tobacco and provide information on how to access tobacco prevention and cessation services but, first and foremost, must focus on changing the social norm of tobacco use. CDC (2007a) states that “an effective state health communication should deliver strategic, culturally appropriate, and high-impact messages in a sustained, adequately funded campaign integrated into the overall state tobacco program effort.” There are many reasons why tobacco users do not seek assistance when quitting tobacco use, one of which may be a lack of knowledge that such assistance is available. Several approaches may be used to increase tobacco users’ awareness of, and interest in, tobacco-cessation interventions. One communication approach is a mass-media campaign that alerts consumers about the hazards of tobacco use and informs them that assistance is available to help them quit. Product advertising can also alert consumers to tobacco-cessation medications or other programs, such as quitlines. In contrast, the advertising of tobacco products, particularly to young adults, has an enormous effect on increasing demand for tobacco products.

Advertising and Promotions

The tobacco industry has long understood that mass-media advertising and communication shape attitudes toward its brand images. As a result, cigarettes are one of the most heavily advertised US products, with advertising and promotion expenditures from 1940 to 2005 totaling $250 billion (in 2006 dollars) and reaching $13.5 billion in 2005 alone (in 2006 dollars) (NCI, 2008). Since the 1971 federal ban on television advertising of cigarettes and similar restrictions on the nature of advertising linked to the 1998 Master Settlement Agreement,1 the rate of smoking among people 18–24 years old has steadily declined (CDC, 2007b), but it continues to be a public-health problem as young people initiate tobacco use.

Reports such as the Institute of Medicine’s (IOM’s) Ending the Tobacco Problem: Blueprint for the Nation (IOM, 2007), NCI’s The Role of the Media in Promoting and Reducing Tobacco Use (NCI, 2008), CDC’s Best Practices for Comprehensive Tobacco Control Programs (CDC, 2007a) and Tobacco: Guide to Community Preventive Services (CDC, 2009a), and other studies (Saffer and Chaloupka, 2000) have summarized a large body of literature on the effect of advertising on smoking behavior and concluded that the prevailing scientific opinion indicated a causal relationship between tobacco advertising and increased tobacco use. Because of the strong effect of visual advertising on tobacco

1

National Association of Attorneys General. http://www.naag.org/settle.htm (accessed February 2, 2009).



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