Research

Background.Tobacco companies include on the packaging of their products URLs directing consumers to websites that contain pro-tobacco messages. Online media tend to be underregulated and provide the industry with an opportunity to present users with pro-tobacco communication. The objective of our study was to document the content of websites that were advertised on tobacco packs in 14 low- and middle-income countries. 

Methods. We purchased tobacco packs from 14 low- and middle-income countries in 2013 and examined them for the presence of URLs. We visited unique URLs on multiple occasions between 1 October 2016 and 9 August 2017. We developed a coding checklist and used it to conduct a content analysis of active corporate websites to identify types of pro-tobacco communication. The coding checklist included the presence of regulatory controls and warnings, engagement strategies, marketing appeals (for example, description of product popularity, luxury/quality, taste), corporate social responsibility programmes, and image management. We coded brand websites separately and also described social media and other website types. We identified 89 unique URLs, of which 54 were active during the search period. We assessed 26 corporate websites, 21 brand websites, two non-tobacco websites, and five social media pages. We excluded two corporate websites and 14 brand websites due to limited accessible content or incomplete content.

Results. Corporate social responsibility was discussed on all corporate websites, and marketing appeals were also common. Corporate websites were also more likely to include more non-specific (12/24, 50%) than specific (7/24, 29%) health warnings. Promotions (6/7, 86%) and sociability appeals (3/7, 43%) were common on brand websites. The small number of social media webpages in our sample used gendered marketing.

Conclusions. URLs appearing on tobacco packs direct consumers to websites where users are exposed to marketing that highlights the "positive" contributions of tobacco companies on corporate websites, and extensive promotions and marketing appeals on brand websites and social media pages. It is essential that marketing regulations become more comprehensive and ban all pro-tobacco communication, a policy that is in line with Articles 5.3 and 13 of the WHO Framework Convention on Tobacco Control (WHO FCTC). For countries that already ban Internet tobacco advertising, enforcement efforts should be strengthened. Tobacco companies' use of URLs on packs may also be compelling for plain packaging advocacy, where all branding is removed from the pack and large graphic health warning labels are the only communication on the tobacco packaging. Future research should consider including tobacco websites in marketing surveillance.

https://doi.org/10.2196/15160

Background. The reports suggesting a beneficial effect of nicotine on coronavirus disease 2019 (COVID-19) severity may encourage smoking. We aimed to analyze tweets on COVID-19 and smoking coming from casual Twitter users and Twitter accounts representing the tobacco industry.

Methods. We collected tweets on COVID-19 and smoking from 1 January to 1 May 2020, using the Twitter application programming interface. We analyzed sentiment, likes or retweet to followers ratios, and the posts coming from the casual users to find pieces of news that could affect the discourse. Tweets coming from industry were analyzed manually. We analyzed 33 890 tweets on COVID-19 and smoking.

Results. The sentiment of tweets was negative, hitting a nadir in mid-March, but became less negative in April when preprint reports suggesting benefits from smoking on COVID-19 outcomes were released. Similar trends were observed for the ratios of likes or retweets to followers. We found 58 messages from the tobacco industry concerning COVID-19. Twenty-two (37.9%) mentioned the efforts of tobacco companies to support the development of a COVID-19 vaccine. Two tweets included US Food and Drug Administration statements that there is no evidence that vaping increases the risk of COVID-19.

Conclusions. The occurrence of preprint reports suggesting benefits of smoking during COVID-19 might increase sentiment and reactions to tweets on tobacco products and the virus. The authors of potentially controversial articles should restrain from the promotion of their results before the completion of the peer-review process. Twitter presents a convenient tool to monitor e-discourse during a health crisis. The research community should monitor the tobacco industry's social media.

https://doi.org/10.1089/cyber.2020.0384

Background. Most adults in the United States of America use smartphones for Internet access. Understanding what they see when they view smartphone-optimized (mobile) tobacco websites is important, as it can inform tobacco education and cessation strategies. This study describes mobile tobacco websites for leading brands of cigarettes, cigars, smokeless tobacco (smokeless), e-cigarettes and hookahs.

Methods. We identified 130 leading tobacco brands based on sales, advertising spending and self-reported data. Of these, 62 brands had mobile websites. We conducted an inductive content analysis (that is, where we derived the coding scheme from what we observed) of website characteristics by dual-coding: age requirements, warning display, brand engagement methods (for example, social features) and sales strategies (for example, coupons).

Results. All cigarette and most smokeless websites required age-verified accounts for entry, while 76% of e-cigarette websites required accounts only for making purchases. All cigarette and smokeless websites showed warnings, but a minority of e-cigarette and cigar websites did, and no hookah websites did. Many websites required users to scroll up to view warnings. Most e-cigarette websites, most hookah websites and half of cigar websites linked to multiple social media platforms; however, most cigarette and smokeless websites facilitated socialization internally. All cigarette, most smokeless and no hookah websites offered coupons. Many cigarette and smokeless coupons were time-sensitive and location-based.

Conclusions. We highlighted issues on how tobacco brand websites address youth access, display warnings, engage consumers and facilitate purchase. Results can help public health educators and practitioners better understand tobacco marketing as a context for designing tobacco interventions.

http://dx.doi.org/10.1136/tobaccocontrol-2018-054549

Background. Three major tobacco companies in the United States of America were ordered to publish corrective statements intended to prevent and restrain further fraud about the health effects of smoking. The court-ordered statements began appearing in newspapers and on television in late 2017. The objective of this study was to examine the social media dissemination of the tobacco corrective statements during the first six months of the implementation of the statements.

Methods. We conducted a descriptive content analysis of Twitter posts using an iterative search strategy through Crimson Hexagon and randomly selected 19.74% (456/2309) of original posts occurring between 1 November 2017 and 27 March 2018, for coding and analysis. We assessed post volume over time, source or author, valence, linked content and reference to the industry (for example, Big Tobacco, tobacco industry and Philip Morris) and media outlet televsion or newspaper). Retweeted content was coded for source/author and prevalence.

Results. Most posts were published in November 2017, surrounding the initial release of the corrective statements. Content was generally neutral (58.7%, 268/456) or positive (33.3%, 152/456) in valence, included links to additional information about the statements (94.9%, 433/456), referred to the industry (87.7%, 400/456), and did not mention a specific media channel on which the statements were aired or published (15%). The majority of original posts were created by individual users (55.2%, 252/456), whereas the majority of retweeted posts were posted by public health organizations (51%). Differences by source are reported, for example, organization posts are more likely to include a link to additional information compared with individual users (P=.03).

Conclusions. Conversations about the court-ordered corrective statements are taking place on Twitter and are generally neutral or positive in nature. Public health organizations may be increasing the prevalence of these conversations through social media engagement.

https://doi.org/10.2196/12878

Background. Standardized tobacco packaging has been, and remains, a contentious policy globally, attracting corporate, public health, political, media and popular attention. In January 2015, the Government of the United Kingdom of Great Britain and Northern Ireland announced it would vote on draft regulations for the policy before the May 2015 General Election.

Methods. We explored reactions to the announcement on Twitter, in comparison with an earlier period of little Government activity on standardized packaging. We obtained a random sample of 1038 tweets in two four-week periods, before and after the Government's announcement. Content analysis was used to examine the following Tweet characteristics: support for the policy, purpose, Twitter-user's geographical location and affiliation, and evidence citation and quality. Chi-squared analyses were used to compare Tweet characteristics between the two periods.

Results. Overall, significantly more sampled Tweets were in favour of the policy (49%) in comparison to those opposed (19%). Yet, at Time 2, following the announcement, a greater proportion of sampled tweets opposed standardized packaging compared to the period sampled at Time 1, prior to the announcement (p<0.001). The quality of evidence and research cited in URLs linked at Time 2 was significantly lower than at Time 1 (p<0.001), with peer-reviewed research more likely to be shared in positive Tweets (p<0.001) and in Tweets linking to URLs originating from the health sector (p<0.001). The decline in the proportion of positive Tweets was mirrored by a reduction in Tweets by health sector Twitter-users at Time 2 (p<0.001).

Conclusions. Microblogging sites can reflect offline policy debates and are used differently by policy proponents and opponents dependent on the policy context. Twitter-users opposed to standardized packaging increased their activity following the Government's announcement, while those in support broadly maintained their rate of Twitter engagement. The findings offer insight into the public health community's options for using Twitter to influence policy and disseminate research. In particular, proliferation of Twitter activity following pro-public health policy announcements could be considered to ensure pro-health messages are not overshadowed by anti-regulation voices.

https://doi.org/10.1371/journal.pone.0211758

Background. This research examined the influence of natural cigarette advertising on tobacco control policy support, and the potential for misbeliefs arising from exposure to cigarette marketing to affect such support. Ample research indicates that natural cigarettes such as Natural American Spirit (NAS) are widely and erroneously perceived as safer than their traditional counterparts because of their marketed "natural" composition. Yet regulatory action regarding natural cigarette marketing has been limited in scope, and little research has examined whether misleading product advertising affects support for related policy, an important component of the policy process.

Methods. Here, we administered a large-scale randomized experiment (n = 1128), assigning current and former smokers in the United States of America to an NAS advertising condition or a control group and assessing their support for tobacco industry regulation.

Results. Results show that exposure to NAS advertising reduces support for policies to ban potentially misleading terminology from cigarette advertising, and these effects are stronger for daily smokers. Further, misinformed beliefs about the healthy composition of NAS partially mediate effects on policy support. Yet interestingly, exposure to NAS marketing does not reduce support for policies to establish standards for when certain terms are permissible in cigarette advertising.

Conclusions. The results of this analysis indicate potential spillover effects from exposure to NAS advertising in the realm of support for regulatory action pertaining to tobacco industry marketing.

https://doi.org/10.3390/ijerph16193554

The WHO FCTC requires all ratifying parties to implement comprehensive bans on all forms of TAPS, including online media, and to protect public health polices from tobacco industry interference. However, the borderless nature of the Internet, coupled with narrow definitions of advertising and interference, means the tobacco industry still uses online and social media to sell and promote its products, highlight supposed corporate social responsibility practices, and challenge public health views and policies.

https://doi.org/10.17061/phrp2931924

Background. Lesbian, gay, bisexual and transgender (LGBT) populations use tobacco at disparately higher rates nationwide, compared to national averages. The tobacco industry has a history targeting LGBT with marketing efforts, likely contributing to this disparity. This study explores whether exposure to tobacco content on traditional and social media is associated with tobacco use among LGBT and non-LGBT populations.

Methods. This study reports results from LGBT (N = 1092) and non-LGBT (N = 16430) respondents to a 2013 nationally representative cross-sectional online survey of adults int eh United States of America (N = 17522). Frequency and weighted prevalence were estimated and adjusted logistic regression analyses were conducted.

Results. LGBT populations reported significantly higher rates of past 30-day tobacco media exposure compared to non-LGBT, this effect was strongest among LGBT people who were smokers (p < .05). LGBT people more frequently reported exposure to, searching for, or sharing messages related to tobacco couponing, e-cigarettes,and anti-tobacco issues on new or social media (for example, Twitter, Facebook, etc.) than did non-LGBT people (p < .05). Non-LGBT people reported more exposure from traditional media sources such as television, most notably anti-tobacco messages (p = .0088). LGBT people had higher odds of past 30-day use of cigarettes, e-cigarettes, and cigars compared to non-LGBT people, adjusting for past 30-day media exposure and covariates (p ≤ .0001).

Conclusions. LGBT people (particularly LGBT smokers) are more likely to be exposed to and interact with tobacco-related messages on new and social media than their non-LGBT counterparts. Higher levels of tobacco media exposure were significantly associated with higher likelihood of tobacco use. This suggests tobacco control must work toward reaching LGBT communities across a variety of media platforms, particularly new and social media outlets. This study provides important information about LGBT communities tobacco-related disparities in increased exposure to pro-tobacco messages via social media, where the tobacco industry has moved since the 1998 Master Settlement Agreeement in the United States of America with four leading tobacco companies. Further, LGBT people when assessed as a single population appear to identify having decreased exposure to anti-tobacco messages via traditional media, where we know a large portion of tobacco control and prevention messages are placed. The study points to the need for targeted and tailored approaches by tobacco control to market to the LGBT community using online resources and tools in order to help reduce LGBT tobacco-related health disparities. Although there have been localized campaigns, only just recently have such LGBT-tailored national campaigns been developed by the United States Centers for Disease Control and Prevention, the United States Food and Drug Administration, and Truth Initiative (formerly Legacy), an assessment of the content, effectiveness, and reach of both local and national campaigns will be important next steps.

https://doi.org/10.1093/ntr/nty049

Background. Guidelines for implementing the WHO FCTC recommend prohibiting tobacco industry corporate social responsibility (CSR) initiatives, but few African countries have done so.

Methods. We examined African media coverage of tobacco industry CSR initiatives to understand whether and how such initiatives were presented to the public and policy-makers. We searched two online media databases (Lexis Nexis and Access World News) for all news items published from 1998 to 2013, coding retrieved items through a collaborative, iterative process. We analysed the volume, type, provenance, slant and content of coverage, including the presence of tobacco control or tobacco interest themes.

Results. We found 288 news items, most of which were news stories published in print newspapers. The majority of news stories relied solely on tobacco industry representatives as news sources, and portrayed tobacco industry CSR positively. When public health voices and tobacco control themes were included, news items were less likely to have a positive slant.

Conclusions. This suggests that there is a foundation on which to build media advocacy efforts. Drawing links between implementing the WHO FCTC and prohibiting or curtailing tobacco industry CSR programmes may result in more public dialogue in the media about the negative impacts of tobacco company CSR initiatives.

https://doi.org/10.1080/17441692.2016.1149203

Internet and mobile technologies are used by most of the world population. These technologies are not just available for those individuals highly engaged in public discourse; they are an essential tool in their daily lives of most everyone. Not surprisingly, the use of mobile health and online health for smoking cessation is quite well studied and evidence shows they can be cost-effective. However, the tobacco industry is also leveraging the power of those channels for mass communication.

Furthermore, we will explore how bogus smoking cessation "treatments", such as auto-hypnosis, are being promoted in apps stores or social media. Overall, we will study user cases on how social media and mobile technology has been used to promote harmful public health messages. These case studies will be used to provide some guidelines on how to create strategies to use social technologies such as mobile apps and social networks to promote smoking cessation and increase awareness about tobacco risks. This presentation will also be based on our experience from the project SmokeFreeBrain, in which we combined online and mobile technologies for smoking cessation.

https://doi.org/10.18332/tpc/91861

Background and challenges to implementation. The purpose of the Uganda Cancer Society (UCS) is to coordinate civil society efforts for a systematic contribution towards effective cancer control in Uganda. UCS is moving towards fully integrating tobacco control in it activities. Globally, tobacco is responsible for 20% of all cancer deaths. UCS recognizes that Uganda´s Tobacco Control Act does not include tobacco taxation in its provisions, yet high tobacco taxes are proven as the most effective measure for demand reduction. UCS is aware that tobacco industry is heavily interfering with tobacco control in Uganda and has taken the Government to court challenging the Tobacco Control Act. Therefore, UCS is building strategic partnerships to foster local efforts in trying to push for higher tobacco taxes and stronger industry monitoring. UCS has joined the Prevent20 global coalition of cancer organizations (wecanprevent20.org) and built partnership with Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM - www.atim.co.za).

Intervention or response. UCS approaches its advocacy through the Power Prism framework, utilizing its six power tools. UCS media advocacy looks at engaging the public through opinion pieces published on local media and posted on social media platforms as a way to get government attention. UCS currently monitors industry interference through media surveillance geared towards understanding the nature and focus of tobacco-related content.

Results and lessons learnt. A recent opinion piece titled “Tobacco's cost to our country” by UCS on New Vision, a popular Uganda news website, and as of 21 July 2017 had attracted 10 057 views, generating over 30 reactions including shares, and over 200 clicks. Preliminary assessment of media posts indicates that a majority of media content favors the tobacco industry and most of it aligns with legislative interference.

Conclusions and key recommendations. UCS believes that its efforts will push the Government to adopt higher tobacco taxes and establish mechanisms such as a strict code of conduct to deter government officials from working with tobacco industry.

https://doi.org/10.18332/tid/84466

Background. Amid growing academic and policy interest in the influence of think tanks in public policy processes, this article demonstrates the extent of tobacco industry partnerships with think tanks in the United States of America, and analyzes how collaborating with a network of think tanks facilitated tobacco industry influence in public health policy.

Methods. Through analysis of documents from tobacco companies and think tanks, we demonstrate that the Atlas Economic Research Foundation, a network of 449 free-market think tanks, acted as a strategic ally to the tobacco industry throughout the 1990s. Atlas headquarters, while receiving donations from the industry, also channeled funding from tobacco corporations to think tank actors to produce publications supportive of industry positions.

Results. Thirty‐seven per cent of Atlas partner think tanks in the United States of America received funding from the tobacco industry; the majority of which were also listed as collaborators on public relations strategies or as allies in countering tobacco control efforts. By funding multiple think tanks, within a shared network, the industry was able to generate a conversation among independent policy experts, which reflected its position in tobacco control debates. This demonstrates a coherent strategy by the tobacco industry to work with Atlas to influence public health policies from multiple directions.

Conclusions. There is a need for critical analysis of the influence of think tanks in tobacco control and other health policy sectors, as well as greater transparency of their funding and other links to vested interests.

https://doi.org/10.1002/hpm.2351

Background. Despite recent increases in little cigar and cigarillo (LCC) use – particularly among urban youth, African-Americans and Latinos – research on targeted strategies for marketing these products is sparse. Little is known about the amount or content of LCC messages users see or share on social media, a popular communication medium among youth and communities of colour.

Methods. Keyword rules were used to collect tweets related to LCCs from the Twitter Firehose posted in October 2014 and March–April 2015. Tweets were coded for promotional content, brand references, co-use with marijuana and subculture references (for example, rap/hip-hop and celebrity endorsements) and were classified as commercial and “organic”/non-commercial using a combination of machine-learning methods, keyword algorithms and human coding. Metadata associated with each tweet were used to categorize users as influencers (1000 and more followers) and regular users (under 1000 followers).

Results. Keyword filters captured over 4.3 million LCC tweets. Analyses revealed that 17% of account users posting about LCCs were influencers and 1% of accounts were overtly commercial. Influencers were more likely to mention LCC brands and post promotional messages. Approximately 83% of LCC tweets contained references to marijuana, and 29% of tweets were memes. Tweets also contained references to rap/hip-hop lyrics and urban subculture.

Conclusions. Twitter is a major information-sharing and marketing platform for LCCs. Co-use of tobacco and marijuana is common and normalized on Twitter. The presence and broad reach of LCC messages on social media warrants the urgent need for surveillance and serious attention from public health professionals and policy-makers. Future tobacco use prevention initiatives should be adapted to ensure that they are inclusive of LCC use.

http://dx.doi.org/10.1136/tobaccocontrol-2016-053094

Background. Since legislation prohibiting tobacco advertising in traditional media, online communication platforms and social media have become one of the few avenues for the tobacco industry to promote its products to Australians. Little is currently known about the exposure of young people to these new media promotions.

Methods. We set out to measure exposure to Internet-based tobacco advertising and branding among Australian youth, identify common formats of branding encountered, and examine the association between exposure and smoking susceptibility. The Tobacco Promotion Impact Study is a repeat cross-sectional telephone survey of young people (12–24 years) in two Australian states, conducted yearly from 2010 to 2013 (total n=8820). The survey included questions about past-month exposure to Internet-based tobacco advertising and tobacco company branding. Changes in levels of exposure, characteristics of exposed youth, and the association between exposure and smoking susceptibility were explored.

Results. Past-month exposure to Internet-based tobacco advertising and branding among young people increased over the years of the survey (advertising: 21% in 2010 to 29% in 2013; branding: 20% in 2010 to 26% in 2013). The participants who were younger, female, from a lower socioeconomic status, and never-smokers were more likely to report exposure. Facebook was the most commonly cited platform for encountering tobacco branding in 2013 (22% of all branding). Compared with young people interviewed in 2013, participants in 2010 were significantly less likely to report exposure to tobacco branding on social media – odds ratio (OR] 0.26, 95% confidence interval (CI) 0.20–0.33, P<.001 – or 2011 (OR 0.46, 95% CI 0.37–0.57, P<.001). Among never-smokers aged 12–17 years, exposure to online advertising and branding (OR 1.32, 95% CI 1.11­–1.57, P=.002) or branding alone (OR 1.39, 95% CI 1.10–1.77, P=.007) were significant predictors of smoking susceptibility.

Conclusions. Ensuring tobacco advertising bans are inclusive of Internet-based media is essential. Given the global nature of Internet-based content, cooperation among signatory nations to the WHO FCTC will be necessary.

https://doi.org/10.2196/jmir.5595

Background. A 2012 report showed that 13.1% of middle and high school students in the United States of America were exposed to tobacco coupons in the past 30 days. The current study reanalysed data from the National Youth Tobacco Survey 2012 to examine the associations between exposure to tobacco coupons in the past 30 days and predictors of smoking among youth and by smoking status in the United States of America.

Methods. Some 24 658 middle and high school students were asked if and where they had received tobacco coupons in the past 30 days. Demographics, smoking behaviours, smoking-related beliefs, susceptibility to smoking and confidence in quitting smoking were assessed. Analyses were stratified by smoking status (never-smokers, experimenters and current smokers). Data were weighted to be representative of all youth in the United States of America.

Results. Exposure to tobacco coupons was associated with lower likelihood of denying the social benefits of cigarette smoking and believing all tobacco products are dangerous; higher likelihood of being susceptible to smoking (among never-smokers); a lower likelihood to feel confident in quitting cigarettes completely (among current smokers); and a higher likelihood to intend to purchase cigarettes in the next 30 days (among experimenters and current smokers; p < 0.05).

Conclusions. Tobacco coupons may promote smoking and hinder smoking cessation among youth. Regulating tobacco coupons may reduce youth smoking in the United States of America. Further research is needed to determine the effect of tobacco coupons on youth tobacco use globally.

http://dx.doi.org/10.1136/tobaccocontrol-2014-052147

According to a spokesman for British American Tobacco (BAT), the launch of the Switch/Convertibles sub-brand was 'the largest scale activity in the history of BAT Russia' ensuring that 'BAT is well positioned to take advantage of this new technology.' The packs, through their association with iconic items of the digital age, may be attempting to become 'extensions of the self' in the way that smartphones represent not only useable items but an intrinsic part of a user's identity. Given the special place occupied by mobile digital technology as a hallmark of status, belonging, and independence for teenagers and other young people, 15-17 cigarette packs that share a stylistic similarity to popular handheld devices (such as smartphones and digital music players) may perhaps reflect a desire to associate these packs with other 'must have' and 'never leave home without it' consumer goods.

http://dx.doi.org/10.1136/tobaccocontrol-2013-051209

Background. The commercial potential of social media is utilized by tobacco manufacturers and vendors for tobacco promotion online. However, the prevalence and promotional strategies of pro-tobacco content in social media are still not widely understood. The goal of this study was to reveal what is presented by the tobacco industry, and how it promotes itself, on social media sites.

Methods. The top 70 popular cigarette brands are divided into two groups according to their retail prices: group H (brands with high retail prices) and group L (brands with low retail prices). Three comprehensive searches were conducted on Facebook, Wikipedia and YouTube using the top 70 popular cigarette brands as keywords. We identified tobacco-related content including history and culture, product features, health warnings, home page of cigarette brands, and Web-based tobacco shops. Furthermore, we examined the promotional strategies utilized in social media.

Results. According to the data collected from 3 March 2014 to 10 March 2014, 43 of the 70 representative cigarette brands had created 238 Facebook fan pages, 46 cigarette brands were identified in Wikipedia, and there were over 120 000 pro-tobacco videos on YouTube, associated with 61 cigarette brands. The main content presented on the three social media websites differs significantly. Wikipedia focuses on history and culture (67%, 32/48; P < .001). Facebook mainly covers history and culture (37%, 16/43; P < .001) and major products (35%, 15/43), while YouTube focuses on the features of major tobacco products (79%, 48/61; P=.04) and information about Web-based shops (49%, 30/61; P=.004).

Concerning the content presented by groups H and L, there is no significant difference between the two groups. With regard to the promotional strategies used, sales promotions exist extensively in social media. Sales promotion is more prevalent on YouTube than on the other two sites (64%, 39/61 vs 35%, 15/43; P=.004). Generally, the sale promotions of higher-cost brands in social media are more prevalent than those of lower-cost brands (55%, 16/29 vs 7%, 1/14; P < .001 for Facebook; 78%, 28/36 vs 44%, 11/25; P=.005 for YouTube).

Conclusions. The prevalence of cigarette brands in social media allows more pro-tobacco information to be accessed by online users. This dilemma indicates that corresponding regulations should be established to prevent tobacco promotion in social media.

https://doi.org/10.2196/jmir.3665

Background. Although China ratified the WHO FCTC in 2005, the partial ban on tobacco advertising does not cover the internet. Weibo is one of the most important social media channels in China, using a format similar to its global counterpart, Twitter. The Weibo homepage is a platform to present products, brands and corporate culture. There is great potential for the tobacco industry to exploit Weibo to promote products.

Methods. Seven tobacco industry Weibo accounts that each had more than 5000 fans were selected to examine the content of Weibos established by tobacco companies or their advertising agents.

Results. Of the 12 073 posts found on the seven accounts, 92.3% (11 143) could be classified into six main themes: traditional culture, popular culture, social and business affairs, advertisement, public relations and tobacco culture. Posts under the theme of popular culture accounted for about half of total posts (49%), followed by “advertisement” and “tobacco culture” (both at 12%), “traditional culture” and “public relations” (both at 11%), and finally “social and business affairs” (5%). Some 33% of posts included the words “cigarette” or “smoking” and 53% of posts included the tobacco brand name, indicating that tobacco companies carefully construct the topic and content of posts.

Conclusions. Weibo is an important new online marketing tool for the Chinese tobacco industry. Tobacco industry use of Weibo to promote brands and normalize smoking subverts China's ratification of the WHO FCTC. Policies to control tobacco promotion needs to be reformed to address this widespread circumvention of China's tobacco advertising ban.

https://doi.org/10.1371/journal.pone.0099336

Background. Internet-based marketing has become an attractive option for promoting tobacco products due to its potential to avoid advertising restrictions. In Argentina, several cigarette brands have designed websites for the local market, which promote user participation.

Methods. The intent of the study was to report on the use of tobacco company-sponsored websites by medical students and recently graduated physicians. An online self-administered survey was conducted among eligible medical students and recent graduates from the University of Buenos Aires (UBA). Sampling was from lists of email addresses of students enrolled in two required courses. Eligibility criteria were ages 18–30 years and reporting on smoking status. Questions on Internet use included accessing a tobacco brand website at least once during their lifetime and any use of tobacco promotional materials.

Results. The response rate was 35.08% (1743/4969). The final sample included 1659 participants: 73.06% (1212/1659) were women and the mean age was 26.6 years (Standard Deviation 1.9). The majority were current medical students (55.70%, 924/1659) and 27.31% (453/1659) were current smokers. Men were more likely to report having seen a tobacco advertisement on the Internet (P=.001), to have received a tobacco promotion personally addressed to them (P=.03), to have used that promotion (P=.02), and to have accessed a tobacco-sponsored website (P=.01). Among respondents, 19.35% (321/1659) reported having accessed a tobacco-sponsored website at least once in their lifetime and almost all of them (93.8%, 301/321) accessed these sites only when it was necessary for participating in a marketing promotion. Most people logging on for promotions reported entering once a month or less (58.9%, 189/321), while 25.5% (82/321) reported accessing the tobacco industry Internet sites once a week or more. In adjusted logistic regression models, participants were more likely to have accessed a tobacco brand website if they were former smokers (OR 2.45, 95% CI 1.42–4.22) or current (OR 8.12, 95% CI 4.66–14.16), if they reported having seen a tobacco advertisement on the Internet (OR 2.44, 95% CI 1.77–3.37), received a tobacco promotion personally addressed to them (OR 5.62; 95% CI 4.19–7.55), or used one of these promotions (OR 14.05, 95% CI 9.21–21.43). Respondents were more likely to be current smokers if they received a tobacco promotion (OR 2.64, 95% CI 2.02–3.45) or if they used one of these promotions (OR 1.93, 95% CI 1.31–2.85).

Conclusions. Our study suggests that tobacco industry websites reached medical students and young physicians in a middle-income country with their marketing promotions. Current or proposed legislation to ban tobacco advertising needs to include Internet sites and related social media.

https://doi.org/10.2196/jmir.2528

Background. A gap in knowledge exists about youth exposure to pro-tobacco campaigns via new electronic media outlets. In response, we used national data to delineate the associations between tobacco ads/promotions delivered through new media outlets (that is, social network sites and text messages) and youth attitudes/beliefs about tobacco and intent to use (among youth who had not yet used tobacco).

Methods. Data were derived from the 2011 National Youth Tobacco Survey, a nationally representative sample of youth in the United States of America enrolled in both public and private schools (N = 15 673). Logistic regression models were used to examine associations between demographic characteristics and reported exposure to tobacco ads/promotions via social networking sites and text messages. Logistic regression models were also used to investigate associations between exposure tobacco ads/promotions and attitudes toward tobacco.

Results. We found that highly susceptible youth (that is, minorities, very young youth and youth who have not yet used tobacco) have observed tobacco ads/promotions on social networking sites and text messages. These youth are more likely to have favorable attitudes toward tobacco, including the intention to use tobacco among those who had not yet used tobacco.

Conclusions. Our findings underscore the need for policy strategies to more effectively monitor and regulate tobacco advertising via new media outlets.

https://doi.org/10.1093/ntr/ntt168

In the offline world, where we have strong evidence of what tobacco control policies and programmes work and where we have successfully put them into practice, there have been many solid “wins” for tobacco control. These strategies include increasing tobacco excise taxes, passing smoke-free air laws, implementing counter-marketing campaigns and offering tobacco cessation assistance. By contrast, with Internet 2.0, the field of tobacco control does not have a comprehensive list of effective policies and programmes to counteract the sale and promotion of tobacco products in the new media environment. We are distressed to see that with the progression of new technology, the gap between “pro-tobacco” and tobacco control forces seems to be growing larger. This should be a wake-up call for a more concerted effort.

http://dx.doi.org/10.1136/tobaccocontrol-2011-050360

Background. This paper reviews how the tobacco industry is promoting its products online and examines possible regulation models to limit exposure to this form of marketing. Opportunities to use new media to advance tobacco control are also discussed and future research possibilities are proposed.

Methods. Published articles and “grey literature” reports were identified through searches of the electronic databases, PUBMED and Google Scholar using a combination of the following search terms: tobacco or smoking and new media, online media, social media, Internet media, Web 2.0, Facebook, YouTube and Twitter.

Results. We found that the rapid evolution of the media landscape presents a potential obstacle to fully realizing the benefits of regulating tobacco marketing activities and effectively communicating tobacco control messages. New media also offer the tobacco industry a powerful and efficient channel for rapidly countering the denormalizing strategies and policies of tobacco control. Evidence of tobacco promotion through online media is emerging, with YouTube being the most researched social media site in the tobacco control field.

Conclusions. The explosive rise in Internet use and the shift to these new media being driven by consumer-generated content through social platforms may mean that fresh approaches to regulating tobacco industry marketing are needed.

http://dx.doi.org/10.1136/tobaccocontrol-2011-050193

Because sugary beverages are implicated in the global obesity crisis, major soft-drink manufacturers have recently employed elaborate, expensive, multinational corporate social responsibility (CSR) campaigns. These campaigns echo the tobacco industry's use of CSR as a means to focus responsibility on consumers rather than on the corporation, bolster the the populartiy of the companies and their products and prevent regulation. In response to health concerns about their products, soft-drink companies appear to have launched comprehensive CSR initiatives sooner than did tobacco companies. Unlike tobacco CSR campaigns, soft-drink company CSR campaigns explicitly aim to increase sales, including among young people. As they did with tobacco, public health advocates need to counter industry CSR with strong denormalization campaigns to educate the public and policy-makers about the effects of soda CSR campaigns and the social ills caused by sugary beverages. Tobacco companies launched CSR campaigns to rehabilitate themselves with the public when their image had been tarnished. Because the most comprehensive initiatives were introduced well after intense public outcry, however, their CSR efforts struggled to achieve their aims.

https://doi.org/10.1371/journal.pmed.1001241

Background. The WHO FCTC bans all forms of tobacco advertising, promotion and sponsorship (TAPS). The comprehensiveness of this ban has yet to be tested by online social networking media such as Facebook. In this paper, the activities of employees of the transnational tobacco company, British American Tobacco (BAT), on Facebook and the type of content associated with two globally popular BAT brands (Dunhill and Lucky Strike) are mapped.

Methods. BAT employees on Facebook were identified and then the term “British American Tobacco” was searched for in the Facebook search engine and results recorded, including titles, descriptions, names and the number of Facebook participants involved for each search result. To further detail any potential promotional activities, a search for two of BAT's global brands, Dunhill and Lucky Strike, was conducted.

Results. Each of the three search terms generated more than 500 items across a variety of Facebook subsections.

Conclusions. Some BAT employees are energetically promoting BAT and BAT brands on Facebook through joining and administrating groups, joining pages as fans, and posting photographs of BAT events, products and promotional items. BAT employees undertaking these actions are from countries that have ratified the WHO FCTC, which requires signatories to ban all forms of tobacco advertising, including online and cross-border exposure from countries that are not enforcing advertising restrictions. The results of the present research could be used to test the comprehensiveness of the advertising ban by requesting that governments mandate the removal of this promotional material from Facebook.

http://dx.doi.org/10.1136/tc.2009.032847