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also reduced consumption, with complete advertising bans having the greatest impact. Since 1971, advertising for tobacco products has been banned on all broadcast media in the United States. Under the 1998 Master Settlement Agreement, Joe Camel and other cartoon characters were banned from appearing in cigarette advertisements, sponsorships were restricted, and cigarette advertisements were banned on billboards and buses. Outside of the United States, many countries have implemented complete bans on all forms of tobacco advertising. The landmark Framework Convention on Tobacco Control, a worldwide public health treaty sponsored by the World Health Organization in 2003 (Shibuya et al. 2003; Taylor and Bettcher 2000), urges all ratifying countries to ban all tobacco advertising (if their constitution permits it), including cigarette advertising on the Internet. The impact of advertising bans and restrictions at home and abroad will be diluted if the tobacco industry aggressively markets its products online and if bans, such as those included in the Framework Convention, are not adequately implemented and enforced.

This appendix addresses two fundamental questions: (1) What are the major threats to tobacco control posed by the sales and marketing of cigarettes on the Internet and (2) what current policies and practices and promising new ones can counteract these threats? The first section provides background on the scope and magnitude of Internet cigarette sales. The next section examines the three major threats to tobacco control efforts: online sales of cheap “tax-free” cigarettes, online marketing and promotional efforts by Internet cigarette vendors and tobacco companies, and online cigarette sales to minors. In the final section we review policies designed to regulate these practices and conclude with a proposed framework for regulating Internet cigarette sales.

BACKGROUND ON INTERNET CIGARETTE SALES

Trends in the Number of Internet Cigarette Vendors

Over the past 6 years, there has been a substantial increase in the number of Internet cigarette vendors. Although there is no national licensing system for Internet vendors that would precisely enumerate the number, researchers have relied on comprehensive web searching strategies to estimate the number of Internet vendors. Ribisl and colleagues (2001) used a standardized searching protocol whereby data collectors manually entered several search strings (e.g., discount cigarettes, tax-free cigarettes) into multiple search engines (Ribisl et al. 2001). This approach identified 88 unique domestic Internet cigarette vendors in January 2000. Unpublished follow-up studies using a similar protocol identified 195 domestic vendors in January 2002 and 338 domestic and international vendors in January 2003. Of the 338 sites found in 2003, 266 (78.7 percent) were domestic, 34 (10.1 percent) were outside the United States, and the location could not be determined for 38 (11.2 percent). In January 2004, 775 Internet cigarette vendors were identified, of which 323 (41.7 percent) were domestic, 347 (44.8 percent) were outside the United States, and the location could not be determined for 105 (13.5 percent). In January 2005, 664 Internet cigarette vendors were identified. Of those vendors, 306 (46.1 percent) were domestic, 300 (45.2 percent) were outside of the United States, and the location could not be determined for 58 (8.7 percent). Although a small number of international vendors were identified in January 2000 and 2002, they were excluded from the sample because the original study focused on domestic vendors and policies that were unique to the United States (e.g., presence of a U.S. Surgeon General’s warning on the site). However, in 2003 and subsequent years, the eligibility criteria were



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