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Impact of research on tobacco advertising, promotion and sponsorship for tobacco control

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

Published in: Healthcare
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Impact of research on tobacco advertising, promotion and sponsorship for tobacco control

  1. 1. Impact of research on tobacco advertising, promotion and sponsorship for tobacco control Ute Mons Cancer Prevention Unit & WHO Collaborating Center for Tobacco Control German Cancer Research Center (DKFZ), Heidelberg, Germany ICO-WHO Symposium on Tobacco Control | December 3, 2018 | Barcelona @UteMons
  2. 2. Seite 212/10/2018 | Autor Abteilung Background
  3. 3. Seite 312/10/2018 | Autor AbteilungTobacco advertising, promotion and sponsorship (TAPS) • TAPS = levels 1 and 2 • Integrated levels of marketing and promotion • Each level from 1 through 4 represents a broader and more indirect level of marketing effort • …but also a more powerful one (efforts at the stakeholder level can have impact on policies) • Challenge to goals of tobacco control/ public health • As direct channels become more restricted, efforts and resources will be allocated to more indirect channels • Importance of monitoring
  4. 4. Seite 412/10/2018 | Autor Abteilung FCTC on TAPS Article 13 – Tobacco advertising, promotion and sponsorship 2. Each Party shall, in accordance with its constitution or constitutional principles, undertake a comprehensive ban of all tobacco advertising, promotion and sponsorship. This shall include […] a comprehensive ban on cross-border advertising, promotion and sponsorship originating from its territory. In this respect, within the period of five years after entry into force of this Convention for that Party, each Party shall undertake appropriate […] measures […]. 3. A Party that is not in a position to undertake a comprehensive ban due to its constitution or constitutional principles shall apply restrictions on all tobacco advertising, promotion and sponsorship. […] 4. As a minimum, and in accordance with its constitution or constitutional principles, each Party shall: a. prohibit all forms of tobacco advertising, promotion and sponsorship that promote a tobacco product by any means that are false, misleading or deceptive or likely to create an erroneous impression about its characteristics, health effects, hazards or emissions; c. restrict the use of direct or indirect incentives that encourage the purchase of tobacco products by the public; e. undertake a comprehensive ban or, in the case of a Party that is not in a position to undertake a comprehensive ban due to its constitution or constitutional principles, restrict tobacco advertising, promotion and sponsorship on radio, television, print media and, as appropriate, other media, such as the internet, within a period of five years; and prohibit, or in the case of a Party that is not in a position to prohibit due to its constitution or constitutional principles restrict, tobacco sponsorship of international events, activities and/or participants therein. 5. Parties are encouraged to implement measures beyond the obligations set out in paragraph 4.
  5. 5. Seite 512/10/2018 | Autor Abteilung Scientific evidence
  6. 6. Seite 612/10/2018 | Autor Abteilung Important assessments of evidence I NCI Monograph #19, 2008 • Comprehensive synthesis of scientific literature on media communication in tobacco promotion • Conclusions (Selection): • Media communications play a key role in shaping tobacco-related knowledge, opinions, attitudes, and behaviors among individuals and within communities • The total weight of evidence – from multiple types of studies, conducted by investigators from different disciplines, and using data from many countries – demonstrates a causal relationship between tobacco advertising and promotion and increased tobacco use
  7. 7. Seite 712/10/2018 | Autor Abteilung Important assessments of evidence II Lovato et al. 2011 • Methods: • Systematic review on TAPS and smoking initiation, included 19 longitudinal studies with in total >29.000 baseline never-smokers • Conclusions: • Longitudinal studies consistently suggest that exposure to tobacco advertising and promotion is associated with the likelihood that adolescents will start to smoke • Based on the strength and specificity of this association, evidence of a dose-response relationship, the consistency of findings across numerous observational studies, temporality of exposure and smoking behaviours observed, as well as the theoretical plausibility regarding the impact of advertising, we conclude that tobacco advertising and promotion increases the likelihood that adolescents will start to smoke
  8. 8. Seite 812/10/2018 | Autor Abteilung Important assessments of evidence III Surgeon General Report, 2012 • Comprehensive literature review • Conclusions (Selection): • The evidence is sufficient to conclude that there is a causal relationship between advertising and promotional efforts of the tobacco companies and the initiation and progression of tobacco use among young people
  9. 9. Seite 912/10/2018 | Autor Abteilung Important assessments of evidence IV NCI Monograph #21, 2016 • Comprehensive literature review • Conclusions (Selection): • The weight of the evidence from multiple types of studies done by researchers from a variety of disciplines and using data from many countries indicates that a causal relationship exists between tobacco company marketing activities and tobacco use, including the uptake and continuation of tobacco use among young people. • In high-income countries, comprehensive policies to ban the marketing activities of tobacco companies are effective in reducing tobacco use, but partial marketing bans have little or no effect
  10. 10. Seite 1012/10/2018 | Autor Abteilung TAPS regulations
  11. 11. Seite 1112/10/2018 | Autor AbteilungInsufficient implementation of FCTC Art. 13 in Europe 2014
  12. 12. Seite 1412/10/2018 | Autor AbteilungInsufficient implementation of FCTC Art. 13 in Europe 2018
  13. 13. Seite 1512/10/2018 | Autor Abteilung Example: Germany
  14. 14. Seite 1612/10/2018 | Autor Abteilung • Significant increase in FCTC policy implementation Insufficient implementation of FCTC Art. 13
  15. 15. Seite 1812/10/2018 | Autor Abteilung Intermediate conclusions • Strong evidence for causal association between tobacco marketing activities and tobacco use • Strong evidence for effectiveness of comprehensive policies to ban the marketing activities of tobacco companies in reducing tobacco use • Usually high population support for TAPS bans • Clear requirements through FCTC to implement a comprehensive TAPS ban • Efforts to harmonize advertising restrictions through EU directives …and yet: • Substantial differences in country efforts to undertake a comprehensive TAPS ban • Insufficient FCTC implementation
  16. 16. Seite 1912/10/2018 | Autor Abteilung Explanations
  17. 17. Seite 2012/10/2018 | Autor Abteilung Potential explanations Tobacco industry Research Tobacco control policies Scientific evidence Political will Population support Goal: To curb the tobacco epidemic FCTC implementation  Poor communication of evidence  Tobacco industry interference  Insufficient political will
  18. 18. Seite 2112/10/2018 | Autor AbteilungHow to communicate evidence / public health advocacy Don’t imagine that if you publish evidence, they will come • Be proactive, be persistent, be passionate • Develop networks, found/join alliances Understand your audience and don’t expect evidence to speak for itself • Synthesize evidence concisely to minimise its cognitive burden • Use story-telling and case studies, frame your message • Know your enemies, anticipate opposition arguments and prepare your responses Exploit windows of opportunity • Reach out and present your solution when attention rises to a problem • Keep up to date with what’s in the news and with the latest published evidence Understand and accept the real-world policy-making processes • Find mentors, learn from examples and case studies • Find allies/partners who are involved, build trust and offer your support • Don’t make excessive demands – be realistic and prepared to compromise – use criticism wisely
  19. 19. Seite 2212/10/2018 | Autor AbteilungHow to communicate evidence / public health advocacy • Scientific articles • Analyses of advertising and documentation • Scientific evidence factsheets • Contrasting industry arguments with evidence • Showing public support • Mobilization of NGOs and medical associations • Media advocacy • Letters to MPs • Personal communication with MPs
  20. 20. Seite 2312/10/2018 | Autor Abteilung • To avoid a European tobacco advertising ban in the 1990s the tobacco industry paid scientists to generate reports stating that tobacco advertising does not influence tobacco consumption • Tobacco industry prepared proposals for weak legislation and disseminated those into European parliament via German MEPs • Weak self-regulatory measures were proposed to avoid TAPS restrictions • Tobacco industry managed to prevent an outdoor advertising ban in 2016 • To avoid abolition of vending machines, tobacco industry paid 12 million Euro for a youth prevention campaign Smoking calms you down Correct: smokers don‘t need to worry about their future because half of them die prematurely Tobacco industry interference: example Germany
  21. 21. Seite 2412/10/2018 | Autor Abteilung • German paradox: despite weak tobacco control and prominent tobacco advertising youth prevalence is declining steadily • Makes „child framing“ of messages difficult • Tobacco industry refers to „German model“ when claiming that educational prevention is more effective than tobacco control • Philip Morris: “Educational programmes, seen as and proven to be one of the most effective drivers in discouraging youth smoking and helping smokers quit are proving successful. For example the German programme “Be Smart – Don’t Start”, forms part of a comprehensive education programme that has seen youth smoking rates more than halved since 2001” • Imperial Tobacco: “Germany has a tobacco control strategy with education embedded at its core, and it delivers proven results“ Tobacco industry interference: example Germany
  22. 22. Seite 2512/10/2018 | Autor Abteilung Popular arguments against TAPS bans I „A ban on tobacco advertising won’t decrease tobacco use, and youth smoking is declining already despite outdoor advertising” - There is compelling evidence that TAPS bans significantly reduce cigarette consumption - The decline in youth smoking is a success of regulatory measures, such as tax increases and a ban of sales to minors - Initiation is not prevented in many cases, but rather shifted to legal age – opinions and attitudes towards smoking shaped by earlier exposure to TAPS
  23. 23. Seite 2612/10/2018 | Autor Abteilung Popular arguments against TAPS bans III „TAPS does not encourage people to start smoking; it’s just about informing consumers about the products and enticing current smokers to switch brands.” - There is compelling evidence that smoking encourages tobacco use among youths
  24. 24. Seite 2712/10/2018 | Autor Abteilung Insufficient political will • Cultural and historical reasons • respect for freedom of choice • no political interference in personal choices • no public health tradition • industry-friendliness • corporatistic policy system with comprehensive stakeholder engagement • Fertile ground for tobacco industry arguments © Paul Cairney
  25. 25. Seite 2812/10/2018 | Autor Abteilung Popular arguments against TAPS bans II „Cigarettes are a legal product for adults who can make responsible decisions” - Cigarettes are legal but they are not like any other consumer products - Many adults are addicted to tobacco
  26. 26. Seite 2912/10/2018 | Autor Abteilung Conclusions • Evidence on effects of TAPS on smoking and on effectiveness of TAPS bans is compelling • Coercive FCTC requirements on TAPS legislation • …but insufficient translation of evidence into action and insufficient FCTC implementation in many countries • Targeted communication/dissemination of evidence needed • Curbing tobacco industry interference is crucial • Both can help increasing political will to strengthen tobacco control
  27. 27. Seite 3012/10/2018 | Autor Abteilung Contact: u.mons@dkfz.de
  28. 28. Seite 3112/10/2018 | Autor Abteilung Popular arguments against TAPS bans IV „TAPS bans pave the way for other advertising bans. If we ban tobacco advertising today, there will be an alcohol advertising ban the next day, and then a marketing ban for sweet and salty snacks the day after that.” - In Germany, this argument was already brought forward in discussions about TV advertising bans for cigarettes in 1975… - Tobacco is unique in its harmfulness
  29. 29. Seite 3212/10/2018 | Autor Abteilung Scientific evidence on TAPS and TAPS bans Some preliminary remarks • Advertising effects are complex and multidimensional • Difficult to establish control groups (RCTs not possible and observational studies suffer from confounding bias) • Some effects are only indirect and/or long-term • „Background noise“ from other exposures • No single study design/method can provide the weight of evidence necessary for causal inferences regarding effects of TAPS and effectiveness of TAPS bans • While some study designs are superior to others ( conceptual framework of ITC), only a body of evidence from different methods and designs enable an assessment • Econometric studies • Qualitative studies (incl. analyses of media content, tobacco industry documents) • Psychological studies (experiments) • Epidemiological studies (esp. prospective, longitudinal) • Quasi-experimental designs
  30. 30. Seite 3312/10/2018 | Autor Abteilung • In 2016 a law was proposed to ban outdoor advertising as of 2020 • Many meetings between tobacco industry representatives and German ministries to discuss plans regarding an outdoor advertising ban • Law failed because industry-friendly MPs blocked a parliamentary vote Tobacco industry interference: example Germany

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