Content Analysis of Trends in Print Magazine Tobacco Advertisements.

Tobacco control efforts have resulted in significant reduction in cigarette smoking among United States (U.S.) adults over the past five decades, but has slowed down in recent years.1 Centers for Disease Control and Prevention examined excise tax data from the U.S. Department of Treasury’s Alcohol and Tobacco Tax and Trade Bureau, and reported that from 2000 to 2011, whereas consumption of cigarettes decreased 32.8%, consumption of non-cigarette combustible tobacco increased 123.1%. The percentage of combustible tobacco (comprised of loose tobacco and cigars) consumption increased from 3.4% in 2000 to 10.4% in 2011. The largest changes was observed from 2008 to 2011, when small cigar consumption decreased from 5.9 billion to 0.8 billion (an 86.4% decrease), whereas large cigar consumption increased from 5.7 billion to 12.9 billion (a 126.3% increase).2 In addition, use of other non-cigarette tobacco products (NCTPs), particularly e-cigarettes in the last decade has increased,3–6 resulting in a poly-tobacco product marketplace. Ten years of data from the National Survey on Drug Use and Health Results show that rates of poly-tobacco use were essentially unchanged from 2002 to 2011 (8.7% to 7.4%), though some product combinations, including cigarettes and smokeless tobacco, cigars and smokeless tobacco, and use of more than two products increased. In tobacco users under age 26, the proportion of poly-tobacco use increased, even as overall tobacco use declined.5 Furthermore, data from the 2011, 2012, and 2013 National Youth Tobacco Surveys of students in grades 6–12 clearly revealed that between 2011 and 2013, the number of never-smoking youth who used e-cigarettes increased three-fold, from 79,000 to more than 263,000.4 Thought to be driving the recent increase in NCTP use, there have been increased expenditures on NCTP marketing and promotion.7,8 According to the Federal Trade Commission’s report on cigarette and smokeless tobacco advertising and promotion, the U.S. expenditure on advertising and marketing of smokeless tobacco products rose from $444.2 million in 2010 to $451.7 million in 2011.9 Over a 3-month period in 2012, almost $20 million were spent on advertising NCTPs with the greatest amount spent on the promotion of smokeless (∼$8 million) and snus (∼$10 million), and the largest circulation reported for e-cigarette advertisements (ads).8 E-cigarette advertising expenditures across magazines, TV, newspapers, and internet tripled from $6.4 million in 2011 to $18.3 million in 2012.7 Underscoring the growth of NCTPs in the U.S. marketplace,2–5 recent sales figures estimate sale of smokeless tobacco products exceeds $2.94 billion.9 Of great concern to the tobacco control community, these smokeless tobacco products are marketed as viable alternatives to smoking particularly in places where clean indoor air laws have imposed external restrictions on smoking (e.g., worksites, public transportation, restaurants and bars).10–12 The potential for such marketing trends to undermine smoking prevention and cessation efforts,10,13–15 particularly for youth and young adults cannot be overlooked. Increasing number of studies demonstrate strong link between tobacco marketing and youth smoking experimentation and use.16–19 Therefore, robust surveillance of NCTP advertising is critical to inform Food and Drug Administration (FDA) regulation and to protect public health.8 The tobacco control community has less agreement as to whether smokeless tobacco products (such as moist snuff and snus) and e-cigarettes are beneficial or harmful for public health and if they should be used as a substitute/alternate for smoking among those who experience difficulty quitting or do not want to quit.20–22 The latest policy statement from the American Association for Cancer Research (AACR) and the American Society of Clinical Oncology (ASCO) on e-cigarettes recognizes that e-cigarettes may be helpful in potentially altering patterns of tobacco use and affect the health of the public. However, given a lack of definitive data, the AACR and ASCO recommend additional research on these devices, including assessing the health impacts of e-cigarettes, understanding patterns of e-cigarette use, and determining what role e-cigarettes have in cessation.20 With the passing of the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) in June, 2009, regulatory approaches related to advertising, marketing, and promotion of tobacco products were conferred to the FDA, with a particular emphasis on restrictions to decrease the marketing and appeal of tobacco products to children and adolescents. Besides marketing restrictions circulated by the FDA in March, 2010, such as prohibition of the use of tobacco brand names in sponsorship of sporting, entertainment, and cultural events; prohibition of the use of tobacco brand names or logos on clothing, hats, and other non-tobacco items; and limitation of tobacco advertising in publications with a large youth readership, the FDA also prohibited false or misleading labels, labeling, and advertising for tobacco products, such as modified risk (unless approved by the FDA) or therapeutic claims. Additionally, the FDA banned the use of descriptors such as “light’, “mild”, or “low”. These statutory provisions in Section 911b of the Tobacco Control Act became effective in June, 2010.23,24 In order to inform regulatory decisions around marketing of tobacco products, a descriptive surveillance of tobacco product advertising is important. Marketing and promotion of NCTPs, particularly for snus and e-cigarettes often compare these products with conventional cigarettes. Ads describe the NCTPs as healthier, cleaner, and easier to use than conventional cigarettes. For instance, a content analysis of 59 branded e-cigarette retail websites demonstrated use of claims that e-cigarettes were cleaner (95%), cheaper (93%), and easier to use anywhere (71%) as compared to conventional cigarettes.25 Similarly, a content analysis of print and television ads for non combustible tobacco products revealed that all of the e-cigarette ads contained a comparative theme, framing e-cigarettes as desirable alternatives to smoking.8 Ads for snus have followed similar trends, with newspaper and magazine ads promoting snus as a better alternative to cigarettes or smokeless tobacco.12 As well, recent research highlights that little cigar/cigarillo ads on YouTube were marketed as cheaper, smoother, and less harmful than cigarettes.26 Clearly, the preponderance of comparative themes is well evident in NCTP ads, but ads are also well known to carry multiple themes. Past research demonstrates that besides comparative themes, NCTP ads also highlight individuality, masculinity, and sociability aspects of product use, while also utilizing celebrity endorsements, taste and availability of varied flavors as marketing strategies.8,12,25,27 Whereas past research highlights persuasive themes and marketing strategies in tobacco product advertisements, they usually focus on one specific product type. The utilization of print media in creating persuasive messages about different kinds of tobacco products has not been examined previously, and is a focus of this study. Exposure of people, particularly youth to print ads in magazines continues to stay very high, despite exposure to ads online, on TV, and radio. For instance, recent research revealed that e-cigarette print ads in magazines reached 32.2 million teens and young adults from January through November 2013.28 Therefore, we focused our analysis on NCTP print ads, and report on a comprehensive analysis of NCTP advertising in magazines to better understand the multiple facets of rhetoric and persuasive themes utilized by tobacco companies to market NCTPs. In addition, we present a comparative analysis with cigarette advertising in order to demonstrate similarities and differences in persuasive approaches to marketing all tobacco products. The findings from this study will help inform FDA about the tobacco print advertising landscape for all tobacco products and provide specific recommendations for FDA marketing regulations.