Implementing bans on the advertising, promotion, and sponsorship of tobacco products is linked to 20% lower odds of smoking, and 37% lower risk of taking up the habit, reveals a pooled data analysis of the available research, published online in Tobacco Control.
The findings indicate that these bans do influence behaviour, lending further weight to calls for their wider international implementation and enforcement, conclude the researchers.
In 2019 alone, more than a billion people around the globe regularly smoked tobacco, and smoking caused nearly 8 million deaths, note the researchers.
To curb the toll taken by smoking, the World Health Organization set out guidance for countries on how to adopt comprehensive tobacco control policies in its Framework Convention on Tobacco Control (FCTC), explain the researchers.
Yet only 17 of the 182 parties involved have implemented comprehensive bans of all the listed types of tobacco advertising, promotion, and sponsorship, while 37 haven't implemented any bans at all, they add.
To update and strengthen the evidence base, amid a rapidly evolving media and advertising landscape, the researchers explored the impact of comprehensive tobacco product advertising, promotional, and sponsorship bans on smoking prevalence, uptake, and cessation, drawing on the most recently published research up to April 2024.
After excluding studies that were duplicates, poorly designed, or ineligible, they included 16, all of which were published in English, and involved around half a million participants, in their pooled data analysis.
Two studies analysed the impact of bans on current smoking over a period of less than 5 years, 5 over a period of 5–10 years, and 3 over a period of more than 10 years.
Smoking uptake was evaluated for fewer than 5 years in 2 studies, and for more than 10 years in another 2. All 3 studies looking at smoking cessation evaluated the impact of bans over 5–10 years.
Pooled data analysis of all the study results showed that bans were associated with a 20% lower prevalence of smoking and a 37% lower risk of smoking uptake.
But there was no association between the bans and smoking cessation, possibly because of the small number of studies assessing this and the relatively high attrition rates noted in those studies, suggest the researchers.
Further detailed analysis revealed that the associations found between the bans and smoking prevalence differed by duration of the evaluation period. For example, the reduction in this was greater in studies evaluating the policy over 5 to 10 years than in those evaluating shorter periods.
Twelve (81%) of the included studies had a moderate risk of bias, while 3 (19%) had a high risk, and most of the studies assessed only partial bans, acknowledge the researchers.
Most of the included studies were also of observational design with no direct comparators, so limiting their ability to make causal inferences.
"Tobacco advertising and promotion increase awareness and receptivity towards cigarettes and provoke positive attitudes towards tobacco smoking. Youth and young adult populations are particularly susceptible to the negative influences of tobacco advertisement as exposure to tobacco marketing more than doubles their chances of smoking initiation," explain the researchers.
"Our results suggest that [advertising, promotional, and sponsorship bans] can be effective in reducing smoking prevalence and the risk of smoking uptake…..Given the findings of this review, it is likely that comprehensive bans would have greater impacts on smoking behaviour," they write.
And they conclude: "The findings reinforce the need for countries to implement and enforce existing [tobacco advertising, promotional, and sponsorship] bans to reduce tobacco smoking and its consequences."
