Abstract
In 2006, US District Judge Gladys Kessler ordered tobacco companies to make corrective statements through paid advertisements informing the public of their deceptive practices. This landmark ruling and its subsequent execution represent the first time the tobacco industry sponsored a nationwide corrective advertising campaign against its own products. To assess the reach of the court-ordered antismoking advertisements within the US adult population, stratified by demographic characteristics and tobacco use. This nationally representative, population-based cross-sectional survey of US adults included respondents to the 2018 Health Information National Trends Survey 5, Cycle 2. Respondents were representatives of households selected by equal-probability sampling of the Marketing Systems Group database of addresses that included all nonvacant US residential addresses. Data collection was conducted from January to May 2018, and analysis took place from December 2018 to April 2019. Self-reported exposure to court-ordered antismoking advertisements. The overall sample of 3484 respondents included 2054 women (weighted percentage, 50.8%), 1976 non-Hispanic white respondents (weighted percentage, 59.9%), 2952 respondents who lived in urban US areas (weighted percentage, 84.9%), and 450 current smokers (weighted percentage, 15.6%). Estimated exposure to court-ordered antismoking advertisements was 40.6% (95% CI, 37.5%-43.7%) among the full sample and 50.5% (95% CI, 41.4%-59.6%) among current smokers. Exposure was lowest among those aged 18 to 34 years (37.4%; 95% CI, 28.0%-46.8%), those with a high school education or less (34.5%; 95% CI, 29.3%-39.8%), and those with household annual income less than $35 000 (37.5%; 95% CI, 32.0%-42.9%). Among current smokers, Hispanic respondents had lower exposure rates (42.2%; 95% CI, 18.5%-65.9%) than non-Hispanic white respondents (51.7%; 95% CI, 40.4%-63.1%). As the advertising campaign's duration increased, exposure rates increased. Individuals with a high school education or less had lower odds of antismoking advertisement exposure than those with college or postgraduate degrees (adjusted odds ratio, 0.67; 95% CI, 0.48-0.94). Current smokers had higher odds of exposure than never smokers (adjusted odds ratio, 1.81; 95% CI, 1.17-2.80). Among those exposed to antismoking advertisements, 70.5% saw multiple antismoking messages. Approximately 1 of 2 smokers reported exposure to the federal court-ordered antismoking advertisements. However, exposure was relatively lower among several subgroups, including individuals aged 18 to 34 years, only one-third of whom reported exposure. Increasing the duration of antismoking advertisements as well as expanding their coverage to youth-oriented media may increase their potential public health impact.
Highlights
In 1999, amid mounting evidence of deliberate and concerted efforts by the tobacco industry to mislead the general public about the health risks of smoking, the US Department of Justice filed a lawsuit against the industry for violating the Racketeer Influenced and Corrupt Organizations Act.[1]
In 2006, US District Judge Gladys Kessler ruled in favor of the Department of Justice and instructed tobacco companies to issue corrective statements informing the public of their deceptive practices, which spanned several decades, regarding the following areas: (1) the adverse health effects of smoking; (2) the addictiveness of smoking and nicotine; (3) the lack of significant harm reduction from smoking low-tar, light, ultra-light, mild, and natural cigarettes; (4) the manipulation of cigarette design to boost nicotine delivery; and (5) the adverse health effects of exposure to secondhand smoke.[1]
Our study found that, as the advertising campaign’s duration lengthened, exposure rates improved significantly in the general population and in all demographic groups. This finding lends support to the recommendations of studies[10,20] that call for repeated exposure as a means to ensure a sustained effect. While these federal court–ordered advertising campaigns represent a critical point in tobacco control from a historical and legal perspective, our findings suggest that their real-world association with preventing initiation and promoting cessation may be limited on account of their suboptimal population-level penetrance, especially among young adults, who are at greatest risk for smoking
Summary
In 1999, amid mounting evidence of deliberate and concerted efforts by the tobacco industry to mislead the general public about the health risks of smoking, the US Department of Justice filed a lawsuit against the industry for violating the Racketeer Influenced and Corrupt Organizations Act.[1] In 2006, US District Judge Gladys Kessler ruled in favor of the Department of Justice and instructed tobacco companies to issue corrective statements informing the public of their deceptive practices, which spanned several decades, regarding the following areas: (1) the adverse health effects of smoking; (2) the addictiveness of smoking and nicotine; (3) the lack of significant harm reduction from smoking low-tar, light, ultra-light, mild, and natural cigarettes; (4) the manipulation of cigarette design to boost nicotine delivery; and (5) the adverse health effects of exposure to secondhand smoke.[1] Judge Kessler ordered tobacco companies to sponsor the dissemination of these corrective messages through paid advertisements in major newspapers, on television, retail point-of-sale displays, cigarette package onserts, and their corporate websites.[1] Following several years of litigation and appeals,[2,3] the biggest tobacco companies in the United States began sponsoring antismoking advertisements, which appeared for the first time on prime time television and in major newspapers across the country in November 2017.3,4 While the TV and newspaper advertising campaigns are ended, court-ordered antismoking advertising via cigarette package onserts and tobacco company websites are ongoing, but point-of-sale displays remain subject to litigation.[5]. A 2010 study[11] examined the corrective statements and consumer beliefs about smoking and found a positive association of these statements with antismoking beliefs
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