The environmental profile of a community’s health: a cross-sectional study on tobacco marketing in 16 countries


OBJECTIVE To examine and compare tobacco marketing in 16 countries while the Framework Convention on Tobacco Control requires parties to implement a comprehensive ban on such marketing. METHODS Between 2009 and 2012, a kilometre-long walk was completed by trained investigators in 462 communities across 16 countries to collect data on tobacco marketing. We interviewed community members about their exposure to traditional and non-traditional marketing in the previous six months. To examine differences in marketing between urban and rural communities and between high-, middle- and low-income countries, we used multilevel regression models controlling for potential confounders. FINDINGS Compared with high-income countries, the number of tobacco advertisements observed was 81 times higher in low-income countries (incidence rate ratio, IRR: 80.98; 95% confidence interval, CI: 4.15-1578.42) and the number of tobacco outlets was 2.5 times higher in both low- and lower-middle-income countries (IRR: 2.58; 95% CI: 1.17-5.67 and IRR: 2.52; CI: 1.23-5.17, respectively). Of the 11,842 interviewees, 1184 (10%) reported seeing at least five types of tobacco marketing. Self-reported exposure to at least one type of traditional marketing was 10 times higher in low-income countries than in high-income countries (odds ratio, OR: 9.77; 95% CI: 1.24-76.77). For almost all measures, marketing exposure was significantly lower in the rural communities than in the urban communities. CONCLUSION Despite global legislation to limit tobacco marketing, it appears ubiquitous. The frequency and type of tobacco marketing varies on the national level by income group and by community type, appearing to be greatest in low-income countries and urban communities.

DOI: 10.2471/BLT.15.155846

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@inproceedings{Savell2015TheEP, title={The environmental profile of a community’s health: a cross-sectional study on tobacco marketing in 16 countries}, author={Emily Savell and Anna B Gilmore and Michelle Sims and Prem K Mony and Teo Koon and Khalid Yusoff and Scott A Lear and Pamela Seron and Noorhassim Ismail and K Burcu Tumerdem Calik and Annika Rosengren and Ahmad Bahonar and Rajesh Kumar and Krishnapillai Vijayakumar and Annamarie Kruger and Hany Swidan and Rajeev Gupta and Ehimario Igumbor and Asad Afridi and Omar Rahman and Jephat Chifamba and Katarzyna Zatonska and V Mohan and Deepa Mohan and Patricio Lopez-Jaramillo and Alvaro Avezum and Paul Poirier and Andres Orlandini and Wei Li and Martin McKee and Sumathy Rangarajan and Salim Yusuf and Clara K Chow}, booktitle={Bulletin of the World Health Organization}, year={2015} }