摘要：Objectives. We investigated whether state-sponsored antitobacco advertisements are associated with reduced adult smoking, and interactions between smoking-related advertising types. Methods. We measured mean exposure to smoking-related advertisements with television ratings for the top-75 US media markets from 1999 to 2007. We combined these data with individual-level Current Population Surveys Tobacco Use Supplement data and state tobacco control policy data. Results. Higher exposure to state-sponsored, Legacy, and pharmaceutical advertisements was associated with less smoking; higher exposure to tobacco industry advertisements was associated with more smoking. Higher exposure to state- and Legacy-sponsored advertisements was positively associated with intentions to quit and having made a past-year quit attempt; higher exposure to ads for pharmaceutical cessation aids was negatively associated with having made a quit attempt. There was a significant negative interaction between state- and Legacy-sponsored advertisements. Conclusions. Exposure to state-sponsored advertisements was far below Centers for Disease Control and Prevention–recommended best practices. The significant negative relationships between antismoking advertising and adult smoking provide strong evidence that tobacco-control media campaigns help reduce adult smoking. The significant negative interaction between state- and Legacy-sponsored advertising suggests that the campaigns reinforce one another. Cigarette smoking remains the leading cause of preventable death in the United States. State tobacco control programs rely heavily on paid television advertising to promote tobacco control messages, with the goals of influencing attitudes and beliefs about tobacco use, and reducing population smoking. The California Tobacco Control Program, launched in 1990, is the largest and longest-running state-sponsored antismoking media campaign in the United States. 1 Massachusetts introduced a campaign in 1994, Arizona in 1997, and Oregon and Florida in 1998. 2,3 Between 1998 and 2002, at least 30 other states started antismoking media campaigns. Cigarette excise taxes and earmarked funds from the 1998 Master Settlement Agreement (MSA) have financed the majority of such campaigns 4 ; in recent years, however, many of these state campaigns have been significantly cut, or even eliminated. The American Recovery and Reinvestment Act of 2009 allocated $650 million toward the Communities Putting Prevention to Work initiatives, many of which included significant tobacco control media campaigns. 5 This recent infusion of funding represents the largest expansion of state and regional tobacco control media campaigns since 1998. In addition, the US Food and Drug Administration has announced its own sizable tobacco control media campaign scheduled in 2012. 6 State-sponsored antitobacco advertisements are not the only smoking-related messages seen on television in the United States in recent years. Since 1996, when nicotine replacement therapies were approved for over-the-counter distribution, pharmaceutical companies have used television advertising extensively to promote smoking cessation aids. 7 Also as a result of the MSA, the American Legacy Foundation (Legacy) was formed in 1999, and in 2000 introduced “truth,” its national antismoking advertising campaign. In addition, Philip Morris and Lorillard each launched media campaigns in 1998, which included television advertising with putatively antismoking messages. 8 Early evidence has suggested that public investments in antismoking media campaigns contributed to reductions in smoking among youths. 9 Research on the relationship between antismoking advertisements and adult smoking behavior is encouraging but less conclusive. 4,10 Most studies have focused on individual media campaigns within a single state or country, and have not controlled for other smoking-related advertising or other tobacco control policies, such as cigarette excise taxes or clean indoor air regulations, which also influence smoking. 11 For example, a recent Australian study showed that higher levels of televised antismoking advertising was associated with reduced adult smoking, with control for important concurrent tobacco control policies. 12 One multistate study of the relationship between antismoking advertisements and adult smoking in the United States showed that smokers with higher levels of awareness of antismoking media campaigns were more likely to quit, even after control for other tobacco control policies in the 9 states studied. 13 However, that study did not explore the impact of other antitobacco or cessation-related advertising, such as Legacy’s truth campaign or advertisements for pharmaceutical cessation aids. Adults in the United States received substantial levels of exposure to ads for pharmaceutical cessation aids, as well as to Legacy’s predominantly youth-targeted antitobacco media campaign. 7 Exposure to either or both of these smoking-related messages may therefore have had important effects on adult smoking. To date, there has been no research on the relationship between smoking among US adults and concurrent exposure to smoking-related advertisements produced by various sponsors, or potential interactions among advertising produced by various sponsors. We examined the relationships between US adults’ smoking behaviors and their exposure to smoking-related television advertisements sponsored by state health departments, the American Legacy Foundation, tobacco companies, and pharmaceutical companies promoting their cessation products. We hypothesized that higher levels of exposure to state-sponsored antitobacco advertisements would be associated with reduced smoking. Our models controlled for individual characteristics, as well as state tobacco control policies and, therefore, overcame the limitations of previous research on the effects of antismoking advertising on smoking among adults.
