references to the need to eliminate crossborder advertising. Tobacco advertising 

and promotion may cross national borders 

through international print media, 

especially magazines; direct broadcast 

satellite linked to domestic receiving dishes; 

paid product placement in movies and video 

games; and the World Wide Web and other 

Internet-based communication channels. 

To control cross-border advertising 

under the FCTC, Kenyon and Liberman29

recommend a multilayered approach 

including formal law and regulation, 

monitoring and enforcement practices, 

education, and international cooperation. 

An FCTC guideline and protocol on 

cross-border advertising, promotion, and 

sponsorship is in development.30 Article 13 

of the FCTC seeks to curtail protobacco 

cues in the environment so prohealth 

messages can be communicated with fewer 

encumbrances. Finally, Article 11 of the 

FCTC imposes measures to ensure that 

tobacco product packaging and labeling do 

not create erroneous impressions about 

tobacco products. As of April 2008, the 

United States had not become a party to 

the FCTC, although 154 other countries 

had done so.

The continuing ability of tobacco companies 

to overcome limits placed on tobacco 

marketing, as well as the globalization 

of tobacco promotion, means that many 

tobacco marketing strategies originating in 

the United States have adverse consequences 

for other nations. At the same time, 

First Amendment issues (see chapter 8) 

complicate options for limiting tobacco 

marketing in the United States. Progress 

on these issues could be greatly facilitated 

by convening a panel including lawyers 

and experts in first amendment law, media 

and marketing experts, and tobacco control 

experts to outline how the industry might 

evolve its marketing tactics. Areas to 

address might include POP advertising and 

displays of cigarette packs; use of cigarette 

brands and tobacco company names in 

sponsorships; magazine advertising; and 

use of color, imagery, and brand slogans 

in cigarette packaging. Some research has 

been conducted on consumer response to 

“plain packaging” (e.g., black and white, text 

only).31,32 However, more research is needed 

to assess the potential impact of plain 

packaging on smoking-related attitudes 

and behaviors, including the effects across 

sociodemographic groups. Researchers 

could also examine implications of tobacco 

marketing in the United States that extend 
604

1 5 . F u t u r e D i r e c t i o n s

beyond U.S. borders, such as the influence 

of the Marlboro brand. 

In summary, tobacco marketing is still 

pervasive in the United States, and it 

frequently exposes millions of youth and 

smokers who want to quit smoking to 

images and cues designed to promote 

tobacco use. It is important to recognize 

that tobacco control efforts occur within 

this environment of heavy tobacco 

advertising and promotional activity. 

The aggressiveness of tobacco industry 

marketing varies according to the level of 

tobacco control effort,2,33 and the tobacco 

industry lobbies to undermine the creation, 

extent, and targeting of media campaigns 

for tobacco control (see chapter 13). 

This dynamic relationship between tobacco 

industry efforts and tobacco control efforts 

indicates that the balance between these 

countervailing forces will determine the 

success of tobacco control efforts. 

Future Directions for 

Media Strategies in 

Tobacco Control

News Coverage and Media 

Advocacy

Despite general acceptance that news 

coverage can influence public perceptions 

and shape behaviors, tobacco control 

researchers have paid only limited attention 

to news coverage as a potentially important 

exposure variable related to changing 

smoking-related attitudes and behaviors in 

the population (see chapter 9). Although 

media advocacy efforts are commonly used 

in tobacco control, studies exploring change 

in volume and framing of tobacco-related 

news coverage in relation to those efforts are 

still uncommon. Research might usefully 

investigate the news production process to 

determine the issues and frames (ways of 

presenting arguments) that engage news 

directors, reporters, and editorial staff. 

This investigation should be conducted in a 

way that could lead to greater appreciation 

of the complexities of tobacco control and 

effective remedies. The research could 

explore how journalists use controversial 

or scientifically suspect sources to provide 

balance in their stories and could include 

exploration of journalists’ own knowledge 

and attitudes relevant to tobacco issues. 

Research can also help to identify underlying 

common frames that are communicated 

to audiences in news coverage. Although 

case studies may provide insights into new 

or unusual issues, closer examination of 

more general tendencies in news reporting 

is likely to be more instructive and 

generalizable across jurisdictions. 

Studies of Audience Response 

to Tobacco-Related News Media 

Messages

Although studies of audience response 

to paid antitobacco media campaigns are 

common, little attention has been given to 

how news is interpreted by key population 

groups, including smokers in general, 

low-SES groups, and community opinion 

leaders or policymakers. Tobacco control 

programs usually pretest antitobacco ads 

to hone and improve various elements of 

these paid communications, but pretesting 

is rarely done to guide and improve 

media advocacy efforts. Years ago, to 

improve their advocacy efforts, tobacco 

companies used continuous tracking to 

study audience responses to particular 

spokespeople and arguments put forth in 

news debates.34 Tobacco control practitioners 

could conduct similar pretests to select 

and refine ways of communicating to 

lay audiences and to more informed 

audiences of policymakers, especially for 

complex or controversial tobacco control 

issues. Nelson and colleagues35 pointed 

out that a large, knowledge-generating 

research establishment focuses on identifying 
605

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

risk factors, but a very small knowledgeuse research establishment focuses on 

translating scientific knowledge into policy 

and practice. Thus, knowledge is lacking on 

how tobacco control evidence is disseminated 

and used through various media channels. 

Consequently, this field is ripe for research 

attention. This issue is particularly important 

for media advocacy pertaining to complex 

or potentially confusing issues in tobacco 

control, such as harm reduction strategies 

for smoking cessation. 

News Media Effects on Tobacco 

Policies and Smoking in the Population

Researchers need to better understand the 

impact of news coverage on the likelihood 

of change in tobacco control policies and 

individual smoking behavior. Quantitative 

research in this area is uncommon. 

The application of complex statistical 

methods, such as multilevel analysis, timeseries analysis, and event history analysis, 

may offer great promise for separating the 

effects of news coverage from those of other 

determinants of change in tobacco policy.36

The 50 states and the District of Columbia 

and thousands of U.S. counties and cities 

exhibit huge variation across time and place 

in the extent to which audiences are exposed 

to news about tobacco, in the extent to 

which tobacco control policies have been 

implemented, and in smoking behavior. 

This diversity offers a potentially rich 

research environment in which to assess 

linkages between news coverage and both 

policy and behavioral outcomes. 

Furthermore, most studies examined only 

the volume of news coverage without 

attention to news coverage about particular 

tobacco control topics or perspectives. 

Agenda-setting research and framing studies 

suggest that some kinds of news coverage 

may be more influential than others, 

so future research could examine effects 

of both the volume and content of news 

coverage on policy and behavioral change. 

Studies linking news coverage on tobacco 

issues to attempts at smoking cessation 

are sorely needed. No published research 

is available on the extent to which news 

coverage about tobacco, favorable or 

unfavorable, might enhance or undermine 

effects of paid antitobacco advertising 

campaigns. It is important to identify 

best practices for cost-effective paid 

media campaigns. For jurisdictions with 

limited funding for tobacco control, such 

information can be helpful for guiding 

advocacy efforts to achieve “earned media” 

(i.e., unpaid coverage) as a substitute for 

paid antitobacco media campaigns.

For practical reasons, most research 

involving news media has focused on 

newspaper coverage of tobacco, but 

the changing landscape of news and 

“infotainment” media—encompassing 

television, radio, the Internet, and short 

message service or text messaging—also 

deserves attention as a subject for 

study. Social inequalities in news media 

consumption may contribute to observed 

disparities in smoking behavior (see 

chapter 2). Local broadcast and cable 

television news may have broader reach 

across the community than do newspapers 

as a source of news and information. Groups 

with lower SES may pay less attention to 

health-related topics in the news media 

or may be more likely to discount such 

information in favor of their social network’s 

dominant opinions, or other factors may 

apply. However, high levels of media 

coverage of tobacco issues may attenuate 

disparities in beliefs about tobacco and 

health.1,37 Such findings and possibilities 

underline the importance of media advocacy 

efforts as a timely area for future research. 

Media Interventions for 

Tobacco Control

Paid mass media campaigns for tobacco 

control play an important role in a 

comprehensive tobacco control strategy. 
606

1 5 . F u t u r e D i r e c t i o n s

Aside from preventing smoking uptake 

and motivating smoking cessation, 

such campaigns can be key in directing 

smokers to smoking cessation services 

such as quitlines or Web-based cessation 

programs. Media campaigns can also set 

the agenda for the passage of stronger 

tobacco control policies by increasing the 

knowledge of consumers, opinion leaders, 

and policymakers about tobacco control 

issues, including the ways in which smoking 

can lead to adverse health consequences, 

the difficulty of quitting smoking, the 

availability of cessation treatments, and the 

need for improved environmental supports 

to maximize the likelihood of long-term 

abstinence. Environmental supports include 

higher tobacco taxes, more comprehensive 

smoke-free policies, and broader restrictions 

on tobacco marketing. Mass media 

campaigns should be considered as a key 

component of any national or state tobacco 

control program.

The research based on paid mass media 

campaigns provides strong evidence that 

such campaigns decrease youth smoking 

uptake and prompt smoking cessation among 

adults (see chapter 12). Considerably more 

studies have been concerned with youth 

smoking rather than adult smoking as an 

outcome, possibly reflecting greater societal 

concern with and political palatability for 

tobacco control efforts directed at youth 

rather than adults. For two reasons, tobacco 

control efforts need strategies that can 

prompt and support adult smoking cessation. 

First, adult smoking patterns set the 

normative environment for youth smoking. 

Second, smoking cessation rates for adults 

have a much greater impact than do rates of 

smoking initiation for youth on short-term 

trends in smoking prevalence in the general 

population. Reduction in the prevalence of 

adult smoking will have the greatest impact 

on reducing the enormous toll of smokingrelated morbidity and mortality in the near 

future.38 Before the 2008 launch of the 

“EX” campaign by the National Alliance for 

Tobacco Cessation (http://www.thenatc

.org/), no national media campaign in 

the United States sponsored by the public 

health community had been broadcast to 

encourage adult smoking cessation since 

the late 1960s, when the Fairness Doctrine 

required television stations to air large 

numbers of antismoking advertisements 

to counterbalance cigarette commercials 

(see chapters 11–13). State tobacco control 

programs increasingly directed media 

campaigns to adults rather than to youth 

during 1999–2003,39 when state funding for 

tobacco control increased. However, little 

information exists about campaign targeting 

in the years since then when state funding 

for tobacco control generally declined. 

Campaigns directed at adult smoking can 

be expected to influence youth smoking. 

A campaign that successfully reduces 

smoking among adults reduces youth 

exposure to adult-smoker role models 

(including parents)40 and can modify

perceived rates of adult smoking.41,42 Both 

exposure to adult smokers and perceived 

rates of adult smoking can be predictors of 

smoking initiation among youth. In addition, 

if adult smoking seems less desirable, 

motivation to use tobacco as a signifier 

of adulthood may decrease. Finally, most 

adolescents identify with and aspire to be 

treated as adults,40 increasing the likelihood 

that they will attend to messages crafted for 

adults. Thus, campaigns directed at adults 

can produce a two-for-one effect by favorably 

influencing adults and youth (see chapter 11). 

Nonetheless, much more research is 

needed on the effects of media campaigns 

in prompting smoking cessation attempts 

and in encouraging and supporting cessation. 

This research should consider the role 

campaigns can have in sustaining abstinence 

from smoking and preventing relapse to 

smoking, by providing a timely reminder and 

reinforcement for not smoking. Examination 

of the extent to which media campaigns 

might reduce daily cigarette consumption 
607

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

among smokers would also have value. 

Further scrutiny of the population subgroups 

most influenced by adult-focused smoking 

cessation campaigns is particularly 

important. For example, the predominantly 

adult-focused media campaigns in California, 

along with other tobacco control policies 

such as comprehensive smoke-free policies, 

were followed by substantial declines in the 

prevalence of smoking, but young adults 

rather than middle-aged or older adults were 

most responsible for driving these changes.43

In the United States, pharmaceutical 

companies advertise products such as 

nicotine replacement therapies, bupropion, 

and varenicline to help people quit smoking 

(see chapter 11). This marketing is likely 

to enhance awareness of options for 

smoking cessation, but the effects of such 

campaigns on behaviors are unclear. Open 

questions include whether emphasis on 

the difficulty of quitting smoking in these 

ads could result in reduced self-efficacy 

for cessation among subgroups of smokers 

or, conversely, could lead smokers to feel 

they could use pharmaceutical aids to quit 

smoking at any time, thereby reducing the 

sense of urgency to quit smoking as soon as 

possible.44 Other questions revolve around 

which subgroups of smokers benefit most 

when these marketing campaigns prompt 

smokers to use pharmaceutical aids and 

attempt to quit smoking in greater numbers. 

For example, would these campaigns be 

more likely to influence middle- and upperclass audiences than those from lower 

socioeconomic groups, thereby increasing 

the disparity in smoking prevalence between 

the groups? More research is needed in 

these areas.

Mass Media Campaign Expenditures

How Much Audience Exposure Is Needed?

Research to build a stronger evidence base 

to guide media buying for tobacco control 

campaigns is overdue. Three frequently 

asked questions among personnel in 

tobacco control programs are how much 

advertising to buy, over what duration, and 

what kinds of ads work best in preventing 

smoking initiation and prompting cessation. 

Limited research data are available to 

determine the optimal reach and frequency 

for campaigns. The risk is that some 

campaigns may be underexposing or 

overexposing target audiences. Advertising 

theory suggests lack of a dose-response 

relationship between exposure and impact 

but, instead, a nonlinear relationship in 

which increasing advertising exposure 

begins to exert diminishing marginal effects 

on the target behavior, that is, an advertising 

response function45 (see also “Economic 

Issues in Tobacco Advertising” in chapter 7). 

Research is needed to identify the point at 

which increments of advertising exposure 

yield ever-smaller increments in attitude 

or behavior change. In addition, tobacco 

control programs would greatly benefit from 

knowledge of the circumstances in which 

this optimal level of exposure increases 

or decreases according to the presence or 

absence of tobacco control policies, such as 

tax increases or smoke-free policies. Such 

policies can provide additional structural 

inducements or supports for preventing 

smoking initiation or prompting cessation. 

Research methods might relate changing 

weekly advertising doses, as measured 

by gross ratings points, for example, to 

outcomes such as weekly calls to telephone 

quitlines, weekly cigarette sales, or weekly 

measures of smokers’ intentions to quit 

smoking or change smoking behaviors, as 

estimated by population-tracking surveys. 

Further research could help tobacco control 

programs make the most of advertising 

dollars. For example, advertising research 

reveals that the effects of advertising 

linger over the days and weeks after the 

broadcasting ends,46 but relatively little 

is known about the rate at which these 

advertising effects decay in relation 

to tobacco control. People may recall 
608

1 5 . F u t u r e D i r e c t i o n s

antitobacco ads, especially memorable ads, 

long after they are discontinued, but the 

decay of behavioral effects, which are the 

most important outcome, have rarely 

been the subject of study. Advertising 

research suggests that behavioral effects 

of antitobacco advertising would decay 

relatively quickly. Collecting this kind of 

information in evaluations of antitobacco 

media campaigns could help to guide 

tobacco control programs in buying media 

more efficiently, for example, in pulses or 

bursts, also known as flights, rather than as 

a continuous purchase. 

Context for Advertising Exposure

Relatively little is known about the factors 

that might maximize exposure to and 

processing of antitobacco advertising 

messages in the context of communitywide 

campaigns. For example, might placement of 

ads in particular types of television programs 

lead to better processing of the intended 

messages? Some types of programs such 

as comedies47 or narratives48 may limit the 

potential of media campaign advertising 

by exposing smokers when they are in a 

less-than-receptive frame of mind or mood. 

Experimental research in which audiences 

watch television programs, some embedded 

with antitobacco ads, might be one way 

to study effects of program placement. 

In addition, fruitful research methods 

might be interviews of television audiences 

immediately after exposure to a broadcast 

ad47 or examination of the relative efficiency 

of various kinds of ads in different television 

programs in generating calls to telephone 

quitlines.49 Such research could assist 

program planners in developing a strategy 

for purchasing advertising that favors 

particular types of television programs.

As indicated in chapter 2, engagement with 

mass media campaigns does not occur in 

a context free of interpersonal networks. 

Much advertising is viewed or heard in 

the presence of another person, but even 

viewed alone, it may still be the subject of 

later conversations among work colleagues 

or other social groups. As shown by theory 

and evidence, interpersonal communication 

may be prompted by exposure to antitobacco 

advertising and may mediate, reinforce, 

or dampen campaign effects.50 Discussion 

prompted by exposure to antitobacco 

advertising might empower viewers with 

information they feel compelled to share 

with others or allow them to broach a 

previously difficult-to-raise topic, such as 

the need for a family member or friend to 

try to quit smoking. Further research would 

be useful on the kinds of advertisements 

and circumstances under which ad-elicited 

interpersonal discussions reinforce or 

undermine campaign goals.25,47,51–53

Differences in Population Subgroups and 

Effects of Campaigns

Aside from age (youth versus adults), 

a limited number of studies have compared 

the effects of mass media campaigns 

on population subgroups such as race, 

ethnicity, and SES. Patterns of exposure to 

advertising have varied among smokers in 

different SES groups (chapter 2). Smokers 

are more likely than nonsmokers to be heavy 

users of television and radio and less likely 

to read magazines and newspapers or to 

have Internet access.54 Some have criticized 

media campaigns as resonating with middleclass preoccupations over healthy lifestyles 

while bypassing poor, less-educated smokers 

and thereby exacerbating inequalities in 

smoking behavior. Few research studies 

have addressed these issues. 

However, one study of calls to telephone 

quitlines during periods of media campaign 

activity suggests that responsiveness to 

antitobacco advertising is relatively equal 

across SES subgroups, compared with 

periods of no media campaign activity.55

Additional research is needed to assess 

effects on alternative and additional 

behavioral outcomes, such as population 

survey responses of smokers in different SES 

groups or cigarette sales in neighborhoods 
609

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

of different SES. Such research would be 

helpful in determining which population 

subgroups had the greatest positive effects 

from media campaigns or whether effects 

were relatively equal.

Greater Role for Recycling or Sharing 

Effective Antitobacco Advertisements

Tobacco control programs are sometimes 

hesitant to use ads created by other tobacco 

control programs; they prefer to create 

a particular style of ads and branding. 

Fees to actors to recycle existing ads can 

be high, but compared with the time, cost, 

and difficulty of creating effective ads from 

scratch, recycling of ads that performed 

well elsewhere, with appropriate pretesting 

and rebadging, could be more widely 

adopted. This practice could increase the 

cost-effectiveness of funding allocated to 

antitobacco advertising by minimizing the 

need for development of ads. The Media 

Campaign Resource Center at the Office on 

Smoking and Health, Centers for Disease 

Control and Prevention,56 provides online 

access to ads developed by tobacco control 

programs. This resource provides a starting 

point for tobacco control programs wanting 

to recycle or adapt existing ads. An additional 

improvement would be for the Office 

on Smoking and Health, on the basis of 

research, to recommend ads that are likely to 

be most effective. Sharing development costs 

of ads across tobacco control programs is 

another strategy that could achieve this goal.

Media Campaign Content

Need for Emotionally Evocative Advertising

Much research has been performed on 

appraisal, recall, and processing of messages 

from different kinds of antitobacco ads in 

an effort to identify common elements that 

might be more successful (see chapter 11). 

Numerous studies have shown consistently 

that advertising with strong negative 

messages about health consequences 

perform better on target audience appraisals 

and indicators of message processing 

(e.g., recall of the ad, thinking more about 

the ad, or discussing the ad) than do other 

forms of advertising (e.g., humorous or 

emotionally neutral ads). Such emotionally 

evocative ads might feature the negative 

health consequences of smoking or the ways 

in which the tobacco industry has been 

shown to mislead the public about health 

effects, addiction, or marketing to youth. 

However, few population-based studies 

have directly compared the impact of these 

message types on smoking outcomes such 

as intention to smoke and smoking behavior. 

Further research is needed to determine 

whether the more proximal indicators 

of superior performance (e.g., appraisal, 

recall, and discussion about advertising) 

translate into population effects on actual 

smoking behavior.

A continuing challenge for tobacco control 

programs is to create ads that permit 

smokers to gain fresh insights into the risks 

posed by smoking and the benefits of quitting 

smoking. Although effective with their target 

audiences, emotionally evocative advertising 

messages are less palatable to the persons 

or groups funding tobacco control than are 

emotionally neutral or “feel good” messages. 

A key task for persons who disseminate 

research is to ensure that those who fund 

tobacco control efforts understand why 

investment in particular kinds of campaigns 

is likely to yield the best outcomes. Much is 

yet to be learned about other elements of ads 

that might increase the likelihood audiences 

will attend to and process intended messages 

about tobacco (see chapter 11).

Research results suggest that narrative ads, 

which tell a story about a real person, and 

storylines that elicit emotional responses 

or help people identify with the characters, 

might reduce the target audience’s tendency 

to argue against the intended message 

of the ad.57,58 Future research might 

focus on the extent to which different 

types of antismoking messages influence 

psychological outcomes beyond overt 
610

1 5 . F u t u r e D i r e c t i o n s

beliefs and attitudes about smoking. Such 

outcomes might be accessibility of attitudes 

about smoking, implicit attitudes about 

smoking, or unconscious activation of goals, 

behavior, or both. Each of these outcomes 

could affect smoking cessation or the 

potential to be influenced by advertising.

Findings in one study suggest that 

measuring the response to antismoking 

advertising needs to address more than 

whether attitudes are positive or negative. 

For example, the accessibility of an attitude is 

a key factor in the influence of that attitude 

on behavior.59 Although research suggests 

that more accessible attitudes are more 

likely to predict behavior,60,61 it is unknown 

whether particular types of messages are 

more likely to increase the accessibility of 

antismoking attitudes. The strength of the 

association between antismoking attitudes 

and the self might also be a predictor of 

behavior change. Evidence from the broader 

field of advertising research suggests that 

advertising is more effective if it encourages 

the viewer to relate the information in the 

message to self and past experiences.62 This 

self-referencing response might enhance the 

effectiveness of antismoking messages, and 

some kinds of ads (e.g., personal testimonial 

or narrative messages) might be more likely 

to encourage this kind of response. 

Other evidence suggests that simply 

measuring the supposed antecedents of 

behavior change (e.g., ad recall, attitudes, 

or intentions) is not enough to predict 

behavior because behavior can be influenced 

without conscious awareness. Consumers 

have been influenced by advertising 

without explicit recall, and researchers 

suggest that purchasing behavior is based 

on knowledge about a product rather than 

what is explicitly recalled about an ad.63

Antismoking messages, even when not 

explicitly recalled, might serve to shift 

smokers’ implicit attitudes toward those 

of nonsmokers.64,65 Social psychological 

research has also shown that changes in 

intentions are not necessary for an effect 

on behavior.66 Some behaviors can be 

driven by nonconscious goals, which can be 

automatically activated without conscious 

awareness. Because this process does not 

rely on conscious decision making, it is 

less likely to be influenced by cognitive 

reactance or biases that may arise in 

response to antismoking ads. Antismoking 

messages might influence smokers’ behavior 

by using models to prime the goal to quit 

smoking. Future studies might consider 

which types of messages are most likely to 

have an effect at this implicit level. 

In a new line of research, investigators are 

beginning to examine physiological responses 

(e.g., heart rate and skin conductance) to 

exposure to tobacco control ads that vary 

in the strength of the argument and the 

sensation value of the message.67 Such 

physiological responses are being compared 

with self-reported responses to determine 

whether they might be more discriminating 

measures of advertising-induced attention 

and arousal and whether they might 

predict ultimate behavioral response. In the 

broader field of neuromarketing, scientists 

are beginning to experiment with using 

functional magnetic resonance imaging to 

study patterns of brain responses to different 

ads and branded products.68,69

Research would be useful for identifying the 

extent to which different kinds of advertising 

messages reach and influence all smoker 

subgroups, including those with different 

race and ethnicity and those of lower SES. 

Examination of dose effects for different 

kinds of campaign messages would also be 

instructive for media buyers, because some 

kinds of advertising messages may not 

require as frequent repetition as others to 

generate desired outcomes. 

Corrective Advertising About Tobacco 

Industry Product Claims

In recent years, a variety of potential reducedexposure tobacco products such as Eclipse 
611

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

and Advance have been introduced into the 

marketplace. Several studies show that ads 

promoting these products increased smokers’ 

beliefs that they pose lower health risks 

than conventional cigarettes and reduced 

smokers’ interest in quitting smoking (see 

chapter 11). Past experience surrounding 

promotion of low-tar cigarettes (chapters 3–5 

and 11) showed the tobacco industry to be 

adept at designing misleading messages 

about smoking risks. Depending on the 

extent to which potential reduced-exposure 

products become more widely promoted and 

used, a future communications challenge 

will be to ensure that consumers assess 

risk more closely aligned to the scientific 

evidence about the actual risks these 

products may pose. Proposals from the public 

health community that entertain a harmreduction perspective for tobacco control, 

if implemented, could critically change 

the future communications environment 

for tobacco control.70 Research on risk 

trade-offs among smokers, decision making 

under uncertainty, and careful pretesting 

of proposed harm-reduction messages will 

be crucial for guiding the development of 

media communications on tobacco control 

that clarify rather than confuse public 

understanding. 

Alternative Channels for Media 

Communications in Tobacco Control

Changing Face of Television

Nearly all of the published research on media 

messages promoting tobacco control has 

involved television because it is by far the 

most widely used medium. Several research 

studies assessed the effects of screening 

ads before movies to protect audiences 

against portrayals of smoking in movies 

(see chapter 10). Research on tobacco 

control campaigns that use other media 

channels such as radio, print, and billboard 

messages is rare. Because these media 

require less investment, they may be a useful 

adjunct to or substitute for televised media 

campaigns in jurisdictions where tobacco 

control funding is poor. Additional research 

on the effects of antitobacco campaigns 

using these channels of communications 

would be useful. In general, however, 

television advertising is needed to carry 

the volume of message required to ensure 

adequate population exposure, so tobacco 

control programs need sufficient resources 

to conduct televised media campaigns. 

However, the number of cable channels has 

grown, requiring greater scrutiny of which 

television channels and which programs are 

watched by smokers and by youth, including 

those of lower SES,71 to ensure delivery of an 

adequate dose of campaign messages. 

Studies of media use suggest that, far 

from abandoning television, audiences are 

using multiple media sources.26,71 Digital 

technologies such as TiVo enable viewers 

to edit out standard television ads from 

recorded television programs, but it is 

unclear how often this happens in practice. 

The likely beneficiaries of any move away 

from television advertising are the Internet, 

product placement in television shows, and 

video-on-demand advertising. This situation 

reinforces the urgency for research to 

monitor and understand the effects of 

smoking-related messages embedded in 

these communication channels.

Online Media

Online media hold great promise for mass 

delivery of smoking cessation advice and 

support because they are four times more 

commonly used by smokers seeking help to 

quit smoking than are dedicated telephone 

quitlines.72 However, most sources of 

Web-based help lack evidence-based content, 

despite research evidence showing that 

interactive, tailored, Web-based expertsystems programs can significantly increase 

rates of smoking cessation (see chapter 11). 

Because maintaining these Web-based 

systems can be inexpensive once they are 

established, they may provide highly efficient 

assistance to the majority of smokers who 

prefer not to use “formal” sources of help 
612

1 5 . F u t u r e D i r e c t i o n s

to quit smoking. A challenge for tobacco 

control programs is the considerable costs 

to set up and program these expert systems, 

suggesting that sharing of existing systems 

across programs might make good financial 

sense. The upfront investment required to 

cross the chasm between research prototype 

evaluation and real-world online product 

availability could be taken on by for-profit 

companies or large nongovernmental 

organizations. Per-participant fees and fee 

scales based on population size are two 

possible ways to recoup costs. A limited 

amount of research suggests that such 

intervention options might be an advantage 

to groups of lower SES (see chapter 11). 

Present rates of access to and use of the 

Internet by these groups are much lower 

than for other groups. Thus, there is a long 

way to go before equality might prevail.73

However, this situation may change as 

content-management systems and the 

tailoring of application frameworks are 

further developed and implemented. 

Rapidly changing technologies have 

created many new program and research 

opportunities in the field of new media. 

The video-sharing Web site YouTube has 

hosted antitobacco ads, achieving additional 

exposure among visitors to the site and 

prompting people to comment and/or 

send the Internet link to others in their 

network. A video tribute to a person’s 

mother who died of lung cancer, entitled 

“Thanks Tobacco, You Killed My Mom,” 

was posted on April 13, 2007, on YouTube.74

By June 18, 2007, the video had been viewed 

over 10,000 times. One visitor to the site 

wrote, “Powerful stuff. I smoked for 17 years 

before quitting three weeks ago, and was 

having a bad day today. I went looking for 

a reminder of why I quit smoking.... Wow, 

my urge to smoke just vanished as I watched 

this. Sorry for your loss.”

A Pew survey in October–November 2006 

found that 55% of U.S. youth aged 12 to 17 

who use the Internet have accessed social 

networking sites such as MySpace or 

Facebook,75 where a user can create a profile 

and build a personal network to connect 

to other users. For example, the American 

Legacy Foundation launched “new truth” 

profile pages (InfectTruth) on popular 

Internet social networking sites such as 

MySpace, Hi5, Bebo, Piczo, and Xanga, 

a community of online diaries and journals76

to offer a “truth-like” take on the harms of 

tobacco and tools to help teens share the 

information with one another. Unpublished 

preliminary results indicate that during a 

typical campaign using television, radio, 

print, and traditional online banners, 

traffic to Legacy’s www.thetruth.com 

Web site77 reached approximately 30,000–

40,000 unique visitors a week. With the 

addition of the social networking sites, 

traffic on Legacy’s “truth” Web site increased 

to 50,000–60,000 unique visitors a week.78

Research is needed to determine the extent 

to which such sites can communicate 

desired messages to promote smoking 

prevention and their effects on youth. 

In addition, research would be helpful in 

ascertaining (1) the effects of online chat 

rooms and sharing of online quittingrelevant images and messages among 

smokers trying to quit and (2) how personal 

organizers and text messaging might benefit 

cessation attempts by providing reminders 

and prompts to avoid smoking.79 These 

personal communication vehicles could also 

help to assess responses to media messages 

such as antismoking advertisements.

Conclusions

All tobacco control strategies, including 

media interventions, operate in the context 

of some level of tobacco promotion and 

therefore need to counter varying degrees 

of tobacco marketing. The tobacco industry 

has weathered restrictions on tobacco 

marketing in the United States, and tobacco 

promotion remains pervasive and effective 
613

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

in encouraging tobacco use. History has 

demonstrated that when limits are placed 

on tobacco promotion, the industry resists 

and then evolves new strategies to effectively 

reach current and potential smokers with 

media messages that promote its products. 

Similarly, when media interventions appear 

to be effective in reducing tobacco use, 

they often are challenged or countered by 

the tobacco industry. Understanding this 

dynamic relationship between tobacco 

promotion and tobacco control is critical 

in conceptualizing and designing relevant 

research that contributes to the evidence 

base for tobacco control.

Monitoring tobacco industry activities in 

the changing media environment is a key 

research task for the future. Continuing 

industry activities include efforts to 

work around new restrictions on tobacco 

marketing and to create new marketing 

strategies. In tobacco control, improving 

the evidence base for efficient use of the 

media and selecting and refining messages 

and channels to reach and influence current 

and potential smokers are key goals for the 

research agenda. 

As implied throughout this chapter, research 

must be seen as a means toward achieving 

progress in tobacco control, rather than 

as an end in itself. Evidence is sufficient to 

conclude that tobacco marketing and tobacco 

use in movies encourage youth smoking 

initiation. Decisions about further restricting 

tobacco promotion, mounting adequately 

funded and effective media campaigns 

for tobacco control, and funding further 

research are made in a political environment. 

Reducing the enormous toll of tobaccorelated illness and premature death in the 

United States will depend on the extent to 

which research, such as that summarized 

in this monograph, informs tobacco control 

policy and program decisions.
614

1 5 . F u t u r e D i r e c t i o n s

References

1. Viswanath, K., N. Breen, H. Meissner, 

R. P. Moser, B. Hesse, W. R. Steele, and 

W. Rakowski. 2006. Cancer knowledge and 

disparities in the information age. Journal 

of Health Communication 11 Suppl. 1: 

S1–S17. 

2. Loomis, B. R., M. C. Farrelly, and 

N. H. Mann. 2006. The association of retail 

promotions for cigarettes with the Master 

Settlement Agreement, tobacco control 

programmes and cigarette excise taxes. 

Tobacco Control 15 (6): 458–63. 

3. Dewhirst, T. 2004. POP goes the power 

wall: Taking aim at tobacco promotional 

strategies utilised at retail. Tobacco Control

13 (3): 209–10. 

4. Fox, R. J., D. M. Krugman, J. E. Fletcher, and 

P. M. Fischer. 1998. Adolescents’ attention to 

beer and cigarette print ads and associated 

product warnings. Journal of Advertising

27 (3): 57–68. 

5. White, V. M., M. M. White, K. Freeman, 

E. A. Gilpin, and J. P. Pierce. 2006. Cigarette 

promotional offers: Who takes advantage? 

American Journal of Preventive Medicine

30 (3): 225–31. 

6. Laugesen, M., and C. Meads. 1991. 

Advertising, price, income and publicity 

effects on weekly cigarette sales in New 

Zealand supermarkets. British Journal of 

Addiction 86 (1): 83–89. 

7. Philip Morris USA. 2007. Smoking 

and health issues: Non-full-flavor 

“onsert” language. Philip Morris USA. 

http://www.philipmorrisusa.com/en/health_

issues/low_tar_cigarettes/onsert.asp.

8. Physicians for a Smoke-Free Canada. 

2006. Picture based cigarette health 

warnings: Legislation and regulations. 

http://www.smoke-free.ca/warnings/

countries%20and%20laws.htm.

9. Hammond, D., G. T. Fong, P. W. McDonald, 

K. S. Brown, and R. Cameron. 2004. Graphic 

Canadian cigarette warning labels and 

adverse outcomes: Evidence from Canadian 

smokers. American Journal of Public Health

94 (8): 1442–45. 

10. O’Hegarty, M., L. L. Pederson, D. E. Nelson, 

P. Mowery, J. M. Gable, and P. Wortley. 2006. 

Reactions of young adult smokers to warning 

labels on cigarette packages. American 

Journal of Preventive Medicine 30 (6): 467–73. 

11. Hammond, D., G. T. Fong, A. McNeill, 

R. Borland, and K. M. Cummings. 2006. 

Effectiveness of cigarette warning labels 

in informing smokers about the risks of 

smoking: Findings from the International 

Tobacco Control (ITC) Four Country Survey. 

Tobacco Control 15 Suppl. 3: iii19–iii25. 

12. Hammond, D., G. T. Fong, R. Borland, 

K. M. Cummings, A. McNeill, and P. Driezen. 

2007. Text and graphic warnings on 

cigarette packages: Findings from the 

international tobacco control four country 

study. American Journal of Preventive 

Medicine 32 (3): 202–9. 

13. Thompson, E. M., and A. C. Gunther. 2007. 

Cigarettes and cinema: Does parental 

restriction of R-rated movie viewing reduce 

adolescent smoking susceptibility? Journal 

of Adolescent Health 40 (2): 181.e1–181.e6. 

14. YouTube. http://www.youtube.com.

15. Office of National Drug Control Policy. 

2006. White House anti-drug office begins 

posting videos on YouTube. Washington, 

DC: Office of National Drug Control Policy. 

http://www.whitehousedrugpolicy.gov/news/

press06/091906.html.

16. Freeman, B., and S. Chapman. 2007. 

Is “YouTube” telling or selling you 

something? Tobacco content on the 

YouTube video-sharing website. Tobacco 

Control 16 (3): 207–10. 

17. Moore, E. S. 2006. It’s child’s play: 

Advergaming and the online marketing of 

food to children. Kaiser Family Foundation 

Report. http://www.kff.org/entmedia/7536

.cfm.

18. Haninger, K., and K. M. Thompson. 2004. 

Content and ratings of teen-rated video 

games. JAMA: The Journal of the American 

Medical Association 291 (7): 856–65. 

19. Henriksen, L., A. L. Dauphinee, Y. Wang, and 

S. P. Fortmann. 2006. Industry-sponsored 

anti-smoking ads and adolescent reactance: 

Test of a boomerang effect. Tobacco Control

15 (1): 13–18. 

20. Farrelly, M. C., C. G. Healton, K. C. Davis, 

P. Messeri, J. C. Hersey, and M. L. Haviland. 

2002. Getting to the truth: Evaluating 

national tobacco countermarketing 

campaigns. American Journal of Public 

Health 92 (6): 901–7. 

21. Hersey, J. C., J. Niederdeppe, W. D. Evans, 

J. Nonnemaker, S. Blahut, D. Holden, 

P. Messeri, and M. L. Haviland. 2005. The 

theory of “truth”: How counterindustry 
615

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

campaigns affect smoking behavior among 

teens. Health Psychology 24 (1): 22–31. 

22. Goldberg, M. E., and J. Hartwick. 1990. 

The effects of advertiser reputation and 

extremity of advertising claim on advertising 

effectiveness. Journal of Consumer Research

17 (2): 172–79. 

23. Berens, G., C. B. M. van Riel, and 

G. H. van Bruggen. 2005. Corporate 

associations and consumer product 

responses: The moderating role of corporate 

brand dominance. Journal of Marketing

69 (3): 35–48. 

24. Petty, R. E., M. A. Fleming, J. R. Priester, 

and A. H. Feinstein. 2001. Individual 

versus group interest violation: Surprise 

as a determinant of argument scrutiny and 

persuasion. Social Cognition 19 (4): 418–42. 

25. Wakefield, M., Y. Terry-McElrath, S. Emery, 

H. Saffer, F. Chaloupka, G. Szczypka, B. Flay, 

P. O. O’Malley, and L. Johnston. 2006. 

Effect of televised, tobacco company-funded 

smoking prevention advertising on youth 

smoking-related beliefs, intentions, and 

behavior. American Journal of Public Health

96 (12): 2154–60. 

26. Viswanath, K., and K. M. Emmons. 2006. 

Message effects and social determinants of 

health: Its application to cancer disparities. 

Journal of Communication 56 Suppl. 1: 

S238–S264. 

27. Hersey, J. C., J. Niederdeppe, W. D. Evans, 

J. Nonnemaker, S. Blahut, M. C. Farrelly, 

D. Holden, P. Messeri, and M. L. Haviland. 

2003. The effects of state counterindustry 

media campaigns on beliefs, attitudes, and 

smoking status among teens and young 

adults. Preventive Medicine 37 (6 Pt. 1): 

544–52. 

28. World Health Organization. 2005. WHO 

Framework Convention on Tobacco Control 

(WHO FCTC). http://www.who.int/tobacco/

framework/WHO_FCTC_english.pdf.

29. Kenyon, A. T., and J. Liberman. 2006. 

Controlling cross-border tobacco: 

Advertising, promotion and sponsorship—

Implementing the FCTC. Univ. of Melbourne 

Legal Studies Research Paper No. 161. 

http://papers.ssrn.com/sol3/papers

.cfm?abstract_id=927551.

30. World Health Organization. 2007. 

Elaboration of a template for a protocol on 

cross-border tobacco advertising, promotion 

and sponsorship. Publication no. A/FCTC/

COP/2/10. Geneva: Conference of the Parties 

to the WHO Framework Convention on 

Tobacco Control. http://www.who.int/gb/

fctc/PDF/cop2/FCTC_COP2_10-en.pdf.

31. Goldberg, M. E., J. Liefeld, K. Kindra, 

J. Madill-Marshall, J. Lefebvre, 

N. Martohardjono, and J. Vredenburg. 

1995. When packages can’t speak: Possible 

impacts of plain and generic packaging of 

tobacco products. Expert panel report to 

Health Canada. Ottawa, ON: Health Canada, 

Office of Tobacco Control.

32. Goldberg, M. E., J. Liefeld, J. Madill, and 

H. Vredenburg. 1999. The effect of plain 

packaging on response to health warnings. 

American Journal of Public Health 89 (9): 

1434–35. 

33. Slater, S., F. J. Chaloupka, and M. Wakefield. 

2001. State variation in retail promotions 

and advertising for Marlboro cigarettes. 

Tobacco Control 10 (4): 337–39. 

34. The Wirthlin Group. Philip Morris. 

The EPA’s announcement on second hand 

smoke: A pulseline analysis. Feb 1993. 

http://legacy.library.ucsf.edu/tid/jmn85e00.

35. Nelson, D. E., J. A. Woodward, 

R. C. Brownson, P. L. Remington, and 

C. Parvanta. 2002. Future directions. 

In Communicating public health 

information effectively: A guide 

for practitioners, ed. D. E. Nelson, 

R. C. Brownson, P. L. Remington, and 

C. Parvanta, 205–12. Washington, DC: 

American Public Health Association.

36. Asbridge, M. 2004. Public place restrictions 

on smoking in Canada: Assessing the role of 

the state, media, science and public health 

advocacy. Social Science and Medicine

58 (1): 13–24. 

37. Ettema, J. S., J. W. Brown, and R. V. Luepker. 

1983. Knowledge gap effects in a health 

information campaign. Public Opinion 

Quarterly 47 (4): 516–27. 

38. Peto, R. 1997. Global tobacco mortality: 

Monitoring the growing tobacco epidemic. 

Presented at the Tenth World Conference 

on Tobacco OR Health, 24–28 August 1997, 

Beijing, China.

39. Emery, S., G. Szczypka, L. M. Powell, 

and F. J. Chaloupka. 2007. Public health 

obesity-related TV advertising: Lessons 

learned from tobacco. American Journal 

of Preventive Medicine 33 (4S): S257–S263.

40. Hill, D. 1999. Why we should tackle adult 

smoking first. Tobacco Control 8 (3): 333–35. 

41. Conrad, K. M., B. R. Flay, and D. Hill. 1992. 

Why children start smoking cigarettes: 
616

1 5 . F u t u r e D i r e c t i o n s

Predictors of onset. British Journal of 

Addiction 87 (12): 1711–24. 

42. Tyas, S. L., and L. L. Pederson. 1998. 

Psychosocial factors related to adolescent 

smoking: A critical review of the literature. 

Tobacco Control 7 (4): 409–20. 

43. Messer, K., J. P. Pierce, S. H. Zhu, 

A. M. Hartman, W. K. Al-Delaimy, 

D. R. Trinidad, and E. A. Gilpin. 2007. 

The California Tobacco Control Program’s 

effect on adult smokers: (1) Smoking 

cessation. Tobacco Control 16 (2): 85–90. 

44. Bolton, L. E., J. B. Cohen, and P. N. Bloom. 

2006. Does marketing products as remedies 

create “get out of jail free cards”? Journal of 

Consumer Research 33 (1): 71–81. 

45. Lodish, L. M., M. Abraham, S. Kalmenson, 

J. Livelsberger, B. Lubetkin, B. Richardson, 

and M. E. Stevens. 1995. How T.V. advertising 

works: A meta-analysis of 389 real world split 

cable T.V. advertising experiments. Journal of 

Marketing Research 32 (2): 125–39. 

46. Tellis, G. J. 2003. Effective advertising: 

Understanding when, how, and why 

advertising works. Thousands Oaks, CA: 

Sage Publications.

47. Durkin, S., and M. Wakefield. 2006. 

Maximizing the impact of emotive 

antitobacco advertising: Effects of 

interpersonal discussion and program 

placement. Social Marketing Quarterly

12 (3): 3–14. 

48. Wang, J., and B. J. Calder. 2006. Media 

transportation and advertising. Journal of 

Consumer Research 33 (2): 151–62. 

49. Carroll, T., and B. Rock. 2003. Generating 

Quitline calls during Australia’s National 

Tobacco Campaign: Effects of television 

advertisement execution and programme 

placement. Tobacco Control 12 Suppl. 2: 

ii40–ii44. 

50. Southwell, B. G., and M. C. Yzer. 2007. The 

roles of interpersonal communication in 

mass media campaigns. In Communication 

yearbook 31, ed. C. S. Beck, 419–62. 

Mahwah, NJ: Lawrence Erlbaum.

51. Hafstad, A., and L. E. Aaro. 1997. Activating 

interpersonal influence through provocative 

appeals: Evaluation of a mass mediabased antismoking campaign targeting 

adolescents. Health Communication 9 (3): 

253–72. 

52. van den Putte, B., M. C. Yzer, and 

S. Brunsting. 2005. Social influences on 

smoking cessation: A comparison of the 

effect of six social influence variables. 

Preventive Medicine 41 (1): 186–93. 

53. Hornik, R., and I. Yanovitzky. 2003. 

Using theory to design evaluations of 

communication campaigns: The case of the 

National Youth Anti-Drug Media Campaign. 

Communication Theory 13 (2): 204–24. 

54. Alexander, A., J. Owers, R. A. Carveth, 

C. A. Hollifield, and A. N. Greco. 2003. 

Media economics: Theory and practice.

3rd ed. Mahwah, NJ: Lawrence Erlbaum.

55. Siahpush, M., M. Wakefield, M. Spittal, and 

S. Durkin. 2007. Antismoking television 

advertising and socioeconomic variations in 

calls to Quitline. Journal of Epidemiology 

and Community Health 61 (4): 298–301. 

56. Centers for Disease Control and Prevention. 

2007. Media Campaign Resource Center: 

Tobacco counter-advertising collection. 

http://apps.nccd.cdc.gov/mcrc.

57. Dal Cin, S., M. P. Zanna, and G. T. Fong. 

2004. Narrative persuasion and overcoming 

resistance. In Resistance and persuasion,

ed. E. S. Knowles and J. A. Linn, 175–91. 

Mahwah, NJ: Lawrence Erlbaum.

58. Green, M. C. 2006. Narratives and cancer 

communication. Journal of Communication

56 Suppl. 1: S163–S183. 

59. Fazio, R. H. 1990. Multiple processes by 

which attitudes guide behavior: The MODE 

model as an integrative framework. In 

Advances in experimental social psychology,

vol. 23, ed. M. P. Zanna, 75–109. New York: 

Academic Press.

60. Hersey, J. C., J. Niederdeppe, S. W. Ng, 

P. Mowery, M. Farrelly, and P. Messeri. 2005. 

How state counter-industry campaigns 

help prime perceptions of tobacco industry 

practices to promote reductions in youth 

smoking. Tobacco Control 14 (6): 377–83. 

61. Roskos-Ewoldsen, D. R., J. H. Yu, and 

N. Rhodes. 2004. Fear appeal messages affect 

accessibility of attitudes toward the threat 

and adaptive behaviors. Communication 

Monographs 71 (1): 49–69. 

62. Burnkrant, R. E., and H. R. Unnava. 1995. 

Effects of self-referencing on persuasion. 

Journal of Consumer Research 22 (1): 

17–26. 

63. Lee, A. Y. 2002. Effects of implicit memory 

on memory-based versus stimulus-based 

brand choice. Journal of Marketing Research

39 (4): 440–54. 

64. Huijding, J., P. J. de Jong, R. W. Wiers, and 

K. Verkooijen. 2005. Implicit and explicit 
617

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

attitudes toward smoking in a smoking and 

a nonsmoking setting. Addictive Behaviors

30 (5): 949–61. 

65. Swanson, J. E., E. Swanson, and 

A. G. Greenwald. 2001. Using the implicit 

association test to investigate attitudebehaviour consistency for stigmatised 

behaviour. Cognition and Emotion 15 (2): 

207–30. 

66. Bargh, J. A., P. M. Gollwitzer, A. Lee-Chai, 

K. Barndollar, and R. Trotschel. 2001. The 

automated will: Nonconscious activation 

and pursuit of behavioral goals. Journal of 

Personality and Social Psychology 81 (6): 

1014–27. 

67. Strasser, A., J. Cappella, M. Fishbein, 

W. Shadel, and C. Lerman. 2006. The effect 

of smoking cessation PSAs on cognitive and 

physiologic responses. Nicotine & Tobacco 

Research 9 Suppl. 2: S119–S120. 

68. McClure, S. M., J. Li, D. Tomlin, K. S. Cypert, 

L. M. Montague, and P. R. Montague. 2004. 

Neural correlates of behavioral preference 

for culturally familiar drinks. Neuron 44 (2): 

379–87. 

69. Iacoboni, M. 2007. Who really won the 

Super Bowl? The story of an instant-science 

experiment. http://www.edge.org/3rd_

culture/iacoboni06/iacoboni06_index.html.

70. Martin, E. G., K. E. Warner, and P. M. Lantz. 

2004. Tobacco harm reduction: What do the 

experts think? Tobacco Control 13 (2): 123–8. 

71. Nelson, D. E., M. Gallogly, L. L. Pederson, 

M. Barry, D. McGoldrick, and E. W. Maibach. 

2008. Use of consumer survey data to 

target cessation messages to smokers 

through mass media. American Journal of 

Public Health 98 (3): 536–42.

72. Biener, L., R. L. Reimer, M. Wakefield, 

G. Szczypka, N. A. Rigotti, and G. Connolly. 

2006. Impact of smoking cessation aids 

and mass media among recent quitters. 

American Journal of Preventive Medicine

30 (3): 217–24. 

73. Viswanath, K. 2005. Science and society: 

The communications revolution and cancer 

control. Nature Reviews Cancer 5 (10): 

828–35. 

74. Thanks Tobacco, You Killed My Mom. 

2007. YouTube, http://www.youtube.com/

watch?v=u_8BerrJg0M.

75. Lenhart, A., and M. Madden. 2007. Social 

networking websites and teens: An overview. 

Washington: Pew Internet and American 

Life Project. http://www.pewinternet.org/

PPF/r/198/report_display.asp.

76. American Legacy Foundation. 2006. Truth 

extends interactive reach: Engage young 

people on social networking web sites. 

http://www.americanlegacy.org/730.htm.

77. American Legacy Foundation. 2007. 

The truth. American Legacy Foundation. 

http://www.thetruth.com.

78. Vallone, D. 2007. Media and social 

marketing: The next generation of NCI 

state and community tobacco control 

policy research and dissemination. Paper 

presented at the annual meeting of the 

Society for Research on Nicotine and 

Tobacco, Austin, TX.

79. Rodgers, A., T. Corbett, D. Bramley, 

T. Riddell, M. Wills, R. B. Lin, and M. Jones. 

2005. Do u smoke after txt? Results of a 

randomised trial of smoking cessation using 

mobile phone text messaging. Tobacco 

Control 14 (4): 255–61. 

619

Appendix

Michigan’s Proposal A

Chapter 14 reviews media efforts by the tobacco industry to defeat state tobacco control 

ballot initiatives and referenda. That chapter presents the outcomes of 42 state tobacco 

initiatives and referenda held from 1988 to 2006, and provides an analysis of industry 

media campaigns used in seven initiatives and referenda that proposed increases in 

tobacco taxes.

Michigan’s Proposal A (1994) was materially different from the other 41 initiatives and 

referenda, which focused exclusively on tobacco. Proposal A affected many types of taxes, 

including tobacco excise taxes, sales taxes, income taxes, and business-related taxes. This 

appendix presents a summary of Proposal A because of several compelling features of this 

campaign: (1) when approved by the voters, Proposal A resulted in the largest cigarette 

tax increase in the history of the nation (50¢ per pack), giving Michigan the highest state 

cigarette tax rate in the country at that time (75¢ per pack); (2) the tobacco industry was 

the major funder of the anti-Proposal A coalition, allowing it to conduct an intense media 

campaign; and (3) Proposal A proponents, in their own media communications, focused 

on the industry’s involvement in the opposition campaign. It should be noted that many 

states approved larger cigarette tax increases in later years, including several that have 

adopted increases of $1.00 or more per pack since 2005. 
620

A p p e n d i x . M i c h i g a n ’ s P r o p o s a l A

I

n July 1993, the Michigan state legislature eliminated local school property taxes, thereby 

reducing annual funding for the state’s public schools by almost $7 billion. That action 

grew out of several concerns: (1) property taxes were too high (Michigan had the eighth 

highest property tax burden in the country); (2) property assessments were increasing too 

quickly; and (3) geographic differences in the revenue from property taxes—which were 

the chief source of funds for the public school system—were creating significant disparities 

in per-pupil funding across school districts.1

To fill the new funding gap for the public school system, the legislature voted on 

December 24, 1993, to offer the voters two alternative revenue proposals through a ballot 

referendum identified as Proposal A. This measure was placed on the ballot in a special 

election to be held on March 15, 1994. If voters approved Proposal A (called the “ballot plan”), 

the state constitution would be amended to increase the state sales tax from 4.0% to 6.0%, 

increase the state cigarette tax from 25¢ to 75¢ per pack, limit future property assessment 

increases, and reduce the state income tax rate from 4.6% to 4.4%. Defeat of the ballot 

measure would automatically put into effect the alternative plan (called the “statutory 

plan”), which included an increase in the income tax from 4.6% to 6.0%, an increase in the 

state cigarette tax from 25¢ to 40¢ per pack, and an increase in the single business tax rate. 

The two proposals had other differential effects on tax policy. However, both options imposed 

an identical ad valorem tax on tobacco products other than cigarettes (cigars, non-cigarette 

smoking tobacco, and smokeless tobacco) at 16.0% of the wholesale price.2 The ballot plan 

included a provision earmarking 6% of total tobacco tax revenues (about $35 million) to 

“improving the quality of health care of the residents of this state.” The statutory plan did 

not include a health earmark.

From the standpoint of tobacco, the variance between the ballot plan and the statutory 

plan was the cigarette tax differential of 35¢ per pack and the 6% health earmark in the 

ballot plan (assuming that some of the earmarked revenue might be allocated to tobacco 

control). Those differences were enough to drive the tobacco industry into the camp opposing 

Proposal A, whose most prominent members were the Michigan Education Association 

(MEA), a teachers’ union; other labor unions; the Michigan Municipal League; and the 

League of Women Voters. Supporters of the ballot plan included Governor John Engler, 

business interests, utilities, and many health organizations motivated to support the measure 

because of its larger cigarette tax increase. 

Tobacco companies provided the main financial backing for the opposition coalition, named 

“Michigan Citizens for Fair Taxes.” Before disclosures of campaign contributions were 

required, Proposal A supporters reported that they had learned from industry sources that 

... the Tobacco Institute has been authorized by the tobacco companies to spend upwards of 

$4 million over the next four weeks in a campaign of deceit and distortion unprecedented in 

Michigan. That is as much money in four weeks as both Michigan gubernatorial candidates are 

allowed to spend during an entire general election campaign.... In opposing Proposal A, the 

tobacco lobbyists from outside our state are threatening the health of Michigan’s residents and 

our state’s economy.3
621

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Walker Merriman, vice president of the Tobacco Institute, stated that the tobacco lobby’s 

contributions to the anti-Proposal A campaign will be 

... whatever we have that we think is appropriate. Pick a number. $100 or $100 million. I don’t 

think anyone should reasonably expect us to tip our hand.4

The first required disclosure of campaign contributions indicated that $3,965,731 had 

been donated through February 27, 1994, to defeat Proposal A. Of this amount, 86% came 

from tobacco interests, including $1,783,018 from the Tobacco Institute, $1,244,396 from 

R.J. Reynolds, $150,089 from Lorillard, and $140,149 from American Tobacco Company. 

Donations in support of the measure, on the other hand, amounted to $1.063 million.5,6

A later disclosure indicated that “contributions from tobacco companies and lobbying 

groups made up most of the $5 million raised by the Michigan Citizens for Fair Taxes,” 

Direct mail brochure from the Michigan Citizens for Fair Taxes campaign (here and 

next page)
622

A p p e n d i x . M i c h i g a n ’ s P r o p o s a l A

including $2.2 million from the Tobacco Institute, $1.3 million from R.J. Reynolds, and 

$302,609 from American Tobacco Company. About $4.4 million was spent by this group 

on television advertising.7

Proposal A opponents used aggressive media advocacy, particularly toward the end of the 

campaign, including television and radio advertisements and direct mail. Even though 

tobacco industry donations covered most of the opposition’s campaign expenditures, their 

media messages ignored the cigarette tax differential. Instead, they focused on the unfairness 

of a sales tax increase and other nontobacco issues. However, one argument from the tobacco 

industry’s media archive—that tobacco taxes are “regressive” (disproportionately affecting 

the poor)—was applied to the proposed sales tax increase.

Opposition forces sent at least five different direct mail pieces to households throughout 

the state in the two weeks leading up to the vote. The cover of one large, four-page 

color brochure showed a photograph of a school bus, with an image of Governor Engler 

superimposed on the front grille above the headline, “Better look under the hood.” Inside 

the brochure was a photograph of a demolished school bus—an image that disturbed 

and offended many parents whose children ride school buses—under another headline, 

“Proposal A is a disaster for our kids.” The accompanying text argued that passing Proposal A 

would benefit “special interests”—an ironic claim in light of the fact that most of the 

opposition’s expenditures were underwritten by the tobacco industry.

Another direct mail brochure featured photographs of senior citizens “held hostage.” It claimed 

that “Proposal A hurts working people and seniors most, who pay a higher percentage of income 

in sales taxes—an especially cruel burden for seniors with fixed incomes.”
623

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Proposal A supporters had much less funding in their political coffers. However, they were 

able to garner a substantial amount of earned media through press releases, press conferences, 

“town hall” meetings, newspaper op-ed columns and letters to the editor, and media interviews. 

They also purchased time on radio stations.8 A key message in their paid and unpaid media 

communications was the role of the tobacco companies in funding the opposition campaign. 

On a television program in Traverse City, for example, Governor Engler held up an empty 

Marlboro package and said,

Reprinted by permission of the Detroit Free Press.

Reproduced with permission of Dave Cloverly.
624

A p p e n d i x . M i c h i g a n ’ s P r o p o s a l A

Joe Camel is the only thing that stands in the way of our being successful on March 15. We are 

not going to let cigarette companies come in here and bankroll the whole campaign, blow a lot 

smoke about what proposal A is or isn’t, all in an effort to protect the manufacture of cigarettes 

in North Carolina and Kentucky.9

The role of the tobacco lobby in funding the anti-Proposal A campaign was covered extensively 

by the media in its news and editorial pages. For example, at least eight editorial cartoons on 

the subject were published in major newspapers during the three-month campaign—two in 

the Detroit Free Press (March 9 and 10, 1994), three in the Detroit News (February 23, 

March 10, and March 17, 1994), and three in the Grand Rapids Press (March 4, 13, and 15, 

1994). The theme of teachers and tobacco interests as “strange bedfellows” was featured in 

one of these cartoons and in editorial commentary:

Allied against the March 15 school finance ballot plan are quintessential strange bedfellows—

those who teach kids good habits and those who sell bad ones. The Michigan Education 

Association (MEA) wants to help kids. The tobacco industry wants to hook them.10

In the end, voters approved Proposal A by a huge margin—69% to 31%—giving Michigan 

the highest cigarette tax rate among all 50 states. After the vote, Chris Christoff, a political 

writer for the Detroit Free Press, noted that the campaign against the referendum “was 

criticized for its misleading advertisements and its highly negative tone.”11 William Ballenger, 

editor of the newsletter Inside Michigan Politics, said that “In terms of truthfulness, the 

anti-Proposal A campaign is right down there in the quagmire, the worst I’ve seen going 

back 25 years.”12 Craig Ruff, president of an independent, Lansing-based consulting firm, 

Reproduced with permission of The Detroit News.
625

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

attributed the passage of Proposal A—at least in part—to the tobacco industry’s role in the 

opposition campaign:

The opponent’s misuse of their war chest to fight the ballot question can be described only as 

highway robbery, and the tobacco industry got stung. The campaign against Proposal A set new 

and anything but laudable standards for purposeful misinformation. Political strategies have 

underestimated voters before, but never on this scale. The stockholders of the tobacco companies 

ought to sue for recovery; rarely have millions of bucks been so misspent. How many computers 

in Michigan classrooms could those North Carolina millions have bought?13

After passage of Proposal A, the state legislature adopted legislation creating the Healthy 

Michigan Fund, into which were placed the earmarked revenues from tobacco taxes. About 

$4 million from this fund were appropriated annually for tobacco control programs, although 

that amount has been reduced in recent years. Because of large disparities in cigarette tax 

rates between Michigan and other states (especially Indiana, a neighbor state, whose cigarette 

tax was 15.5¢ per pack at the time), another $1 million from the fund was allocated for law 

enforcement efforts to interdict interstate cigarette smuggling.
626

A p p e n d i x . M i c h i g a n ’ s P r o p o s a l A

References

1. Michigan Citizens for Fairness in Public 

School Funding. 2006. Some background on 

Proposal “A.” http://www.mischoolfunding

.org/background.htm.

2. Michigan House and Senate Fiscal Agencies. 

2006. School finance in Michigan before 

and after the implementation of Proposal A. 

http://senate.michigan.gov/sfa/publications/

jointrep/finpropa/95comp.html.

3. Right Plan for Michigan Committee. 1994. 

Warning: Tobacco lobby wants your income 

taxes to go up, so taxes on the [cigarettes] 

don’t! Press release.

4. Bell, D. 1994. Tobacco industry to fight 

Proposal A. Detroit Free Press, February 18.

5. Detroit Free Press. 1994. Butt out! Big 

tobacco has no business trying to buy state 

voters. Editorial. Detroit Free Press, March 8.

6. Grand Rapids Press. 1994. Blowing smoke 

at Proposal A. Editorial. Grand Rapids Press,

March 10.

7. Gongwer. 1994. Tobacco interests spend 

$3.8 million in failed ballot campaign. 

Report 72. Gongwer News Service,

April 14.

8. Gongwer. 1994. Tobacco industry targeted 

in first pro-“A” radio ad. Report 35. 

Gongwer News Service, February 22.

9. Weeks, G. 1994. Who will win, John Engler 

or Joe Camel? Wait till the smoke clears. 

Detroit News, February 27.

10. Weeks, G. 1994. Odd couple: MEA, tobacco 

industry team up to fight school ballot 

issue. Detroit News, February 10.

11. Christoff, C. 1994. Voters pick sales tax: 

Ad blitz funded by tobacco lobby is rejected. 

Detroit Free Press, March 16.

12. Christoff, C. 1994. Ad campaign is so 

unfair it’s a turnoff: Both sides point out 

deception on Proposal A. Detroit Free 

Press, March 12.

13. Ruff, C. 1994. Voters are the winners, 

because they didn’t buy the lies. Detroit 

Free Press, March 17.
627

Index

A

Abrams v. United States, 295

Accord (brand), 167

ACS (American Cancer Society), 310, 433, 442, 

503, 508, 562, 564

ACSH (American Council on Science and 

Health), 156

Action on Smoking and Health (ASH), 550

addictiveness

avoidance of, in branded advertising, 150

news coverage of, 341

adolescents. See youth

Adult Use of Tobacco Surveys, 167

Advance (brand), 461

advertising theme, 146

misleading advertising, 310, 611

target market for, 59

adventure theme, 148

adverse health effects. See health consequences

advertising, by tobacco industry. See tobacco 

advertising and promotion

advertising bans

ambiguities in legislation, 85–87, 101

broadcast, 82–83

Canada, 311

constitutional aspects, 300–301

effectiveness of, 275–276, 280–281

European Union, 312–313

global, 313–316

history of, 551

industry response to, 39–40, 272, 273t, 274–

275, 280

partial, ineffectiveness of, 82–87, 280–281, 599

rationales for, 74–86

youth, 58, 157–158, 300

advertising elasticity, 275–276

advertising exposure. See media exposure

advertising response functions, 270–272

antitobacco messages, 607

brand-level, 270

market-level, 271f, 271–272

national-level, 270f, 270–271

Advertising Review Council (ARC), 112–113

Advertising Standards Authority (ASA), 69

advertising themes, 145–150, 170. See also

specific theme

adolescent, 216–227, 278–279

antitobacco, 450, 455, 457–459

gender-oriented, 220, 278

movies and, 362

opposition to state initiatives and, 583, 589–

591, 590t, 592

advertising-to-sales (A-S) ratio, 120–121, 123t,

268–269

affective response, 29–30

African Americans

adolescent smokers, 215, 217

quitline use, 533

as target market, 56–57, 59, 144–145, 160–162, 

198–200

age groups. See also young adults; youth

segmentation by, 57–58

for antitobacco advertising, 461–462

agenda-setting hypothesis, 42, 332, 605

AHA (American Heart Association), 559, 561–562, 

564

ALA (American Lung Association), 433, 559, 562, 

564

Alaska Natives, as target market, 164–165, 171

alcohol consumption, market segmentation and, 

60–61

“Alive with Pleasure” campaign, 224–225

Altria Group. See Philip Morris USA

ambivalent attitude, 33–34

Amendment 3 (Missouri), 589, 590t, 591

Amendment 35 (Colorado), 584, 587–588, 589t,

591, 591t

American Academy of Family Physicians, Tar Wars 

program, 444

American Cancer Society (ACS), 310, 433, 442, 

503, 508, 562, 564

American Council on Science and Health (ACSH), 

156

American Heart Association (AHA), 559, 561–562, 

564

American Indians, as target market, 164–165, 

171

American Legacy Foundation, 433, 567–571

InfectTruth, 612

media literacy research, 198

Note. Page numbers followed by t and f denote tables and figures, respectively.
628

I n d e x

PM21 campaign and, 201

purposes of, 569

restrictions on, 569–571

“truth” campaign, 31, 433, 447, 456, 462, 

520–522, 536, 551, 569, 571

American Legacy Media Tracking Survey, 520

American Lung Association (ALA), 433, 559, 562, 

564

American Nonsmokers’ Rights Foundation, 559, 

561, 567–568

American Psychological Association, 213

American Spirit (brand), 165

American Stop Smoking Intervention Study 

(ASSIST), 41, 340, 351, 499t, 505, 550

American Tobacco Company

FTC settlement with, 309

marketing expenditures, 124t

opposition to state initiatives, 621–622

package design, 107

product placement, 116

targeted marketing, 55, 155, 160

anxiety reduction theme, 146, 170, 225–227, 

278–279, 373

Arab countries, entertainment media in, 400

ARC (Advertising Review Council), 112–113

Arizona

Proposition 200, 562–565, 571

Proposition 206, 584

Arizona for a Healthy Future Coalition, 564

Arizona Tobacco Education and Prevention 

Program (AzTEPP), 531, 551, 562–565, 571

arousal, and advertising impact, 459–460, 468, 600

Arzberger, Gus, 564

ASA (Advertising Standards Authority), 69

ASH (Action on Smoking and Health), 550

Ashton, Mary Madonna, 552

Asian Americans, as target market, 59, 163–164

ASSIST (American Stop Smoking Intervention 

Study), 41, 340, 351, 499t, 505, 550

A Su Salud, 499t, 506–507

attitudes

dual process models of, 32–35

entertainment media effects on, 376–392

expectancy-value theories of, 30–32

influences on, 33

media effects on, 27, 29–30, 610

news coverage and, 341–344

toward advertising, 240, 257–258, 279–280

types of, 33–34

Attitudes Toward the Effects of Smoking on 

Health (Brown & Williamson), 77

audience

defining, 55–62, 87

fragmentation of, 598

measurement techniques, 39

power balance between media and, 40, 43

audience-making, 37

audience reach, 374–376

audience response

assessment of, 385

to movie content, 376–392

to news media, 604–605

audio media, 358

audiovisual advertising, FTC definition of, 102, 

105

audiovisual media, 358

Australia

advertising bans, 85, 380

advertising code violations, 82

antitobacco media interventions, 433, 444, 

446, 462

corporate image in, 182

Internet marketing, 111

magazine advertising, 396–397

market segmentation, 57, 59

media advocacy strategy, 41

National Tobacco Campaign, 509, 512, 515–516, 

519–520, 534

news coverage, 333, 336–337, 340, 347

point-of-purchase promotions, 599

“Quit for Life” programs, 493, 494t, 498t,

501–502, 504, 509, 515, 533–534

smoke-free bars, 340

smoking cessation programs, 502

viral marketing, 110

youth smoking, 264, 519–520

youth smoking prevention campaigns, 192–193, 

446, 463

Australian National Quitline Service, 534

Austria, 523

authoritative behavior of parents, youth smoking 

and, 266

awareness of advertising, 240–241, 256–257, 513. 

See also brand recognition

AzTEPP (Arizona Tobacco Education and 

Prevention Program), 531, 551, 562–565, 571

B

badge products, 63

BADvertising Institute, 444
629

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Ballenger, William, 624

Banzhaf III, John, 433

Baptiste, Bryan, 164

Barclay (brand), 148

Barrichello, Rubens, 68

bars

promotions at, 159–160, 165–166

smoke-free policies, 340

Basic (brand), 61, 147

Basic Times (magazine), 145

BAT. See British American Tobacco

behavior

compensatory, 77, 460

measures of, 239, 518

media activism and, 445

media effects on, 27, 29–30, 211–291, 607, 610 

(See also media-effects research)

corporate advertising, 203

entertainment media, 376–392

news coverage, 333, 341–344, 349, 351

message structure and, 34

behavioral decision theory, 30

Behavioral Risk Factor Surveillance System, 530

behavioral segmentation, 60–62, 143

behavior change

expectancy-value theories of, 30–32

social cognitive theory of, 31–32

theories of, 34–35

Belgium, 105

beliefs. See also attitudes

about cigarette advertising, 240

entertainment media effects on, 388–391

Belshé, Kimberly, 561

Benson & Hedges (brand)

indirect advertising, 105

slogan, 226

surreal advertising, 69–72, 74, 85

Bigelow v. Virginia, 296

billboard advertising. See outdoor advertising

Billboard Utilising Graffitists against Unhealthy 

Promotions (BUGA UP), 444

bisexual population, as target market, 165–166

blue-collar workers, as target market, 153–156

Blum, Alan, 443

Bob Beck campaign, 221

bonus tobacco products, 149–150

FTC definition of, 104

brain imaging, in marketing research, 35

brand(s). See also specific brand

corporate sponsorship promoting, 186

marketing expenditures by, 125t, 126, 133

in movies (See product placement)

niche, 59

premium, 62

value, 61

youth (See youth brands)

brand choice, time-series studies of, 277–278

branded specialty item distribution, 150

FTC definition of, 104

youth smoking and, 265–266

brand equity, 63, 126, 126t, 184

brand extension, 85, 150, 277–278

brand image

adolescents and, 213, 232–238, 235t–236t,

278–279

communication of, 62–74, 87

effectiveness of, 54

gender and, 56

packaging design and, 600

tar content and, 56

brand image associations, corporate, 185–186

branding, 63–64

brand loyalty, 149–150

adolescent smokers and, 57

marketing expenditures and, 269

young adult smokers and, 159

brand-preference advertising, Canadian ban on, 

311–312

brand recognition, 240, 257, 267–268, 279, 513

brand sharing, 105

brand stretching, 85, 105

Breathe Easy, 499t

Brewer, Janice K., 564

British American Tobacco (BAT)

brand image, 65

deceptive advertising, 77–78

marketing expenditures, 124t, 125t

package design, 107

viral marketing, 109–110

broadcast advertising. See also radio advertising; 

television advertising

ban on, 82, 142, 599

Fairness Doctrine and, 550

FTC definition of, 105

shift away from, 83, 120, 130–133, 268, 551, 599

Broder, David, 582

Brown-John, C. Lloyd, 74

Brown & Williamson (B&W)

corporate image, 182

deceptive advertising, 77
630

I n d e x

package design, 106

product placement, 115–116, 401

sponsorships, 185

targeted marketing, 56, 58–59, 145, 152, 158, 

161–162, 164

viral marketing, 109

Brozek, Michael F., 554

Brynner, Yul, 432

Buccellato, Ellen, 169

Buccellato, Vincent, 169

Buckley, Christopher, 365

“buddy systems,” smoking cessation, 466–467

budgets. See funding

Buena Vista Pictures (Disney), 401

BUGA UP (Billboard Utilising Graffitists against 

Unhealthy Promotions), 444

Bull Durham (brand), 160

bupropion, 434, 448

Burnett, Leo, 67, 115, 155

Burning Brain Society, 116

Bush, Jeb, 567–568

Buy Me That (video), 410

buzz marketing. See viral marketing

B&W. See Brown & Williamson

C

California

MSA violations prosecuted in, 82

Proposition 65, 308

Proposition 86, 588–589, 590t, 591

Proposition 99, 390, 446, 528–529, 556, 559, 

561–562, 584

tobacco industry opposition to, 585–586, 

586t, 590t, 591

Proposition 188, 584

sampling distribution prohibited in, 309

smokeout days, 442

Tobacco Control Program, 403, 433, 446, 455, 

528–530, 551, 556–562, 560f, 562t, 571

youth antitobacco programs, 446, 491, 525, 

529–530, 560

California Smokers’ Helpline, 534

California Tobacco Education and Research 

Oversight Committee, 561

California Tobacco Surveys, 529–530, 559

California Youth Tobacco Surveys, 530

Camel (brand). See also Joe Camel

adolescent smoking and, 58

advertising themes, 145–148, 220–221, 278

brand image, 233

celebrity endorsements, 363

deceptive advertising, 76

indirect advertising, 105

package design, 107

product placement, 374

target markets for, 61–62, 143–145, 151, 156, 

158–159

viral marketing, 109

youth-oriented marketing, 215, 220–222, 233, 

241, 265, 277–279

Camel Exotic Blends (brand), 59–60, 144, 149, 164

Camel Turk, 144, 154

Campaign for Tobacco-Free Kids, 111

Canada

advertising bans, 311

advertising code violations, 82

antitobacco programs, 498t

corporate image, 182

deceptive advertising, 77–78

entertainment media, 400

health warnings, 312

legislation, 85, 294, 310–312, 316

market segmentation, 57, 59, 61

as model for United States, 312

news media, 342

package design, 108

partial advertising ban, 86

point-of-purchase promotions, 599

tobacco legislation, 57

youth antismoking campaign, 527

Canadian Supreme Court, tobacco control 

rulings, 311–312

cancer, tobacco-related, 2–3

Cancer Information Service (CIS), 533

Capri (brand), 155

carbon monoxide yield, disclosure of, 308

cardiovascular health studies, 482, 492–493, 

494t–497t, 501–502, 535

Carlson, Arne H., 555–556

Carlton (brand), 61, 77

Castle Rock Entertainment, 400

category merchandise options (CMOs), 131

causality, assessment of, 6–8, 238, 281, 342

CDC. See Centers for Disease Control and 

Prevention

ceiling effect, 127

celebrity endorsements, 374. See also specific 

celebrity

branding and, 64

of cigars, 396
631

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

FTC definition of, 102–103

history of, 153, 156, 360–364

media effects of, 377, 380

of smokeless tobacco, 81

viral marketing and, 109

censorship, of movies, 399–400

Centers for Disease Control and Prevention 

(CDC), 309, 403, 433, 531, 533, 555

Media Campaign Resource Center, 434, 441, 609

Central Hudson Gas & Electric Corporation v. 

Public Service Commission, 297–298, 300

chain of contingency, 29–30

Chaplinsky v. New Hampshire, 295

Chelsea (brand), 167

Chesterfield (brand), 156, 360–361

Chicago school of sociology, 40

Chilcote, Samuel D., Jr., 557

children. See also youth

antitobacco ads created by, 443–444

brand recognition by, 218

entertainment media and, 358–360, 371, 394

media effects on, 27–29

media literacy education, 410–411

Chiles, Lawton, 565, 567

“chippers,” 61

choice behavior, 30, 32

Christian population, as target market, 168–169

Christoff, Chris, 624

The Chronicles of Riddick: Escape from Butcher 

Bay (game), 113

cigar(s)

health consequences and, 396

health warnings on, 307–308

increasing use of, 129

news coverage of, 338–339

cigar advertising and promotion

expenditures on, 127–129, 129t

FTC reports on, 102

print media, 396–397

product placement, 116

Cigarette Advertising and Promotion Code (US), 

81

product placement ban, 117–118, 374, 401

violations of, 80–81

cigarette brands. See brand(s); specific brand

cigarette circumference

brand image and, 56

deceptive advertising and, 78

Cigarette Code (UK), 69, 71–73

cigarette excise taxes

antitobacco programs funded by, 525, 528–529, 

531–532, 562–563

state initiatives on, 584, 592, 619–626

cigarette length, brand image and, 56

cigarette packaging, 106–108, 133, 149, 600–601

accessories, 107

global rule on, 603

warnings on (See health warnings)

Cigarettes, Cinema, and the Myth of Cool (film), 

403

Cigarettes and Other Tobacco Products Act 

(India), 117

cigar “lifestyle” magazines, 396

Cinco de Mayo festivals, 162–163

Cipollone v. Liggett Group, Inc, 302

CIS (Cancer Information Service), 533

City by the Sea (film), 422

civil disobedience, 444

clean indoor air restrictions, state initiatives on, 

584

climate, market segmentation by, 59–60

Clinton, Bill, 406

cluster sampling procedure, 490–491

CML (magazine), 145

CMOs (category merchandise options), 131

Coalition for Tobacco-Free Arizona, 564

cobranding, 64

coffee consumption, market segmentation and, 60

cognitive neuroscience, 35

cognitive responses, 29–30

cognitive revolution, 41–42

cohort studies, 484, 502

collaborative filtering, 466

color, use of, 64–65, 74, 85, 107–108, 149

Colorado, Amendment 35, 584, 587–588, 589t,

591, 591t

combination products, tobacco products as, 304

comedies, tobacco use in, 371

commercial speech, 295–297

Canada, 310–311

compelled, 298–299

defined, 296

entertainment media and, 399–400

misleading, 299–301

COMMIT (Community Intervention Trial for 

Smoking Cessation), 44, 498t, 503, 505–506

committed smokers, 61

communications inequality, 42–43

community-based studies. See controlled field 

experiments

community-level effects, controlling for, 483, 536
632

I n d e x

company Web sites

content analysis of, 398

FTC definition of, 102

compelled commercial speech, 298–299

compensatory behavior, 77, 460

Comprehensive Smokeless Tobacco Health 

Education Act, 101, 302, 306–307

Comprehensive Smoking Education Act, 306–307

concerned smokers, 156, 166–168

confounding, 385, 510

consciousness, social production of, 40

consistency of promotional message, 65–66, 87

constitutional perspectives, 293–316. See also

legislation

consumer groups, defining, 55–62, 86

consumer health informatics systems. See

interactive health communications

consumer marketing, 5

content analysis

company Web sites, 398

magazine advertising, 396–397

movies, 364–376

music videos, 395

news coverage, 7, 333, 351

video games, 398

context, for media exposure, 333, 341, 608

control groups, 6

controlled field experiments, 7, 482–509. See also

specific study

adult smoking, 492–508, 494t–500t

antitobacco advertisements, 449–456

design and context of, 481

methodological issues, 482–484, 535

smoking cessation programs, 502–508

summary of, 508–509, 535–537

youth smoking, 484–492, 486t–489t

control variables, choice of, 7

convenience stores, importance of, 130–131, 133, 

599

coolness theme, 147

Copenhagen (brand), 154

co-promotion, with alcohol brands, 60–61

copy platforms, 62

core speech, 297

CORIS (Coronary Risk Factor Study), 493, 495t,

501

corporate advertising, 189–198, 601–603. See 

also sponsorships

on company Web sites, 197–198

effects on company perceptions and sales, 

190–196

effects on sales and use of tobacco products, 

202–203

effects on tobacco control policy, 196–197, 204

global impact of, 203–204, 603

media literacy and, 198, 602

monitoring of, 203–204

research on, 602–603

types of, 189

corporate advocacy, 189–190

direct, 189–190

effect of antismoking campaigns on, 196

indirect, 190

corporate brand image associations, 185–186

corporate image, negative, 182–184, 183f, 196, 

200–202, 204, 390

corporate image campaigns, 180, 184, 189, 193–

196, 204, 601–603

accountability, 203

criticism of, 201

effectiveness of, 202

expenditures, 193, 194f

monitoring of, 203

youth and, 601–602

corporate interests, popular vote bypassing, 

578–579

corporate philanthropy, 189

corporate social responsibility, 204

benefits of, 187

consumer perceptions and, 203

corporate advertising of, 195

integrated public relations campaign and, 200

negative associations, 188

research on, 180

corrective advertising, 101, 301, 460–461, 

610–611

counteradvertisements, 444, 462–463

Countrywide Integrated Noncommunicable 

Disease Intervention framework (WHO), 443

coupons

expenditures on, 119–120, 122t

FTC definition of, 102

Coye, Molly, 559

creative promises, formation of, 62

Cremers, Ludo, 106

cross-border advertising, elimination of, 315, 

603–604

cross-sectional studies, 238. See also specific study

antitobacco campaigns, 484, 491, 501–502, 

511–512, 516–534, 536

entertainment media effects, 377–383, 378t–

379t, 412
633

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

marketing expenditures, 271–272, 273t, 274, 280

national media campaigns, 516–523

post-only, 511

pre-post, 511–512

smoking cessation programs, 504–506

state media campaigns, 523–527

youth smoking, 241–258, 242t–255t

cues, persuasive, 33

Cullman, Joseph F. III, 81, 142, 148

cultivation hypothesis, 42

cultural activities, sponsorship of. See

sponsorships

cultural values, antitobacco media and, 462

curiosity about smoking, youth and, 265–266

Curran, J. Joseph, Jr., 402

correspondence with MPAA, 414–421

Czech Republic, 257, 313

D

Dakota (brand), 154, 156, 444–445

danger theme, 222

data analysis, statistical, 483–484

databases, 181, 213, 365, 377, 385, 434, 480

Davis, Bette, 362–363

Davis, Gray, 560–561

28 Days (film), 374

Dean, James, 362, 364

death, in surreal advertising, 72

deceptive speech, 300–301. See also false 

advertising; misleading advertising

decision making, 33, 55

Delaware, Legacy case in, 569–571

demand, ability of marketing to create, 212

demographic segmentation, 55–58, 143

depression reduction theme, 225–227, 278–279

designer cigarettes, 155

desirable associations theme, 146–149, 170, 410

Deukmejian, George, 556

developing countries, tobacco use in, 2–3

diffusion of innovations theory, 36–37

digital media, 358

digital technologies, 611

direct mail advertising, FTC definition of, 102

direct marketing, personalized, 144–145

direct vote. See state initiatives and referenda

discounted prices. See price discounts

disease outcome. See health consequences

distress reduction theme, 146, 170, 225–227, 

278–279, 373

DOC (Doctors Ought to Care), 443–444

documentary analysis, 7–8

Doral (brand), 61, 156

Double Eagles (brand), 152

Douglas, Kirk, 362

dramas, tobacco use in, 371, 392–393

drug delivery devices, tobacco products as, 304

dual process models, of attitude and persuasion, 

32–35

Duffin, Anne, 192

Duffy, Steve, 565

Dunhill (brand), 61

Dying for a Fag (film), 522

E

Eagan, Terry, 558

Ebony (magazine), 161

Eckhart, Dennis, 404, 422

Eclipse (brand)

advertising theme, 146

Internet marketing, 111–112

misleading advertising, 310, 461, 610–611

secondhand smoke and, 167

econometric studies, of consumption-advertising 

relationship, 272–277, 273t, 280

economic costs, as rationale for regulation, 75, 87

economics, of marketing expenditures, 269–272

editorial division, 38

EIC (Entertainment Industries Council), 403

Elaboration Likelihood Model (ELM), 33

elasticity of advertising, 275–276

emotional response

to antitobacco advertising, 457–460, 468, 

609–610

in decision making, 33

tobacco use in movies and, 373

endorsements. See celebrity endorsements

Engle class-action suit (Florida), 180, 183

Entertainment Industries Council (EIC), 403

entertainment media, 357–428. See also specific 

medium

commercial speech and, 399–400

devices restricting access to, 408–409

exposure to, 359–360, 373, 407, 409–411

health consequences and, 373–374, 389–390, 

402

influence of, 42, 389, 601

media literacy and, 409–411

newer forms of, 398–399
634

I n d e x

parental supervision of, 407–409

product placement in (See product placement)

tobacco control advertising in, 409, 412

tobacco use policy, 401–404

types of, 358

violence in, 388, 406

youth and, 358–360, 370–372, 376–377, 380–

384, 394–395, 406–409, 412

entertainment media effects, 376–392, 412–413

cross-sectional studies, 377–383, 378t–379t, 412

experimental studies, 385–392, 386t–387t, 412

longitudinal studies, 378t–379t, 384f, 412

Entertainment Software Rating Board, 112

environmental factors

influence on behavior, 31–32

media messages as, 34

Environmental Protection Agency (EPA), 43

Environmental Rights Action/Friends of the 

Earth Nigeria (ERA/FoEN), 117

erotic themes, 148

Escort (brand), 59

Estonia, 442

ethnicity. See also specific ethnic group

quitline use and, 534

segmentation by, 56–57, 59, 144–145, 160–165

for antitobacco advertising, 462–463

European Union (EU)

Internet marketing ban, 112

legislation, 294, 312–313, 316

Eurotrip (movie), 109

Eve (brand), 55–56, 155

event history analysis, 342

event marketing. See sponsorships; specific event 

or brand

excitement theme, 222, 278

expectancy-value models, 30–32

expenditures. See marketing expenditures

experiential thinking, 33

experimental studies, 7, 238. See also controlled 

field experiments; specific study

entertainment media, 385t–387t, 385–392, 412

expert systems, integrated health 

communications, 464–466, 612

explicit attitude, 33–34

external advertising, 272

F

Fairness Doctrine, 3, 44, 83, 509

creation of, 433, 469, 550–551, 606

cross-sectional evaluation of, 516–519, 534, 

536–537

false advertising. See also misleading advertising

FTC action against, 305–306

global ban on, 314

low-tar and light cigarettes, 309–310

FCC Fairness Doctrine. See Fairness Doctrine

FCLAA. See Federal Cigarette Labeling and 

Advertising Act

FCP (Full Court Press) project, 531

FCTC. See Framework Convention on Tobacco 

Control

FDA. See Food and Drug Administration

FDAMA (Food and Drug Administration 

Modernization Act), 298

Federal Cigarette Labeling and Advertising Act 

(FCLAA), 101, 145, 294, 301

versus FTC trade regulation rule, 306–307

policy goals, 306

preemption of warnings under, 301–303

Federal Communications Commission, Fairness 

Doctrine. See Fairness Doctrine

Federal Food, Drug, and Cosmetic Act, 303–304

federal preemption, 301–303

Federal Reports Elimination and Sunset Act, 

101–102

Federal Trade Commission (FTC)

alert on tar and nicotine ratings, 309

authority of, 294, 316

deceptive advertising and, 77

definitions used by, 102–105

efforts to regulate tobacco advertising, 301, 

305–310

Minnesota Plan and, 552

reports, 101–102, 119–127, 119t, 120f, 121t–

125t, 306–307

cigars, 127–128, 129t

corporate advertising, 180, 602

Internet marketing and, 111

light cigarettes, 127

smokeless tobacco, 129–130, 130t

tar and nicotine level measurements, 308–309

trade regulation rule, versus FCLAA, 306–307

Federal Trade Commission Act, 305

femininity, as advertising theme, 217–220, 278

field experiments, 7

films. See movies

filtered cigarettes, deceptive advertising, 76–77

filtering, collaborative, 466

Finland

indirect advertising in, 105
635

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

North Karelia Project, 442–443, 482, 485, 

486t–489t, 495t, 501, 535

First Amendment, 294–301, 316, 603

California Tobacco Control Program and, 562

categories excluded from, 295–296

entertainment media and, 399–400

Flair (magazine), 145

flighting, 271–272

Florida

antitobacco media campaign, 443

Engle class-action suit, 180, 183

Medicaid lawsuit, 565–567

Teen Summit on Tobacco Education, 566

Tobacco Pilot Program, 447, 565–567

“truth” campaign, 512–515, 525–527, 536, 551, 

566–567, 569

youth smoking prevention, 447, 512–515, 

565–566

Florida Tobacco Control Program (FTCP), 

343–344

Florida Youth Tobacco Surveys, 344, 526–527

focus groups

in direct democracy campaigns, 583

entertainment media effects, 376, 397

Food, Drug, and Cosmetic Act, 305

Food and Drug Administration (FDA)

efforts to regulate tobacco products, 303–305, 

316

jurisdiction of, 294, 303, 316

NRT approved by, 448

tobacco advertising ruling, 551

Food and Drug Administration Modernization Act 

(FDAMA), 298

Forbes, Malcolm, 347

Ford, James T., 559

Ford, Yancey W., Jr., 169

foreign brands, product placement of, 374

foreign countries. See also specific country

American products distributed in

regulation of, 82, 315, 603–604

Western brand imagery in, 170

antitobacco media campaigns in, 522–523

entertainment media in, 383, 400

legislation in, 310–315

tobacco use in, 2–3

Formula One motor racing, 68–69, 313

Fourteenth Amendment, 295

Framework Convention on Tobacco Control 

(FCTC), 3, 44, 54, 294, 313–316, 603–604

Article 13, 315, 603

Internet marketing ban, 112

news coverage and, 348, 351

product placement ban, 118

ratification of, 118, 315–316, 351, 603

framing, 42, 583, 592, 605

by news media, 333–335, 339, 350

France, 105–106

“A Frank Statement to Cigarette Smokers,” 76, 

189–190

free air time, for antismoking messages, 433, 

550–551. See also Fairness Doctrine

freedom of expression, 295, 310, 399, 603. See 

also First Amendment

free sampling. See sampling distribution

Fritsch, Marc, 195

FTC. See Federal Trade Commission

FTCP (Florida Tobacco Control Program), 

343–344

FUBYAS. See young adults

Full Court Press (FCP) project, 531

funding, tobacco control programs

from cigarette excise taxes, 525, 528–529, 

531–532, 562–563

interactive health communications, 467

from MSA, 510

statewide, 554–555, 558–562, 562t, 563–564, 

567–568, 571

fun theme, 222–225, 278

G

Gauloises, 106

gay population, as target market, 165–166

gender. See also men; women

adolescent psychological needs and, 213, 217–

220, 278–279

antitobacco programming and, 501

entertainment media effects and, 385, 393

image enhancement and, 227, 231

segmentation by, 55–56, 144–145, 150–157

smokeless tobacco use by, 234

smoking cessation programs and, 505

smoking initiation and, 277

smoking prevalence by, 151

General Cigar Company, 116

geographic segmentation, 58–60, 143

Gerard, Sue, 564

Germany, 313, 497t

Glantz, Stanton A., 404

Glickman, Dan, 402
636

I n d e x

global bans, 313–316, 603–604

global brand equity, 126, 126t

global health, tobacco use and, 2–3, 54

globalization, media growth and, 2–3, 603–604

Goerlitz, David, 151

government, influence of news media on, 342

GPC (brand), 61

Great American Smokeout (ACS), 441, 503

Greece, 523

Greene, John, 563–564

guard dog function, 41

guerilla marketing. See viral marketing

H

“Hall of Shame” Web site (Roswell Park Hospital), 

153

Halo 2 (game), 113–114, 398

harm-reduced cigarettes, 61–62, 79, 611. See also

potential reduced-exposure products

Harvard School of Public Health, 402

Havoc, June, 360

Hawaiian images, 164

health advocates, failure to respond to tobacco 

industry, 555–556

health behavior. See behavior

Health Belief Model (HBM), 30

health care costs, as rationale for regulation, 

75, 87

health-conscious smokers, as target market, 

59, 61

health consequences

avoidance of, in branded advertising, 150

cigar smoking and, 396

disparities in, 42–43

entertainment media and, 373–374, 389–390, 

402

news coverage of, 341, 344, 395

as rationale for regulation, 75, 87

tobacco industry’s attempt to shift focus from, 

553

Health Education Authority for England, AntiSmoking TV Campaign, 500t, 507–508, 534

health information

news media as source of, 330

online, 463–468

Health News Index, 331

health reassurances, 146, 166–168

deceptive advertising and, 77–78, 611

smoking initiation and, 277–278

health-risk promotion, tobacco industry strategy 

of, 195

health stories, defined, 331

health warnings

Canada, 312

cigars, 307–308

constitutionality of, 301

global rule on, 314

inadequate, tort claims based on, 302–303

pictorial, 601

regulations on, 302–304, 306–307, 311–312, 

314, 601

smokeless tobacco, 307

Heartbeat Wales, 497t, 503

Heartland (magazine), 145

heroic figure image, 155

Heuristic-Systematic Model (HSM), 33

hierarchical linear models, 483

Hill and Knowlton, 76

Hispanic Americans, as target market, 59, 145, 

162–163, 198–200

Hitchcock, Alfred, 70

Hoffmeister study, 497t

holidays, marketing campaigns during, 60

hollow followers, 217

Holmes, Oliver Wendell, 295

homosexual population, as target market, 165–166

Hong Kong

advertising restrictions, 347

indirect advertising in, 105

packaging in, 107

youth smoking in, 257

Horizon (brand), 167

How Pro-Social Messages Make Their Way into 

Entertainment Programming, 402

HSM (Heuristic-Systematic Model), 33

Hull, Jane Dee, 565

human-to-human interaction, in smoking 

cessation programs, 466–467

Hungary, 313

I

IAA (International Advertising Association), 275

identity. See self-image

IEG (Independent Evaluation Group) 

Sponsorship Report, 184

IHC. See interactive health communications

Illinois Consumer Fraud and Deceptive Practices 

Act, 309
637

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

image enhancement

market segmentation and, 62, 143

youth smoking and, 213, 227–238, 228t–230t,

278–279

imagery. See also brand image; specific brand 

or image

gender-oriented, 217–220

in package design, 107, 149

sexual, 72–73, 148–149, 221

subjective interpretation of, 376

in surreal advertising, 68–74

symbolic, 33, 85, 583

tobacco use in movies, 372–373

IMC (integrated marketing communications), 

case study of, 66–68

Imperial Tobacco Ltd., 59, 72, 77–78, 154

implicit attitude, 33–34

Independent Evaluation Consortium, 560

Independent Evaluation Group (IEG) 

Sponsorship Report, 184

India

antitobacco campaign, 512, 515

indirect advertising in, 105

product placement in movies, 116–117

indirect advertising, 69, 105–106

individual level

communications inequality at, 43

mass communications at, 3

individual-level framework, for media effects 

research, 25, 27, 29–36

individual-level variability, controlling for, 484, 

536

Industrial Revolution, tobacco use and, 26

“Industry Spokesman” advertisement, 557

InfectTruth (Legacy), 612

InfoFlow measure, 346

information, demand for, 39

informational advertising

Canadian ban on, 311–312

global rule on, 314

information dissemination, by news media, 336

information processing, 34

behavior change and, 34–35, 459–460, 469, 609

information subsidies, reliance on, 39

information technologies, in health 

communications, 467–468

informing, 54–55

infotainment, 349, 605

Initiative 149 (Montana), 584, 587, 589t, 591, 

591t

The Insider (film), 390

Institute for Analytical Research Inc., 77

in-store promotion. See point-of-purchase 

promotions

integrated marketing communications (IMC), 

case study of, 66–68

integrated public relations campaign, 198–202, 

199f

Integrative Model of Behavior, 31

intention to act, influences on, 30–32

interactive health communications (IHC), 

463–468

dissemination of, 467

future directions for, 467–468, 606, 611–612

types of interactivity, 464–467

International Advertising Association (IAA), 275

International Dairy Foods Association v. 

Amestoy, 299

International Quit and Win Campaign (WHO), 

443

Internet. See also Web sites

entertainment media, 358, 398

interventions aimed at, 409

smoking cessation programs on, 463–468, 606, 

611–612

tobacco control advertising on, 609, 611–612

Internet marketing, 110–112, 133, 601

EU ban, 313

FTC definition of, 103

global rule on, 315, 603

as legislative ambiguity, 85

regulation of, 110–112

via company Web sites, 197–198

youth and, 109–110, 409, 601, 612

Internet social networking sites, 612

interpersonal communication, media effects and, 

35–36, 608

Issue 4 (Ohio), 584

J

Japan Tobacco Inc., 164

Jerich, Ronald A., 555

Jewish population, as target market, 168–169

Joe Camel, 165

adolescent smoking and, 58, 218, 220–223, 

226, 277

female, 156

FTC complaint against, 307

Michigan Proposal A and, 623–624

in package design, 107
638

I n d e x

retirement of, 158

youth market and, 217

Johnston, Myron, 57, 217

journalism, divisions of, 38

journalists

framing of news coverage by, 333–335, 339, 350

influence of advertising on, 345

K

Kansas, antitobacco campaign, 446–447

Kelm, Thomas A., 555

Kent (brand), 63, 77, 148

Kent, Herbert A., 63

Kessler, David, 303

Kessler, Gladys, 76, 101

Keye, Paul, 557

Kilkenny Health Project, 497t

Killian, Mark, 564

Kim (brand), 155

King, James E., Jr., 567

Kizer, Kenneth W., 556

knowledge-gap hypothesis, 41–43

Kool (brand)

advertising themes, 147

brand image, 233

packaging design, 106, 149

target market for, 56–58, 60–61, 158, 161, 166

youth-oriented marketing, 233, 265

Kool Mixx campaign, 108, 144, 161–162

L

labeling regulations, 302–304. See also health 

warnings

Canada, 311–312

global, 314, 603

laboratory-based experiments, 7

Lamb, Stephen P., 571

Landry, John, 56

Lanham Act, 75–76

Lark (brand), 363

latent quitters, 61

Lauria, Thomas, 346

learning, social cognitive theory of, 31–32

Legacy. See American Legacy Foundation

legislation, 293–316. See also advertising bans; 

Fairness Doctrine; specific law

entertainment media, 399–400

international comparison of, 310–315, 603–

604

state (See state initiatives and referenda; 

specific state)

legislative ambiguities, partial advertising and, 

85–87, 101

lesbian, gay, bisexual, and transgender (LGBT) 

populations, as target market, 165–166

Life (magazine), 161

lifestyle advertising, Canadian ban on, 311–312

lifestyle analysis, 62

Liggett & Myers (L&M)

corporate image, 182

indirect advertising, 105

marketing expenditures, 123, 124t

package design, 106

product placement, 116

targeted marketing, 56, 166

light cigarettes

corrective advertising for, 460–461

deceptive advertising, 76, 78, 308–309

marketing expenditures on, 127, 128f

target market for, 166–168

Limited Capacity Model of Motivated Mediated 

Message Processing, 34

linear models, 483

line extensions, segmented market campaigns 

for, 59

lingering effect of advertising, 271

LISREL analyses, 456

literacy skills, interactive health communications 

and, 465

litigation. See also specific lawsuit

corporate advertising and, 197, 203

against tobacco companies, 182–183

L&M. See Liggett & Myers

Loewy, Raymond, 64

logos, 63–64, 218, 311

longitudinal studies, 238, 484–485

entertainment media effects, 378t–379t, 383–

385, 384f, 412

news media effects, 349

population-based, 510–516, 535

national campaigns, 515–516, 536

state campaigns, 512–515, 530, 535–536

youth smoking, 258–268, 259t–263t

Lorillard Tobacco Company. See also specific 

brand

advertising themes, 226–227

California Tobacco Control Program and, 562
639

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

corporate image, 182, 192

correspondence with California Assistant 

Attorney General, 422

deceptive advertising, 77

Legacy case, 569–571

marketing expenditures, 124t, 125t

opposition to state initiatives, 621

package design, 106

product placement, 401

targeted marketing, 56–58, 62, 170

youth-oriented marketing, 217, 224–227

youth smoking prevention campaign, 150, 

190–192, 433, 449, 462, 570

Lorillard v. Reilly, 298, 300, 302

low-tar cigarettes

corrective advertising for, 460–461

deceptive advertising, 76–79, 308–310

smoking initiation and, 277–278

target market for, 166–168

Lucky Strike (brand)

logo, 63–64

magazine advertising, 363

product placements, 374

target market, 55, 155, 360

viral marketing, 109

Lundberg, George D., 330

M

MADD (Mothers Against Drunk Driving), 188

magazine(s). See also specific magazine

coverage of tobacco-related issues in, 337–338, 

345–346

influence of advertising on, 345–346, 395–396

promotional, 145, 396

tobacco-related content in, 395–396

women’s, 156–157, 346, 395–396

magazine advertising, 83, 395–398

antitobacco, 438t–440t, 441

blue-collar market, 153

content analysis of, 396–397

dominant themes in, 146–147

ethnic-oriented, 161

expenditures on, 126, 127t

female-oriented, 156–157, 346, 395–396

FTC definition of, 103

LGBT-oriented, 165

religious-oriented, 168

in target marketing, 144

trend influence and, 110

youth market, 84–85, 157–158, 233, 236, 241, 

397

Malaysia, 105

Malmgren, Kurt L., 557

Mangini v. R.J. Reynolds Tobacco Company, 58

Marden, Roy, 183

marginal effects, 271–272

marketing

consumer, 5

neural, 35

stakeholder, 5

marketing expenditures, 100, 118–127, 119t,

120f, 121t–125t, 132–133, 598–599

advertising bans and, 272, 273t, 274–275

antitobacco, 607–609

by brand, 125t, 126, 133

cigars, 127–129, 129t

classification of, 102–105, 126–127

by company, 123, 124t, 133

corporate image advertising, 193, 194f

cross-sectional studies of, 273t, 274

economics of, 269–272

light cigarettes, 127, 128f

by media type, 119, 121t, 126, 127t

smokeless tobacco, 129–130, 130t, 133

sponsorships, 184

time-series studies of, 272–274, 273t

tobacco consumption relative to, 212–213, 

268–278, 280

econometric studies, 272–277, 273t, 280

youth brands, 84–85

marketing strategy, development of, 54–55

marketplace rationale, for free speech, 295

market research, 39

market segmentation, 55–62, 86, 143–145. See 

also targeted marketing; specific segment

behavioral, 60–62, 143

demographic, 55–58, 143

geographic, 58–60, 143

psychographic, 62, 143

Marlboro (brand)

advertising code violations, 81

advertising themes, 146–147, 220–221, 223, 226

brand image, 63, 66, 233

indirect advertising, 105

integrated marketing communications, 66–68

marketing expenditures, 126, 133

package design, 107

product placement, 374

surreal advertising, 69–71, 85
640

I n d e x

target market for, 56, 61–62, 144–145, 151–

152, 154, 156, 159, 162

youth-oriented marketing, 215, 220–224, 226, 

233, 241, 265, 277

“Marlboro Adventure Team,” 67–68

“Marlboro Classics” clothing, 105

“Marlboro Country,” 71

Marlboro Golds (brand), 364

Marlboro Grand Prix, 68

Marlboro Lights (brand), 166, 232

Marlboro Man

consistent imagery of, 66–67

effectiveness of, 54

package design, 107

target market for, 152, 159, 166

Marlboro Milds (brand), 226

Marlboro Red (brand), 232

Marlboro Song, 226

masculinity, as advertising theme, 217–220, 278, 

364

Massachusetts

corrective advertising in, 460

Question 1, 584, 586, 587t, 590t

smokeout days, 442

youth smoking prevention campaigns, 457, 

512–513

Massachusetts Tobacco Control Program (MTCP), 

456–458, 512–513, 530–531, 563

1998 Master Settlement Agreement (MSA), 3, 44

agenda setting and, 42

corporate sponsorship since, 180

entertainment media and, 401, 403–404, 414, 

418

FTC actions after, 307

Legacy foundation and, 551, 571

news coverage of, 340–341, 351

outdoor advertising ban, 59, 83–84, 158

PM21 campaign and, 201

point-of-purchase promotions after, 131–133

product placement ban, 118

release of corporate documents, 182

shift in advertising media after, 131–133, 268, 

276

state initiatives and referenda on, 584

state lawsuits resolved by, 567–569

tobacco control efforts since, 433, 469

tobacco control funding, 510

vilification clause, 569–571

violations of, 82

youth-oriented advertising ban, 58, 157–158

matched-pair design, 482

Maxwell, Hamish, 347

Mayo, Virginia, 360, 362

McCracken, Grant, 61

MCRC (Media Campaign Resource Center), 434, 

441, 609

M&C Saatchi, 72

media

globalization and, 2–3

multilevel perspective on, 3–6, 4f, 44

state initiatives and, 585

media activism, antitobacco, 443–445

media advocacy, 41, 604–605

news coverage and, 344, 350

for tobacco control, 335–336

Media Campaign Resource Center (MCRC), 434, 

441, 609

media channels

audience fragmentation and, 598

for tobacco control advertising, 438t–440t,

441, 469, 611–612

media content

analyses of (See content analysis)

variables in, manipulation of, 385

media delivery, options for, 358

media effects

complexity of, 6–7

interpersonal communication and, 35–36, 608

at societal level, 41–42

theories of, 34–35

media-effects research, 25–49

analysis levels, 25

audience exposure, 607–608

corporate advertising, 181, 602

design challenges, 6–8, 238–239

entertainment media, 364–392, 601

history of, 27–28

individual-level framework for, 25, 27, 29–36

Internet use, 467–468, 612

levels of theory and analysis, 28–44

mass media campaigns, 606–607

need for, 598

news coverage, 331, 332t, 336–344, 348–349, 

604–605

organizational-level framework for, 25, 27, 

36–40

packaging, 600–601

point-of-purchase promotions, 599–600

search methodology and sources, 181–182, 

365, 377, 385, 480
641

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

societal-level framework for, 25, 27, 40–44

tobacco control (See tobacco control research)

youth smoking (See youth smoking research)

media exposure, 100–101

context for, 333, 341, 608

dose-response relationship, 256, 279–280, 384, 

537, 607

effect on public opinion, 196

entertainment media, 359–360, 373, 407, 

409–411

external estimates of, 240–241

measures of, 239–240, 513

self-reported, 240–241, 256–257

tobacco control advertising, 434, 435t–437t,

468, 607–608

youth, 212, 279–280, 434, 435t–437t

evidence base for, 238–268

randomized studies of, 233–238, 235t–236t

media industry

evolution of, 40

history of, 26

interdependent relationships within, 39–40

new technologies in, 27, 611–612

organizational characteristics of, 36–39, 37f

reliance on advertising, 41

social science and, 39

tobacco industry influence on, 43

media literacy

corporate advertising and, 198, 602

education in, 410–411

entertainment media and, 409–411

socioeconomic status and, 602

of youth, 236–237, 410–411, 601

media message

characteristics of, and impact, 449, 450t,

459–460, 469

news coverage and, 334

processing of, 34, 459–460, 469, 609

receptivity to, 240, 258, 513

repetition, consistency, and relevance of, 

65–66, 87

structure of, 34, 459–460

subjective interpretation of, 376

media production processes, 27

news coverage, 349

organizational-level analysis of, 37

systematic approach to, 38–39

Media Records classification system, 127

media role, 2–3, 25–27

in smoking cessation, 35

in social conditions, 40–41

Medicaid lawsuits, state, 565–569

medical informatics, 468

men

antitobacco programming and, 501

smoking cessation programs and, 505

smoking initiation and, 277

smoking prevalence among, 151

as target market, 56, 144, 150–155, 220, 360

mentholated cigarettes, target market for, 56–57, 

144, 156, 158, 161–162, 166

Merit Ultra Lights (brand), 61, 77, 166

Merlo, Ellen, 66, 186

Merriman, Walker, 621

meta-analysis, of consumption-advertising 

relationship, 275–277, 280

Metro-Goldwyn-Mayer, 401

Metropolitan Museum of Art (New York City), 185

metropolitan statistical areas (MSAs), 490–491

Michigan, Proposal A, 585, 619–626

Michigan Citizens for Fair Taxes, 620–621

Midwestern Prevention Project, 508

mild cigarettes, deceptive advertising, 76, 78

Milestone, Lewis, 362

military service members

price discounts to, 153

smoking prevalence among, 151

as target market, 151–153

Mill, John Stuart, 295

Miller, James Blake, 152

Minnesota

antitobacco programs, 433, 442

Target Market campaign, 524–525

Minnesota Heart Health Program, 442–443, 482, 

485, 486t–489t, 496t, 502–503, 535

The Minnesota Plan for Nonsmoking and Health, 

552–556, 570–571

Miramax, 401

misleading advertising. See also false advertising

correction of (See corrective advertising)

FDA action against, 305–306

global ban on, 314

low-tar and light cigarettes, 309–310, 461, 

610–611

as rationale for regulation, 75–79, 87

misleading speech, 299–300

Missouri, Amendment 3, 589, 590t, 591

Misty (brand), 56

mixed-effect models, 483

modeling, symbolic, 32
642

I n d e x

Monitoring the Future survey, 521–522

Montana

Initiative 149, 584, 587, 589t, 591, 591t

school-based programming, 490

Montclair (brand), 165

Moonlight Tobacco (brand), 59

More (brand), 148–149

mortality

as rationale for regulation, 75, 87

tobacco use-related, 2–3, 43

Mothers Against Drunk Driving (MADD), 188

Motion Picture Association of America (MPAA), 

370, 376, 400, 402

correspondence with State Attorneys General, 

414–421

motivation, attitude change and, 33–34

movies. See also entertainment media; specific 

film

audience reach, 374–376

censorship of, 399–400

as global advertising medium, 374

historical perspective, 360–364

influence of, 42, 601

link between tobacco industry and, 360–364

product placement in (See product placement)

rating of, 366, 370, 373, 400–401, 404–408, 601

tobacco control advertising in, 373

tobacco use in, 360, 362, 370–376, 412

beliefs about smoking and, 388–391

characteristics of, 372–373

content analysis of, 364–376

methodological issues, 366–370, 367t–

369t, 380–381, 381t

by movie type, 370–371

general reactions to movies and, 391–392

restriction of, 391, 413

collaborative approaches to, 403–404

confrontational approaches to, 404–407

other potential strategies, 407–409

voluntary, 401–402

trends in, 371–372

tobacco use prevalence and, 371

movie theaters, antitobacco advertising in, 409

Mozingo, Roger L., 557

MPAA. See Motion Picture Association of America

MSA. See 1998 Master Settlement Agreement

MSAs (metropolitan statistical areas), 490–491

MTCP (Massachusetts Tobacco Control Program), 

456–458, 512–513, 530–531, 563

Mudde study, 499t, 507

Mullaney, Arthur P., 442

multiple-wave survey designs, 384

Murdoch, Rupert, 152, 347

music, tobacco use in, 394–395

music videos, content analysis of, 395

Mutual Film Corporation v. Industrial 

Commission of Ohio, 399

N

narrative advertising, effectiveness of, 609

NASBE (National Association of State Boards of 

Education), 553

NASCAR sponsorship, 155, 158

national antitobacco media campaigns

comprehensive, 527–533

cross-sectional studies of, 516–523, 536

longitudinal studies of, 515–516, 536

National Association of Attorneys General, 409

correspondence with MPAA, 414–421

National Association of State Boards of Education 

(NASBE), 553

National Association of Theatre Owners, 376, 

400, 409

National Cancer Institute

ASSIST project, 41, 340, 351, 499t, 505, 550

Cancer Information Service, 533

Tobacco Control Monograph 9, 128

Tobacco Control Monograph 16, 550

Tobacco Control Monograph 19 (See Tobacco 

Control Monograph 19)

Tobacco Control Research Branch, 8

National Center for Chronic Disease Prevention 

and Health Promotion, 402

National Clearinghouse for Smoking and Health 

(NCSH), 433

National Health Interview Survey (NHIS), 517

National Hod Rod Association (NHRA), 155

National Household Survey on Drug Abuse, 215

National Institute on Drug Abuse, 403

National Institutes of Health (NIH), 433

National Longitudinal Study of Youth, 394

National Tobacco Campaign (Australia), 509, 512, 

515–516, 519–520, 534

Native Americans, as target market, 164–165, 171

Natural American Spirit, 79

natural cigarettes, 79

naturalistic exposure studies, of antitobacco 

advertising, 456–458

Naylor, Nick, 365
643

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

NCSH (National Clearinghouse for Smoking and 

Health), 433

negative emotions, impact of, 459–460, 468

negative image of tobacco industry, 182–184, 

183f, 196, 200–202, 204, 390

response to (See corporate image campaigns)

negative publicity, 201

Netherlands, 499t, 507

neural marketing, 35

neurocognitive science, 35

Nevada, Question 4, 584

New Hampshire

entertainment media study, 407

smoking cessation program, 507

Newport (brand)

advertising themes, 147, 226–227

brand image, 233

target market for, 56–58, 145, 159, 162, 166

youth-oriented marketing, 215, 224–227, 233, 

265

Newport Slim Lights (brand), 155

news coverage

content analysis, 333, 351

descriptive studies of, 336–341

of health consequences, 331, 341, 344, 395

increase in, 331

influence on behavior, 333, 341–344, 349, 351

influence on public opinion, 332–333, 341–

344, 351

of Master Settlement Agreement, 340–341, 

351

of secondhand smoke, 337, 339

selection and content, 331–335

smoking cessation and, 343

as source of health information, 330, 336

as source of public opinion, 330, 336

thematic, 333–334

of tobacco industry, 340–341, 346–347

volume of, 335

youth-focused, 339

youth smoking and, 343–344

news media, 329–356, 604–605

advocacy by, 335–336, 344, 350

agenda setting by, 332–333

competition and, 340–341

framing of issues by, 333–335, 339, 350

future directions, 348–350

influence of tobacco industry on, 345–348

new technologies influencing, 330, 349

production process, 349

research on, 331, 332t, 336–344, 348–349, 

604–605

sources of, 38–39, 350

surveillance system, 338

tobacco control policy and, 339, 341–344, 349, 

351

new smokers, 57–58, 61, 144, 158–159, 214. See 

also youth smoking initiation

newspaper(s)

coverage of tobacco-related issues, 337–338

influence of advertising on, 345

student, 346

newspaper advertising

antitobacco, 438t–440t, 441

blue-collar market, 154

expenditures on, 126, 127t

FTC definition of, 103

news values, 38

newsworthiness, of tobacco control, 331, 348–

349

new truth profile pages (Legacy), 612

New York City

public smoking ban, 189

tobacco control program, 444–445, 532

New Zealand

news media in, 342–343

partial advertising ban in, 85

tobacco control program, 528, 534

NHIS (National Health Interview Survey), 517

NHRA (National Hod Rod Association), 155

Nice Work (novel), 72

niche brands, 59

Nichols, Andrew W., 564

nicotine, FDA regulation of, 303–305

nicotine ratings, disclosure of, 308–309

nicotine replacement therapy (NRT), advertising 

of, 434, 448, 455, 458, 469, 607

“Nicotine Soundbites” advertisement, 561

nicotine yield, deceptive advertising and, 77

Nigeria, 85, 116–117

NIH (National Institutes of Health), 433

nonbranded specialty item distribution, 150

FTC definition of, 104

youth smoking and, 265–266

nonconscious goals, 610

non-tobacco-product bonus, FTC definition of, 104

non-tobacco products, logos on, prohibition of, 

311

North Karelia Project (Finland), 442–443, 482, 

485, 486t–489t, 495t, 501, 535
644

I n d e x

Norway

antitobacco media campaign, 522

indirect advertising in, 105

youth antitobacco programs, 491–492

No Smoking Day (UK), 442, 534

Now, Voyager (film), 362–363

NRT (nicotine replacement therapy), advertising 

of, 434, 448, 455, 458, 469, 607

O

objectivity, in news stories, 39

occasion-themed advertisements, 60

occupational practices, systematic approach to, 

38–39

O’Connor, Sandra Day, 302, 305

Office of National Drug Control Policy, 522, 601

Office on Smoking and Health (OSH), 402–403, 

433

Ohio, Issue 4, 584

Oklahoma, Question 713, 584, 586–587, 587t,

591, 591t

Old Gold (brand), 432

O’Loughlin study, 498t

Omaha Platform of the Populist Party, 578

Omni (brand), 167

Omnibus Nonsmoking and Disease Act 

(Minnesota), 553

online smoking cessation programs, 463–468, 

606, 611–612

online support groups, 466–467

online therapists, 466–467

onserts (Philip Morris), 600

opinion leaders

media effect on, 36

as target market, 198–200

opinion polls, in direct democracy campaigns, 

583–584

Oregon

tobacco control program, 531–532

youth antitobacco programs, 491

organizational-level framework, for media effects 

research, 25, 27, 36–40

organizational specialization, 38

OSH (Office on Smoking and Health), 402–403, 

433

outdoor advertising

antitobacco, 438t–440t, 441, 444

ban on, 59, 83–84, 158

ethnic market, 163

expenditures on, 126, 127t

FTC definition of, 103

health warnings mandated for, 307

LGBT-oriented, 166

shift to, 551, 599

target market for, 59

themes in, 223

outdoor life theme, 147–148

P

Pacific Islanders, as target market, 163–164

packaging, 106–108, 133, 149, 600–601

accessories, 107

global rule on, 603

warnings on (See health warnings)

Pall Mall (brand), 154

pan masala, 105

Papua New Guinea, 74

Paramount Pictures, 401

parental behavior, youth smoking and, 266

parental supervision, of entertainment media, 

407–409

Park, Robert, 40

passive smoking. See secondhand smoke

Pearson v. Shalala, 299

peer acceptance, adolescent need for, 36, 216–217, 

265, 278, 383

perceived effectiveness, 457

Perpich, Rudolph G., 554–555

personality characteristics, market segmentation 

by, 62, 143

personalized direct marketing, 144–145

persuasion, 55

neural routes of, 35

persuasion models, 29–30

dual process, 32–35

pharmaceutical industry advertising, 434, 448, 

455, 458, 469, 607

philanthropic events, sponsorship of. See

sponsorships

Philip Morris USA. See also specific brand

advertising themes, 147, 220, 226

antitobacco advertising, 457, 462

“Bill of Rights” tour, 443

California Tobacco Control Program and, 558

corporate advertising, 180–184, 189–198, 194f,

198–202

corporate Web site, 197–198

deceptive advertising, 78
645

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

health warnings, 195

integrated marketing campaign, 66–68, 198–

202, 199f

Internet marketing, 111

litigation against, 182

marketing expenditures, 123, 124t, 125t, 126, 

133

news media and, 346–347

onserts, 600

package design, 106–107

product placement, 114–116, 401

Project Sunrise, 195

promotional allowances, 131

specialty item distributions, 150

sponsorships, 184–186, 189

targeted marketing by, 56–57, 59–60, 62, 143, 

151–152, 156, 161–166, 169

youth-oriented marketing, 217, 220, 223–224, 

226, 232

youth smoking prevention campaign, 150, 

190–192, 433, 449, 455–456, 520, 522, 

536, 570

Philippines, 169

physiological responses, to tobacco control 

advertising, 610

pictorials

in brand image, 64

health warnings using, 601

Pitt, Brad, 364

Player’s (brand), 61, 154

PM21 campaign, 198–202, 199f

Point-of-Purchase Advertising Institute, 131

point-of-purchase promotions, 599–600

FTC definition of, 103

research on, 600

shift to, 84, 120, 131–133, 268, 551, 599

UK regulation of, 69

youth smoking and, 132, 158, 236, 599–600

political mobilization of bias, 583

political symbols, 583

politicians, influence of news media on, 342

popularity, adolescent need for, 216–217, 278

popular music, tobacco use in, 394–395

population-based studies, 484, 501, 509–535, 609. 

See also specific study

comprehensive antitobacco programs, 527–533

design and context of, 481

longitudinal, 510–516, 530

methodology, 510–512, 535

overview of, 509–510

summary of, 534–537

population groups. See also specific group

antitobacco message and, 607–609

targeted marketing of, 150–171

“tobacco-graphics,” 143

population level, mass communications at, 3–4

populist movement, 578–579

positioning, 55–58

potential reduced-exposure products (PREPs), 

167–168, 196

corrective advertising, 610–611

health themes and, 146, 461

Power and Precision software, 388

power balance, between audience and media, 

40, 43

Pow Wow Blend (brand), 79

“The Precious Legacy,” 169

preemption, 301–303

premium brands, 62

PREPs. See potential reduced-exposure products

pre-quitters, 87

price competition, 269

price discounts, 150, 599

expenditures on, 120, 122t, 133

FTC definition of, 103

to military service members, 153

price elasticity of demand, for cigarettes, 120

price promotions, 269

price sensitivities, 120, 150, 506

pricing decisions, 269

print media, 358. See also magazine(s); 

newspaper(s)

for smoking cessation, tailored, 465, 468

print media advertising. See also magazine 

advertising; newspaper advertising

influence on publication content, 345

shift from broadcast to, 83, 120, 133, 268, 

551, 599

PRISM awards, 403

prisoners, as target market, 170

product consumption patterns, fluctuations in, 60

product descriptors, deceptive advertising and, 76

product differentiation, 63

product placement, 114–118, 115t, 363, 599, 601

by brand, 374, 375t

criticism of, 445

documented evidence of, 372

of foreign brands, 374

MSA and, 401

restrictions on, 81, 117–118, 374, 399–402, 404
646

I n d e x

Project SCUM, 165

“Project Sunrise” (Philip Morris), 195

“Project Whisper” (BAT), 110

promotion, of tobacco products. See tobacco 

advertising and promotion

promotional allowances

expenditures on, 119, 122t, 132–133

FTC definition of, 103

mechanics of, 131

promotional magazines, 145, 396

promotional planning, 55–62, 87

propaganda model, 29, 40

Proposal A (Michigan), 585, 619–626

Proposition 65 (California), 308

Proposition 86 (California), 588–589, 590t, 591

Proposition 99 (California), 390, 446, 528–529, 

556, 559, 561–562, 584

tobacco industry opposition to, 585–586, 586t,

590t, 591

Proposition 188 (California), 584

Proposition 200 (Arizona), 562–565, 571

Proposition 206 (Arizona), 584

protection motivation theory, 31

4Ps (product, price, place, promotion), 54

PSAs (public service announcements), 481, 533, 

536–537, 550–551

Psycho (Hitchcock), 70, 72

psychographic segmentation, 62, 143

psychological mechanisms

of communication, 34

of persuasion approach, 29–33

psychological needs, adolescent, 213–216

gender and, 213, 217–220

influence of marketing and, 213–227, 278–280

psychological responses, to tobacco control 

advertising, 609–610

Public Airways Act, 392

public entertainment events, FTC definitions of, 

103–104

Public Health Cigarette Smoking Act, 82, 101, 306

public-health-sponsored campaigns, televised, 

445–448, 469

public image. See corporate image

public opinion

media effects on, 27, 29

news media as source of, 330, 332–333, 336, 

351

public relations. See also corporate advertising

primary tools of, 184

in targeted marketing, 145

public relations campaign, integrated, 198–202, 

199f

public service announcements (PSAs), 481, 533, 

536–537, 550–551

pulsing, 271–272

puns, in advertising, 72

Q

qualitative analysis, of media content, 7–8, 376–

377, 609–611

quantitative analysis, of media content, 7–8, 

609–611

quasi-experimental designs, 7, 390, 480, 482, 

484, 493, 508. See also controlled field 

experiments

Quebec Court of Appeal (Canada), 311–312

Quebec Superior Court trial (Canada), 57

Question 1 (Massachusetts), 584, 586, 587t, 590t

Question 4 (Nevada), 584

Question 713 (Oklahoma), 584, 586–587, 587t,

591, 591t

quit and win contests, 442–443, 503

“Quit for Life” programs (Australia), 493, 494t,

498t, 501–502, 504, 509, 515, 533–534

quitlines, 606, 608

calls to, effect of media campaigns on, 533–534

television advertising of, 508

R

race. See also specific racial group

quitline use and, 533–534

segmentation by, 56–57, 59, 144–145, 160–165

for antitobacco advertising, 462–463

Racketeer Influenced and Corrupt Organizations 

(RICO) Act, 76, 101

radio advertising

antitobacco, 438t–440t, 441, 490

ban on, 83, 142

Fairness Doctrine and, 550

FTC definition of, 105

history of, 432–433

randomized studies, 238–239

tobacco control campaigns, 482–484, 493, 512

youth advertising exposure, 233–238, 235t–236t

rating systems, movie, 400–401, 404–408

rational thinking, 33

reach, audience, 374–376

Real Edge (magazine), 145
647

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

Reality Bites (film), 389

rebelliousness theme, 220–222, 278, 362, 364, 393

Rebel Without a Cause (film), 362, 364

recall of specific advertising, 240–241, 256–257, 

381, 381t, 513–514

receptivity to advertising, 240, 258, 513

recycling of antitobacco advertising, 609

referenda. See state initiatives and referenda; 

specific referendum

Regal (brand), 72

Regent (brand), 360–361

regional variations, in marketing, 59

regulation

of Internet marketing, 110–112

rationale for, 74–86

“Regulations Restricting the Sale and 

Distribution of Cigarettes and Smokeless 

Tobacco to Protect Children and 

Adolescents” (FDA), 303–304

Reiner, Robert, 400

Reitman, Jason, 365

relaxation theme, 226–227, 278, 373

relevance of promotional message, 65–66, 87

religious groups, as target market, 168–169

reminding, 55

repetition of promotional message, 65–66, 87

reporting, 38

reputation, 184

research. See media-effects research

retail promotional allowances, FTC definition of, 

103

retail settings, advertising in. See point-ofpurchase promotions

retail value added category

expenditures on, 119–120, 122t

FTC definition of, 104

reviews

antitobacco campaign effectiveness, 480–481

consumption-advertising relationship, 275–

277, 280

rhythm of the business, 60

RICO (Racketeer Influenced and Corrupt 

Organizations) Act, 76, 101

Rio (brand), 162

risk perception, health behavior and, 30

risk reduced claims, deceptive advertising and, 78

risk taking theme, 148, 222–225, 278, 373

Ritz (brand), 148, 155

R.J. Reynolds Tobacco Company, 63. See also

specific brand

advertising themes, 147, 220–221, 226

California Tobacco Control Program and, 558, 

561–562

corporate image, 182

counteradvertising, 444–445

FTC complaint against, 307

indirect advertising, 105–106

Internet marketing, 111–112

marketing expenditures, 123, 124t, 125t

misleading advertising, 310

MSA violations by, 82

natural cigarettes, 79

opposition to state initiatives, 621–622

packaging design, 149

PREPs, 167

product placement, 114, 401

sampling distributions, 309

sponsorships, 184–186

targeted marketing, 58, 62, 145, 151, 153, 156, 

158, 161, 164–165, 169

viral marketing, 109

youth-oriented marketing, 214, 217, 220–224, 

226, 232, 277

RJR MacDonald Inc. v. Canada (Attorney General), 

311

roachers, 110

Robert Wood Johnson Foundation, 403

romantic themes, 148, 362

Roswell Park Hospital, “Hall of Shame” Web site, 

153

Rubin v. Coors Brewing Co., 299–300

Ruff, Craig, 624

Russell, Rosalind, 360

Russia, 400

S

Salem (brand)

advertising theme, 145

brand image, 63

target market for, 56–57, 156, 166

sales maximization, 269

sample attrition, 484

sample size, 388

sample weighting, 238

sampling distribution

bans on, 81–82, 305, 309

FTC definition of, 104

to military service members, 152

youth smoking initiation and, 256, 265–266

sampling units, 483–484
648

I n d e x

Satin (brand), 56, 155

satisfaction theme, 145–146, 170

saturation advertising, 101

Schattschneider’s mobilization of bias theory, 583

school-based antitobacco programming, 490, 

492, 506, 508, 531, 535, 537

Schumacher, Michael, 68

Screengems Productions, 364

ScreenIt.com, 370, 374, 376

search methodology, 181–182, 365, 377, 385, 480

seasonal variation, market segmentation by, 

59–60

secondhand smoke

cigarettes designed to reduce, 167

media campaign against, 446–447, 450, 468

news coverage of, 337, 339–340

as rationale for regulation, 75, 87

state initiatives on, 584

secular trends, research design and, 482, 511, 

535–536

Seeking Tobacco Alternatives with Realistic 

Solutions (STARS) project, 403

segmentation. See market segmentation; specific 

segment

self-conflict, 231

self-efficacy, 31–32

self-help clinics, televised, 504

self-image

adolescent, 213, 227–238, 228t–230t, 278–280, 

364

corporate image campaigns and, 187

entertainment media and, 377

market segmentation by, 62, 143

self-regulation

by entertainment media, 399–400

by tobacco industry, 79–82, 87, 401

sensation seeking theme, 34, 222–225, 278

SES. See socioeconomic status

sex appeal, as advertising theme, 217–221, 278

sexual imagery, 72–73, 148–149, 221

Shadow of Destiny (game), 398

Shofe, Allen M., 555

Silk Cut (brand), 69–74, 85

Sinco, Luis, 152

Singapore, 528

Skoal (brand), 144

Skoal Bandits (brand), 158–159

slim cigarettes

brand image and, 56

deceptive advertising, 78

slogans

antitobacco campaigns, 515, 519–520, 570

tobacco industry, 64, 226

Smith, Sharon, 109

Smokefree Educational Services, 444–445

Smoke Free Movies campaign, 404–407, 445

Smokeless Tobacco Act, 302–303

smokeless tobacco industry. See also specific 

brand

celebrity endorsements for, 81

gender and, 234

health warnings mandated for, 307

marketing expenditures, 129–130, 130t, 133

self-regulation of, 81–82, 87, 401

target marketing by, 144–145

youth market for, 158–159, 234

Smokeless Tobacco Master Settlement Agreement 

(STMSA), 84

smokeout initiative, 442, 503

smokers

image of

adolescent’s, 191–192, 232–238, 235t–236t,

279

entertainment media and, 388–391

on-screen, characteristics of, 372–373

smoking. See tobacco use

smoking cessation

contests, 442–443, 503

expectancy-value models in, 30

expert-tailored, 465

information centers, 533–534

news coverage and, 343

online, 463–468, 606

role of media in, 35, 606–607

short term media-based events, 441–442

studies of, 502–508

televised clinics, 504

smoking cessation products, advertising of, 434, 

448, 455, 458, 469, 607

smoking initiation

entertainment media and, 361, 365, 384, 389, 

394

social learning and, 389

stages in, 239

time-series studies of, 277–278

youth (See youth smoking initiation)

smoking susceptibility

antitobacco campaign aimed at, 524

entertainment media and, 380, 382, 382f, 389

measures of, 239, 257, 265–267, 279–280
649

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

“Smooth Character” Campaign, 221–223

Snatch (film), 364

social cognitive theory, 31–32

social conditions

media role in, 40–41

tobacco use in movies and, 371, 373

social costs, as rationale for regulation, 75, 87

social determinants, 35

social influences, controlling for, 238–239, 256, 

279

social issues

news coverage of, 335, 339

sponsorship of (See sponsorships)

socialization, role of media in, 26–27

social needs, adolescent, 216–217, 265, 278

social network analysis, 36

social networking, online, 612

social network-level framework, for media effects 

research, 25, 27, 40–44

social norms

behavior change and, 30–32, 446, 455

effect of tobacco advertising on, 100

entertainment media and, 389

media messages reinforcing, 41

movies and, 363–364

social responsibility, corporate. See corporate 

social responsibility

social science, 39–40

social smokers, 61

social support, in smoking cessation programs, 

466–467

social values, marketing targeted at, 199

societal alignment, 198

societal level, media effects at, 41–42

societal-level framework, for media effects 

research, 25, 27

socioeconomic status (SES)

entertainment media and, 359

Internet use and, 612

knowledge gap and, 41–43

media literacy and, 602

news media consumption and, 605

quitline use and, 534

tobacco use prevalence and, 42–43, 598, 607

sociology, 39–40

soldiers. See military service members

Som + Bank (film), 400

Sony Pictures, 401

Sorrell, William H., 570

Souter, David, 300

South Dakota, 584

Spain, 267, 313

specialization, 38

specialty item distribution, 150

FTC definition of, 104

youth smoking and, 265–266

speech

categories of, 295–296

commercial (See commercial speech)

freedom of, 295, 310, 399, 603 (See also First 

Amendment)

sponsorships, 179–209

blue-collar market, 154–155

branding and, 64

effects on consumer perceptions and sales, 

187–189, 202–203

effects on tobacco control policy, 189

ethnic-oriented, 162–163

EU ban on, 312–313

expenditures on, 184

female-oriented, 156–157

FTC definition of, 104

global ban on, 313–315

rationale behind, 185

refusal of, 188

religious-oriented, 169

restrictions on, circumvention of, 86

shift from broadcast advertising to, 83, 120, 

133, 268, 551, 599

in target marketing, 144

young adult-oriented, 160

youth-oriented, 158–159, 186, 224

sports

smokeless tobacco and, 234

sponsorship of (See sponsorships; specific event)

tobacco control and, 565

sports theme, 147–148

stakeholder(s)

nested relationship of, 4, 4f

in news coverage, 333, 350

stakeholder marketing, 5

Stanford Five-City Project, 482, 485, 486t–489t,

490, 496t, 501–503, 535

Stanford Three Community Study, 482, 493, 

494t, 501, 535

STARS (Seeking Tobacco Alternatives with 

Realistic Solutions) project, 403

starters, 57, 87, 158

state antitobacco media campaigns. See also

specific state
650

I n d e x

comprehensive, 527–533

cross-sectional studies of, 523–527

exposure to, 434, 436t, 437t

funding for, 554–555, 558–562, 562t, 563–564, 

567–568, 571

longitudinal studies of, 512–515, 530, 535–536

smokeout days, 442

tobacco industry response to, 549–575

State Attorneys General, 409

correspondence with MPAA, 414–421

state initiatives and referenda, 577–600. See also

specific state

from 1988-2006, 581t–582t, 585, 592

analysis results, 589–591, 590t, 591t

criticisms of, 579–582

history of, 578–579

language of, 580, 583

methods, 584–585

role of media in, 583–584

states with, 579t

by type allowed, 580t

success of, 592

tobacco industry opposition to, 585–592, 590t,

591t, 619–626

state lawsuits, against tobacco industry, 565–569

state prohibitions, on sales to minors, 305

statistical data analysis, 483–484

statistical power, issues of, 482–483

Statue of Nicotina, 443

stealth marketing. See viral marketing

stereotyping, youth smoking and, 265

Stewart, James, 360

STMSA (Smokeless Tobacco Master Settlement 

Agreement), 84

Stone’s theory of causal stories, 583

stop-smoking contests, 442–443, 503

stop-smoking days, 118, 442–443, 503

The Strange Loves of Martha Ivers (film), 362

stress reduction theme, 146, 170, 225–227, 

278–279, 373

structural model, 40–41

Students Working Against Tobacco (SWAT), 343, 

566

study samples, 238, 483–484

subjective probability theory, 30

support groups, online, 466–467

Supremacy Clause (U.S. Constitution), 301

Surgeon General’s reports

1964 (first)

entertainment media and, 392

FTC actions after, 306

health cigarettes after, 166

interest in regulating tobacco advertising 

after, 301

misleading advertising and, 76

news coverage after, 351

1989, 345

surreal advertising, 68–74, 85

surveys, 7, 484

multiple-wave, 384

SWAT (Students Working Against Tobacco), 343, 

566

Sweden, 105

Swift, Jane, 563

switchers, 58

symbolic imagery, 33, 85

political, 583

symbolic modeling, 32

Symington, John Fife III, 563–564

T

TACNH (Technical Advisory Committee on 

Nonsmoking and Health), 552

taglines, 64

tailoring, 143–145, 461–463, 465, 608–609

Talman, William, 432–433

targeted marketing, 150–171. See also market 

segmentation; specific target

antitobacco ads, 461–463, 468, 608–609

in integrated public relations campaign, 198–202

objectives of, 142–143

protests against, 161–162, 171

tar ratings, disclosure of, 308–309

Tar Wars program (AAFP), 444

tar yield

brand image and, 56

deceptive advertising and, 77

FTC measurement of, 308–309

taxes

antitobacco programs funded by, 525, 528–529, 

531–532, 562–563

state initiatives and referenda on, 584, 592, 

619–626

TCPA (Tobacco Products Control Act), 311

Teague, Claude, 232

Technical Advisory Committee on Nonsmoking 

and Health (TACNH), 552

technological innovation, 27, 611–612

as legislative ambiguity, 86
651

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

news media and, 330, 349

Teenage Attitudes and Practices Surveys, 215, 234

Telecommunications Act of 1996, 408

telecounseling services, 467

telephone advertising, FTC definition of, 104–105

television

changing face of, 611

devices restricting access to, 409

exposure to, 359–360

link between tobacco industry and, 392

news coverage, 334, 337–338

smoking cessation clinics on, 504

tobacco industry sponsorship of, 362–363

tobacco use on, 392–394, 393t

Television, School, and Family Smoking 

Prevention and Cessation Project, 491

television advertising

antitobacco, 438t–440t, 441, 445–449, 489–

491, 608

relative performance of, 449–456, 451t–454t

ban on, 83, 142

exposure to, 434, 435t

Fairness Doctrine and, 550

FTC definition of, 105

history of, 153, 432–433

of smoking cessation products, 448

youth-oriented, 157, 241

temporal association, 385

testimonials, FTC definition of, 102–103

Texas

lawsuit against tobacco industry, 566–567

smoking cessation program, 499t, 500t,

506–508

youth antitobacco programs, 492

Texas v. Johnson, 296

Thailand, 400

Thank You for Smoking (film), 365

theaters, antitobacco advertising in, 409

thematic news coverage, 333–334

Theory of Planned Behavior (TPB), 30–31

Theory of Reasoned Action (TRA), 30–31

thinking, rational versus experiential, 33

Thompson v. Western States Medical Center, 298

“Thumbs Up! Thumbs Down!” project, 370–371

time, advertising effect over, 271

time-series studies

Fairness Doctrine, 517–518

marketing expenditures, 272–274, 273t, 280

smoking initiation and brand choice, 277–278

TIRC (Tobacco Industry Research Committee), 76

TiVo, 611

Tobacco Act (Canada), 311–312

tobacco advertising and promotion, 4–5, 54–74

affective response to, 29–30

cigars (See cigar advertising and promotion)

effectiveness of, 54

expenditures (See marketing expenditures)

extent of, 118–132

false (See false advertising)

history of, 100, 360–364

key principles of, 54–74

media reliance on, 41

misleading (See misleading advertising)

monitoring of, 613

planning of, 55–62, 87

primary purposes of, 54–55

regulation of, 3 (See also legislation)

rationale for, 74–86

sources of data on, 101–102

targets of (See market segmentation; targeted 

marketing)

themes of (See advertising themes)

types of, 102–118

Tobacco Advertising and Promotion Act (UK), 69

tobacco consumption

effects of marketing on, 212–213, 268–279, 280

corporate advertising, 190–196, 202–203

econometric studies, 272–277, 273t, 280

fluctuating patterns in, 60

news media effects on, 343

tobacco control

dynamic relationship with tobacco industry, 

598, 604

effectiveness of, 469

effect of corporate advertising on, 189

efforts of tobacco industry to influence, 549–

575, 598

funding of (See funding)

future directions, 597–617

media advocacy for, 335–336

newsworthiness of, 331, 348–349

tobacco control advertising, 431–478

characteristics of, 449, 450t, 469

emotional response to, 457–460, 468, 609–610

in entertainment media, 390–392, 409, 412

evidence base, 468, 605

expenditures on, 607–609

exposure to, 434, 435t–437t, 607–609

future directions, 604–612

historical overview of, 432–433
652

I n d e x

interactive health communications, 463–468

media activism, 443–445

in movies, 373

nontelevised, 434–445, 438t–440t

psychological responses to, 609–610

recent developments in, 433–434

recycling or sharing of, 609

short term media-based, 441–442

targeting and tailoring of, 461–463, 468, 

608–609

televised, 445–449

relative performance of, 449–463, 451t–454t

tobacco industry-sponsored, 191, 448–449

Tobacco Control Monograph 9, 128

Tobacco Control Monograph 16, 550

Tobacco Control Monograph 19

chapter overviews and conclusions, 10–20

major conclusions, 9–10

organization of, 8–9

preparation of, 8

Web page, 9

tobacco control policy

Canada as model for, 312

effect of corporate advertising on, 196–197, 204

entertainment media and, 399–400

news media effects on, 339, 341–344, 351, 605

options, 275

tobacco control programs

comprehensive, 510, 527–533

effectiveness of, 3, 335, 550, 551f, 560, 565–

567, 569

future directions, 605–612

history of, 2–3, 44

media advocacy in, 41, 340

MSA funding of, 510

tobacco industry efforts to influence, 549–575

tobacco control research, 479–546

controlled field experiments, 482–509

methodology, 480

population-based studies, 484, 501, 509–535

prior reviews, 480–481

summary of, 535–537

Tobacco Control Research Branch (NCI), 8

tobacco industry. See also specific company

antitobacco advertisements sponsored by, 

448–449, 469

dynamic relationship with tobacco control, 

598, 604

efforts to influence tobacco control, 549–575, 

598

history of, 26

Legacy activities restricted by, 569–571

magazine industry and, 395

movie industry and, 360–364

negative image of, 182–184, 183f, 196, 200–202, 

204, 390

news media and, 340–341, 345–348

opposition to state initiatives and referenda, 

585–592, 590t, 591t, 619–626

outreach to tobacco control organizations, 196

response to advertising bans, 39–40

response to Fairness Doctrine, 550–551

self-regulation of, 79–82, 87, 401

state lawsuits against, 565–569

television industry and, 363, 392

youth smoking prevention campaigns, 150, 

204, 469, 520, 522, 536, 553, 570–571, 602

Tobacco Industry Labor Management Committee, 

552

Tobacco Industry Research Committee (TIRC), 76

Tobacco Industry Testing Laboratory, 308

Tobacco Institute

news coverage, 346

opposition to state initiatives, 620–621

response to state tobacco control programs, 

552–554, 557, 565

tobacco-producing states, antitobacco campaigns 

in, 521

Tobacco Products Control Act (Canada), 57, 85

Tobacco Products Control Act (TCPA), 311

tobacco use

costs of, 2

in developing countries, 2–3

media effect on (See media effects)

mortality related to, 2–3

tobacco use prevalence, 2–3

among adolescents, 58

among military service members, 151

decline in, 42–43

disparities in, 42–43

by gender, 151

news media effects on, 605

seasonal patterns in, 60

socioeconomic status and, 42–43, 598, 607

Tobacco Use Prevention Advisory Committee 

(TUPAC), 564

tobacco user status, market segmentation by, 61

TPB (Theory of Planned Behavior), 30–31

TRA (Theory of Reasoned Action), 30–31

transgender population, as target market, 165–166
653

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

transit advertising, FTC definition of, 105

Transtheoretical Model (TTM), 32

Tremor, 109

trend influence marketing, 110

True (brand), 146

“truth” campaign

American Legacy Foundation, 31, 433, 447, 

456, 462, 520–522, 536, 551, 569, 571

Florida, 512–515, 525–527, 536, 551, 566–567, 

569

TTM (Transtheoretical Model), 32

tunnels of influence, 159–160

TUPAC (Tobacco Use Prevention Advisory 

Committee), 564

Turkey, 105

Twentieth Century Fox, 401

two-step flow hypothesis, 36

type I errors, 483, 536

U

ultralight cigarettes, 166–168

United Kingdom

advertising code violations, 82

antitobacco media campaign, 462, 522–523

legislation, 69, 313

magazine advertising, 396–397

market segmentation, 57

media-effects research, 276

news coverage, 342

No Smoking Day, 442, 534

smoking cessation programs, 500t, 507–508, 

534

surreal advertising, 68–74, 85

youth-oriented marketing, 214

youth smoking, 257, 264, 267–268

youth smoking prevention campaign, 463

United States v. Philip Morris USA Inc., et al., 101

United States v. United Foods, Inc., 299

Universal City Studios, 401

Unlimited (magazine), 67, 145, 223

Uptown (brand), 161–162

urea, 570–571

U.S. Congress

entertainment media hearings, 404

FDA authority legislation, 305

FTC reports to, 306–307

U.S. Constitution

direct votes under, 579–580

First Amendment (See First Amendment)

Supremacy Clause, 301

U.S. Department of Justice (DOJ), RICO Act 

violations lawsuit, 101, 213

U.S. Food and Drug Administration. See Food 

and Drug Administration (FDA)

U.S. Smokeless Tobacco Corporation (USST), 

144–145, 154

U.S. Supreme Court

versus Canadian Supreme Court, 312

FDA governing statute ruling, 304–305

First Amendment cases, 295–300

impact on advertising restrictions, 300–301

tar and nicotine ratings ruling, 309

user navigation, integrated health 

communications, 464

user status, market segmentation by, 61

USST (U.S. Smokeless Tobacco Corporation), 

144–145, 154

Utah, tobacco control programs, 455

V

Valenti, Jack, 402–404

State Attorneys General correspondence with, 

418–421

Valentine v. Chrestensen, 296

validity, 7

value brands, 61

values, 30–32

Vantage (brand), 80, 148

Vatican art treasures exhibition, 185

V-Chip, 408–409

Vermont

entertainment media study, 407

school-based programming, 490

smoking cessation program, 507

VIBE (magazine), 161

Viceroy (brand), 162

video advertising, FTC definition of, 102, 105

video games, 358

as advertising vehicle, 112–114, 601

content analysis of, 398

violence in, 398

Vierthaler, Bonny, 444

Vietnamese-American men, smoking cessation 

program, 500t, 507

vilification clause (MSA), 569–571

violence

in entertainment media, 388, 406

in surreal advertising, 72–73
654

I n d e x

in video games, 398

viral marketing, 108–110, 133

as legislative ambiguity, 86

to young adults, 160

Virginia, antitobacco campaign, 448, 455

Virginia Pharmacy Board v. Virginia Citizens 

Consumer Council, 296–297

Virginia Slims (brand)

brand image, 56, 63

target market for, 55–56, 145, 155, 162–163, 165

vitality of smoking theme, 148

voice card advertising, 152

W

Warner Brothers Entertainment, 401

warnings. See health warnings

Waxman, Henry, 561

Wayne County (Michigan) Medical Society 

Foundation, 444

Web sites. See also Internet

Legacy, 612

tobacco company

content analysis of, 398

corporate advertising on, 197–198

FTC definition of, 102

wholesale promotional allowances, FTC definition 

of, 103

Willy the Penguin, 158

Wilson, Pete, 558–560

Wilson, Rip, 564

Winfield (brand), 59

Winston (brand)

advertising themes, 147

brand image, 63, 233

natural cigarettes, 79

packaging design, 149

product placement, 374

target market for, 56, 61, 144, 151, 154–157, 162

youth-oriented marketing, 223, 233, 265

women

antitobacco programming and, 501

smoking cessation programs and, 505

smoking initiation and, 277

smoking prevalence among, 151

as target market, 55–56, 145, 154–157, 198–

200, 220

history of, 360–361

tobacco control programs aimed at, 552

women’s magazines, 346, 395–396

working class, as target market, 153–156

World Conference on Tobacco, 112

World Health Organization (WHO), 313–315

Countrywide Integrated Noncommunicable 

Disease Intervention framework, 443

Framework Convention (See Framework 

Convention on Tobacco Control)

International Quit and Win Campaign, 443

World No Tobacco Day (May 31), 118, 442, 503

World Wide Web. see Internet; Web sites

World War II propaganda, 29, 40

Y

Yale University, 29, 40

young adults

brand loyalty, 159

entertainment media and, 372

as target market, 159–160, 214, 223–224, 226

youth

access to tobacco products, FDA regulation of, 

303–304

advertising bans, 58, 157–158, 300

antitobacco ads created by, 443–445

ban on tobacco sales to, 305

brand loyalty, 57, 159

communication channels used by, 157

corporate advertising and, 601–602

curiosity about smoking, 265–266

entertainment media and, 358–360, 370–372, 

376–377, 380–384, 394–395, 406–409, 412

image of tobacco industry, 191–192, 198, 202, 

204, 232–238, 279

Internet marketing to, 109–110, 409, 601, 612

magazine advertising, 84–85, 157–158, 233, 

236, 241, 397

media exposure, 434, 435t–437t

media literacy of, 236–237, 410–411, 601

news coverage aimed at, 339

smokeless tobacco and, 158–159

smoking cessation products and, 448

sponsorships aimed at, 158–159, 186, 224

as target market, 57–59, 61, 80, 84–85, 157–

159

for antitobacco advertising, 461–462

viral marketing and, 109

youth brands, 215–216, 600

advertising expenditures on, 84–85

advertising exposure, 265

advertising themes for, 216–217
655

M o n o g r a p h 1 9 . T h e R o l e o f t h e M e d i a

recognition of, 240, 257, 267–268, 279

self-image and, 232–238, 235t–236t, 278–280

youth psychological needs, 213–216

gender and, 213, 217–220

influence of marketing and, 213–227, 278–280

youth smoking

adult smoking prevention efforts and, 606

brand image and, 232–238, 235t–236t, 278–

280

cigarette prices and, 120, 506

entertainment media and, 42

news coverage and, 343–344

point-of-purchase promotions and, 132, 158, 

236, 599–600

prevalence of, 58

video games and, 112–114, 601

youth smoking initiation

entertainment media and, 377, 380, 382, 382t,

389, 394

family influences on, 383

image enhancement and, 227–232, 228t–230t,

279–280

influences on, 212–214, 266–267, 279–280

measures of, 513–514

news media effects on, 344

product placement and, 599, 601

rates of, 361, 361f

sampling distribution and, 256, 265–266

stages in, 239

time-series studies of, 277–278, 537

youth smoking prevention campaigns

effectiveness of, 150, 193, 196–197, 203, 

449–456, 484–492

mass media, 433

news media and, 337

state-sponsored, 523–524, 536

tobacco industry-sponsored, 150, 190–193, 

204, 449, 469, 520, 522, 536, 553, 570–

571, 602

youth smoking research, 238–268, 279–280

controlled field experiments, 484–492, 486t–

489t, 508, 535

cross-sectional studies, 241–258, 242t–255t

longitudinal studies, 258–268, 259t–263t, 530

methodological issues, 238–240

randomized studies, 233–238, 235t–236t

YouTube, 601, 612

Z

Zack (brand), 106

zero marginal effect, 271