Tobacco marketing restrictions
Regulations that restrict tobacco marketing limit promotion, placement, flavoring, or pricing of tobacco products. Regulations can restrict point-of-sale (POS) advertising, signs, and displays1, require minimum package sizes (e.g., no less than 20 cigarettes), and written warnings for tobacco products2. Regulations can also prohibit sales in health-oriented facilities such as pharmacies3, prohibit daytime advertising, limit the number, size, or location of ads posted by businesses4, and prohibit print ads in child-oriented newspapers and magazines2. The federal Family Smoking Prevention and Tobacco Control Act regulates sales of cigarettes and smokeless tobacco. State and local governments can further restrict promotions and pricing of cigarettes and smokeless tobacco2 and restrict sales and promotion of other tobacco products such as cigars, cigarillos, and pipe tobacco5, but may not restrict advertising content2.
Note: The term “tobacco” in this strategy refers to commercial tobacco, not ceremonial or traditional tobacco. County Health Rankings & Roadmaps recognizes the important role that ceremonial and traditional tobacco play for many Tribal Nations, and our tobacco-related work focuses on eliminating the harms and inequities associated with commercial tobacco.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Reduced tobacco use
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Increased quit rates
Reduced youth smoking
What does the research say about effectiveness?
There is some evidence that marketing restrictions reduce tobacco consumption, though effectiveness varies by approach6, 7. Exposure to tobacco advertising is strongly associated with tobacco use1, 8, 9, 10, 11. However, additional evidence is needed to confirm effects of marketing restrictions and determine the characteristics of successful efforts.
Removing tobacco power wall advertising displays from checkout lines has been shown to decrease adolescents’ likelihood of smoking6. Plain packaging of tobacco products has been shown to be less appealing to youth and adults, and may also discourage smoking12, 13; including graphic health warnings along with plain packaging may further decrease tobacco experimentation14, 15. A European study suggests that advertising bans may help some smokers quit16; comprehensive advertising bans appear more effective than partial bans8, 17, 7. An assessment of New York City’s ban on all flavored tobacco products demonstrates reductions in use of flavored tobacco and decreases in youth tobacco experimentation5.
Tobacco marketing increases the likelihood that youth will experiment with tobacco products or become smokers8, 9, 11. Marketing through point-of-sale (POS) promotions1, 10, mass media, print, and in-store displays9 have all been shown to increase tobacco experimentation. Electronic cigarette (e-cigarette) advertisements increase the likelihood that youth will try e-cigarettes18, regardless of the intended audience19. Exposure to smoking in movies also appears to lead youth to try smoking20, 21, 22. One study suggests that among young adults that tobacco ads appeal to, those with low incomes are more likely to use e-cigarettes and smokeless tobacco while those with less education are more likely to use cigarettes and cigars23.
Cigarette and e-cigarette packages that include health-oriented descriptions (e.g., organic, no additives, all natural) can appeal to current smokers and be perceived as less harmful than other brands24. Packaging designed with adults of sexual and gender minorities (SGM) in mind may be more appealing to SGM populations25. A recent study suggests pro-environmental marketing on cigarette packs can contribute to misperceptions that certain tobacco brands are safer for people and the environment, compared to other brands26. Regulating tobacco package descriptions, including removing phrases like natural, no chemicals, and additive-free, has been shown to reduce current and former smokers’ intentions to use specific brands of cigarettes27.
When drafting marketing regulations, experts suggest fully documenting the need for the law, the justification for enacting the law, and the law’s intent4. Experts also recommend restricting the use of health-oriented language on packages through policy change24 and that the U.S. Food and Drug Administration (FDA) conduct assessments of advertising specifically designed to appeal to more vulnerable populations25. In addition to advertising restrictions, researchers suggest enacting minimum price laws28, restricting samples, discounts, and flavoring for non-cigarette tobacco products29, and restricting access to menthol flavored cigarettes30.
Tobacco advertising appears more concentrated in neighborhoods with primarily black residents31, 32 and residents with low incomes31, 33, 34.
How could this strategy impact health disparities? This strategy is rated no impact on disparities likely.
Implementation Examples
Federal law prohibits tobacco advertising through television20 and restricts magazine and billboard advertising but does not prohibit advertisements in stores2. Tobacco companies cannot sponsor sports or entertainment events or give away branded promotional items2, 35, and free tobacco product samples are banned except in adult-only facilities2. Tobacco marketing on the internet, where it remains unregulated, is increasing36, especially through social media37 and user-generated videos38. With increased smartphone access and internet use by teens, many tobacco websites have incorporated games and activities to encourage regular user engagement and promote brand loyalty37.
In 2020, New York State made major changes to the tobacco retail environment, halting all sales of tobacco products in pharmacies, no longer accepting coupons for tobacco, e-cigarette, and vape products, and stopping multi-pack price promotions39. California is among a handful of states that has included e-cigarettes in the state’s definition of tobacco products, allowing for more uniform regulation40.
Municipalities also implement regulations. Boston, for example, passed a city-wide cigar packaging and pricing regulation in 2011, requiring retail establishments to sell cigars in an original package of at least four cigars unless it meets specified pricing requirements41, 42. New York City banned the sale of any flavored tobacco product, except menthol, which is allowed by federal law, in 20095.
Tobacco Free New York State is a non-profit organization that educates New Yorkers about the dangers of tobacco in retail spaces by providing data, focusing on tobacco’s impact on young adults, and advocating for legislative action43.
The work of National Native Network supports reducing commercial tobacco use and cancer health disparities among members of American Indian and Alaska Native Tribes across North America44. The network offers teachings for Native youth and supports youth-led efforts to keep traditional tobacco use sacred, to prevent commercial tobacco use among Native youth, and to end the use of Native cultural symbols, names, and images in commercial tobacco marketing45.
Implementation Resources
WI DHS-Tobacco is changing - Wisconsin Department of Health Services (WI DHS). Tobacco is changing: Marketing in retail environments.
Tobacco Free NYS - Tobacco Free New York State. Advancing healthier communities where we live, work and play.
PHLC-Tobacco marketing - Tobacco Control Legal Consortium (TCLC). Advertising and marketing. Saint Paul: Public Health Law Center (PHLC).
ChangeLab-Tobacco marketing - ChangeLab Solutions. Addressing the four Ps of tobacco marketing in stores.
US FDA-Tobacco products - U.S. Food and Drug Administration (U.S. FDA). Center for Tobacco Products. Compliance, enforcement, & training: State, local, tribal, and territorial governments.
CPHSS TCLC-Brossart 2014 - Brossart L, Moreland-Russell S, Walsh H, et al. Policy strategies: A tobacco control guide. St. Louis: Center for Public Health Systems Science (CPHSS), George Warren Brown School of Social Work, Washington University, Tobacco Control Legal Consortium (TCLC); 2014.
PHLC-Retail environment and licensure - Tobacco Control Legal Consortium (TCLC). Retail environment and licensure. Saint Paul: Public Health Law Center (PHLC).
US FDA-Tobacco control - U.S. Food and Drug Administration (U.S. FDA). Tobacco Control Act. 2009.
Footnotes
* Journal subscription may be required for access.
1 Robertson 2015 - Robertson L, McGee R, Marsh L, Hoek J. A systematic review on the impact of point-of-sale tobacco promotion on smoking. Nicotine & Tobacco Research. 2015;17(1):2-17.
2 CTFK-FDA 2010 - Campaign for Tobacco-Free Kids (CTFK). The impact of the new FDA tobacco law on state tobacco control efforts. Washington, D.C.: Campaign for Tobacco-Free Kids (CTFK); 2010.
3 PHLC-Tobacco in pharmacies - Tobacco Control Legal Consortium (TCLC). Prohibiting the sale of tobacco products in pharmacies. Saint Paul: Public Health Law Center (PHLC); 2012.
4 PHLC-Tobacco advertising - Tobacco Control Legal Consortium (TCLC). Restricting tobacco advertising. Saint Paul: Public Health Law Center (PHLC).
5 Farley 2017 - Farley SM, Johns M. New York City flavoured tobacco product sales ban evaluation. Tobacco Control. 2017;26(1):78-84.
6 Shadel 2016 - Shadel WG, Martino SC, Setodji CM, et al. Hiding the tobacco power wall reduces cigarette smoking risk in adolescents: Using an experimental convenience store to assess tobacco regulatory options at retail point-of-sale. Tobacco Control. 2016;25(6):679-684.
7 Quentin 2007 - Quentin W, Neubauer S, Leidl R, König HH. Advertising bans as a means of tobacco control policy: A systematic literature review of time-series analyses. International Journal of Public Health. 2007;52(5):295-307.
8 AHA-Mozaffarian 2012 - Mozaffarian D, Afshin A, Benowitz NL, et al. Population approaches to improve diet, physical activity, and smoking habits: A scientific statement from the American Heart Association (AHA). Circulation. 2012;126(12):1514-1563.
9 Cochrane-Lovato 2011 - Lovato C, Watts A, Stead LF. Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours. Cochrane Database of Systematic Reviews. 2011;(10):CD003439.
10 Paynter 2009 - Paynter J, Edwards R. The impact of tobacco promotion at the point of sale: A systematic review. Nicotine & Tobacco Research. 2009;11(1):25-35.
11 Capella 2011 - Capella ML, Webster C, Kinard BR. A review of the effect of cigarette advertising. International Journal of Research in Marketing. 2011;28(3):269-79.
12 Moodie 2012 - Moodie C, Stead M, Bauld L, et al. Plain tobacco packaging: A systematic review. London, UK: Public Health Research Consortium; 2012.
13 Hammond 2013 - Hammond D, Daniel S, White CM. The effect of cigarette branding and plain packaging on female youth in the United Kingdom. Journal of Adolescent Health. 2013;52(2):151-157.
14 Germain 2010 - Germain D, Wakefield MA, Durkin SJ. Adolescents’ perceptions of cigarette brand image: Does plain packaging make a difference? Journal of Adolescent Health. 2010;46(4):385-392.
15 Thrasher 2011 - Thrasher JF, Rousu MC, Hammond D, Navarro A, Corrigan JR. Estimating the impact of pictorial health warnings and “plain” cigarette packaging: Evidence from experimental auctions among adult smokers in the United States. Health Policy. 2011;102(1):41-48.
16 Schaap 2008 - Schaap M, Kunst A, Leinsalu M, et al. Effect of nationwide tobacco control policies on smoking cessation in high and low educated groups in 18 European countries. Tobacco Control. 2008;17(4):248-55.
17 Goel 2006 - Goel RK, Nelson MA. The effectiveness of anti-smoking legislation: A review. Journal of Economic Surveys. 2006;20(3):325-55.
18 Villanti 2016 - Villanti AC, Rath JM, Williams VF, et al. Impact of exposure to electronic cigarette advertising on susceptibility and trial of electronic cigarettes and cigarettes in U.S. young adults: A randomized controlled trial. Nicotine & Tobacco Research. 2016;18(5):1331-1339.
19 Padon 2017 - Padon A, Lochbuehler K, Maloney E, Cappella J. A randomized trial of the effect of youth appealing e-cigarette advertising on susceptibility to use e-cigarettes among youth. Nicotine and Tobacco Research. 2018;20(8):954-961.
20 US DHHS SG-Smoking 2014 - U.S. Department of Health and Human Services (U.S. DHHS). The health consequences of smoking- 50 years of progress: A report of the Surgeon General; 2014.
21 Sargent 2009 - Sargent J, Gibson J, Heatherton T. Comparing the effects of entertainment media and tobacco marketing on youth smoking. Tobacco Control. 2009;18(1):47-53.
22 Charlesworth 2005 - Charlesworth A, Glantz SA. Smoking in the movies increases adolescent smoking: A review. Pediatrics. 2005;116(6):1516-28.
23 Lienemann 2019 - Lienemann B, Rose S, Unger J, et al. Tobacco advertisement liking, vulnerability factors, and tobacco use among young adults. Nicotine and Tobacco Research. 2019;21(3):300-308.
24 Sanders-Jackson 2017 - Sanders-Jackson A, Tan A, Yie K. Effects of health-oriented descriptors on combustible cigarette and electronic cigarette packaging: An experiment among adult smokers in the United States. Tobacco Control. 2018;27(5):534-541.
25 Lee 2020 - Lee J, Blanchflower T, O’Brien K, et al. Assessing the potential impact of cigarette packs designed for lesbian, gay, bisexual, and transgender adults: A randomized experiment to inform U.S. regulation, 2018. Health Promotion Practice. 2020;21(Supplement 1):157S-164S.
26 Epperson 2019 - Epperson A, Lambin E, Henriksen L, et al. Natural American Spirit’s pro-environment packaging and perceptions of reduced-harm cigarettes. Preventive Medicine. 2019;126(June):105782.
27 Gratale 2018 - Gratale S, Maloney E, Cappella J. Regulating language, not inference: An examination of the potential effectiveness of Natural American Spirit advertising restrictions. Tobacco Control. 2019;28(e1):E43-E48.
28 Henriksen 2012 - Henriksen L. Comprehensive tobacco marketing restrictions: Promotion, packaging, price and place. Tobacco Control. 2012;21(2):147-53.
29 Freiberg 2012 - Freiberg M. Options for state and local governments to regulate non-cigarette tobacco products. Annals of Health Law. 2012;21(2):407-45.
30 Freiberg 2014 - Freiberg M. The minty taste of death: State and local options to regulate menthol in tobacco products. Catholic University Law Review. 2014;64:949-974.
31 Lee 2015 - Lee JGL, Henriksen L, Rose SW, Moreland-Russell S, Ribisl KM. A systematic review of neighborhood disparities in point-of-sale tobacco marketing. American Journal of Public Health. 2015;105(9):e8-e18.
32 Primack 2007 - Primack BA, Bost JE, Land SR, Fine MJ. Volume of tobacco advertising in African American markets: Systematic review and meta-analysis. Public Health Reports. 2007;122(5):607-15.
33 Widome 2013 - Widome R, Brock B, Noble P, Forster JL. The relationship of neighborhood demographic characteristics to point-of-sale tobacco advertising and marketing. Ethnicity & Health. 2013;18(2):136-51.
34 Frick 2012 - Frick RG, Klein EG, Ferketich AK, Wewers ME. Tobacco advertising and sales practices in licensed retail outlets after the Food and Drug Administration regulations. Journal of Community Health. 2012;37(5):963-967.
35 US FDA-Tobacco control - U.S. Food and Drug Administration (U.S. FDA). Tobacco Control Act. 2009.
36 Ibrahim 2010 - Ibrahim JK. The tobacco tug-of-war: Advertising and counter advertising tobacco products to youth. Pediatric Allergy Immunology, and Pulmonology. 2010;23(2):105-11.
37 CTFK-Internet 2021 - Campaign for Tobacco-Free Kids (CTFK). Tobacco product marketing on the internet. Washington, D.C.: Campaign for Tobacco-Free Kids (CTFK); 2021.
38 Forsyth 2013 - Forsyth SR, Kennedy C, Malone RE. The effect of the internet on teen and young adult tobacco use: A literature review. Journal of Pediatric Health Care. 2013;27(5):367-76.
39 NYS DOH-Tobacco control - New York State Department of Health (NYS DOH). NYS Tobacco control policies. 2021.
40 PHLC-E-cigarettes CA - Public Health Law Center (PHLC). E-cigarette regulations: California.
41 Sbarra 2017 - Sbarra C, Reid M, Harding N, Li W. Promising strategies to remove inexpensive sweet tobacco products from retail stores. Public Health Reports. 2017;132(1):106-109.
42 Li 2016 - Li W, Gouveia T, Sbarra C, et al. Has Boston’s 2011 cigar packaging and pricing regulation reduced availability of single-flavoured cigars popular with youth? Tobacco Control. 2016;0:1-6.
43 Tobacco Free NYS - Tobacco Free New York State. Advancing healthier communities where we live, work and play.
44 NNN-Keep It Sacred - National Native Network: Keep It Sacred. About the National Native Network.
45 NNN-Youth - National Native Network: Keep It Sacred. Youth and Tobacco.
Related What Works for Health Strategies
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