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The environmental profile of a community's health: a cross-sectional study on tobacco marketing in 16 countries

Savell E 1 , Gilmore AB 1 , Sims M 1 , Mony PK 2 , Koon T 3 , Yusoff K 4 Show all authors , Lear SA 5 , Seron P 6 , Ismail N 7 , Calik KB 8 , Rosengren A 9 , Bahonar A 10 , Kumar R 11 , Vijayakumar K 12 , Kruger A 13 , Swidan H 14 , Gupta R 15 , Igumbor E 16 , Afridi A 17 , Rahman O 18 , Chifamba J 19 , Zatonska K 20 , Mohan V 21 , Mohan D 21 , Lopez-Jaramillo P 22 , Avezum A 23 , Poirier P 24 , Orlandini A 25 , Li W 26 , McKee M 27 , Rangarajan S 3 , Yusuf S 3 , Chow CK 28

Affiliations 

  • 1 Department for Health, University of Bath, Bath, England
  • 2 Division of Epidemiology and Population Health, St John's Medical College and Research Institute, Bangalore, India
  • 3 Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Canada
  • 4 Faculty of Medicine, Universiti Teknologi MARA, Shah Alam, Malaysia
  • 5 Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
  • 6 Department of Internal Medicine, Universidad de La Frontera, Temuco, Chile
  • 7 Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
  • 8 Faculty of Health Sciences, Marmara University, Istanbul, Turkey
  • 9 Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  • 10 Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran
  • 11 School of Public Health, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
  • 12 Dr Somervell Memorial CSI Medical College, Karakonam, India
  • 13 Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
  • 14 Primary Health Care Sector, Dubai Health Authority, Dubai, United Arab Emirates
  • 15 Fortis Escorts Hospital, Jaipur, India
  • 16 School of Public Health, University of the Western Cape, Cape Town, South Africa
  • 17 Community Health Sciences, Aga Khan University, Karachi, Pakistan
  • 18 Independent University Bangladesh, Dhaka, Bangladesh
  • 19 Physiology Department, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
  • 20 Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
  • 21 Madras Diabetes Research Foundation, Chennai, India
  • 22 Medical School, Universidad de Santander, Bucaramanga, Colombia
  • 23 Research Division, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
  • 24 Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
  • 25 ECLA Foundation, Rosario, Santa Fe, Argentina
  • 26 National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
  • 27 ECOHOST, London School of Hygiene & Tropical Medicine, London, England
  • 28 The George Institute for Global Health, Sydney Medical School (Westmead Campus), University of Sydney, PO Box M201, Missenden Road, Camperdown, NSW 2050, Australia
Bull World Health Organ, 2015 Dec 01;93(12):851-61G.
PMID: 26668437 DOI: 10.2471/BLT.15.155846

Abstract

OBJECTIVE: To examine and compare tobacco marketing in 16 countries while the Framework Convention on Tobacco Control requires parties to implement a comprehensive ban on such marketing.

METHODS: Between 2009 and 2012, a kilometre-long walk was completed by trained investigators in 462 communities across 16 countries to collect data on tobacco marketing. We interviewed community members about their exposure to traditional and non-traditional marketing in the previous six months. To examine differences in marketing between urban and rural communities and between high-, middle- and low-income countries, we used multilevel regression models controlling for potential confounders.

FINDINGS: Compared with high-income countries, the number of tobacco advertisements observed was 81 times higher in low-income countries (incidence rate ratio, IRR: 80.98; 95% confidence interval, CI: 4.15-1578.42) and the number of tobacco outlets was 2.5 times higher in both low- and lower-middle-income countries (IRR: 2.58; 95% CI: 1.17-5.67 and IRR: 2.52; CI: 1.23-5.17, respectively). Of the 11,842 interviewees, 1184 (10%) reported seeing at least five types of tobacco marketing. Self-reported exposure to at least one type of traditional marketing was 10 times higher in low-income countries than in high-income countries (odds ratio, OR: 9.77; 95% CI: 1.24-76.77). For almost all measures, marketing exposure was significantly lower in the rural communities than in the urban communities.

CONCLUSION: Despite global legislation to limit tobacco marketing, it appears ubiquitous. The frequency and type of tobacco marketing varies on the national level by income group and by community type, appearing to be greatest in low-income countries and urban communities.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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