The environmental profile of a community’s health

A cross-sectional study on tobacco marketing in 16 countries

Emily Savell, Anna Gilmore, Michelle Sims, Prem K Mony, Teo Koon, Khalid Yusoff, Scott A Lear, Pamela Seron, Noorhassim Ismail, K Burcu Tumerdem Calik, Annika Rosengren, Ahmad Bahonar, Rajesh Kumar, Krishnapillai Vijayakumar, Annamarie Kruger, Hany Swidan, Rajeev Gupta, Ehimario Igumbor, Asad Afridi, Omar Rahman & 13 others Jephat Chifamba, Katarzyna Zatonska, V Mohan, Deepa Mohan, Patricio Lopez-Jaramillo, Alvaro Avezum, Paul Poirier, Andres Orlandini, Wei Li, Martin McKee, Sumathy Rangarajan, Salim Yusuf, Clara Chow

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Objective: Tobacco industry marketing is a major determinant of smoking prevalence. The Framework Convention on Tobacco Control requires Parties to implement a “comprehensive ban” on tobacco marketing. This paper examines tobacco marketing in 16 high, upper-middle, lower-middle, and low income countries (HIC, UMIC, LMIC, LIC).

Methods: The Environmental Profile of a Community’s Health study provided cross-sectional data on tobacco marketing collected between 2009-2012. This included direct observations during a 1km walk in 462 communities across 16 countries, and self-reported exposure to 11 forms of marketing among almost 12,000 individuals. Multilevel regression models were used to examine differences in marketing between urban/rural communities and country income groups, controlling for potential confounders.

Findings: 10% of individuals reported seeing five or more types of tobacco marketing in the last six months. Multilevel regression analysis showed that compared with HICs the observed number of advertisements per community was 81 times higher in LICs (p=0.004), the number of tobacco outlets 2.5 times higher in both LICs (p=0.019) and LMICs (p=0.012), while the odds of self-reported exposure to at least one form of traditional marketing (television, radio, posters, signage, print, cinema) were almost 10 times higher in LICs (p=0.030). For 13 of 15 measures, marketing exposure was significantly lower in rural than urban communities.

Conclusion: Despite global legislation, tobacco marketing is ubiquitous and varies substantially by country income and community type; it is greatest in low income countries and in urban communities. Urgent efforts must be made to restrict tobacco marketing particularly in lower income countries.
Original languageEnglish
Pages (from-to)851-861G
Number of pages18
JournalBulletin of the World Health Organization
Volume93
Issue number12
DOIs
Publication statusPublished - 1 Dec 2015

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Marketing
Tobacco
Cross-Sectional Studies
Health
Rural Population
Tobacco Industry
Multilevel Analysis
Posters
Television
Motion Pictures
Radio
Legislation
Smoking
Regression Analysis

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The environmental profile of a community’s health : A cross-sectional study on tobacco marketing in 16 countries. / Savell, Emily; Gilmore, Anna; Sims, Michelle; Mony, Prem K; Koon, Teo; Yusoff, Khalid; Lear, Scott A ; Seron, Pamela; Ismail, Noorhassim; Calik, K Burcu Tumerdem; Rosengren, Annika; Bahonar, Ahmad; Kumar, Rajesh; Vijayakumar, Krishnapillai; Kruger, Annamarie; Swidan, Hany; Gupta, Rajeev; Igumbor, Ehimario; Afridi, Asad; Rahman, Omar; Chifamba, Jephat; Zatonska, Katarzyna; Mohan, V; Mohan, Deepa; Lopez-Jaramillo, Patricio; Avezum, Alvaro; Poirier, Paul; Orlandini, Andres; Li, Wei; McKee, Martin; Rangarajan, Sumathy; Yusuf, Salim; Chow, Clara.

In: Bulletin of the World Health Organization, Vol. 93, No. 12, 01.12.2015, p. 851-861G.

Research output: Contribution to journalArticle

Savell, E, Gilmore, A, Sims, M, Mony, PK, Koon, T, Yusoff, K, Lear, SA, Seron, P, Ismail, N, Calik, KBT, Rosengren, A, Bahonar, A, Kumar, R, Vijayakumar, K, Kruger, A, Swidan, H, Gupta, R, Igumbor, E, Afridi, A, Rahman, O, Chifamba, J, Zatonska, K, Mohan, V, Mohan, D, Lopez-Jaramillo, P, Avezum, A, Poirier, P, Orlandini, A, Li, W, McKee, M, Rangarajan, S, Yusuf, S & Chow, C 2015, 'The environmental profile of a community’s health: A cross-sectional study on tobacco marketing in 16 countries', Bulletin of the World Health Organization, vol. 93, no. 12, pp. 851-861G. https://doi.org/10.2471/BLT.15.155846
Savell, Emily ; Gilmore, Anna ; Sims, Michelle ; Mony, Prem K ; Koon, Teo ; Yusoff, Khalid ; Lear, Scott A ; Seron, Pamela ; Ismail, Noorhassim ; Calik, K Burcu Tumerdem ; Rosengren, Annika ; Bahonar, Ahmad ; Kumar, Rajesh ; Vijayakumar, Krishnapillai ; Kruger, Annamarie ; Swidan, Hany ; Gupta, Rajeev ; Igumbor, Ehimario ; Afridi, Asad ; Rahman, Omar ; Chifamba, Jephat ; Zatonska, Katarzyna ; Mohan, V ; Mohan, Deepa ; Lopez-Jaramillo, Patricio ; Avezum, Alvaro ; Poirier, Paul ; Orlandini, Andres ; Li, Wei ; McKee, Martin ; Rangarajan, Sumathy ; Yusuf, Salim ; Chow, Clara. / The environmental profile of a community’s health : A cross-sectional study on tobacco marketing in 16 countries. In: Bulletin of the World Health Organization. 2015 ; Vol. 93, No. 12. pp. 851-861G.
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T2 - A cross-sectional study on tobacco marketing in 16 countries

AU - Savell, Emily

AU - Gilmore, Anna

AU - Sims, Michelle

AU - Mony, Prem K

AU - Koon, Teo

AU - Yusoff, Khalid

AU - Lear, Scott A

AU - Seron, Pamela

AU - Ismail, Noorhassim

AU - Calik, K Burcu Tumerdem

AU - Rosengren, Annika

AU - Bahonar, Ahmad

AU - Kumar, Rajesh

AU - Vijayakumar, Krishnapillai

AU - Kruger, Annamarie

AU - Swidan, Hany

AU - Gupta, Rajeev

AU - Igumbor, Ehimario

AU - Afridi, Asad

AU - Rahman, Omar

AU - Chifamba, Jephat

AU - Zatonska, Katarzyna

AU - Mohan, V

AU - Mohan, Deepa

AU - Lopez-Jaramillo, Patricio

AU - Avezum, Alvaro

AU - Poirier, Paul

AU - Orlandini, Andres

AU - Li, Wei

AU - McKee, Martin

AU - Rangarajan, Sumathy

AU - Yusuf, Salim

AU - Chow, Clara

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AB - Objective: Tobacco industry marketing is a major determinant of smoking prevalence. The Framework Convention on Tobacco Control requires Parties to implement a “comprehensive ban” on tobacco marketing. This paper examines tobacco marketing in 16 high, upper-middle, lower-middle, and low income countries (HIC, UMIC, LMIC, LIC). Methods: The Environmental Profile of a Community’s Health study provided cross-sectional data on tobacco marketing collected between 2009-2012. This included direct observations during a 1km walk in 462 communities across 16 countries, and self-reported exposure to 11 forms of marketing among almost 12,000 individuals. Multilevel regression models were used to examine differences in marketing between urban/rural communities and country income groups, controlling for potential confounders. Findings: 10% of individuals reported seeing five or more types of tobacco marketing in the last six months. Multilevel regression analysis showed that compared with HICs the observed number of advertisements per community was 81 times higher in LICs (p=0.004), the number of tobacco outlets 2.5 times higher in both LICs (p=0.019) and LMICs (p=0.012), while the odds of self-reported exposure to at least one form of traditional marketing (television, radio, posters, signage, print, cinema) were almost 10 times higher in LICs (p=0.030). For 13 of 15 measures, marketing exposure was significantly lower in rural than urban communities.Conclusion: Despite global legislation, tobacco marketing is ubiquitous and varies substantially by country income and community type; it is greatest in low income countries and in urban communities. Urgent efforts must be made to restrict tobacco marketing particularly in lower income countries.

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