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• Published: 21 January 2021

The effects of tobacco control policies on global smoking prevalence

• Luisa S. Flor   ORCID: orcid.org/0000-0002-6888-512X 1 ,
• Marissa B. Reitsma 1 ,
• Vinay Gupta 1 ,
• Marie Ng   ORCID: orcid.org/0000-0001-8243-4096 2 &
• Emmanuela Gakidou   ORCID: orcid.org/0000-0002-8992-591X 1  

Nature Medicine volume  27 ,  pages 239–243 ( 2021 ) Cite this article

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Substantial global effort has been devoted to curtailing the tobacco epidemic over the past two decades, especially after the adoption of the Framework Convention on Tobacco Control 1 by the World Health Organization in 2003. In 2015, in recognition of the burden resulting from tobacco use, strengthened tobacco control was included as a global development target in the 2030 Agenda for Sustainable Development 2 . Here we show that comprehensive tobacco control policies—including smoking bans, health warnings, advertising bans and tobacco taxes—are effective in reducing smoking prevalence; amplified positive effects are seen when these policies are implemented simultaneously within a given country. We find that if all 155 countries included in our counterfactual analysis had adopted smoking bans, health warnings and advertising bans at the strictest level and raised cigarette prices to at least 7.73 international dollars in 2009, there would have been about 100 million fewer smokers in the world in 2017. These findings highlight the urgent need for countries to move toward an accelerated implementation of a set of strong tobacco control practices, thus curbing the burden of smoking-attributable diseases and deaths.

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Decades after its ill effects on human health were first documented, tobacco smoking remains one of the major global drivers of premature death and disability. In 2017, smoking was responsible for 7.1 (95% uncertainty interval (UI), 6.8–7.4) million deaths worldwide and 7.3% (95% UI, 6.8%–7.8%) of total disability-adjusted life years 3 . In addition to the health impacts, economic harms resulting from lost productivity and increased healthcare expenditures are also well-documented negative effects of tobacco use 4 , 5 . These consequences highlight the importance of strengthening tobacco control, a critical and timely step as countries work toward the 2030 Sustainable Development Goals 2 .

In 2003, the World Health Organization (WHO) led the development of the Framework Convention on Tobacco Control (FCTC), the first global health treaty intended to bolster tobacco use curtailment efforts among signatory member states 1 . Later, in 2008, to assist the implementation of tobacco control policies by countries, the WHO introduced the MPOWER package, an acronym representing six evidence-based control measures (Table 1 ) (ref. 6 ). While accelerated adoption of some of these demand reduction policies was observed among FCTC parties in the past decade 7 , many challenges remain to further decrease population-level tobacco use. Given the differing stages of the tobacco epidemic and tobacco control across countries, consolidating the evidence base on the effectiveness of policies in reducing smoking is necessary as countries plan on how to do better. In this study, we evaluated the association between varying levels of tobacco control measures and age- and sex-specific smoking prevalence using data from 175 countries and highlighted missed opportunities to decrease smoking rates by predicting the global smoking prevalence under alternative unrealized policy scenarios.

Despite the enhanced global commitment to control tobacco use, the pace of progress in reducing smoking prevalence has been heterogeneous across geographies, development status, sex and age 8 ; in 2017, there were still 1.1 billion smokers across the 195 countries and territories assessed by the Global Burden of Diseases, Injuries, and Risk Factors Study. Global smoking prevalence in 2017 among men and women aged 15 and older, 15–29 years, 30–49 years and 50 years and older are shown in Extended Data Figs. 1 , 2 , 3 and 4 , respectively. We found that, between 2009 and 2017, current smoking prevalence declined by 7.7% for men (36.3% (95% UI, 35.9–36.6%) to 33.5% (95% UI, 32.9–34.1%)) and by 15.2% for women globally (7.9% (95% UI, 7.8–8.1%) to 6.7% (95% UI, 6.5–6.9%)). The highest relative decreases were observed among men and women aged 15–29 years, at 10% and 20%, respectively. Conversely, prevalence decreased less intensively for those aged over 50, at 2% for men and 9.5% for women. While some countries have shown an important reduction in smoking prevalence between 2009 and 2017, such as Brazil, suggesting sustained progress in tobacco control, a handful of countries and territories have shown considerable increases in smoking rates among men (for example, Albania) and women (for example, Portugal) over this time period.

In an effort to counteract the harmful lifelong consequences of smoking, countries have, overall, implemented stronger demand reduction measures after the FCTC ratification. To assess national-level legislation quality, the WHO attributes a score to each of the MPOWER measures that ranges from 1 to 4 for the monitoring component (M) and 1–5 for the other components. A score of 1 represents no known data, while scores 2–5 characterize the overall strength of each measure, from the lowest level of achievement (weakest policy) to the highest level of achievement (strongest policy) 6 . Between 2008 and 2016, although very little progress was made in treatment provision (O) 7 , 9 , the share of the total population covered by best practice (score = 5) P, W and E measures increased (Fig. 1 ). Notably, however, a massive portion of the global population is still not covered by comprehensive laws. As an example, less than 15% of the global population is protected by strongly regulated tobacco advertising (E) and the number of people (2.1 billion) living in countries where none or very limited smoke-free policies (P) are in place (score = 2) is still nearly twice as high as the population (1.1 billion) living in locations with national bans on smoking in all public places (score = 5).

To assess national-level legislation quality, the WHO attributes a score to each MPOWER component that ranges from 1 to 5 for smoke-free (P), health warning (W) and advertising (E) policies. A score of 1 represents no known data or no recent data, while scores 2–5 characterize the overall strength of each policy, from 2 representing the lowest level of achievement (weakest policy), to 5 representing the highest level of achievement (strongest policy).

Source data

In terms of fiscal policies (R), the population-weighted average price, adjusted for inflation, of a pack of cigarettes across 175 countries with available data increased from I$3.10 (where I$ represents international dollars) in 2008 to I$5.38 in 2016. However, from an economic perspective, for prices to affect purchasing decisions, they need to be evaluated relative to income. The relative income price (RIP) of cigarettes is a measure of affordability that reflects, in this study, what proportion of the country-specific per capita gross domestic product (GDP) is needed to purchase half a pack of cigarettes a day for a year. Over time, cigarettes have become less affordable (RIP 2016 > RIP 2008) in about 75% of the analyzed countries, with relatively more affordable cigarettes concentrated across high-income countries.

Our adjusted analysis indicates that greater levels of achievement on key measures across the P, W and E policy categories and higher RIP values were significantly associated with reduced smoking prevalence from 2009 to 2017 (Table 2 ). Among men aged 15 and older, each 1-unit increment in achievement scores for smoking bans (P) was independently associated with a 1.1% (95% UI, −1.7 to −0.5, P  < 0.0001) decrease in smoking prevalence. Similarly, an increase of 1 point in W and E scores was associated with a decrease in prevalence of 2.1% (95% UI, −2.7 to −1.6, P  < 0.0001) and 1.9% (95% UI, −2.6 to −1.1, P  < 0.0001), respectively. Furthermore, a 10 percentage point increase in RIP was associated with a 9% (95% UI, −12.6 to −5.0, P  < 0.0001) decrease in overall smoking prevalence. Results were similar for men from other age ranges.

Among women, the magnitude of effect of different policy indicators varied across age groups. For those aged over 15, each 1-point increment in W and E scores was independently associated with an average reduction in prevalence of 3.6% (95% UI, −4.5 to −2.9, P  < 0.0001) and 1.9% (95% UI, −2.9 to −1.8, P  = 0.002), respectively, and these findings were similar across age groups. Smoking ban (P) scores were not associated with reduced prevalence among women aged 15–29 years or over 50 years. However, a 1-unit increase in P scores was associated with a 1.3% (95% UI, −2.3 to −0.2, P  = 0.016) decline in prevalence among women aged 30–49 years. Lastly, while a 10 percentage point increase in RIP lowered women smoking prevalence by 6% overall (95% UI, −10.0 to −2.0, P = 0.014), this finding was not statistically significant when examining reductions in prevalence among those aged 50 and older (Table 2 ).

If tobacco control had remained at the level it was in 2008 for all 155 countries (with non-missing policy indicators for both 2008 and 2016; Methods ) included in the counterfactual analysis, we estimate that smoking prevalence would have been even higher than the observed 2017 rates, with 23 million more male smokers and 8 million more female smokers (age ≥ 15) worldwide (Table 3 ). Out of the counterfactual scenarios explored, the greatest progress in reducing smoking prevalence would have been observed if a combination of higher prices—resulting in reduced affordability levels—and strictest P, W and E laws had been implemented by all countries, leading to lower smoking rates among men and women from all age groups and approximately 100 million fewer smokers across all countries (Table 3 ). Under this policy scenario, the greatest relative decrease in prevalence would have been seen among those aged 15–29 for both sexes, resulting in 26.6 and 6.5 million fewer young male and female smokers worldwide in 2017, respectively.

Our findings reaffirm that a wide spectrum of tobacco demand reduction policies has been effective in reducing smoking prevalence globally; however, it also indicates that even though much progress has been achieved, there is considerable room for improvement and efforts need to be strengthened and accelerated to achieve additional gains in global health. A growing body of research points to the effectiveness of tobacco control measures 10 , 11 , 12 ; however, this study covers the largest number of countries and years so far and reveals that the observed impact has varied by type of control policy and across sexes and age groups. In high-income countries, stronger tobacco control efforts are also associated with higher cessation ratios (that is, the ratio of former smokers divided by the number of ever-smokers (current and former smokers)) and decreases in cigarette consumption 13 , 14 .

Specifically, our results suggest that men are, in general, more responsive to tobacco control interventions compared to women. Notably, with prevalence rates for women being considerably low in many locations, variations over time are more difficult to detect; thus, attributing causes to changes in outcome can be challenging. Yet, there is already evidence that certain elements of tobacco control policies that play a role in reducing overall smoking can have limited impact among girls and women, particularly those of low socioeconomic status 15 . Possible explanations include the different value judgments attached to smoking among women with respect to maintaining social relationships, improving body image and hastening weight control 16 .

Tax and price increases are recognized as the most impactful tobacco control policy among the suite of options under the MPOWER framework 10 , 14 , 17 , particularly among adolescents and young adults 18 . Previous work has also demonstrated that women are less sensitive than men to cigarette tax increases in the USA 19 . Irrespective of these demographic differences, effective tax policy is underutilized and only six countries—Argentina, Chile, Cuba, Egypt, Palau and San Marino—had adopted cigarette taxes that corresponded to the WHO-prescribed level of 70% of the price of a full pack by 2017 (ref. 20 ). Cigarettes also remain highly affordable in many countries, particularly among high-income nations, an indication that affordability-based prescriptions to countries, instead of isolated taxes and prices reforms, are possibly more useful as a tobacco control target. In addition, banning sales of single cigarettes, restricting legal cross-border shopping and fighting illicit trade are required so that countries can fully experience the positive effect of strengthened fiscal policies.

Smoke-free policies, which restrict the opportunities to smoke and decrease the social acceptability of smoking 17 , also affect population groups differently. In general, women are less likely to smoke in public places, whereas men might be more frequently influenced by smoking bans in bars, restaurants, clubs and workplaces across the globe due to higher workforce participation rates 16 . In addition to leading to reduced overall smoking rates, as indicated in this study, implementing complete smoking bans (that is, all public places completely smoke-free) at a faster pace can also play an important role in minimizing the burden of smoking-attributable diseases and deaths among nonsmokers. In 2017 alone, 2.18% (95% UI, 1.8–2.7%) of all deaths were attributable to secondhand smoke globally, with the majority of the burden concentrated among women and children 21 .

Warning individuals about the harms of tobacco use increases knowledge about the health risks of smoking and promotes changes in smoking-related behaviors, while full advertising and promotion bans—implemented by less than 20% of countries in 2017 (ref. 20 )—are associated with decreased tobacco consumption and smoking initiation rates, particularly among youth 17 , 22 , 23 . Large and rotating pictorial graphic warnings are the most effective in attracting smokers’ attention but are lacking in countries with high numbers of smokers, such as China and the USA 20 . Adding best practice health warnings to unbranded packages seems to be an effective way of informing about the negative effects of smoking while also eliminating the tobacco industry’s marketing efforts of using cigarette packages to make these products more appealing, especially for women and young people who are now the prime targets of tobacco companies 24 , 25 .

While it is clear that strong implementation and enforcement are crucial to accelerating progress in reducing smoking and its burden globally, our heterogeneous results by type of policy and demographics highlight the challenges of a one-size-fits-all approach in terms of tobacco control. The differences identified illustrate the need to consider the stages 26 of the smoking epidemics among men and women and the state of tobacco control in each country to identify the most pressing needs and evaluate the way ahead. Smoking patterns are also influenced by economic, cultural and political determinants; thus, future efforts in assessing the effectiveness of tobacco control policies under these different circumstances are of value. As tobacco control measures have been more widely implemented, tobacco industry forces have expanded and threaten to delay or reverse global progress 27 . Therefore, closing loopholes through accelerated universal adoption of the comprehensive set of interventions included in MPOWER, guaranteeing that no one is left unprotected, is an urgent requirement as efforts toward achieving the Sustainable Development Goals by 2030 are intensified.

This was an ecological time series analysis that aimed to estimate the effect of four key demand reduction measures on smoking rates across 175 countries. Country-year-specific achievement scores for P, W and E measures and an affordability metric measured by RIP—to capture the impact of fiscal policy (R)—were included as predictors in the model. Although the WHO also calls for monitoring (M) and tobacco cessation (O) interventions, these were not evaluated. Monitoring tobacco use is not considered a demand reduction measure, while very little progress has been made in treatment provision over the last decade 7 , 9 . Further information on research design is available in the Life Sciences Reporting Summary linked to this paper.

Smoking outcome data

The dependent variable is represented by country-specific, age-standardized estimates of current tobacco smoking prevalence, defined as individuals who currently use any smoked tobacco product on a daily or occasional basis. Complete time series estimates of smoking prevalence from 2009 to 2017 for men and women aged 15–29, 30–49, 50 years and older and 15 years and older, were taken from the Global Burden of Disease (GBD) 2017 study.

The GBD is a scientific effort to quantify the comparative magnitude of health loss due to diseases, injuries and risk factors by age, sex and geography for specific points in time. While full details on the estimation process for smoking prevalence have been published elsewhere, we briefly describe the main analytical steps in this article 3 . First, 2,870 nationally representative surveys meeting the inclusion criteria were systematically identified and extracted. Since case definitions vary between surveys, for example, some surveys only ask about daily smoking as opposed to current smoking that includes both daily and occasional smokers, the extracted data were adjusted to the reference case definition using a linear regression fit on surveys reporting multiple case definitions. Next, for surveys with only tabulated data available, nonstandard age groups and data reported as both sexes combined were split using observed age and sex patterns. These preprocessing steps ensured that all data used in the modeling were comparable. Finally, spatiotemporal Gaussian process regression, a three-step modeling process used extensively in the GBD to estimate risk factor exposure, was used to estimate a complete time series for every country, age and sex. In the first step, estimates of tobacco consumption from supply-side data are incorporated to guide general levels and trends in prevalence estimates. In the second step, patterns observed in locations, age groups and years with smoking prevalence data are synthesized to improve the first-step estimates. This step is particularly important for countries and time periods with limited or no available prevalence data. The third step incorporates and quantifies uncertainty from sampling error, non-sampling error and the preprocessing data adjustments. For this analysis, the final age-specific estimates were age-standardized using the standard population based on GBD population estimates. Age standardization, while less important for the narrower age groups, ensured that the estimated effects of policies were not due to differences in population structure, either within or between countries.

Using GBD-modeled data is a strength of the study since nearly 3,000 surveys inform estimates and countries are not required to have complete survey coverage between 2009 and 2017 to be included in the analysis. Yet, it is important to note that these estimates have limitations. For example, in countries where a prevalence survey was not conducted after the enactment of a policy, modeled estimates may not reflect changes in prevalence resulting from that policy. Nonetheless, the prevalence estimates from the GBD used in this study are similar to those presented in the latest WHO report 28 , indicating the validity and consistency of said estimates.

MPOWER data

Summary indicators of country-specific achievements for each MPOWER measure are released by the WHO every two years and date back to 2007. Data from different iterations of the WHO Report on the Global Tobacco Epidemic (2008 6 , 2009 29 , 2011 30 , 2013 31 , 2015 32 and 2017 20 ) were downloaded from the WHO Tobacco Free Initiative website ( https://www.who.int/tobacco/about/en/ ). To assess the quality of national-level legislation, the WHO attributes a score to each MPOWER component that ranges from 1 to 4 for the monitoring (M) dimension and 1–5 for the other dimensions. A score of 1 represents no known data or no recent data, while scores 2–5 characterize the overall strength of each policy, from the lowest level of achievement (weakest policy) to the highest (strongest policy).

Specifically, smoke-free legislation (P) is assessed to determine whether smoke-free laws provide for a complete indoor smoke-free environment at all times in each of the respective places: healthcare facilities; educational facilities other than universities; universities; government facilities; indoor offices and workplaces not considered in any other category; restaurants or facilities that serve mostly food; cafes, pubs and bars or facilities that serve mostly beverages; and public transport. Achievement scores are then based on the number of places where indoor smoking is completely prohibited. Regarding health warning policies (W), the size of the warnings on both the front and back of the cigarette pack are averaged to calculate the percentage of the total pack surface area covered by the warning. This information is combined with seven best practice warning characteristics to construct policy scores for the W dimension. Finally, countries achievements in banning tobacco advertising, promotion and sponsorship (E) are assessed based on whether bans cover the following types of direct and indirect advertising: (1) direct: national television and radio; local magazines and newspapers; billboards and outdoor advertising; and point of sale (indoors); (2) indirect: free distribution of tobacco products in the mail or through other means; promotional discounts; nontobacco products identified with tobacco brand names; brand names of nontobacco products used or tobacco products; appearance of tobacco brands or products in television and/or films; and sponsorship.

P, W and E achievement scores, ranging from 2 to 5, were included as predictors into the model. The goal was to not only capture the effect of adopting policies at its highest levels but also assess the reduction in prevalence that could be achieved if countries moved into the expected direction in terms of implementing stronger measures over time. Additionally, having P, W and E scores separately, and not combined into a composite score, enabled us to capture the independent effect of different types of policies.

Although compliance is a critical factor in understanding policy effectiveness, the achievement scores incorporated in our main analysis reflect the adoption of legislation rather than degree of enforcement, representing a limitation of these indicators.

Prices in I$ for a 20-cigarette pack of the most sold brand in each of the 175 countries were also sourced from the WHO Tobacco Free Initiative website for all available years (2008, 2010, 2012, 2014 and 2016). I$ standardize prices across countries and also adjust for inflation across time. This information was used to construct an affordability metric that captures the impact of cigarette prices on smoking prevalence, considering the income level of each country.

More specifically, the RIP, calculated as the percentage of per capita GDP required to purchase one half pack of cigarettes a day over the course of a year, was computed for each available country and year. Per capita GDP estimates were drawn from the Institute for Health Metrics and Evaluation; the estimation process is detailed elsewhere 33 .

Given that the price data used in the analysis refer to the most sold brand of cigarettes only, it does not reflect the full range of prices of different types of tobacco products available in each location. This might particularly affect our power in detecting a strong effect in countries where other forms of tobacco are more popular.

Statistical analysis

Sex- and age-specific logit-transformed prevalence estimates from 2009 to 2017 were matched to one-year lagged achievement scores and RIP values using country and year identifiers 34 . The final sample consisted of 175 countries and was constrained to locations and years with non-missing indicators. A multiple linear mixed effects model fitted by restricted maximum likelihood was used to assess the independent effect of P, W and E scores and RIP values on the rates of current smoking. Specifically, a country random intercept and a country random slope on RIP were included to account for geographical heterogeneity and within-country correlation. The regression model takes the following general form:

where y c,t is the prevalence of current smoking in each country ( c ) and year ( t ), β 0 is the intercept for the model and β p , β w , β e and β r are the fixed effects for each of the policy predictors. \(\mathrm{P}_{c,\,t - 1},\,\mathrm{W}_{c,\,t - 1},\,\mathrm{E}_{c,\,t - 1}\) are the P, W and E scores and R c , t −1 is the RIP value for country c in year t  − 1. Finally, α c is the random intercept for country ( c ), while δ c represent the random slope for the country ( c ) to which the RIP value (R t − 1 ) belongs. Variance inflation factor values were calculated for all the predictor parameters to check for multicollinearity; the values found were low (<2) 35 . Bivariate models were also run and are shown in Extended Data Fig. 5 . The one-year lag introduced into the model may have led to an underestimation of effect sizes, particularly as many MPOWER policies require a greater period of time to be implemented effectively. However, due to the limited time range of our data (spanning eight years in total), introducing a longer lag period would have resulted in the loss of additional data points, thus further limiting our statistical power in detecting relevant associations between policies and smoking prevalence.

In addition to a joint model for smokers from both sexes, separate regressions were fitted for men and women and the four age groups (15–29, 30–49, ≥50 and ≥15 years old). To assess the validity of the mixed effects analyses, likelihood ratio tests comparing the models with random effects to the null models with only fixed effects were performed. Linear mixed models were fitted by maximum likelihood and t -tests used Satterthwaite approximations to degrees of freedom. P values were considered statistically significant if <0.05. All analyses were executed with RStudio v.1.1.383 using the lmer function in the R package lme4 v.1.1-21 (ref. 36 ).

A series of additional models to examine the impact of tobacco control policies were developed as part of this study. In each model, cigarette affordability (RIP) and a different set of policy metrics was used to capture the implementation, quality and compliance of tobacco control legislation. In models 1 and 2, we replaced the achievements scores by the proportion of P, W and E measures adopted by each country out of all possible measures reported by the WHO. In model 3, we used P and E (direct and indirect measures separately) compliance scores provided by the WHO to represent actual legislation implementation. Finally, an interaction term for compliance and achievement to capture the combined effect of legislation quality and performance was added to model 4. Results for men and women by age group for each of the additional models are presented in the Supplemental Information (Supplementary Tables 1–4 ).

The main model described in this study was chosen because it includes a larger number of country-year observations ( n  = 823) when compared to models including compliance scores and because it is more directly interpretable.

Counterfactual analysis

To further explore and quantify the impact of tobacco control policies on current smoking prevalence, we simulated what smoking prevalence across all countries would have been achieved in 2017 under 4 alternative policy scenarios: (1) if achievement scores and RIP remained at the level they were at in 2008; (2) if all countries had implemented each of P, W and E component at the highest level (score = 5); (3) if the price of a cigarette pack was I$7.73 or higher, a price that represents the 90th percentile of observed prices across all countries and years; and (4) if countries had implemented the P, W and E components at the highest level and higher cigarette prices. To keep our results consistent across scenarios, we restricted our analysis to 155 countries with non-missing policy-related indicators for both 2008 and 2016.

Random effects were used in model fitting but not in this prediction. Simulated prevalence rates were calculated by multiplying the estimated marginal effect of each policy by the alternative values proposed in each of the counterfactual scenarios for each country-year. The global population-weighted average was computed for status quo and counterfactual scenarios using population data sourced from the Institute for Health Metrics and Evaluation. Using the predicted prevalence rates and population data, the additional reduction in the number of current smokers in 2017 was also computed. Since models were ran using age-standardized prevalence, the number of smokers was proportionally redistributed across age groups using the sex-specific numbers from the age group 15 and older as an envelope.

The UIs for predicted estimates were based on a computation of the results of each of the 1,000 draws (unbiased random samples) taken from the uncertainty distribution of each of the estimated coefficients; the lower bound of the 95% UI for the final quantity of interest is the 2.5 percentile of the distribution and the upper bound is the 97.5 percentile of the distribution.

Reporting Summary

Further information on research design is available in the Nature Research Reporting Summary linked to this article.

Data availability

The dataset generated and analyzed during the current study is publicly available at http://ghdx.healthdata.org/record/ihme-data/global-tobacco-control-and-smoking-prevalence-scenarios-2017 ( https://doi.org/10.6069/QAZ7-6505 ). The dataset contains all data necessary to interpret, replicate and build on the methods or findings reported in the article. Tobacco control policy data that support the findings of this study are released every two years as part of the WHO’s Global Report on Tobacco Control; these data are also directly accessible at https://www.who.int/tobacco/global_report/en/ . Source data are provided with this paper.

Code availability

All code used for these analyses is available at http://ghdx.healthdata.org/record/ihme-data/global-tobacco-control-and-smoking-prevalence-scenarios-2017 and https://github.com/ihmeuw/team/tree/effects_tobacco_policies .

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Acknowledgements

The study was funded by Bloomberg Philanthropies (grant 47386, Initiative to Reduce Tobacco Use). We thank the support of the Tobacco Metrics Team Advisory Group, which provided valuable comments and suggestions over several iterations of this manuscript. We also thank the Tobacco Free Initiative team at the WHO and the Campaign for Tobacco-Free Kids for making the tobacco control legislation data available and providing clarifications when necessary. We thank A. Tapp, E. Mullany and J. Whisnant for assisting in the management and execution of this study. We thank the team who worked in a previous iteration of this project, especially A. Reynolds, C. Margono, E. Dansereau, K. Bolt, M. Subart and X. Dai. Lastly, we thank all GBD 2017 Tobacco collaborators for their valuable work in providing feedback to our smoking prevalence estimates throughout the GBD 2017 cycle.

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Luisa S. Flor, Marissa B. Reitsma, Vinay Gupta & Emmanuela Gakidou

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L.S.F., M.N. and E.G. conceptualized the study and designed the analytical framework. M.B.R. and V.G. provided input on data, results and interpretation. L.S.F. and E.G. wrote the first draft of the manuscript. All authors read and approved the final version of the manuscript.

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Extended data

Extended data fig. 1 prevalence of current smoking for men (a) and women (b) aged 15 years and older (age-standardized) in 2017..

Age-standardized smoking prevalence (%) estimates from the 2017 Global Burden of Disease Study for men (a) and women (b) aged 15 years and older for 195 countries. Smoking is defined as current use of any type of smoked tobacco product. Details on the estimation process can be found in the Methods section and elsewhere 3 .

Extended Data Fig. 2 Prevalence of current smoking for men (a) and women (b) aged 15 to 29 years old (age-standardized) in 2017.

Age-standardized smoking prevalence (%) estimates from the 2017 Global Burden of Disease Study for men (a) and women (b) aged 15–29 years old for 195 countries. Smoking is defined as current use of any type of smoked tobacco product. Details on the estimation process can be found in the Methods section and elsewhere 3 .

Extended Data Fig. 3 Prevalence of current smoking for men (a) and women (b) aged 30 to 49 years old (age-standardized) in 2017.

Age-standardized smoking prevalence (%) estimates from the 2017 Global Burden of Disease Study for men (a) and women (b) aged 30–49 years old for 195 countries. Smoking is defined as current use of any type of smoked tobacco product. Details on the estimation process can be found in the Methods section and elsewhere 3 .

Extended Data Fig. 4 Prevalence of current smoking for men (a) and women (b) aged 50 years and older (age-standardized) in 2017.

Age-standardized smoking prevalence (%) estimates from the 2017 Global Burden of Disease Study for men (a) and women (b) aged 50 years and older for 195 countries. Smoking is defined as current use of any type of smoked tobacco product. Details on the estimation process can be found in the Methods section and elsewhere 3 .

Extended Data Fig. 5 Percentage changes in current smoking prevalence based on fixed effect coefficients from bivariate mixed effect linear regression models, by policy component, sex and age group.

Bivariate models examined the unadjusted association between smoke-free (P), health warnings (W), and advertising (E) achievement scores, and cigarette’s affordability (RIP) and current smoking prevalence, from 2009 to 2017, across 175 countries (n = 823 country-years). Linear mixed models were fit by maximum likelihood and t-tests used Satterthwaite approximations to degrees of freedom. P values were considered statistically significant if lower than 0.05.

Supplementary information

Supplementary information.

Supplementary Tables 1–4: additional models results.

Source Data Fig. 1

Input data for Fig. 1 replication.

Source Data Extended Data Fig. 1

Input data for Extended Data 1 replication.

Source Data Extended Data Fig. 2

Input data for Extended Data 2 replication.

Source Data Extended Data Fig. 3

Input data for Extended Data 3 replication.

Source Data Extended Data Fig. 4

Input data for Extended Data 4 replication.

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Flor, L.S., Reitsma, M.B., Gupta, V. et al. The effects of tobacco control policies on global smoking prevalence. Nat Med 27 , 239–243 (2021). https://doi.org/10.1038/s41591-020-01210-8

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DOI : https://doi.org/10.1038/s41591-020-01210-8

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When Cigarette Companies Used Doctors to Push Smoking

By: Becky Little

Updated: March 28, 2023 | Original: September 13, 2018

What cigarette do doctors says causes less throat irritation? In the 1930s and 40s, tobacco companies would happily tell you it was theirs. Doctors hadn’t yet discovered a clear link between smoking and lung cancer, and a majority of them actually smoked cigarettes. So in cigarette ads, tobacco companies used doctors’ authority to make their claims about their cigarettes seem more legitimate.

To the modern-day reader, the pitching of cigarettes as healthy (even to youth and pregnant moms) and the use of doctors’ endorsements may appear horrifying. Yet before 1950, there wasn’t good evidence showing that cigarette smoking was bad for you.

“People started to get worried in the ‘40s because lung cancer was spiking; the lung cancer death rate was going through the roof,” says Martha Gardner , a history and social sciences professor at Massachusetts College of Pharmacy and Health Sciences. “People noticed that and were worried about it, but that didn’t mean they knew it was cigarettes.”

Yes, cigarettes did cause coughing and throat irritation. But companies used this to their advantage to promote their product as better than the competition. It wasn’t all cigarettes that gave you problems—it was just those other ones.

The first cigarette company to use physicians in their ads was American Tobacco, maker of Lucky Strikes. In 1930, it published an ad claiming “20,679 Physicians say ‘LUCKIES are less irritating’” to the throat. To get this number, the company’s ad agency had sent physicians cartons of Lucky Strike cigarettes and a letter asking if they thought Lucky Strikes were “less irritating to sensitive and tender throats than other cigarettes,” while noting “a good many people” had already said they were.

Unsurprisingly, many doctors responded positively to this biased, leading question, and Lucky Strike ads used their answers to imply their cigarettes must be medically better for your throat. In 1937, the Philip Morris company took that one step forward with a Saturday Evening Post ad claiming doctors had conducted a study showing “when smokers changed to Philip Morris, every case of irritation cleared completely and definitely improved.” What it didn’t mention was that Philip Morris had sponsored those doctors.

Philip Morris continued to advertise “studies” it sponsored through the 1940s, the decade that saw the introduction of penicillin. “The American public is thinking about medicine in such a positive way and science in a positive way,” says Gardner , who co-authored an American Journal of Public Health article about doctors in cigarette ads. “So framing it that way seems like it’ll help appeal to people.”

To this end, the R.J. Reynolds Tobacco Company created a Medical Relations Division and advertised it in medical journals. Reynolds began paying for research and then citing it in its ads like Philip Morris. In 1946, Reynolds launched an ad campaign with the slogan, “More doctors smoke Camels than any other cigarette.” They’d solicited this “finding” by giving doctors a free carton of Camel cigarettes, and then asking what brand they smoked.

By the mid-1950s, when tobacco companies had to confront good evidence that their products caused lung cancer, advertising strategies started to shift. “What happens is, all the different cigarette companies kind of work together to try to promote the idea that…we don’t know yet if it’s harmful,” Gardner says. In 1954, these companies released “A Frank Statement to Cigarette Smokers” arguing that research showing a link between cancer and smoking was alarming but not conclusive. Therefore, the companies were forming a research committee to investigate the issue.

After this, cigarette ads stopped featuring doctors because this was no longer a convincing tactic. Doctors were coming out against cigarettes, culminating in 1964 with the U.S. Surgeon General’s report that smoking causes lung cancer, laryngeal cancer and chronic bronchitis.

Still, tobacco companies continued to maintain, through their research committee, that there was still a “controversy” over whether cigarettes were unhealthy until 1998. That year, the Tobacco Institute and the Committee for Tobacco Research (as it was then known) disbanded in accordance with a lawsuit settlement.

Soon after e-cigarettes debuted in Europe in 2006 , tobacco companies began investing heavily in vaping. The Food and Drug Administration noted in 2018 that vaping was increasing at an alarming rate among teens, raising concern that more young people were becoming addicted to nicotine. In 2019, deaths and vaping-related lung illness peaked in the U.S. As of February 2020, there have been  68 confirmed deaths connected to e-cigarettes and vaping products. 

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Cigarette Brand Preference and Pro-Tobacco Advertising Among Middle and High School Students — United States, 2012–2016

Weekly / February 2, 2018 / 67(4);119–124

Siobhan N. Perks 1 ; Brian Armour, PhD 2 ; Israel T. Agaku, DMD, PhD 2 ( View author affiliations )

What is already known about this topic?

Nearly all adult smokers first try cigarettes before age 18 years. Tobacco-advertising activities, among other factors, including peer influence and price, are associated with initiation of smoking and the continued use of tobacco products among youth.

What is added by this report?

Analysis of 2012–2016 National Youth Tobacco Survey data found that Marlboro, Newport, and Camel were the most commonly reported usual brands smoked by middle and high school current (past 30-day) cigarette smokers. In 2016, these three brands accounted for 73.1% and 78.7% of current cigarette smokers in middle and high school, respectively. Ads for these three brands were also the three most commonly identified “favorite cigarette ad” in 2012. Current cigarette smokers who reported exposure to neither e-cigarette ads nor cigarette ads reported significantly lower prevalence of having a usual brand than those who reported exposure to both ads during 2015.

What are the implications for public health practice?

Reducing youth-oriented tobacco marketing, as part of a comprehensive approach in concert with other evidence-based strategies, including comprehensive smoke-free policies, increasing the price of tobacco products, and raising the minimum age of purchase for tobacco products to 21 years, could help reduce the acceptability, affordability, and use of tobacco products among youth.

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Nearly all adult smokers first try cigarettes before age 18 years ( 1 ), and adolescents can show symptoms of nicotine dependence within days to weeks of the onset of occasional cigarette smoking ( 2 ). Having a usual cigarette brand among adolescent smokers could reflect exposure and receptivity to pro-tobacco advertising and tobacco product appeal ( 1 ). To identify usual cigarette brands smoked among U.S. middle and high school students who were current (past 30-day) cigarette smokers, CDC analyzed data from the 2012–2016 National Youth Tobacco Survey (NYTS). Marlboro, Newport, and Camel were the most commonly reported brands smoked during 2012–2016; in 2016, these three were the brands usually smoked for 73.1% and 78.7% of current cigarette smokers in middle and high school, respectively. These three brands also were the three most commonly identified as having a “favorite cigarette ad” in 2012. Efforts to reduce youth exposure to pro-tobacco advertising could help reduce youth smoking ( 1 , 3 ).

NYTS is an annual national survey of U.S. students in grades 6–12.* During 2012–2016, sample sizes ranged from 17,711 (response rate = 63.4%) in 2015 to 24,658 (response rate = 73.6%) in 2012 ( 4 ). Participants were asked, “During the past 30 days, what brand of cigarettes did you usually smoke?” Response options † were “American Spirit,” “Camel,” “GPC, Basic, or Doral,” “Kool,” “Lucky Strike,” “Marlboro,” “Newport,” “Parliament,” “Virginia Slims,” “I did not smoke a usual brand,” “Some other brand not listed here,” “I did not smoke a cigarette in the past 30 days,” and “Not sure.” Responses of “I did not smoke a cigarette in the past 30 days” and “Not sure” were excluded; all other responses were classified as current (past 30-day) cigarette smokers. § Among current cigarette smokers, any response other than “I did not smoke a usual brand” was classified as having a usual brand.

In the 2012 NYTS only, participants were asked, “What is the name of the cigarette brand of your favorite cigarette ad?” Response options were “American Spirit,” “Camel,” “GPC, Basic, or Doral,” “Kool,” “Marlboro,” “Newport,” “Some other brand not listed here,” “I don’t have a favorite cigarette ad,” and “Not sure.” Any response other than “I don’t have a favorite cigarette ad” and “Not sure” was classified as having a favorite cigarette ad. In the 2015 NYTS only, exposure to ads for both regular cigarettes and electronic cigarettes (e-cigarettes) over four media categories was assessed (the Internet, newspapers/magazines, retail stores, and TV/movies). An exposure was classified as reporting seeing ads on the assessed medium “Sometimes,” “Most of the time,” or “Always.” ¶ The tobacco product exposed to on each advertising medium was classified as 1) neither e-cigarettes nor cigarettes, 2) e-cigarettes only, 3) cigarettes only, and 4) both e-cigarettes and cigarettes.

Among current cigarette smokers, brand-specific prevalence was calculated overall and by school level, sex, grade, race/ethnicity, and smoking frequency within the past 30 days (a response of 20–30 days was considered frequent; a response of 1–19 days was considered infrequent).** Binary logistic regression was used to assess brand-specific linear trends during 2012–2016, adjusting for grade, sex, and race/ethnicity. For 2012 only, agreement between usual brand and favorite cigarette ad was assessed among 1,807 current cigarette smokers with data available for both indicators. For 2015 only, the proportion of current cigarette smokers reporting having a usual brand †† was stratified by amount of reported ad exposure to pro-tobacco advertising across media types. Chi-squared tests and logistic regression were used to determine subgroup differences, with statistical significance set at p<0.05. Data were weighted to yield nationally representative estimates.

During 2016, the top three brands usually smoked among current cigarette smokers in all middle school grades combined were Marlboro (38.3%), Newport (21.4%), and Camel (13.4%) ( Table ). During 2016, 16.5% of middle school current cigarette smokers smoked some other specific brand, and 10.4% had no usual brand. The proportion of current cigarette smokers who smoked Marlboro cigarettes during 2016 was highest among non-Hispanic whites (whites) (54.6%) and lowest among non-Hispanic blacks (blacks) (11.5%; p<0.05). Conversely, the proportion who smoked Newport cigarettes during 2016 was highest among blacks (58.4%) and lowest among whites (7.9%; p<0.05). A higher proportion of female smokers (27.2%) smoked Newport cigarettes than did male smokers (16.6%; p<0.05). Trends during 2012–2016 were not significant for middle school students overall or among subgroups.

Among high school current cigarette smokers, the top three brands usually smoked by students in all grades combined in 2016 also were Marlboro (48.8%), Newport (16.6%), and Camel (13.3%) (Table). During 2016, 15.4% of high school current cigarette smokers smoked other specific brands, and 5.9% reported no usual brand. As was the case among middle school students, Newport was the most prevalent brand among black high school students (47.5% in 2016), and Marlboro was the most prevalent brand among white high school students (59.5% in 2016). During 2016, the proportion of high school current cigarette smokers that smoked Camel cigarettes was highest among Hispanics (18.1%) and lowest among blacks (8.9%). Trend analyses during 2012–2016 indicated an increase in the prevalence of Marlboro smoking for all high school students (38.5% to 48.8%), males (39.4% to 50.0%), females (37.5% to 48.0%), ninth graders (34.3% to 42.9%), 10th graders (37.2% to 45.7%), 12th graders (41.1% to 53.2%), whites (45.8% to 59.5%), and both frequent (42.2% to 59.1%) and infrequent smokers (37.8% to 50.8%) (all p-values for trend <0.05). The prevalence of Newport smoking declined during 2012–2016 among all high school students (23.1% to 16.6%), females (26.0% to 16.8%), and whites (15.4% to 9.5%) (all p-values for trend <0.05). The prevalence of Camel smoking during 2012–2016 declined among all high school students (17.8% to 13.3%), males (17.0% to 12.5%), females (18.6% to 14.2%), 10th graders (19.4% to 14.2%), 12th graders (19.8% to 13.6%), whites (19.6% to 11.9%), and infrequent smokers (19.8% to 12.4%) (all p-values for trend <0.05). The proportion of students who smoked no usual brand increased among all high school students (4.1% to 5.9%), females (2.7% to 6.0%), 10th graders (2.9% to 6.8%), 12th graders (3.3% to 5.1%), and blacks (1.6% to 15.9%) during 2012–2016 (all p-values for trend <0.05).

In 2012, among current cigarette smokers who reported smoking a usual brand, 72.1% identified the same brand as their favorite cigarette ad. The top three favorite cigarette ads were also the top three brands usually smoked ( Figure 1 ).

In 2015, across all advertising media, current cigarette smokers who reported exposure to neither e-cigarette ads nor cigarette ads reported significantly lower prevalence of having a usual brand than those who reported exposure to both ads ( Figure 2 ). By specific advertising media, among those exposed to neither e-cigarette nor cigarette ads versus both ads, the proportion who reported having a usual brand was as follows: for movies/TV (neither ad = 80.5%; both ads = 94.2%), for retail stores (neither = 69.8%; both = 94.8%), for Internet (neither = 79.4%; both = 94.5%), and for magazines/newspapers (neither = 88.0%; both = 94.6%) (all p-values <0.05).

During 2012–2016, the top three brands usually smoked by U.S. middle and high school current cigarette smokers were Marlboro, Newport, and Camel; these brands also were the top three favorite cigarette ads reported by current cigarette smokers in middle and high school in 2012. Market data also indicated that these three brands accounted for the largest share (62%) of the U.S. cigarette market during 2016; the percentage shares of retail volume for Marlboro, Newport, and Camel during 2016 were 40.2%, 13.8%, and 8.0% respectively ( 5 ). Cigarette ads use youth-oriented themes, including those highlighting independence, rebellion, and perceived social acceptability of cigarette smoking ( 3 ). Previous epidemiologic studies have demonstrated an association between amount of reported ad exposure and most frequently smoked brands among adolescents ( 6 ); efforts to reduce youth exposure to pro-tobacco advertising might help reduce smoking initiation among U.S. youth ( 1 ).

Targeted marketing of tobacco products to certain groups can explain differences in brand preferences among subgroups ( 1 , 7 , 8 ). Whereas Marlboro smoking was more prevalent among whites, Newport, a predominantly menthol brand, was more often smoked by blacks, which is consistent with previous reports that have documented that menthol cigarettes are marketed to specific demographic groups, including blacks ( 7 , 8 ). Among high school students overall, as well as among females, blacks, and 10th and 12th graders, significant increases were observed in the proportion of smokers reporting no usual brand. Having no usual brand might be an indicator of nonspecific cigarette access patterns, including from social sources such as friends ( 1 ).

The findings in this report are subject to at least four limitations. First, self-reported cigarette smoking is subject to social desirability bias and might be underreported among youth. Second, both brand preferences and pro-tobacco ad exposure were measured at the same time in this cross-sectional study; the data therefore did not permit assessment of temporality. Exposure to ads could increase brand use or brand use could lead to a favorable impression of tobacco ads. Third, these findings might not be generalizable to youth who are not enrolled in traditional schools, (e.g., dropouts [approximately 6.4% among high school students] §§ and those home-schooled [approximately 3.4% of school-aged children]). ¶¶ Finally, the relationships between “favorite cigarette ad” and cigarette brand preferences as assessed in 2012 NYTS might have limited comparability with subsequent years.

In 2014, U.S. cigarette manufacturers spent approximately $8.5 billion, or approximately $1 million per hour, to advertise and promote cigarettes ( 9 ). Information on cigarette brand usually smoked can help guide efforts to reduce cigarette smoking among the approximately 1.6 million U.S. middle and high school cigarette smokers ( 10 ). Reducing youth-oriented tobacco marketing, as part of a comprehensive approach in concert with other evidence-based strategies could help reduce the acceptability, affordability, and use of tobacco products among youth ( 1 ). Such strategies include comprehensive smoke-free policies, increasing the prices of tobacco products, and raising the minimum age of purchase for tobacco products to 21 years ( 1 ).

Conflict of Interest

No conflicts of interest were reported.

Corresponding author: Israel T. Agaku, [email protected] , 404-580-3276.

1 Rollins School of Public Health, Emory University, Atlanta, Georgia; 2 Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

* The study period was restricted to 2012–2016 because the questions assessing cigarette brand usually smoked had different response options in preceding NYTS survey years.

† Because of small sample sizes, “GPC, Basic, or Doral,” “Kool,” “Lucky Strike,” “Parliament,” and “Virginia Slims” were collapsed together into one category (“Other specific brand”).

§ Final analytical sample for each year (past 30-day cigarette smokers) was as follows: 2012 (n = 3,292), 2013 (n = 2,377), 2014 (n = 2,386), 2015 (n = 1,823), and 2016 (n = 1,739).

¶ For each specific advertising medium assessed, participants could select any one of the following response options that best described their frequency of exposure: “Never,” “Rarely,” “Sometimes,” “Most of the time,” or “Always.” Participants could also indicate if they did not use the medium assessed (e.g., “I do not use the Internet”). Participants who answered “Never” or “Rarely,” or who indicated they did not use the assessed medium, were classified as nonexposed to that medium; all other responses were classified as exposed.

** Frequency of cigarette smoking was ascertained with the question “During the past 30 days, on how many days did you smoke cigarettes?” Categorical response options were “0 days,” “1 or 2 days,” “3 to 5 days,” “6 to 9 days,” “10 to 19 days,” “20 to 29 days,” and “All 30 days.” A response of “0 days” was classified as being a current nonsmoker and was excluded. The remaining response options were dichotomized as infrequent (1–19 days) and frequent (≥20 days) cigarette smokers.

†† Outcome was dichotomized as 0 or 1. Persons who reported having a specific brand they usually smoked (“American Spirit,” “Camel,” “GPC, Basic, or Doral,” “Kool,” “Lucky Strike,” “Marlboro,” “Newport,” “Parliament,” “Virginia Slims,” or “Some other brand not listed here”) were treated as a positive response. Those who responded, “I did not smoke a usual brand” were treated as not having a brand usually smoked. Responses of “Not sure” or “I did not smoke a cigarette in the past 30 days” were excluded.

§§ https://www.census.gov/newsroom/press-releases/2016/cb16-tps142.html .

¶¶ https://nces.ed.gov/programs/digest/d15/tables/dt15_206.10.asp?current=yes .

• US Department of Health and Human Services. Preventing tobacco use among youth and young adults: a report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, CDC; 2012. https://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/full-report.pdf
• DiFranza JR, Rigotti NA, McNeill AD, et al. Initial symptoms of nicotine dependence in adolescents. Tob Control 2000;9:313–9. CrossRef PubMed
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• CDC. National Youth Tobacco Survey (NYTS). Atlanta, GA: US Department of Health and Human Services, CDC; 2016. https://www.cdc.gov/tobacco/data_statistics/surveys/nyts/index.htm
• Euromonitor International. Cigarettes in the US. London, United Kingdom: Euromonitor International; 2017. http://www.euromonitor.com/cigarettes-in-the-us/report
• Substance Abuse and Mental Health Services Administration. Cigarette brand preferences in 2005. Rockville, MD: US Department of Health and Human Services, Substance Abuse and Mental Health Services Administration; 2007. https://archive.samhsa.gov/data/2k7/cigBrands/cigBrands.pdf
• Anderson SJ. Marketing of menthol cigarettes and consumer perceptions: a review of tobacco industry documents. Tob Control 2011;20(Suppl 2):ii20–8. PubMed
• Gittelsohn J, McCormick LK, Allen P, Grieser M, Crawford M, Davis S. Inter-ethnic differences in youth tobacco language and cigarette brand preferences. Ethn Health 1999;4:285–303. CrossRef PubMed
• Federal Trade Commission. Federal Trade Commission cigarette report for 2014. Washington, DC: Federal Trade Commission; 2017. https://www.ftc.gov/system/files/documents/reports/federal-trade-commission-cigarette-report-2014-federal-trade-commission-smokeless-tobacco-report/ftc_cigarette_report_2014.pdf
• Singh T, Arrazola RA, Corey CG, et al. Tobacco use among middle and high school students—United States, 2011–2015. MMWR Morb Mortal Wkly Rep 2016;65:361–7. CrossRef PubMed

Abbreviation : SE = standard error. * Assessed with the question: “During the past 30 days, what brand of cigarettes did you usually smoke?” Response options were “American Spirit,” “Camel,” “GPC, Basic, or Doral,” “Kool,” “Lucky Strike,” “Marlboro,” “Newport,” “Parliament,” “Virginia Slims,” “I did not smoke a usual brand,” “Some other brand not listed here,” “I did not smoke a cigarette in the past 30 days,” and “Not sure.” Any response other than “I did not smoke a cigarette in the past 30 days” or “Not sure” was treated as being a current (past 30-day) cigarette smoker. † Trend analyses include data for 2012, 2013, 2014, 2015, and 2016. Prevalence estimates are presented only for 2012 and 2016. § Because of small sample sizes, the responses “GPC, Basic, or Doral,” “Kool,” “Lucky Strike,” “Parliament,” and “Virginia Slims” were combined together as one category (“Other specific brand”). ¶ Assessed with the question “During the past 30 days, on how many days did you smoke cigarettes?” Response options included “0 days,” “1 or 2 days,” “3 to 5 days,” “6 to 9 days,” “10 to 19 days,” “20 to 29 days,” and “All 30 days.” Responses of “0 days” were excluded. All other responses were dichotomized as frequent (≥20 days) or infrequent (1–19 days). ** Statistically significant linear trend during 2012–2016 (p-trend<0.05).

FIGURE 1 . Agreement* between brand of cigarettes usually smoked † and favorite cigarette brand ad § among middle and high school current (past 30-day) cigarette smokers — National Youth Tobacco Survey, United States, 2012

* Restricted to students who smoked cigarettes during the past 30 days and reported having both a favorite cigarette ad and a cigarette brand usually smoked (n = 1,807). The question on favorite cigarette ad was asked only in 2012.

† Assessed with the question: “During the past 30 days, what brand of cigarettes did you usually smoke?” Responses classified as having a brand usually smoked among past 30-day smokers included “American Spirit,” “Camel,” “GPC, Basic, or Doral,” “Kool,” “Lucky Strike,” “Marlboro,” “Newport,” “Parliament,” “Virginia Slims,” and “Some other brand not listed here.”

§ Assessed with the question: “What is the name of the cigarette brand of your favorite cigarette ad?” Responses classified as having a favorite cigarette ad were “American Spirit,” “Camel,” “GPC, Basic, or Doral,” “Kool,” “Marlboro,” “Newport,” and “Some other brand not listed here.”

The figure is a bar chart showing agreement between brand of cigarettes usually smoked and favorite brand ad among middle and high school current (within the past 30 days) cigarette smokers in 2012.

FIGURE 2 . Proportion of middle and high school current (past 30-day) cigarette smokers reporting a usual cigarette brand,* by advertising medium and status of exposure to cigarette and/or electronic cigarette ads † — National Youth Tobacco Survey, United States, 2015 §

* Outcome was dichotomized as 0 or 1. Persons who reported having a specific brand they usually smoked (“American Spirit,” “Camel,” “GPC, Basic, or Doral,” “Kool,” “Lucky Strike,” “Marlboro,” “Newport,” “Parliament,” “Virginia Slims,” or “Some other brand not listed here”) were coded as 1. Those who responded, “I did not smoke a usual brand” were coded as 0. Responses of “Not sure” or “I did not smoke a cigarette in the past 30 days” were excluded.

† Separate questions were asked for electronic cigarettes and regular cigarettes in relation to exposure to pro-tobacco ads on the different media sources (Internet, newspapers/magazines, retail stores, and TV/movies). For both electronic cigarettes and regular cigarettes, respondents’ ad exposure status was coded on each medium as either: 1 = exposed (responses of “Sometimes,” “Most of the time,” and “Always”) or 0 = nonexposed (“Never,” “Rarely,” or those who indicated not using the assessed medium).

§ The questions on exposure to both electronic cigarette and regular cigarette ads were asked only in 2015.

The figure is a bar chart showing the proportion of middle and high school current (within the past 30 days) cigarette smokers reporting a usual brand by advertising medium and status of exposure to cigarette and/or electronic cigarette ads.

Suggested citation for this article: Perks SN, Armour B, Agaku IT. Cigarette Brand Preference and Pro-Tobacco Advertising Among Middle and High School Students — United States, 2012–2016. MMWR Morb Mortal Wkly Rep 2018;67:119–124. DOI: http://dx.doi.org/10.15585/mmwr.mm6704a3 .

MMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services. References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

All HTML versions of MMWR articles are generated from final proofs through an automated process. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version ( https://www.cdc.gov/mmwr ) and/or the original MMWR paper copy for printable versions of official text, figures, and tables.

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Research Article

Exploiting the “video game craze”: A case study of the tobacco industry’s use of video games as a marketing tool

Roles Conceptualization, Data curation, Formal analysis, Funding acquisition, Methodology, Project administration, Supervision, Validation, Writing – original draft

* E-mail: [email protected]

Affiliation Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, California, United States of America

Roles Conceptualization, Formal analysis, Writing – review & editing

• Patricia A. McDaniel, 
• Susan R. Forsyth

• Published: July 25, 2019
• https://doi.org/10.1371/journal.pone.0220407
• Reader Comments

Video games have grown in popularity since the 1970s, and tobacco imagery is present in a substantial subset of games, including those oriented to youth. Much like exposure to tobacco content in films, exposure to tobacco content in video games may influence smoking uptake and use; however, the tobacco industry’s role in facilitating or promoting the use of tobacco imagery in video games is unclear. We explored the industry’s interest in and use of video games to market their products to youth and young adults.

We retrieved and analyzed archival tobacco industry documents. We supplemented information from the documents with current and archived versions of several brand and corporate websites and one website containing user-supplied information on video games.

Tobacco companies recognized the youth appeal and marketing potential of video games as early as 1980. Initial marketing ideas included incorporating video game themes into product packaging and design. More fully realized plans focused on incorporating video games into product promotions in bars, as a high visibility way to attract younger patrons and increase long-term marketing opportunities by generating names for tobacco company direct-marketing databases. Tobacco companies also incorporated video games into in-home product promotions, primarily as components of brand websites, in order to enhance brand image and generate repeat website traffic. A similar desire to attract and keep visitors led to discussions about the inclusion of video games on corporate youth smoking prevention websites, although only one company, Lorillard, followed through.

Conclusions

Video game players are an attractive target market for tobacco companies. Video games, as used by these companies, facilitate consumer engagement with particular tobacco brands or particular corporate messages. Eliminating the use of video games as a promotional vehicle may require limiting tobacco marketing in both physical and online environments.

Citation: McDaniel PA, Forsyth SR (2019) Exploiting the “video game craze”: A case study of the tobacco industry’s use of video games as a marketing tool. PLoS ONE 14(7): e0220407. https://doi.org/10.1371/journal.pone.0220407

Editor: Stefano Triberti, University of Milan, ITALY

Received: May 2, 2019; Accepted: July 15, 2019; Published: July 25, 2019

Copyright: © 2019 McDaniel, Forsyth. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are contained within the reference list and supplementary file, and available for viewing on the web, via the URLs provided therein.

Funding: This work was funded by the Tobacco Related Disease Research Program ( http://www.trdrp.org ), 26IP-0048 (PM). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared no competing interests exist.

Introduction

Since the 1970s, video games have grown in popularity, such that the video game industry now generates three times the revenue of the film industry [ 1 ]. Although regarded as a youthful pastime, in the US, video game play is also common among adults (ages 30–49), with boys and young men predominating in both the younger and older player age groups [ 2 , 3 ]. Since it first appeared in 1978 [ 4 ], advertising in video games has become common [ 5 ], likely due video games’ popularity among youth and adults, key target markets [ 6 ], and to advertising’s potential impact: in-game exposure to brands is memorable [ 7 ] and creates positive brand associations [ 8 ]. Many consumer product companies have embraced the concept, including Budweiser [ 9 ], Coca-Cola, and Subway [ 10 ].

The tobacco industry has long been a marketing innovator, inventing marketing media [ 11 ] and overcoming marketing restrictions [ 12 ]. Tobacco imagery is present in a substantial subset of video games played by adolescents, including those rated as “teen appropriate” by the Entertainment Software Ratings Board [ 13 – 17 ]. This imagery includes branded and unbranded tobacco products (e.g., discarded cigarettes, advertisements for fictional cigarette brands) and characters with lit cigarettes or cigars in their mouths or cigarette packs rolled into shirtsleeves [ 14 – 16 ]. The impact on adolescent smoking initiation of exposure to this imagery is unclear due to limited research and inconclusive results [ 14 ]. Some studies, for example, have found an association between video game playing and smoking, while others have not [ 14 , 18 ]; however, most suffer from methodological flaws, such as grouping video game playing with television or internet use, and small or non-representative samples [ 14 ].

There are several reasons to expect an association between exposure to tobacco imagery in video games and smoking initiation. Exposure to smoking scenes in movies is causally related to youth smoking behaviors, with the relationship explained through theories of media influence [ 15 ]: smoking in movies influences adolescent beliefs about the social acceptability and popularity of smoking, beliefs strongly linked to smoking initiation [ 15 , 19 , 20 ]. Viewing tobacco imagery in video games may have a similar impact on adolescent beliefs about smoking, and ultimately, on smoking behavior. Video games may also have a more direct impact on youth smoking. Engaging in virtual behaviors has been found to modify real-world behavior, with video games offering adolescents opportunities to try behaviors, including smoking, or identities, such as “smoker,” that are rewarded or glorified in the game, and which then transfer to the real world [ 21 – 23 ].

Tobacco companies have been known to create their own video games [ 24 ] and to include video games on tobacco brand websites [ 25 , 26 ]. Yet researchers have not fully explored the tobacco industry’s use of video games as a marketing tool. This paper uses internal tobacco industry documents to examine how and why tobacco companies have employed video games to market their products to youth and adults from the 1980s onwards.

As a result of litigation, nearly 15 million previously undisclosed industry documents [ 27 , 28 ] are archived in a full-text searchable electronic repository [ 29 ]. We searched the archive using standard tobacco industry document search strategies [ 28 , 30 , 31 ], which include starting with broad search terms (“video games,” “online gaming”) and using retrieved documents to identify more specific terms. Our initial broad search terms led to search terms related to brand-related video games (e.g., Newport video game; Doral bingo); games developed for bar nights (e.g., Ultimate Powder; Sega racing simulators); games developed for brand websites (e.g., Camel casino; smokerswelcome.com); youth smoking prevention (e.g., buttoutnow.com; Crisis Crew); and game designers (e.g., Lazertron; Media Circus). These search terms returned thousands of documents. To narrow our findings, we excluded duplicates and documents unrelated to our topic of interest (such as tobacco company marketing activities that did not incorporate a video game component). We located additional relevant documents using a search feature that allows for the identification of documents with adjacent reference (Bates) numbers (sequential numbers stamped on every page as documents are produced in litigation; documents with sequential numbers are frequently related). We stopped searching when additional searches yielded no new documents.

We identified 293 documents that were relevant to our focus on tobacco companies’ interest in video games as a marketing tool; their dates ranged from 1980 to 2008. These included marketing and promotion documents, contracts between tobacco companies and video game makers, tobacco company requests for proposals for video game designs, internal research on consumer behavior related to playing video games, and youth smoking prevention materials. For additional contextual information, we examined current and archived versions of several brand and corporate websites (e.g., Camel.com, buttoutnow.com), and the website Mobygames.com, an online database with user-supplied information on video games, including, for example, promotional and user screenshots.

We analyzed documents using a hermeneutic approach. Broadly, the term “hermeneutic” means interpretation of text, in which one tries to appraise the meaning of the material within the context of the time and place in which it was produced [ 32 – 35 ]. This approach involves identifying themes and thematic clusters, triangulating documentary data by looking for consistency among sources, and employing reliability and validity checks, by, for example, seeking investigator agreement regarding the interpretation of documents [ 36 ].

Consistent with this hermeneutic approach, we did not seek to test specific hypotheses about the tobacco industry’s use of video games as a marketing tool [ 37 – 39 ]. Instead, to develop this interpretive account, the first author reviewed all documents and website material and took detailed notes, and both authors reviewed selected key documents. We relied upon iterative reviews of the documents and our notes to identify and evaluate common themes, construct a timeline of events, and assemble a case study [ 32 , 40 ]. We cite 97 tobacco industry documents in the text; a supplemental file contains a list of all relevant documents.

Initial ideas for capitalizing on the “video game craze”

In the 1980s, tobacco companies explored ways to capitalize on the “widespread video game craze” [ 41 ]. For example, in 1980, RJ Reynolds (RJR) tested the feasibility of a video game tournament as a promotional vehicle for its Camel brand among young adults [ 42 ]. (“Young adult” is the term that the industry began using in the 1970s in place of the more politically sensitive “youth,” irrespective of any social psychological definition of young adulthood) [ 43 ]. An RJR employee noted that video games are among the fasting growing entertainment media in the world. Their popularity is particularly strong within the young adult segment of the marketplace. Video games have not yet been tapped by consumer package good companies seeking young adult loyalty. This puts the CAMEL family and [RJR] in a pre-emptive position [ 42 ].

RJR apparently did not pursue this idea to be the first tobacco company to use video games to market cigarettes to young adults, or at least not overtly: two years, later, in an October 1982 “idea session,” Lorillard personnel noted that “The widespread video game craze has certain fundamental features which we could be the first to exploit ” (emphasis added) [ 41 ]. Their suggestions were to incorporate video game imagery into pack design, or use product names such as “Galaxy,” “Cosmos,” and “Universe” to capitalize on space-themed video game popularity [ 41 ]. While these ideas were apparently rejected, in 1983, Lorillard took a page from RJR’s book, adding video game contests (using existing games) to its spring break Newport promotion in Daytona Beach, Florida [ 44 ].

In 1985, RJR returned to the video game theme as it tried to design brands to compete with Marlboro among youth [ 45 , 46 ]. Marketing ideas for the new brands included video games as promotional vehicles, as branded games [ 47 ] or as “an advertising medium in bars/clubs” [ 48 ]. RJR also considered marketing existing brands near “video game arcades,” where “younger-adult smokers ‘hang out’” [ 49 ].

Tobacco company bar promotions incorporate video games

In the 1980s, tobacco companies began incorporating video games into product promotions in bars. Because bars restricted entry to those age 21 and over, they offered tobacco companies the opportunity to promote their products to young adults while avoiding criticism that they were targeting children [ 50 ]. The goals of bar promotions were to create and reinforce brand image; market to young adults in a smoker-friendly environment; encourage product trial; increase brand visibility; and generate names and addresses for companies’ direct mail databases [ 50 ].

Because bar promotions already included party games (e.g., trivia contests, puzzles, and card games) [ 51 – 54 ], adding video games to the mix fit with bar night activities. However, video games offered advantages over party games. For example, they might include a “bright” “lit up” screen, which, in the words of a Philip Morris (PM) marketing manager, if seen from across the room, “will draw [the] attention [of] adult smokers to come over and participate” [ 55 ]. According to PM, due to their popularity and “high tech” nature, video games also generated more excitement, interest, and traffic [ 56 , 57 ] than traditional party games [ 58 ] among young adults, who PM considered “extremely technology savvy” and eager to use new technology [ 58 ].

PM incorporated video games into its bar promotions (chiefly for its Marlboro brand) from the early 1990s onwards. For example, its Formula 1 racing-themed bar promotions (tied to its sponsorship of a Formula 1 team) included virtual racing simulators and laptop-based video games. Video game maker Sega manufactured PM’s first 4 simulators [ 59 ], in which players raced to finish a computer-generated course, complete with physical cues: “Hit a retaining wall and your cockpit shudders. Take a turn too fast and an airbag inflates at your side, simulating the G-forces that push real drivers around in the saddle. Brake hard and the seat pitches you forward” [ 60 ]. To enable “easy viewing by spectators,” three 19” monitors were positioned above the simulators [ 61 ]. There was Marlboro branding on the cars and the monitor frames “to create added excitement and on-site awareness” [ 60 , 62 ]. Winners received branded merchandise (t-shirts, watches, etc.) [ 63 ], until 1999, when the Master Settlement Agreement prohibited such activity. To participate, bar patrons were required to fill out a “survey” that included their name, address, date of birth, gender, current and previous brand preferences, purchase patterns, and contact information for other smokers “willing to receive free cigarettes and incentive items in the mail” [ 63 ]. A journalist observing players noted that the simulator was compelling enough that nonsmokers also “filled out the survey to say that they [smoked] in order to play the video game” [ 64 ].

After determining that the simulators were a stronger draw than laptop-based video games [ 59 ], PM spent $712,652 between 1997 and 2001 for 24 simulators to expand racing-themed bar promotions. These simulators used an existing computer-based game, IndyCar Racing II, made by Sierra Papyrus, with the software customized to include Marlboro logos on the cars [ 65 ] and a “branded cowling to cover the [computer] monitor and pedestal” [ 66 ]. In 1997, 104,400 people attended bar nights with racing simulators (approximately 300 at each event), generating 13,100 names for PM’s direct marketing database (78% of which were new) [ 67 ].

PM also demonstrated interest in developing a virtual reality game for Marlboro promotions, one that would “immerse players in a 3-D generated computer world” [ 68 ]. As described in a consultants’ presentation, a virtual reality game offers a tremendous ‘crowd attractant’ factor. Since the technology is unique and not always accessible, it attracts people who have not previously been able to experience it. … [It] commands very high visibility and garners extraordinary FREE media/publicity exposure–everyone will want to see the hottest thing traveling through town. … There is no doubt about the positive brand association which will impact not only participating consumers, but [also] people they tell about their exciting experiences [ 68 ].

In September 1995, PM agreed to pay game designers Media Circus approximately $500,000 to create a 4 minute, 3-dimensionsal, virtual reality, Marlboro branded driving experience” [ 69 , 70 ] for bar nights [ 71 – 74 ]. PM had high hopes for the game: the kickoff meeting summary stated that “We’re counting on this game to be the hit of the night …[It] needs to be huge to represent the mega brand image” [ 75 ]. It was expected to have a “Disney like impact … a very big … experience in a small amount of space” [ 75 ]. This document also noted that they had replaced the descriptor “game” with “promotion,” since “PMUSA does not promote to kids and [there is] sensitivity to ‘game’ internally…don’t want to trivialize the … promotion” [ 75 ]. However, PM canceled the project several months later [ 76 ], possibly because of cost considerations [ 77 ].

Brown and Williamson (BW), whose KOOL brand sponsored auto racing in the late 1990s and early 2000s, invested approximately $450,000 in racing simulators for its KOOL bar nights [ 78 ]. Eight teams traveled the US visiting 42 cities for 4–5 week stays, holding bar nights 3–4 times per week, with two racing simulators providing an “‘in your face’ street racing experience” [ 79 – 81 ]. The program’s goal was to “enhance contemporary brand image for KOOL” [ 82 ] particularly among young men [ 83 ]. The simulators were intended to help KOOL “own the evening” [ 84 ]. Young men who were surveyed about their KOOL bar night participation reported that the racing simulator event was “more fun than other sponsored bar nights”; 36% reported that their impression of KOOL was more favorable after the event [ 82 ].

Video games at tobacco company-sponsored bar nights were not focused exclusively on auto racing. For example, in 2000, PM paid Lazertron (later, Arcade Planet) $266,444 for 64 video game consoles and 64 copies of a specially-created Marlboro-branded downhill skiing game, “Ultimate Powder” [ 85 ]. The game’s objective was to avoid obstacles and ski to the Marlboro party as quickly as possible [ 86 ]; it was used at bar nights promoting “Winter Ranch” sweepstakes, whose winners spent time at a Marlboro-themed Montana ranch [ 87 ]. In 2001, PM sought proposals to create 200 touch screen interactive kiosks that would host multiple video games and enable multi-player play [ 88 ]. The goal was to “provide a high visibility branding unit in a bar” that would “generate interest” among “tech savvy” young adult smokers (YAS) and “create talk value” about Marlboro events [ 58 , 88 , 89 ]. Design specifications noted that “screens should draw attention of YAS–use bright colors etc.” [ 58 ]. Potential video games were western/ranch themed (e.g., “cowboy checkers,” “wagon train”), in keeping with broader Marlboro advertising, and contained Marlboro branding on the introductory and exit screens [ 58 , 90 , 91 ]. (It is unclear whether these kiosks were ever created).

RJR planned to launch a new Winston bar program in 2001, an update on the brand’s 1996 “No Bull. No Boundaries” repositioning [ 92 ]. It featured virtual reality units that allowed players to experience sky diving, shark feeding, piloting a fighter jet, etc., in a fully branded Winston environment [ 92 ]; real-life versions of these experiences were offered to Winston sweepstakes winners [ 92 ]. RJR concluded that its target market, 21–34 year olds who “enjoy extreme activities and the thrill of life” [ 92 ] was a “perfect” match for virtual reality technology: “The mere sight of someone wearing a headset generates tremendous levels of interest” [ 93 ]. It sought bids from two companies, cautioning that games should be “durable” and simple enough for “intoxicated patrons” [ 93 ]. It is unclear whether any games were created; a 2002 proposal to consider a virtual reality concept “like nothing you have ever seen” for the 2003 Winston bar program suggested that RJR had not yet committed to the technology [ 94 ]. The cost may have been prohibitive: one bid was nearly $550,000 for one simulator (with software) [ 95 ].

Video games as in-home promotional tools

Tobacco companies also incorporated or considered incorporating video games into in-home product promotions. In 1999, as personal computer ownership was becoming more common, RJR offered Doral smokers steep discounts on video games on CD-ROMs (e.g., Pro Bass Fishing, Beat the House II) with proofs-of-purchase [ 96 , 97 ]. The goal was to “attract younger adult smokers (ages 21–35),” changing their image of the brand “while rewarding existing customers” [ 98 ]. The promotion was deemed a success, with more CD-ROMs requested than anticipated [ 99 ]. Marketing consultants recommended that RJR consider a similar promotion for Winston, partnering with a game developer to create a NASCAR-themed game (with minimal or expansive Winston branding) [ 99 ]. The consultants noted that the “opportunity exists for Winston to pre-empt P[hilip] M[orris] on the use of software in promotions” [ 99 ]. Initially, two developers “declined to participate with a tobacco company,” but after “discussions with RJR and NASCAR top management,” one reconsidered [ 99 ]. The company, Papyrus, released a NASCAR-themed game in 2001 that referenced the Winston cup (including in a billboard inside the game) but it is unclear whether it included other Winston advertising [ 100 ].

In 2004, BW’s KOOL Mixx promotion included a CD-ROM with games “to test your hip hop skills,” distributed in magazines such as Rolling Stone and Vibe [ 101 ]. The company was sued by various attorneys general for targeting youth in violation of the Master Settlement Agreement [ 101 ], and initially agreed to stop distributing the CD-ROM [ 102 ]; RJR, which acquired BW, agreed to a more comprehensive settlement, including limiting distribution of any future CD-ROMs to "adult-only" facilities and by mail to known adult smokers [ 103 ].

In the early 2000s, tobacco companies began creating brand websites, which represented a “powerful new marketing vehicle” that could “bring brand positioning to life” through “sight, sound, [and] motion” [ 104 ]. Among the first was RJR’s Doral website, which included four games, bingo, skeet shooting, crosswords, and bowling [ 105 ]. Other brand websites also considered including video games as a way to “generate repeat traffic” [ 106 ]. By 2005, all of RJR’s major brands (Camel, KOOL, Winston, Salem, etc.) had websites [ 107 ] and several featured games tied to brand promotions. For example, the 2005 Camel website featured “Camel Casino,” which allowed players to play games such as blackjack and poker [ 108 ]; poker “chips” were distributed on packs, at events, via direct marketing, and via email [ 109 ], with the goal of “driv[ing] adult smokers to the brand’s website” for prize redemption or competition in multi-player or individual games [ 110 ]. The company that partnered with RJR on the games, Arkadium, noted that “interactive online games engage consumers with brands in a way never before possible,” with players “devot[ing] significant time and emotional investment in games” [ 111 ]. From 2007–2008, Camel Casino was the second most popular section of Camel’s website, after the home page, drawing 591,542 visits [ 112 ].

KOOL had a “Play on the House/Spades Slam” promotion at retail and in bars in 2002; in 2003, it added an online component that allowed website visitors to play spades against the computer or other online players [ 113 ]. Consultants hired by BW to examine the website’s effectiveness interviewed 125 smokers aged 21–29 who had registered for and spent at least 3 minutes on the website [ 113 ]. 33% spent more than 30 minutes on the website; 23% visited 6 or more times [ 113 ]. The game was the most popular website feature, the “anchor” for website activity, [and had a positive impact on KOOL brand image and purchase among those who usually smoked other brands [ 113 ].

As tobacco companies began creating youth smoking prevention (YSP) programs in the late 1990s [ 114 ], several considered building YSP-branded websites for kids, complete with video games, a “traffic driver” for kids’ sites [ 115 ]. PM, for example, hired consultants in 1998 and 1999 to propose website options for its Think…Don’t Smoke YSP program [ 116 , 117 ]. Possibilities included creating a new website with a “Nascar style racing game with ‘Don’t Smoke’ messages built in (e.g., in leader board)” [ 118 ]. One PM consultant raised the issue of capturing kids’ personal information, and recommended requiring parental permission to use any PM-sponsored YSP website [ 119 ]. The consultant also pointed out that a decision to create a PM-sponsored website would mean that PM was taking responsibility for “privacy, security, data capture, parental permission, monitoring” and for “marketing expertise about kids (in fact, this will be implicit just by having such a site)” [ 119 ]. PM continued exploring the idea of a YSP program web presence, complete with sports-themed video games (snowboarding, BMX bike riding) [ 120 ]; however, it ultimately chose not to create one.

Lorillard, by contrast, moved forward with a website for teens in December 1999, buttoutnow.com, to complement its “Tobacco is Whacko if You’re a Teen” YSP program. The goal of the YSP program was to “address the youth smoking issue in a responsible and visible manner” [ 121 ] (emphasis added), and a web presence, with games, helped advance that goal by “keep[ing] kids at the site” [ 122 ]. The website initially included two video games, “the Search,” and “Crisis Crew” [ 123 ]. The Search involved searching for missing puzzle pieces in a poster featuring the Tobacco is Whacko character [ 124 , 125 ]. The object of Crisis Crew was to avoid a smoking dragon (and demonstrate the value of teamwork and leadership) by assigning various tasks to a group of kids (e.g., building ladders or sailing a ship) [ 125 – 127 ].

The available documents suggest that parental permission was not required for website access, although the privacy policy recommended that visitors aged 13 to 17 “seek parental consent before providing any [personally identifiable information]” [ 128 ]. After one year, the website had drawn nearly 600,000 visitors [ 129 ], with the games ranking second in popularity, well behind the top attraction, information on Lorillard’s college scholarship program [ 130 ]. Both games were replaced in 2002 to “increase traffic and repeat visitors” [ 131 ]. The replacement game featured a skateboarder who fought “against time, physics, and obstacles to spread the anti-smoking message” [ 132 – 134 ]. Traffic did increase in 2002, with the college scholarship pages still the most popular portion of the website [ 132 ]. The website appears to have been active until April 2004 [ 135 ]. Although exposure to television advertisements for Lorillard and PM’s YSP programs was found to be associated with stronger youth approval of smoking and intentions to smoke, weaker perceptions of smoking-related harms, and greater likelihood of current smoking [ 136 ], research has not explored whether the inclusion of video games on Lorillard’s website had a similar impact on youth.

Tobacco companies recognized the marketing potential of video games early in the history of the “video game craze.” Although initial ideas for how to capitalize on this craze included creating packaging and brand names evocative of video games and advertising existing brands near video game arcades, tobacco companies settled on more immersive and interactive marketing strategies. These included adding video game components to bar nights, a common strategy across companies, which saw video games as a way to attract “tech savvy” young adults’ attention and interest, thereby persuading smokers (and in some cases nonsmokers) to provide personal information for tobacco company marketing databases in order to play the games. Inclusion in these databases put participating bargoers at risk: the receipt of direct mail coupons from tobacco companies is associated with smoking initiation among nonsmokers and continued smoking among smokers [ 137 , 138 ].

Video games remain a feature of tobacco company bar nights and traveling “lounges” [ 139 , 140 ]. It is unclear how large of a draw they are, given that consumers now have greater access to video games than they did in the 1990s; however, it seems unlikely that video games would remain a component of these events if they no longer advanced tobacco company goals. Recent technological advances and reduced costs associated with virtual reality games may enable tobacco companies to replace standard video games with a type of game to which they attached high hopes in the mid-1990s and early 2000s. If it met expectations, the fully-branded, immersive, “Disney-like” experience of virtual reality would be a big draw—particularly given the expense of purchasing the technology oneself and the limited content available [ 141 ]. “Disney-like” popularity would ensure the continued growth of tobacco company direct marketing databases, facilitating long-term exposure to tobacco marketing.

Tobacco companies incorporated video games into in-home brand marketing and promotion efforts as well. Video games (both branded and unbranded) were an appealing component of these promotions because they promised to attract a younger audience—an appeal recognized by the attorneys general who brought legal action against BW for its “KOOL Mix” promotion. Branded video games also offered the potential for recurring brand exposures to players of all ages through repeat playing, a feature absent from video games played at bar nights, and one with direct implications for smoking behavior. Although research exploring the relationship between viewing tobacco imagery in video games and subsequent tobacco-related behavior is still in its infancy [ 14 ], there is an established causal relationship between exposure to tobacco marketing in many different media and youth smoking initiation and progression to regular smoking [ 15 ]. Exposure to tobacco marketing for even a limited time can create positive perceptions of smoking and smokers and influence intentions to smoke among youth [ 15 ]. Thus, repeat exposure to tobacco imagery in video games played at home is a critical cause for concern.

Tobacco companies also relied on the popularity of video games to draw visitors to brand and corporate websites. As others have noted, websites offer tobacco companies distinct advantages over traditional media in terms of interactivity, length of exposure, and avoidance of marketing restrictions [ 25 , 142 ]. Video games offer similar advantages, and are thus a natural fit for tobacco brand websites. On brand websites, video games were not only among the most popular features, but, as suggested by internal research, their inclusion may help achieve two perennial tobacco company marketing goals: improving brand image and influencing purchasing decisions. Online video games–which continue to be a feature of tobacco brand websites [ 25 , 26 ]—thus represent a powerful, and, for the moment, largely unregulated tobacco marketing tool. The same is true of online games on tobacco companies’ corporate websites. This appears to be less of a concern at the moment, however. Lorillard was the only tobacco company willing to proceed with a website designed specifically for youth, apparently unconcerned about any potential controversy over collecting data about children that could be used for marketing purposes. This website became inactive in 2004, and we are unaware of other tobacco companies sponsoring similar websites for youth.

In the US, the Master Settlement Agreement places limits on paid tobacco product placement in video games. Our study found no evidence that tobacco companies paid for product placement; instead, the documents we uncovered point to more direct relationships, with tobacco companies commissioning branded games that promoted a particular brand (or corporate) image. Addressing these relationships and eliminating the use of video games as a promotional vehicle may require an approach that focuses on limiting tobacco marketing in both physical and online environments. Indeed, the WHO Framework Convention on Tobacco Control recommends prohibiting “any form of commercial communication … with the aim, effect or likely effect of promoting a tobacco product or tobacco use either directly or indirectly” [ 143 ]. In the US, the 2009 Family Smoking Prevention and Tobacco Control Act gives the Food and Drug Administration broad authority to regulate tobacco marketing in order to promote overall public health [ 144 ]. Thus, in some jurisdictions, it may be possible to restrict tobacco branding or other tobacco imagery in video games. Media campaigns to denormalize tobacco content in video games and more focused efforts to capitalize on some game makers’ apparent reluctance to work with tobacco companies, as occurred with RJR in the 1990s, could also be considered.

Our study provides only a partial understanding of the tobacco industry’s use of video games as a marketing tool. Due to the size of the document databases, we may not have retrieved every relevant document. Some may have been destroyed or concealed by tobacco companies, including, for example, any documents concerning payments for tobacco product placement in video games; others may have never been obtained in the legal discovery process.

Since the activities outlined here, video games have become more sophisticated, ubiquitous, and global, and tobacco content in games has become commonplace [ 145 ]. Video game players remain an attractive target market for tobacco companies, and we can expect continued tobacco industry interest in using games to attract and engage consumers. Given the established causal link between exposure to tobacco content in films and youth smoking initiation [ 15 , 146 ], the tobacco industry’s continued interest in video games as a marketing tool poses a challenge to tobacco control. Strategies to address this challenge are needed.

Supporting information

S1 bibliography. list of all relevant documents retrieved..

https://doi.org/10.1371/journal.pone.0220407.s001

Acknowledgments

The authors would like to thank Elizabeth A. Smith and Ruth E. Malone for reading an earlier version of the manuscript.

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• 141. Gilliand N. Why are VR headset sales declining?: Econsultancy; August 13, 2018. https://econsultancy.com/why-are-vr-headset-sales-declining/ .
• 143. WHO Framework Convention on Tobacco Control. WHO Framework Convention on Tobacco Control. 2003. http://www.who.int/fctc/text_download/en/ .
• 144. Tobacco Control Legal Consortium. Fact Sheet 5: Tobacco Product Marketing Restrictions. 2009. https://publichealthlawcenter.org/sites/default/files/fda-5.pdf .
• 146. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA2012.

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• v.9(Suppl 2); 2000 Jun

Anti-smoking advertising campaigns targeting youth: case studies from USA and Canada

OBJECTIVE —To assist in planning anti-smoking advertising that targets youth. Using five US state campaigns, one US research study, and a Canadian initiative as exemplars, an attempt is made to explain why certain advertising campaigns have been more cost effective than others in terms of reducing adolescent smoking prevalence. Several factors which prior research and theory suggest may be important to cost effectiveness are examined. Specifically, three variables pertaining to the advertising message (content, consistency, and clarity) and two variables related to the advertising execution or style (age of spokesperson and depiction of smoking behaviour) are studied. DESIGN —A case study approach has been combined with supplemental data collection and analysis. To assess campaign effects, published articles and surveys of adolescent smoking prevalence in campaign versus control (non-campaign) locations were utilised. Adolescent subjects provided supplemental data on the advertising message variables. Trained adults content analysed each advertisement to assess the executional variables. SUBJECTS —A total of 1128 seventh grade (age 12-13 years) and 10th grade (age 15-16 years) students participated in the supplemental data collection effort. RESULTS —An anti-smoking advertising campaign initiated by Vermont researchers was found to be the most cost effective in that it significantly reduced adolescent smoking prevalence at a low per capita cost. Next in order of cost effectiveness were California, Massachusetts, and Florida because behavioural outcomes were inconsistent across time and/or grades. California was ranked higher than the other two because it spent less per capita. Minnesota and Canada were ineffective at reducing adolescent smoking prevalence, and no comparison outcome data were available for Arizona. Four factors were found to be associated with increased cost effectiveness: (1) a greater use of message content that prior research suggests is efficacious with youth; (2) a more concentrated use of a single efficacious message; (3) an avoidance of unclear messages; and (4) an increased use of youthful spokespeople that adolescents could more readily identify with. No indication was found that depictions of smoking undermined campaign effectiveness by inadvertently implying that smoking was prevalent. CONCLUSIONS —The highly cost effective Vermont campaign can be used as a model for future efforts. It is estimated that 79% of the Vermont advertisements conveyed efficacious messages, 58% concentrated on a single efficacious message, 70% showed youthful spokespeople, and only 4% contained unclear messages. The results suggest that, in the less effective campaigns, as few as 25% of the advertisements contained messages that prior research indicates should be efficacious with youth, as few as 10% of the advertisements focused on one efficacious message, and up to 32% of the advertisements lacked clearcut messages. Keywords: anti-smoking advertising campaigns; youth targeted advertising; cost effectiveness

The Full Text of this article is available as a PDF (210K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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Ethics and E-Cigarette Advertising

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Dakota Park-Ozee

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Page Trotter

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CASE STUDY: Are Companies like Juul Blowing Smoke?

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E-cigarettes are a growing fad, but they might present a host of potential health problems.  In the wake of criticism from public health advocates, news networks including CNN, CBS, and Viacom completely removed advertising for e-cigarette companies like Juul. The ethicality of this move must be called into question when examining the relationship between public health measures and the media. The Centers for Disease Control and Prevention (CDC) announced that 2,172 cases of lung injury associated with e-cigarette product use have been reported from 49 states and 42 deaths have been documented from 24 states as of November 13, 2019 (CDC, 2019).  These numbers prompted the Trump administration to threaten a ban on flavored e-cigs, news outlets to remove e-cigarette advertising, and Juul’s recent decision to stop all advertising in the United States.

On one hand, the removal of e-cigarette advertisements from networks could diminish potential vape related illnesses that have recently surfaced.  Further, the disappearance of advertisements for e-cigarettes may decrease the number of users who pick one up for unintended reasons. Juul claims to provide their e-cigarette products as options for smokers working to quit.  However, other audiences, especially young people, have picked up e-cigarettes as a new habit rather than as a way to give up an old one.  Juul has been criticized for its use of bright colors and young models in its advertising, so preventing youths from identifying with the product could be fruitful in reducing nicotine use.

Exacerbating the problem is the lack of FDA approval of Juul products as a safer alternative to smoking, despite the company’s consistent advertising of its e-cigarette as a better solution to nicotine addiction. As CNBC reported, “the Food and Drug Administration threatened to fine Juul and criticized its marketing and promotional activities, saying its claims that Juul was a safer alternative to cigarettes violated regulations that require the agency to review smoking cessation devices” (Graham, 2019).  On top of this, at least four lawsuits were filed against Juul that included allegations that Juul “deceptively marketed its product as safe and targeted underage and nonsmokers” (Chaykowski, 2018).  Removing Juul advertisements entirely could prevent this unverified claim from feeding e-cigarette addiction.

On the other hand, the removal of e-cigarette advertisements from networks limits exposure to this alternative for anyone with a genuine interest in using the products to quit smoking.  Though FDA approval is still pending, e-cigarettes may be a beneficial option for people attempting to ween off cigarettes and other addictive tobacco products. While eliminating advertisements may be beneficial for younger nonsmokers, it could prove detrimental for smokers looking for alternative avenues for smoking cessation.

It is unclear whether Juul and other e-cigarette companies will see a dramatic decrease in profit.  Some sources say that it’s “too late” to secure the health of young nonsmokers as many will continue to market the product through word of mouth, despite loss of e-cigarette advertisements in the media.  Dr. Robert Jackler, cofounder of Stanford Research into the Impact of Tobacco Advertising (SRITA), said “while Juul has halted its own [social media] posts, the viral peer-to-peer spread among teens the company initiated will live on indefinitely, or at least until the teen craze for Juul abates” (Chaykowski, 2018).  One could argue that the removal of advertising may not even have a significant effect on the rate of e-cigarette use, especially among younger audiences.

The rise in e-cigarette use is comparable to the heavy usage of tobacco in the 1950s.  What remains to be seen is if we will follow the same path that was taken to address the initial cigarette surge: “under federal law, tobacco companies have been barred from advertising on television and radio since 1971” (Yaffe-Bellany, 2019).  For public health reasons, it may be necessary for some sort of media control to be implemented, but other factors, including the health of current smokers attempting to find alternatives and the fairness of designating what is considered unsafe, should be weighed in this time of uncertainty.

Discussion Questions:

• Whose health should take precedence, non-smokers who might fall victim to the e-cigarette trend or cigarette smokers looking to quit?
• Are media companies who run advertisements responsible for the effects of the products they are paid to advertise?
• What is the burden of proof when it comes to the potential harms and benefits of products and how they might be accounted for in ads?
• Is there a greater ethical responsibility when selling a product that might be attractive to minors?

Further Information:

Centers for Disease Control and Prevention.  “Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products.” Centers for Disease Control and Prevention, November 14, 2019 Available at: https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html#what-we-know

Chaykowski, K., “The Disturbing Focus of Juul’s Early Marketing Campaigns.” Forbes Magazine . November 16, 2018. Available at: https://www.forbes.com/sites/kathleenchaykowski/2018/11/16/the-disturbing-focus-of-juuls-early-marketing-campaigns/

Graham, M., “Juul suspends broadcast, print and digital product advertising in the US.” CNBC, September 25, 2019 . Available at: https://www.cnbc.com/2019/09/25/juul-suspends-broadcast-print-and-digital-product-ads-in-the-us.html

Yaffe-Bellany, D., “TV Networks Take Down Juul and Other E-Cigarette Ads.” The New York Times , September 18, 2019. Available at: https://www.nytimes.com/2019/09/18/business/juul-vaping-ads-cbs.html

Page Trotter and Dakota Park-Ozee Media Ethics Initiative Center for Media Engagement University of Texas at Austin

January 20, 2020

Image Credit: Rist Art / Unsplash

This case study can be used in unmodified PDF form for classroom or educational settings. For use in publications such as textbooks, readers, and other works, please contact the Center for Media Engagement .

Ethics Case Study © 2020 by Center for Media Engagement is licensed under  CC BY-NC-SA 4.0

Our Screens: Food Ads, Tobacco & the Eternal Quest to Blame

Related content:

The two studies published in JAMA Network Open looked at advertising exposure of children to food products and adults to tobacco on screens. Both have some interesting insights to consider.

Exposure to Food and Beverage Advertising

The study utilized data from the Nielsen Company on children aged 2 to 5 and 6 to 11 years who viewed a particular program on broadcast, cable, or syndicated “television” screens. The foods of concern included beverages, cereal, snacks, sweets, other foods (such as fruits, vegetables, meats, pasta, condiments), and fast-food and full-service restaurants. Nutritional assessment followed guidelines from the Federal Trade Commission, CDC, FDA, and USDA to identify foods that should not be marketed to children.

Between 2013 and 2022:

Exposure to food-related TV advertisements decreased by 77.6% (from 4611 to 1035 ads per year) for children aged 2-5 years and by 78.5% (from 4860 to 1046 ads per year) for those aged 6-11 years. The most significant decreases were in cereal advertisements, the smallest for fast-food restaurants, although both were greater than 60%. While sugar-sweetened beverages were slightly more advertised than those not, the decrease here was roughly 74% for both age groups. More importantly, these decreases were dramatically more significant for programming designated for children – where > 35% of the audience is aged 2-11.

• 95.1% decrease in exposure (from 1703 to 84 ads per year) for children aged 2-5; 97% decrease in exposure (from 1745 to 52 ads per year) for those aged 6-11.
• Less than 10% of the total food-related ad exposure came from children’s programming, and the majority of exposure came from non-children’s programming, regardless of the percentage of children (≥20%  or ≥35%) used to define children’s programs.

The vertical legend does not clearly indicate the exposure in 2022; it was essentially 100 or fewer ads for each group—quite a reduction; however, according to the researchers, not enough. 

“…young children continue to view more than 1000 food-related advertisements per year, similar to their 6- to 11-year-old counterparts. Government regulations that restrict advertising of unhealthy foods and beverages applied to programming based on time of day rather than on child-audience share would be more effective. In addition, the finding that the nutritional content of foods and beverages that continue to be advertised, … do not meet the IWG nutrition criteria supports the WHO recommendation for government-led criteria to limit foods and beverages marketed to children.”

As with many studies, the social construct of race, was used as an additional "lens" to analyze the problem. Black children watched screens 25% to 62% more than their White peers but were exposed to proportionally more food ads. Why might that be? Here is where the insight can be found. The study considers screen time across a range of sources. While as a Boomer, the only kids' TV I saw was on regular channels. Today, cable channels cater directly to children, along with a host of YouTube and other Internet sources. 

My grandchild has exposed me to Bluey, Disney, and now Puffin Rock, and I must say there is no advertising on these cable programs. So perhaps rather than another government regulation we might ask the parents to control the programming. And yes, I understand that not everyone has the financial wherewithal to purchase cable, or they find the screen a less expensive babysitting option. But is there a minimal degree of parental responsibility to be exercised?  And if we need to further regulate, those rules should to be applied in some fashion to child-directed “influencers,” a majority of whom feature food in their YouTube videos. 

Tobacco and Screens

The second study looks at exposure to tobacco ads on television and the less-studied streaming platforms. The data was derived from the National Cancer Institute’s Health Information National Trends Survey (HINTS 6), asking for “self-reported exposure to tobacco advertisement, marketing, or promotion on TV or streaming platforms.” In a sample of 5800 respondents, the estimated exposure to tobacco was 12.4%. The researchers further stratified the data to show higher exposure among:

• Individuals aged 35 to 49 years (13.4%)
• Those with a high school education or less (16.4%)
• Non-Hispanic Black or African American respondents (19.4%)
• Individuals with a household income less than $20,000 (17.6%)
• Current smokers (17.0%)

The researchers conclude:

“Study findings call for regulation in the TV and streaming space, given its potential for exploitation. As these platforms continue to dominate the entertainment landscape, it becomes increasingly important to regulate content that may contribute to detrimental health outcomes associated with smoking.”

There has been a ban on tobacco advertising on TV since 1970, and streaming services do not have tobacco advertising either. So, in addition to admitting that the question they asked regarding” advertisement, marketing, or promotion” is subjective, they go on to state that

  “most reported exposures are likely due to tobacco use depictions in shows and movies. This type of promotion is difficult to regulate, as it is unclear whether tobacco companies fund such depictions or are artistic choices by content developers.”

The researchers are not alone in a desire to further regulate the content of our screens. The Truth Initiative, initially funded by the Tobacco Master Settlement and “the largest non-profit public health organization committed to preventing youth and young adult nicotine addiction,” writes ,

“On-screen smoking, which is often glamorized and portrayed as edgy and cool, is rising despite well-established research that it influences young people to start using tobacco products. While the youth smoking rate is low, peer-reviewed research from Truth Initiative demonstrates that exposure to smoking imagery in streaming shows can triple a young person’s odds of starting to use e-cigarettes – today’s top tobacco product among young people. This association between tobacco imagery and tobacco product initiation builds on long-established research confirming that exposure to smoking in movies leads young people to start smoking .” [emphasis added]

It is undoubtedly true that the sources of our entertainment and news have shifted over the past few years. It is equally true that we are influenced by advertising and the content of our screens. But in both the case of foo (children) and tobacco (adults), the individuals identifying harm seem to feel that until these exposures are entirely prohibited, our efforts are insufficient. What are the responsibilities and roles of parents in either instance? Where is the line where we cross over to the Nanny State? 

In the endless debate over advertising and its influence, the real question is whether we're ready to admit that maybe, just maybe, some of this responsibility lies closer to home. While researchers and public health advocates demand more regulation, it might be time for parents to step up, change the channel, or maybe—just maybe—talk to their kids about healthy choices. And for the adults, if you're getting seduced by tobacco in a Netflix binge, well, maybe there's a bigger problem than just what's on your screen.

Sources: Trends in Children’s Exposure to Food and Beverage Advertising on Television JAMA Network Open DOI: 10.1001/jamanetworkopen.2024.29671 

Disparities in Exposure to Tobacco on Television or Streaming Platforms JAMA Network Open DOI: 10.1001/jamanetworkopen.2024.27781

• Food advertising
• Tobacco ads on streaming
• Children's screen time
• Junk food commercials
• Parental responsibility
• Streaming platform regulations
• TV ad impact on health
• Nanny state vs. personal responsibility

View the discussion thread.

Chuck Dinerstein, MD, MBA

Director of Medicine

Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.

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Nearly 90% of Instagram posts by tobacco companies violate either federal regulations or guidance on youth marketing

• Tobacco Industry Marketing

The vast majority of Instagram posts by tobacco brand-owned accounts did not follow U.S. Food and Drug Administration (FDA) regulations regarding warning labels, and many included content likely to appeal to young people, according to a study published in Nicotine & Tobacco Research . Instagram imposes few restrictions on tobacco content, and its enforcement of these restrictions is minimal, according to the study authors.

A surge in unauthorized e-cigarette products in recent years has made enforcement of FDA restrictions on e-cigarette marketing a challenge, especially on social media. This study builds on previous Truth Initiative research showing that Instagram influencers frequently posted and promoted branded vaping content and failed to disclose brand relationships to viewers , highlighting a pattern of violation of federal disclosure requirements and platform policies. Although Instagram has rules against content that aims to sell a product or promote tobacco use, they are rarely enforced.

Instagram is used by more than 70% of teens and young adults in the United States . To protect young people on social media, better enforcement of existing regulations and new regulations addressing social media marketing are needed to curb exposure to this potentially harmful content

Few posts comply with warning labels, and many emphasize youth-appealing themes

Researchers examined a sample of 1,243 Instagram posts and videos from tobacco brand-owned accounts from January 2021 to February 2022, evaluating them based on compliance and themes. According to the study, most of the posts evaluated lacked the federally required health warnings, with only 12.8% containing a fully compliant warning that covered 20% of the post.

More than 400 posts in the sample were evaluated for themes and visual elements that could appeal to young people, including tech-forward aspects and stylized photography. The study found that nearly half (45%) of posts emphasized the high-tech aspect of the product, and 33.6% of the posts used stylized and appealing photography, raising concerns about the potential for youth uptake. The emphasis on advanced technology in e-cigarettes harkens back to JUUL, one of the most popular e-cigarette brands, whose tech-forward design made it an instant success among teens and young adults.

Themes of identity made shareable

According to the study, device customizability and themes related to “vaper identity” were also highlighted in branded posts and were present in 24.5% and 17.7% of the sample, respectively. Furthermore, 32.2% of the posts encouraged social media engagement through likes, comments, or shares, which helps to boost reach without spending advertising money. Finally, 5.7% of the posts included memes, a format designed to be shareable.

Increased enforcement of regulations on e-cigarette marketing on social media is needed

The findings of this study indicate that the regulatory framework restricting e-cigarette advertisement on social media is insufficient, and increased enforcement is needed. The top five e-cigarette companies reported doubling spending on social media advertising from 2018 to 2020 , while reducing spending on other forms of advertising, showing that social media is a lucrative space for many brands.

Instagram, which allows people younger than 21 to sign up and access all posts, gives tobacco companies nearly unrestricted access to young people and has even become a platform where underage youth can obtain e-cigarettes through a practice known as discreet shipping .

To protect young people on social media, existing regulations must be enforced. Furthermore, additional regulation may be necessary to curb the use of themes and imagery that is known to attract young people.

More in tobacco industry marketing

Zyn rewards program follows Big Tobacco’s marketing playbook

How popular are oral nicotine pouches and lozenges?

A look at how Big Tobacco infiltrated baseball

ITC Limited: One of India's Foremost Private Sector Companies

Devashish Shrivastava

ITC Limited is an Indian global aggregate organization headquartered in Kolkata, West Bengal. Established in 1910 as the 'Magnificent Tobacco Company of India Limited' , the organization was renamed as the 'India Tobacco Company Limited' in 1970 and then to 'I.T.C. Constrained' in 1974. The specks in the name were expelled in September 2001 and the organization was renamed as 'ITC Limited'.

The organization completed 100 years in 2010 and during 2012-13, it had a yearly turnover of $8.31 billion and a market capitalization of $52 billion. It employs more than 30,000 individuals in over 60 areas in India and is part of the Forbes 2000 rundown.

History & How ITC Was Started Products & Brands Under ITC Business Model & Marketing Strategy of ITC Growth Of Business Conclusion FAQs

History & How ITC Was Started

Tobacco Business

Since the organization was to a great extent dependent on horticultural assets, it wandered into associations in 1911 with the ranchers of southern India for sourcing leaf tobacco. Under the organization's umbrella, the 'Indian Leaf Tobacco Development Company Limited' was framed in the Guntur area of Andhra Pradesh in 1912. The principal cigarette processing plant of the organization was set up in 1913 in Bangalore .

In 1918, leaf-purchasing focuses were made in southern India. ITC's cigarette manufacturing plant at Munger was outfitted with a printing office in 1925, clearing the path for its first non-tobacco business. Even though the initial six years of the company's presence were essentially committed to the development and union of cigarettes and leaf tobacco organizations, ITC's bundling and printing business were set up in 1925 as a key in the reverse mix for ITC's cigarettes business. It is today India's most complex bundling house. More industrial facilities were set up in the next years for cigarette producing capacity all over India.

In 1928, development started for the organization's central command, the 'Virginia House', at Calcutta. ITC procured Carreras Tobacco Company's plant at Kidderpore in 1935 to further fortify its essence. ITC set up an indigenous cigarette tissue-paper-production plant in 1946 to essentially lessen import costs and an industrial facility for printing and bundling was set up at Madras in 1949. The company obtained the assembling business of Tobacco Manufacturers (India) Limited and the integral lithographic printing business of Printers (India) Limited in 1953.

Also read: Mukesh Ambani Is All Set To Revolutionize The E-Commerce

Indianization Of Business

The organization was changed into a Public Limited Company on 27 October 1954. The initial move towards Indianization was taken around the same time with 6% of the Indian shareholding of the organization. During the 1960s, innovation was given more concentration with the setting up of cigarette hardware and channel pole fabricating offices planned for accomplishing independence in cigarette production.

Ajit Narain Haskar became ITC's first Indian director in 1969, and this was important for encouraging Indian administration within the organization. As the organization's proprietorship was logically Indianized, under Haskar's authority, the name of the organization was changed from 'Magnificent Tobacco Company of India Limited' to 'India Tobacco Company Limited' in 1970.

ITC likewise turned into the first organization in quite a while to begin staged-Indianization of capital; the Indian shareholding component of ITC developed from 6% to 25%. ITC went into brand sponsorship for different games, beginning from the Scissor's Cup in 1971. Creative market crusades and electronic information handling began during the 1970s.

In 1973, ITC set up its incorporated research focus in Bangalore, went for expansion, and wandering into innovative work. With the unfurling enhancement designs, the name of the organization was changed to 'I.T.C. Limited' in 1974. The Indian shareholding aspect increased to 40% during this time. ITC went into the cordiality part with inn business in 1975 with the ITC Welcomgroup Hotel Chola in Madras.

ITC picked the cordiality segment for its capability to procure elevated amounts of outside trade, create the travel industry framework, and foster a huge scale of immediate and aberrant business. The shareholding went over 60% in 1976 and more lodgings were started by the organization in the next years. In 1979, ITC entered the paperboards business by advancing ITC Bhadrachalam Paperboards Limited. J N Sapru took over as the organization's director in 1983 and universal development began with the obtaining of Surya Nepal Private Limited in 1985.

The year 1986 saw overwhelming moves from the organization with the opening of an Indian eatery in the city of New York , the securing and renaming of Vishvarama Hotels to ITC Hotels Limited, and the setting up of two new pursuits - the ITC Classic Finance Limited and ITC Agro Tech Limited. ITC likewise went into the eatable oils industry with the dispatch of the 'Sundrop' brand of cooking oils in 1988. Tribeni Tissues Limited was gained in 1990. K L Chugh accepted the job of administrator in 1991, and ITC Global Holding Private constrained was launched as a universal exchanging organization ( Singapore ) in 1992.

In 1994, every one of the inns under the organization was moved into the recorded backup organization ITC Hotels Limited. ITC, through the brand 'Wills', supported the 1996 Cricket World Cup.

Y C Deveshwar took over as the organization's administrator in 1996, and the corporate administration structure was re-framed to help the successful administration of various organizations. ITC left the eatable oils business and monetary administrations, sold the ITC Classic Finance Limited to ICICI Limited, and handed the 'Sundrop' business to ConAgra Foods Limited in 1998.

In the year 2000, creative activity for ranchers called 'e-Choupal' began in Madhya Pradesh 2000. That year saw the dispatch of ITC's 'Wills Sport' scope of easygoing wear with the first retail outlet in New Delhi and ITC's entrance into stationery items and gifting business through the 'Articulations' scope of welcome cards and 'Cohort' note pads.

An entirely claimed data innovation auxiliary, ITC Infotech India Limited was launched in 2000 and ITC Bhadrachalam Paperboards Limited was converted into ITC Limited. The name of the organization was changed to 'ITC Limited' precluding the spots and adjusting the system 'No stops for ITC' in 2001. A representative investment opportunity plan was presented, and a web-based interface for the organization was propelled. Backups for ITC Infotech were set up in the United Kingdom and the USA.

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Products & Brands Under ITC

• Cigarettes: Insignia, India Kings, Classic, Gold Flake, Silk Cut, Navy Cut, Scissors, Capstan, Berkeley, Bristol, and Flake.
• Prepared Foods: Kitchens of India, Aashirvaad, Sunfeast, Mint - O, Candyman, and Bingo.
• Way Of Life Retailing: Wills Lifestyle, John Players, and Miss Players.
• Individual Care: Essenza Di Wills, Fiama Di Wills, Vivel Di Wills, Vivel, and Superia.
• Welcome, Gifting, And Stationary: Brands incorporate Classmate, PaperKraft, and Color Crew. Propelled in 2003, Classmate proceeded to turn into India's biggest scratchpad brand in 2007.
• Security Matches: IKno, Mangaldeep, VaxLit, Delite, and Aim.

• Incense Sticks: Ship, I Kno, and Aim brands of security matches and the Mangaldeep brand of agarbattis (incense sticks).
• Nourishments: ITC's real sustenance brands incorporate Kitchens of India; Aashirvaad, B common, Sunfeast, Candyman, Bingo! what's more, and Yippee! ITC is India's biggest vendor of marked nourishment with over Rs. 4,600 crores in 2012-13. It is available crosswise over 6 classifications in the nourishment business that include nibble sustenances, prepared to-eat suppers, organic product juices, dairy items, and dessert shops.
• Individual consideration items incorporate aromas, haircare, and skincare classifications. Significant brands are Fiama Di Wills, Vivel, Savlon Soap, and Handwash, Essenza Di Wills, Superia, and Engage.
• Lodgings: ITC's Hotels division (under brands including WelcomHotel) is India's second-biggest in-network with more than 90 inns throughout India. Brands in the friendliness area possessed and worked by its auxiliaries incorporate Fortune Park Hotels and WelcomHeritage Hotels.
• Paperboard: Products, for example, claim to fame paper, realistic and other paper are sold under the ITC brand by the ITC Paperboards and Specialty Papers Division. Classmate stationery products that are popular for their quality are manufactured by ITC.
• Bundling And Printing: ITC's Packaging and Printing division work producing offices at Haridwar and Chennai.
• Data Technology: ITC works through its completely possessed backup ITC Infotech India Limited.

Also read: A Case Study of Thomas Cook

Business Model & Marketing Strategy of ITC

Established in 1910 as Imperial Tobacco Company of India, the organization at first managed tobacco items for a considerable length of time before broadening into non-tobacco items during the 1970s. ITC from that point forward has developed as a multi-business combination having business in different enterprises: Hotels, Lifestyle retail stores , prepared to eat division, confectionary segment, Paperboards portion, body care items and so forth.

ITC is one of India's prominent multi-business ventures with a market capitalization of $52 billion and a gross sales value of $10 billion. ITC is crowned among the world's best big Companies, Asia's FAB 50, the World's Most renowned Companies by Forbes magazine, and as 'India's Most Admired Company' in an overview directed by Fortune India magazine and Hay Group. ITC was also included as one of the world's biggest practical worth makers in the buyer merchandise industry in an examination by the Boston Consulting Group. ITC has been recorded among India's Most Valuable Companies by Business Today magazine. The company is among India's '10 Most Valuable (Company) Brands' as indicated by an investigation led by Brand Finance and distributed by the Economic Times. ITC likewise positions itself among Asia's 50 best-performing organizations arranged by Business Week.

ITC's business model and marketing strategies are as follows:

Advantage Of Competition

• Big Conglomerate: Throughout the years, ITC has turned into a huge combination offering a huge scope of items and administrations running from agri-products and nourishment items in the FMCG segment to IT solutions. Involvement in such a differing cluster of items and administrations has helped the organization raise as an unmistakable player in the market: cigarettes, hotels and paperboards, and packaging divisions.
• Vast Experience: With 108 years of involvement in the Indian market, ITC has built a hearty conveyance structure that is parallel to none of its rivals present. This has helped the organization to comprehend the needs of the customers, making it monetarily solid and aggressive.
• The X-Factor: ITC's E-Chaupal activity planned for making the web accessible to Indian ranchers has contacted the lives of a large number of ranchers and their families in the provincial piece of the nation. ITC has expanded brand nearness through this social activity and has brought some brand quintessence focus to the firm.

Use Of BCG Matrix

ITC's business sections are FMCG-Cigarettes, FMCG-Foods, ITC Infotech, Agri-Business, Hotels, Paperboards and Packaging, Branded Apparels, and Packaged Foods. Out of these, FMCG-Cigarettes is its money cow while Agri-Business, Hotels, Paperboards, and Packaging come in the "star" section for ITC. FMCG-Foods still gives off an impression of being a question mark for the firm while Branded attire and Packaged substances are ordered as canines for the firm.

Distribution

The organization works with its business channel; items are made accessible to the discount vendors through Carried and Forward Agents (CFA's) which is then sent to the retailers in towns directly or through Small Wholesale Dealers to reach the customers in the remotest of Indian areas.

Brand Value

ITC has been positioned 772 on Forbes magazine rundown of top 2000 organizations all around. The brand has been esteemed at $51.5 billion as of June 2018. ITC also found a place at 239th position in the universe's best bosses rundown of Forbes Magazine and Asia's 50 greatest performing organizations rundown assembled by Business Week.

Investigation Of Market

Under the GST system , extra cess being charged over the GST of 28% on cigarettes and tobacco-related items, ITC has assessed a steady taxation rate of over 20%. Investigators have assessed that the organization's deals volumes of cigarettes have endured a shot and has declined by over 5% in the last quarter. Remote trade profit over the most recent 10 years remained at $7.1 Billion of which agri fares comprised 56% of the offer. In the social division with direct work to more than 32,000 individuals and through drives like e-chaupal, social and homestead ranger service activity, and 'Mission SunehraKal', ITC has contacted the lives of a huge number of ranchers and their families in provincial India.

On the earth front, ITC has been a Water Positive Enterprise (16 years straight), Carbon Positive Enterprise (13 years straight), and solid waste reusing Positive (11 years straight). This is the main undertaking in the realm of practically identical measurements to have accomplished and supported the 3 key worldwide lists of natural maintainability.

Analysis Of Clients

With its different scope of items and administrations, ITC caters to a diverse scope of clients going from the age group of 5-60 years and even more with its items running from Candyman and Mint-o to Aashirvaad and so on.

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Growth Of Business

Cigarette-to-cleanser producer ITC has revealed 10.69% year-on-year development merged net benefit at Rs 13,162.30 crores for the money related year 2018-19, driven by paperboards, paper and bundling, lodgings and FMCG business.

"The organization had posted a united net benefit of Rs 11,890.78 crore in the budgetary year 2017-18," ITC said in a recording to the Bombay Stock Exchange. United income from tasks expanded possibly by 4.55% to Rs 49,862.11 crore in FY19 when contrasted with Rs 47,688.5 crore in FY18. On the quarterly premise, the FMCG major posted an 18.72% development in net benefit at Rs 3,482 crore in the Jan-Mar period when contrasted with Rs 2,932 crore in a similar quarter of the most recent year. Income expanded to Rs 12,206 crore in Q4FY19 when contrasted with Rs 10,586.80 crore in Q4FY18, helped by exchanging openings oilseeds, wheat, and espresso in agribusiness, higher volumes and improved acknowledgement in paperboards and improvement in RevPar in lodgings. The working benefit (EBITDA) of the organization expanded to Rs 4,572 crore against Rs 4,144 crore in the year-prior period.

"The organization conveyed one more year of strong execution despite a difficult working condition. The Cigarettes Business, affected by soak increment in assessments under the GST system, honed centre around conveying world-class items through nonstop advancement alongside top tier execution consequently solidifying its market standing," ITC said in the trade documenting. A week ago, rival Hindustan Unilever Limited (HUL) revealed a 15.98% y-o-y development in united net benefit at Rs 6,060 crore for the money related the year 2018-19, against income of Rs 39,860 crore. ITC's board has prescribed a profit of Rs 5.75 per customary portion of Re 1 each for the monetary year finished 31st March 2019, subject to the imperative endorsement, which will be paid on July 16, 2019.

In a different advancement, the organization delegated Sanjiv Puri, Managing Director, as the Chairman of the Company with impact from May 13, 2019. Puri's advancement comes after YC Deveshwar, ITC's longest-serving Chairman, passed away on Saturday. Thus, Puri's new assignment is Chairman and Managing Director of the organization. Following profit declaration, portions of ITC declined in negative territory to exchange at Rs 288.50 each, down 3.09% on the BSE.

ITC ltd. is a leading FMCG Company in India and for the last three consecutive years, it has shown accelerated growth in the FMCG portfolio. ITC has placed itself successfully as a market leader in various verticals and will continue to dominate through several brands.

What is ITC Limited?

ITC Limited is an Indian global aggregate organization headquartered in Kolkata, West Bengal. It has a diversified presence across industries such as cigarettes, FMCG, hotels, packaging, paperboards and speciality papers and agribusiness.

What is the main business of ITC?

ITC Limited is an Indian conglomerate with diversified businesses in Fast Moving Consumer Goods comprising foods, personal care, cigarettes, apparel, stationery products, incense sticks, safety matches, hotels, packaging and others.

Which brands are under ITC?

• Foods - Aashirvaad, Sunfeast, Candyman, Bingo, Yippee.
• Personal Care - Essenza Di Wills, Fiama Di Wills, Vivel Di Wills, Vivel, and Superia.
• Lifestyle - Wills Lifestyle, John Players, and Miss Players.
• Stationery - Classmate, Paperkraft.
• Matches & Agarbatti - AIM, Mangaldeep, Homelites.

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• Open source marketing: Camel cigarette brand marketing in the “Web 2.0” world
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• B Freeman ,
• School of Public Health, University of Sydney, Australia
• B Freeman, 129A School of Public Health (A27), University of Sydney, New South Wales 2006, Australia; bfreeman{at}health.usyd.edu.au

Background: The international trend towards comprehensive bans on tobacco advertising has seen the tobacco industry become increasingly innovative in its approach to marketing. Further fuelling this innovation is the rapid evolution and accessibility of web-based technology. The internet, as a relatively unregulated marketing environment, provides many opportunities for tobacco companies to pursue their promotional ambitions.

Methods: In this paper, “open source marketing” is considered as a vehicle that has been appropriated by the tobacco industry, through a case study of efforts to design the packaging for the Camel Signature Blends range of cigarettes. Four sources are used to explore this case study including a marketing literature search, a web-based content search via the Google search engine, interviews with advertising trade informants and an analysis of the Camel brand website.

Results: RJ Reynolds (RJR) has proven to be particularly innovative in designing cigarette packaging. RJR engaged with thousands of consumers through their Camel brand website to design four new cigarette flavours and packages. While the Camel Signature Blends packaging designs were subsequently modified for the retail market due to problems arising with their cartoon-like imagery, important lessons arise on how the internet blurs the line between marketing and market research.

Conclusions: Open source marketing has the potential to exploit advertising ban loopholes and stretch legal definitions in order to generate positive word of mouth about tobacco products. There are also lessons in the open source marketing movement for more effective tobacco control measures including interactive social marketing campaigns and requiring plain packaging of tobacco products.

https://doi.org/10.1136/tc.2008.027375

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Tobacco advertising bans and technological innovations have prompted major changes to the ways in which tobacco companies approach the marketing and promotion of their brands. In a growing number of nations, orthodox “above the line” advertising options (essentially advertising in the mass media) 1 have been closed by tobacco advertising legislation. This same fate awaits tobacco advertising in 161 nations that have now ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC). 2 Article 13 of the FCTC requires ratifying nations to undertake a complete ban on tobacco advertising and promotion, which is broadly defined as “any form of commercial communication, recommendation or action with the aim, effect or likely effect of promoting a tobacco product or tobacco use either directly or indirectly”, unless prevented from doing so by their constitution. 3 The tobacco industry has developed innovative solutions to keep tobacco product brands in the front of consumers’ minds.

These seismic changes have positioned the cigarette package as the cornerstone of tobacco company marketing plans. 4 While eye-catching packaging is an important element of advertising for many consumer goods, cigarette packages are unique in that they are continuously handled by smokers and often left out in public view on bar and restaurant tables. 5 Metallic finishes, 6 eye-catching colours, 7 novel shapes, 8 special editions, 9 split packs, 10 and collector tins 11 have all been used to attract consumers to tobacco products.

The 2008 US National Cancer Institute (NCI) monograph on the role of the media in promoting and preventing tobacco use highlights the lack of research in the area of internet-based tobacco advertising and promotion. 12 The internet, as a relatively unregulated marketing environment, provides many opportunities for tobacco companies to pursue their promotional ambitions and to exploit the unprecedented opportunities that interactive cyberspace provides to marketers. 13 The internet provides a continually evolving range of technologically innovative opportunities for tobacco companies to keep favourable associations with smoking and particular brands in consumers’ minds. In this paper, we consider “open source marketing” as a vehicle that has been appropriated by the tobacco industry, through a case study of efforts to design the packaging for the Camel Signature Blends range of cigarettes. We use four sources to explore this case study including a marketing literature search, a web-based content search via the Google search engine ( http://www.google.com ), interviews with advertising trade informants and an analysis of the Camel brand website. While the Camel Signature Blends packaging designs were subsequently modified for the retail market due to problems arising with their cartoon-like imagery, important lessons arise on how the internet blurs the line between marketing and market research.

Open source marketing

The term “open source” originated in the field of computer software development where those developing software sought to make program designs transparent and to utilise the collective intelligence of other internet users to develop and refine the software. 14 The end product is a collaboration between the producer and the users of the software. The popular Firefox 15 web browser is an example of open source software that also utilised marketing volunteers to then publicise the availability and merits of the program. No one was paid to develop nor market the product. 16 As the worldwide web has evolved beyond being simply a means to retrieve information provided by experts and interest groups, to become a fully interactive platform where users/consumers generate the bulk of the online content, “open source” has come to be more broadly applied.

This fundamental re-orientation to “Web 2.0”, whereby the worldwide web is now a place to both find and contribute material, 17 has provided unprecedented opportunities for companies to engage with consumers in product and brand development. The key to understanding the importance of Web 2.0 in open source marketing is the ease with which consumers and marketers can share, cooperate and cocreate. 14 Utilising typical Web 2.0 tools, companies can implement a range of methods to increase engagement with consumers. Strategies may include hosting blogs where consumers can talk about the product, encouraging consumers to make their own advertisements and to post them on video sharing websites, or developing social forums where consumers can design their own packaging and compare and share their design with other consumers. 18 A social media expert explains, there are “potentially thousands or even millions of people who are willing to tell you what they think…It’s not going to cost you anything, and what you get out of it will be tremendously valuable”. 19

Given advances in the accessibility of digital video production and sharing, consumers have been known to create their own advertising messages, regardless of whether a company formally engages in open source marketing. For example, in 2006 the credit card company MasterCard noticed that consumers were making their own versions of their international television advertisement “Priceless” 20 and sharing them through popular websites. MasterCard decided to capitalise on this free promotion and encouraged people to submit their versions of the advert through the MasterCard website. The company agreed to post the best examples on the official MasterCard website. No prizes or incentives of any kind were offered, and yet the company received more than 100 000 entries. Companies fully engaged in open source marketing can co-opt this free material to extend brand attributes. 21

It may seem that open source marketing is little more than conducting large-scale focus groups over the internet. However, open source marketing puts more control in the hands of the consumer than traditional focus groups. For example, one market research company has developed an online survey tool that measures consumer preferences through a step-by-step approach to package design. Each survey participant builds a design based on their own preferences, as opposed to only giving feedback on a predetermined set of options developed by the marketing or design team. 22

Companies can be reluctant to fully engage in open source marketing as the very real possibility exists that consumers will post overly negative and abusive comments about the product or satirise product attributes. This may be particularly true for tobacco products, given the success of tobacco industry denormalisation efforts and the often volatile emotions brought to the discussion of smoking. 23 However, marketers insist it is how a company responds to negative feedback, as opposed to the negative feedback itself, which matters. According to social media commentators, “the blogosphere is a very forgiving community. People will quickly let bygones be bygones”. 19

As part of their open source marketing plans, companies are encouraged to interact with their consumers’ blogs and post their own comments and feedback on the consumer-generated content. The social media consortium, Every Dot Counts, has published a guide for companies on how to interact and effectively track bloggers, particularly those who have criticised a company. 24 A key piece of advice is to post the webpage link to the company website so other commentators can easily see the company side of the argument. Following this advice, Philip Morris (PM) could post a sympathetic comment on a smoker’s blog who was discussing her dislike of the graphic health warnings on her cigarette package and how it was turning her off of smoking. The smoker could even be encouraged to visit the quit smoking section of the PM website as a sign of their corporate social responsibility. 25

Open source marketing case study: Camel and Camel Signature Blends

Marketers often maintain that the “brands that break through are the ones that engage consumers” 22 and that the internet has made it easier to engage consumers by allowing them to contribute directly to marketing campaigns and brand development. RJ Reynolds (RJR) has a history of engaging consumers in product design and encouraging them to spread positive word of mouth about their products. 13 RJR has embraced these concepts by opening up its marketing processes to brand the Camel and Camel Signature Blends cigarettes. 26

Methodology

We employed a case study approach to better understand how and why RJR has used open source marketing techniques to promote Camel and Camel Signature Series cigarettes. Two related events led us to employ this approach. First, a 12 February 2008 Google blog alert for “package cigarette marketing” notified us that RJR was using open source techniques to redesign Camel cigarette packaging. 27 Google alerts are daily email updates of the latest relevant Google results (web, news, etc.) based on one’s choice of query or topic. 28 Selections can be made from the following types of media: blogs, news, video, groups, web, or a comprehensive summary of all types. Typical uses of Google alerts include: monitoring a developing news story, keeping abreast of a competitor or industry, getting the latest information on a celebrity or event, or keeping tabs on a favourite sports team. However, alerts are useful tools to track newly-published research and public discourse on health issues. Second, two informants sent us a copy of a marketing presentation by a brand management company that had assisted RJR in developing their open source campaigns.

Case study approaches focus on research questions that primarily ask “how and why” and are best suited for studying current or recent events. It is also a useful approach when studying a contemporary phenomenon in its real-life context, which in our paper means exploring the way users of the internet are engaging with a tobacco company. Case studies rely on direct observation of the events and often involve interviews with the subjects. 29 Interviewing the tobacco industry and their marketing partners for this particular case is impractical given it is not in the industry’s best interest to fully cooperate with tobacco control researchers. 30

Another unique aspect of case study design is the collection of multiple sources of evidence in order to triangulate data and build a fuller picture of the phenomenon being studied. 29 31 After we received the Google alert and the presentation from the informants, we formulated our data collection strategies, which included a literature search, interviews with the informants, an online search using the popular international search engine Google and a content analysis of the Google search results and the Camel brand website. Our findings from the interviews were validated by each of the two informants

Finally, a case study provides researchers with the opportunity to reflect, review and consider what findings could mean. 32 Given the recentness of the events we have investigated, it is not possible to fully examine the impact of RJR’s activities. While this case study is primarily an intrinsic investigation, our data analysis reflects on what the broader implications of RJR’s plans could mean for future marketing initiatives and how they may impact future tobacco control measures.

RJR has proven to be particularly innovative in designing cigarette packaging. The RJR Camel brand has recently come under public scrutiny for the packaging of its sister product, Camel No 9. 33 With its sleek hot pink and black box, the packaging has obvious appeal to young fashion-conscious women. 34 During 2007, print advertising campaigns in popular US women’s magazines featured the highly stylised packaging.

A 12 February 2008 Google blog alert for “package cigarette marketing” first notified us that RJR was using open source techniques to redesign Camel cigarette packaging. 27 The blog Without Warning 27 documented RJR’s marketing scheme of mailing elaborately packaged empty Camel cigarette boxes to individuals the company claimed were adult smokers. The material emphasised that this cigarette is “all in a smooth-looking, new pack voted on by thousands of loyal adult smokers”. This claim suggests the vital role that packaging plays in cigarette promotions, but also that RJR has engaged their consumer base to modernise the Camel brand. Modernising the brand is a key part of the Camel marketing strategy to attract new consumers and retain existing ones. 35

A promotional video on the Camel website 36 confirms that the packaging change was the “first major pack change in 94 years” and that “5 million adult smokers were invited to offer their input”. The video thanks smokers for their help in designing a “cleaner and more prominent” package and cheerfully concludes by telling viewers to “enjoy your smokes”. Interestingly, consumer feedback on the way the new packaging redesign was promoted to smokers was overwhelmingly negative, due to the excessive use of paper and cardboard within the mailed package. For example, videos decrying the amount of packaging used can be viewed on YouTube. 37 RJR posted an apology to consumers on their website, which reads in part:

“[Y]ou’ve told us that we could have used less paper communicating it to you. We’re listening and are committed to exploring ways and opportunities on how we can become more environmentally friendly. Moving forward, we’re going to make sure that our use of materials is better balanced to reduce waste”.

A search of the health (through search engine PubMed) and marketing (through search engine Business Source Premier (BSP)) literature for the terms “camel and marketing” generated 35 papers (PubMed) and 123 papers (BSP). There were 2 articles that appeared in both searches from a total of 156 unique papers. Only one marketing trade publication item mentioned the open source techniques RJR was using to promote the Camel brand. 26

The 2007 news item from the marketing trade journal Brandweek describes RJR’s success in using open source to market the Camel brand variant, Camel Signature Blends cigarettes. The author suggests the marketing habits of tobacco companies have changed as “the formerly secretive RJ Reynolds, for instance, has embraced [transparency] by opening up its marketing research process to net a new cigarette, Camel Signature”. 26 Smokers were recruited to rate and propose pack designs and logos. The project, which was initially targeted to engage 6000 people, netted 30 000 participants and resulted in 4 new flavours with eye-catching package designs ( fig 1 ) being introduced onto the market. These four flavour and package variants were dubbed Frost, Mellow, Robust and Infused. The cigarettes contain a small bead in the filter that delivers the unique flavours.

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Open source package designs for the Camel Signature Blends. From left to right: Frost, Infused, Robust and Mellow. Source: http://www.camelsite.com/signature/SignatureThanks.aspx .

We were unable to independently verify, or analyse the profile characteristics, of the reported 30 000 participants in the open source campaign. Regular internet users, and in particular users who are most likely to generate their own unique content, tend to be younger in age. 38 A 2007 study on the personality profile of people who are likely to blog online found that bloggers have a high degree of “openness” and thus are likely to be creative, open to new experiences and have a diversity of interests. 39 It would seem a successful open source marketing campaign would attract young and creative internet users.

Open source marketing presentation by Passport Design

We met two informants, A and B, who had attended an open source marketing presentation in Sydney in March 2008 given by the brand design agency, Passport. (The website is currently undergoing a redesign and is limited in content to contact information and visuals of their client brands. http://www.passportdsn.com.au/index.html .) Both informants are sales and market analysts for a consumer good company. Passport has offices in Melbourne and Sydney, Australia and Connecticut, USA. One of the open source marketing accounts the Passport presenter described as managing was the successful package design for the RJR Camel and Camel Signature Blends cigarettes. The open source campaigns were targeted at the US market, but as Camel is an international brand, the new package design will be part of RJR’s global marketing efforts. Following the presentation, the presentation slides were made available to participants through a secure website link, however the RJR content had been subsequently removed from the presentation. The informants provided us with an account of what they had seen at the presentation and a hard copy of the edited presentation slides. 40

The presentation begins with key points on the direction and importance of open source marketing. (Copies of the presentation can be made available by an email request to the corresponding author.) Open source marketing is defined as the “co-collaboration[sic] of products and services between consumers and brand owners”. The presenter confirms the importance of the internet in this new way of engaging with consumers: “technology growth has ensured that one-way communication platforms are no longer satisfactory”. The presentation suggests that “building brand awareness is no longer our biggest challenge…engagement is” and that because “consumers no longer trust brand owners or big organisations” open source marketing will help companies to “build trust by being completely transparent”. Of particular importance to tobacco control is the presenter’s claim that “packing is the only true connection a brand has with its consumers”.

The presentation then clarifies why collaboration is essential in brand development and provides examples of how a company can successfully collaborate with consumers. “Providing our co-collaborators [sic] with high level direction is the first step to participation, as we then enjoy watching communities create and innovate in ways that enlarge and enrich the brand into the future”. Detailed examples in the presentation include Jones Soda, Bazooka Bubble Gum and the missing Camel Signature Blends. Also included is a general listing of other well known corporations that employ open source techniques: Coca-Cola, General Electric, Volkswagen, Mercedes Benz and Nike.

Informant A commented that the presenter said that the reason Camel was launching the Signature Blends was because they had “lost a lot of market share, and they needed to reignite the brand and attract smokers – young adult females especially”. Given this desired target market, they thought the best way to market to them successfully was “to engage with them using technology, the internet”. The project was described as a “massive success – really resurrected the brand”. According to the RJR website, Camel is the third best-selling cigarette brand in the US and the “largest and fastest-growing full-price brand and has a track record of consistent share growth and marketplace momentum”. 41 RJR also reported that during the first quarter of 2008, Camel gained 0.5 share points. 42 This success is attributed to updated packaging and brand extension innovations such as Camel No. 9 and Camel Signature Blends.

Both informants noted that the presenter emphasised that RJR allowed the design agency to have total control over the process of engaging with consumers through designated websites and blogs and that they agreed they were committed to being “accountable” to what the consumer wanted. Informant B quoted the presenter as stating that she “really liked working with the tobacco companies because of the opportunity and need to be innovative – given the continuously changing legislation about what they [the tobacco industry] are allowed to do”.

The focus of the open source collaboration was primarily on the packaging design and flavours. Consumers were directed to the Camel brand website and blog, where they could discuss package design and vote on what they wanted to see as a final concept. When the final designs were chosen, participants were mailed samples of the cigarette boxes that included people’s names on them. Informant B said that, “if a design was chosen by say “Jim from New Jersey” they printed that right on the box – to personalise it and show that Camel had listened and chosen what actual real people had asked for”.

Online search for evidence of open source marketing and Camel Signature Blends

On 4 June 2008 the search term “camel signature” was entered on Google. The first 50 results are summarised in table 1 . Of the first 50 webpage links, 19 contained content relating to Camel Signature Blends; 15 of the 19 links were product reviews or other commentary about the cigarette. The first four search results were for product reviews. This is significant as the higher the results are in a search list the more likely they are to be clicked on by users and the more relevant they are deemed to be by the user. 43 Only two anti-smoking links were returned, despite current advocacy campaigns in the US to ban all flavoured cigarettes. 44 45 The remaining two relevant links were for Camel-branded items that were available for purchase.

• View inline

One of the review links 46 included a video review of a young male smoker tasting the Robust flavour. He describes it is a “thick and heavy” taste and awarded it 1.5 thumbs up out of 2. In all, 28 others had commented on his review, agreeing with his review or recommending the three other Signature Blend flavours. Other review links 47 contain similar dialogue about the relative merits of the taste, the eye-catching packaging and the “mystery” of the flavour beads.

Another of the review links was related to a question on the Yahoo! Answers forum, which asked, “Camel signature blend cigarettes? 4 new flavors frost, infused, robust, mellow. does anyone know what those mean for flavors, and when they come out thanks”. This question was answered by a user identified only as “camelsmoker” with the following response:

“Infused: Spiced up with a silky-smooth finish Frost: Crisp and bright with finest Asian mint providing a crisp clean taste Mellow: CAMEL’s classic blend of Turkish tobacco is accented with toasted honey, giving it a sweet and velvety smooth finish with a hint of cedar Robust: Hearty and burly blended with delicate Turkish notes and a nutty, full finish They will hit stores near the end of April”. 48

While it is not possible to verify who “camelsmoker” is, it is entirely possible that either an RJR or marketing agency employee who was monitoring blog activity of the Camel brand seized the opportunity to promote the products.

Unfortunately, we were not alerted to the open source marketing project until it had completed, so we are unable to provide a description of the Camel website during the actual collaboration process. The Camel website now reveals that despite the apparent success of the open source marketing efforts to design the new Signature cigarettes and packages, RJR are not “able to continue with this program and will not be going to market with the artist generated pack designs for Signature Blends. The Signature Blends will still be available at retail stores”. No explanation is offered, but images of the open source designed packs still appear above the vague announcement. The probable explanation for this abrupt change in plans is that the US National Association of Attorneys General (NAAG) had identified the design of the Signature packs as being in potential violation of the Master Settlement Agreement in that the packages contain “cartoon-like depictions”. 49 NAAG also highlights that the promotion is of “further concern to the extent it entices individuals to RJR’s interactive website, which invites visitors to vote for their favourite Signature Blends and to participate in other online games and promotions that would appear to appeal to youth and very young adults”. 49

While the NAAG appear to have successfully prevented the novel packaging, if the not the actual product, from continued distribution, the interactive website and open source marketing techniques are still being used on the website for Camel’s latest product launch, the Camel Crush cigarette. The website describes the Camel Crush cigarette as “a unique tobacco technology, allowing adult tobacco consumers to smoke a non-menthol product and at any point, squeeze the filter to change the taste experience to menthol”. The “Open Circle” forum on the Camel brand website features an interactive discussion board and question and answer forum.

Implications for tobacco control

“Powerful things come from the street, from the people who use the product. The internet has thrown open the door to consumers seeking opportunities to show off heretofore hidden talents, whether that be as a citizen journalist/blogger, photographer or even marketer”. 22

Regulating online advertising

Against the broad definition of advertising and the comprehensiveness of the advertising ban required by FCTC signatories, 3 it is critical to ask whether open source marketing should be considered a “commercial” communication and therefore also be banned. In the case study we have described, consumers themselves have designed the marketing and packaging messages. The tobacco industry could argue that open source marketing is nothing more than legitimate market research being conducted through internet platforms rather than the traditional avenues of focus groups or telephone surveys. The industry has a track record of attempting to disguise marketing as market research through cigarette giveaways and sampling 50 51 and to skirt marketing laws at special industry invite-only events. 52 Open source marketing bears these same hallmarks of exploiting loopholes and stretching legal definitions in order to generate positive word of mouth about their products. When designing regulations to ban advertising of tobacco products, the marketing processes, in this case engaging with consumers on a massive scale to develop products, appear as important as the actual physical hallmarks of marketing, such as the package or an online advertisement.

RJR was careful to implement their consumer engagement through password-protected websites and blogs (although we readily obtained a password without ever having to prove our identity or age), where it could be easily monitored by the company and less readily by the tobacco control sector. Regulation that requires reporting on specific marketing activities and provides regulators with open access to these sites could assist in monitoring these initiatives.

When users register on the Camel website, they can elect to receive electronic newsletters and product offers. This enables RJR to grow a database of users that they can continue to communicate with and engage in open source marketing. In a March 2008 speech to investors, incoming Altria Chairman and Chief Executive Officer, Michael Szymanczyk, revealed that Philip Morris USA also has an extensive consumer database that is being used “to create one-to-one relationships with adult tobacco consumers”. He reported that this database contains the information of over 25 million adult cigarette smokers and will be used to “support expansion into other products that are appealing to adult tobacco consumers”. 53 It appears that Altria is also well positioned to pursue open source marketing techniques.

What this paper adds

This is the first tobacco control research paper to document the use of open source marketing in tobacco advertising. Open source marketing is a new phenomenon that links consumers, manufacturers and advertisers through web-based channels.

Many tobacco advertising bans do not currently consider the role of consumers in generating and sharing marketing materials.

Social marketing

There are also lessons in the open source marketing movement for more effective tobacco control social marketing campaigns. Social marketing expert, Gerard Hastings, is firm that the health sector must learn from and use the same marketing tools as industry: “the success of the tobacco, alcohol and food industries provides a rich stream of evidence that marketing works. If marketing can make us buy a Ferrari it can also encourage us to drive it safely”. 54 Companies have encouraged an open two-way dialogue about their brand and made advertising campaign elements (video clips, music) available to consumers for their own manipulation. However, the same cannot be said for tobacco control. The California Department of Public Health has taken a step in this direction by holding a contest where members of the public made their own anti-smoking ads and the best one was aired on television (see the website: http://www.beareelhero.com/ ). If consumers are indeed “no longer interested in being told what to buy or what to think”, social marketing campaigns must also respond in a way that enables greater audience involvement.

The successful Australian “Every Cigarette Is doing You Damage” campaign 55 exemplifies an ideal contender for greater consumer engagement. Most Australians are familiar with this campaign and have an opinion on the provocative content. 56 Consumers could be encouraged to propose and vote on which smoking illness should be featured next. A deeper level of engagement would see consumers producing their own forms of the ads and sharing the content with others. Moderating and mediating discussion boards and blogs could be shared among quit line counsellors and community health promoters. While fear of the ads being parodied or criticised heavily may concern the government agencies that fund these ads, the benefits of continued consumer engagement with the campaign could outstrip any negative commentary. In the future, tobacco control, just like the for-profit sector, will need to recognise that successful campaigns and brands are ones that consumers want to join. 57

Plain packaging

The Camel Signature Blend case study provides further evidence for the primacy of packaging in branding and marketing and that the plain packaging of cigarette products must become a global tobacco control priority. Without stylised packaging, the key elements of open source marketing, including brand identity and brand engagement, would be profoundly limited. Without brand imagery manifest through packaging, consumers are left with very little, save the brand name, to identify and engage with.

This case study provides an example of how the internet and increased consumer engagement is being used to promote Camel cigarettes. Ongoing monitoring of this trend and investigation of other tobacco company online marketing techniques is necessary in order to ensure tobacco control policies remain effective.

Acknowledgments

We thank the two informants who shared invaluable information from the open source presentation. We also thank the excellent comments provided by our three reviewers, Rick Pollay, Timothy Dewhirst and Pam Ling.

• ↵ World Health Organization . Full list of signatories and parties to the WHO Framework Convention on Tobacco Control. http://www.who.int/fctc/signatories_parties/en/index.html (accessed 22 June 2008) .
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• ↵ National Cancer Institute . The Role of the Media in Promoting and Reducing Tobacco Use . Tobacco Control Monograph No. 19. Bethesda, Maryland, USA : US Department of Health and Human Services, National Institutes of Health, National Cancer Institute , 2008 .
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• ↵ Mozilla . Firefox. http://www.mozilla.com/en-US/firefox/ (accessed 25 August 2008) .
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• ↵ Coca Cola Corporation . Design your own Coke bottle. http://www.mycoke.com (accessed 25 August 2008) .
• ↵ Mastercard . Examples of “Priceless” ads designed by consumers. http://www.priceless.com/us/personal/en/pricelesstv/ (accessed 25 August 2008) .
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• ↵ Every Dot Connects . Negative product review revised after company founder engages with critic. http://everydotconnects.com/wordpress/wp-content/uploads/2008/05/casestudy-babblesoft.pdf (accessed 4 May 2008) .
• ↵ Philip Morris . QuitAssist . http://www2.pmusa.com/en/quitassist/index.asp (accessed 22 June 2008) .
• ↵ Without warning . Your lungs are not important. http://without-warning.blogspot.com/2008/02/your-lungs-are-not-important.html (accessed 10 May 2008) .
• ↵ Google . Google alerts can be created and managed through the website. http://www.google.com/alerts (accessed 25 August 2008) .
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• ↵ RJ Reynolds . Camel Smokes. http://www.camelsmokes.com (accessed 25 August 2008) .
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• ↵ Passport . Passionate about brand design. Sydney, Australia: Passport , 2008 .
• ↵ RJ Reynolds . Brand portfolio. http://www.rjrt.com/company/brandsPortfolio.asp (accessed 19 August 2008) .
• ↵ PR Newswire . RAI CEO: ‘Returning Value in a Challenging Time’. http://news.moneycentral.msn.com/provider/providerarticle.aspx?feed = PR&date = 20080430&id = 8564306 (accessed 19 August 2008) .
• ↵ Campaign for Tobacco-Free Kids . New Generation of tobacco products threatens efforts to reduce tobacco use, save lives in U.S., report warns. Press office release. http://www.tobaccofreekids.org/Script/DisplayPressRelease.php3?Display = 1062 (accessed 20 July 2008) .
• ↵ Sillyreviews . com. Camel Signature Blends review. http://www.sillyreviews.com/cigarettes/camel-signature-blends-robust-flavor-cigarettes-review-with-video/ (accessed 25 August 2008) .
• ↵ Associated Content . Other Camel Signature reviews available. http://www.associatedcontent.com/image/112203/index.html?cat = 7 (accessed 25 August 2008) .
• ↵ Yahoo! Answers . Camel Signature Blend cigarettes? http://answers.yahoo.com/question/index?qid = 20070408172824AAjKysw (accessed 4 June 2008) .
• Szymanczyk M
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Funding: This paper was supported by grant 396402, funded by The National Health and Medical Research Council, Australia on the future of tobacco control.

Competing interests: None.

Linked Articles

• Editorial New directions in tobacco promotion and brand communication Timothy Dewhirst Tobacco Control 2009; 18 161-162 Published Online First: 22 May 2009. doi: 10.1136/tc.2009.029595

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MediaMarktSaturn Germany

From gaming PCs, coffee machines, washing machines, and beyond, people shop at mediamarkt.de for great products and deals. The goal was to activate a new incremental performance display channel to maintain high efficiency at scale and improve ROAS. That’s why the team decided to work with Microsoft Advertising.

The solution

Remarketing combined with Microsoft’s audience intelligence is driving high-quality traffic and user engagement delivering incremental revenue at scale.

• After successful test in Summer 2023 agency and the client decided to incorporate feed-based audience campaign as an evergreen approach for the holiday season. Because the feed-based campaign was performing well, client and the agency decided to expand in November and December.
• Audience ads were driving incremental revenue, delivered competitive media KPIs and outperforming other platforms in terms of ROAS.
• MediaMarktSaturn Brand resonated extremely well with Microsoft tech savvy audience and the workday consumer browsing and shopping on Microsoft properties like: Microsoft Start, Edge and Outlook.

To achieve high efficiency at scale and improve ROAS, the team created a remarketing campaign that leveraged Microsoft’s audience intelligence, and:

• Incorporated a feed-based audience campaign for the holiday season.
• Included Audience ads to drive incremental revenue, deliver competitive media KPIs and outperform ROAS compared to other platforms.

"With Microsoft, we were able to reach very engaged audiences."

— Elke Fuchs, Teamlead Digital Paid Media, MediaMarktSaturn

The results

The MediaMarkt Campaign resonated extremely well with tech savvy Microsoft audiences—in fact, the Microsoft Audience Campaign delivered a 23x higher ROAS compared to other campaigns. The precise targeting approach combined with the Microsoft audience intelligence consistently delivered high-quality traffic, which was well monetized. The conversion rate on the Microsoft feed-based campaign was 26x higher compared to other campaigns.

Competitive bids and easy to implement campaign setup empowered the MediaMarkt team to achieve more volume than anticipated. With the Microsoft feed-based audience campaign, MediaMarkt generated a 14x higher revenue within the October through December campaign timeframe.

With the incredible success of this initiative, MediaMarkt will continue optimizing their performance campaigns. In the near future, MediaMarkt also plans to take advantage of Microsoft’s omni-channel, multi format solutions across the entire customer journey.

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Why Tipping Is Everywhere

In the united states, many say tipping is expected in more places these days. here’s how tipping culture exploded..

This transcript was created using speech recognition software. While it has been reviewed by human transcribers, it may contain errors. Please review the episode audio before quoting from this transcript and email [email protected] with any questions.

Hello. Excuse me?

My name is Sabrina. This is Claire. We’re journalists. Could we ask you a question?

You just did.

[LAUGHS]: Another one. [UPBEAT MUSIC]

What is your view of tipping?

I think it’s become excessive. Whatever they do, they got that jar and they’re wanting you to put a tip in there.

They have the iPad. And it’s like, all right, how much you want to tip? And it’s like you bought a $5 coffee. It’s like, all right, well, tip $3.

There’s a lot of pressure. You feel like you have to tip. And I feel like people are watching you at that moment.

Yeah, yeah. I feel a lot more pressure to tip more. Wages haven’t kept up, so I feel like I should be tipping more. And it’s annoying because my wages haven’t gone up either, so it’s annoying.

The other day I just bought a loaf of bread, and the tip thing came up, gave me the option of 15 percent or 20 percent. Do I really have to tip somebody to buy a loaf of bread?

I went to the self-service machine. And it was like, add a tip. And it’s like add a tip for what? I’m the one that did the work, you know what I’m saying?

You’re like, I should be tipping myself.

I actually am a tip worker. We’re literally paid less wages in order for the customers to pay us.

What do tips mean for you and your work?

It’s how I feed my family.

Yes. 100 percent.

Unless you work in the service industry, you don’t really understand how crucial tipping is.

Tips mean a lot. They are 60 percent, 50 percent of my paycheck. And my hourly is pretty low to begin with.

Whatever I get at the end of the night goes towards dinner. Or for example, I didn’t have money for sanitary pads one time. And then that tip, grabbed it.

I feel like a lot of people feel like you did nothing for me. You just put a cup on the counter and I took it. Like, why should I pay you extra for that?

What do you say to someone who says that? You didn’t do anything, you just put my food in a bag.

If you knew what my paycheck looked every week, you would think different. Or maybe not, maybe you don’t feel bad for me and you’re like, get a different job. But like, this is a job I’m good at and the job I like. And I’d like to be able to make a living off of it. That extra dollar or two really makes a difference.

From “The New York Times,” I’m Sabrina Tavernise and this is “The Daily.”

Tipping, once contained to certain corners of the economy, has exploded, creating confusion and angst and now even becoming an issue in the presidential campaign. Today, economics reporter, Ben Casselman, cracks open the mystery of this new era of tipping.

It’s Thursday, August 29.

So Sabrina.

Can I ask you a personal question?

What is your philosophy on tipping?

[LAUGHS]: Exactly.

Sabrina, I think I’m a sucker. Look, I’ve always tried to be a good tipper in restaurants. It feels like part of the deal.

I worked as a waitress for many years. That was the only way I actually made money. If there’s no tip, there’s no salary. Restaurants, it’s a rule.

Absolutely. But now tipping is everywhere. You see these tip screens in places you never would have tipped before. I mean, never mind the coffee shop, you see it at the fast food place. You see it at the oil change place. I’ve heard stories of people seeing it at the self-checkout line. Who’s even getting that tip?

And every time a tip screen pops up, I always tip.

Oh, my god, Ben, so do I.

It’s totally irrational. I hate it. But there’s some part of me, and I don’t love this about myself, that is just convinced somebody is going to be sitting there judging me or I’m terrified that they’re going to. And, oh, my god, if I click No Tip, am I a bad person?

And someone behind me in line might see that.

I can’t click that No Tip button.

I am exactly the same. Every single time I’m presented with this iPad screen thingy, the tips come up. I press max, 30 percent. My husband, an economist, thinks this is ridiculous.

He says, you’re tipping 30 percent on a bottle of water someone just handed you. Don’t do that. That is crazy. But I keep doing it because I can, so I should. I don’t know, I have guilt about it.

Your husband is objectively correct. This is crazy. But tipping is not about objective cold economic logic. It’s emotional. It’s cultural.

There are norms around it. And right now, we have no idea what those norms are. And so we’re all stuck in this panicked moment of trying to decide which button you press and whether you should be expected to tip in this circumstance.

OK, so we are both suckers. We’ve established that. What we need to do now is figure out this panicked moment. I want you to explain this to me, Ben. Why has tipping exploded?

I think there are three reasons. The first of these is just technology. Several years ago, we started to see these tablet-based checkout systems everywhere. And it’s very easy to just add a tip screen onto there, that little, do you want to add a tip, 10 percent, 15 percent, 20 percent.

Right. And as I had less cash and then no cash in my wallet, this was always the way I paid for things.

Yeah, so it became very easy technologically to add tipping. But then the real shift came in the pandemic.

If you think back to that moment, many of us were lucky enough to be able to work from home and to be relatively safe. And we felt a lot of gratitude for the people who weren’t able to do that, who were bringing us food and delivering groceries. And so there was an explosion in tipping. And an explosion in tipping, even in places where we didn’t used to tip.

If you go and pick up takeout at a restaurant, you probably always tip your delivery driver. But if you went to the restaurant and you picked it up, you didn’t tip there. But now in the pandemic moment, they add a tip screen saying, would you like to tip? And yeah, of course, I’d like to tip. These people are risking their lives out there to make my chicken tikka masala.

Right. You basically wanted to tip the UPS guy.

Yes. And so we were tipping everybody. And so that allowed tipping to spread into these new areas. It got a beachhead in places where it didn’t used to be.

And maybe if the story ended there, it would have been this moment in time and then it all would have gone back to the way it always used to be. But that didn’t happen because we had this intense worker shortage when things started to reopen.

And how does that fit into this?

Businesses start to reopen. They need workers. They’re having a hard time finding them. Workers are reluctant to come back for all sorts of reasons. And tipping became a way of attracting workers.

Businesses were paying more, but they were also looking for other ways to get workers. And saying, we’ll add a tip screen that’ll boost your pay further. And if there’s one coffee shop where there’s a tip screen and there’s another coffee shop where there isn’t, you can be pretty sure which one you’re going to go work at.

Completely. I mean, we were talking to workers yesterday, and they were very specific about which chain stores allowed tips and which ones didn’t. And they much preferred working for the ones that allowed tips. I mean, it makes sense.

And I asked them, as a proportion of your earnings, how much are tips? Tips are a lot. Does that mean you make less in the place that doesn’t have the screen that allows it? Absolutely.

We saw workers demanding this. In fact, when some Starbucks stores were unionizing, one of the things they demand is, we want to be able to take tips on credit card payments.

Interesting, yeah.

This became a source of negotiation between businesses and their workers. And the thing is, once that happens, it’s really hard to put the genie back in the bottle.

But why? I mean, this all sprung up into our lives in the matter of a couple of years. So why can’t it go back to the way it was just as quickly?

Imagine that coffee shop worker that you were talking to yesterday, who’s now making, in many cases, 20 percent, 30 percent, even 40 percent of their earnings in tips. The business can’t just say, never mind, we’re going to get rid of the tip screen. Maybe, we’ll put out a tip jar and people can leave $1 or $2 when they want to. That’s a huge pay cut for that worker.

OK, they could instead say we’re going to get rid of tipping and we’re going to raise your pay. Instead of paying you $15 an hour and $5 in tips, we’ll give you $20 an hour. But now the business is going have to raise prices as a result.

And you, Sabrina, the coffee-drinking public are going to say, no way, I’m not going there and paying $8 for my latte or whatever the price may be. And so for the business, they can’t just get rid of the tip, because they can’t just cut off the pay and they can’t raise prices enough to raise pay accordingly.

Right. Nonstarter for the business.

Can’t work for them. And the worker is certainly not going to stick around if they try to do that.

So has there been some experimentation with this? I mean, have restaurants actually tried to go tipless?

Yeah, so we’ve seen an example of exactly this. A few years back, Danny Meyer, a big New York restaurateur, and a bunch of other restaurants as well tried getting rid of tipping completely. They said, this system is unfair, it’s unequal. We’re going to raise wages for everybody, for waiters, but also for cooks.

We’re going to raise our prices, accordingly, to pay for that. And customers will understand. They’ll understand that they’re paying the same amount at the end of the day, it just is in the form of a direct cost instead of a cost plus a tip. And it didn’t work.

For a bunch of reasons. But mostly because customers looked at the price on the menu and people didn’t want to pay it. I also think, look, we all complain about tipping. But customers also kind of like the tip. They kind of like looking generous.

You get to show off to your date or to your father-in-law. And, of course, you can, at least in theory, express your dissatisfaction by withholding a tip or by tipping less. Not you and me, we apparently don’t do that. But some people do, I hear.

The restaurant’s like, suckers, OK, great. Yeah, we don’t even have to worry about them.

Customers rebelled against the idea of not tipping. And most of those restaurants eventually went back to the old model.

Interesting. So we do have this love-hate relationship with tipping.

Yes. We hate being asked, but we like the control. And I think that is part of why all these changes feel so difficult for so many people, because it doesn’t necessarily feel like you have the control anymore.

That screen in front of you with the barista watching you, with the person in line behind watching you —

Oh, my gosh, I’m sweating already.

— you don’t feel like can press the No Tip button. Or at least suckers like you and me don’t.

Exactly. The choice is gone.

The choice is gone. Or the choice, at least, is sort of psychologically more taxing.

Right. [LAUGHS]

You feel pressured to do it.

OK, so that’s the customer experience. But with this new uptick in tipping, one question I always have is, is the worker on the other side of the screen getting this tip or will the business owner pocket it?

The worker is getting the tip with some caveats. By law, the business owner or the managers, they can’t take the tips. If you click a Tip button or you leave $1 in the tip jar or you tip in any way, if that ends up in the pockets of the business owner or the general manager or what have you, that is wage theft. It happens. We certainly hear stories about it happening, but it’s certainly not legal and it’s certainly not the norm.

That doesn’t mean that the worker, the person who hands you your latte, is the person getting your dollar. It often gets pooled across all of the workers who are working that shift or even all of the workers who work over an entire week. But it’s going to the workers.

People like us can rest assured that the workers are getting the full benefit of that tip that you’re pushing.

In many ways, what you are doing as the customer is you are subsidizing the wage. If you, you coffee shop worker, want to get $25 an hour, you don’t care whether that’s $20 in pay and $5 in tip or $25 in pay or any breakdown of that.

$25 is $25.

$25 is $25. When I leave a tip of $1, on some level, that’s $1 less that coffee shop has to pay you, the barista. Tips are helping the business pay their workers. They’re shifting. The business is shifting some of the burden for paying its workers off of its revenue onto its customers.

In other words, you and I, Ben, we are kind of helping foot the bill for these wages.

Absolutely. And from the businesses’ perspective, that’s a pretty great deal, because they basically get to charge, say, $4 for the latte and then for the customers who are willing to pay more, they’re basically charging more. Those people throw on the tip.

It’s a way of the business getting the maximum dollars that it can out of the maximum number of customers that it can attract.

But for workers, this system where they’re increasingly reliant on customer tips carries some real risks.

[UPBEAT MUSIC]

We’ll be right back.

Tell me about these risks of our tipping system.

Look, tipping has always had a lot of problems associated with it. If you think in restaurants, they’re often really big pay disparities where the servers at the front of the house, who are getting tipped, often make a lot more money, especially at a nice restaurant, than the cooks and dishwashers and all of the people at the back of the house.

You hear these stories of people going to cooking school and then basically bailing on the cooking career and becoming waitresses and waiters because it’s just more money.

Yeah. And then within tipped occupations, there’s a lot of inequity here. There have been studies that have shown that a pretty young woman gets tipped better than other people, that white people often get tipped better. There are tons of problems around sexual harassment, because if your earnings are dependent on the table that you’re serving liking you, then maybe you put up with things that workers shouldn’t have to put up with.

Those are the problems that have always existed in this system. But then as tipping spreads, the risk is, first, just more workers have to deal with this, but also that more workers become more dependent on tips for their earnings.

In the short term, this has all worked out pretty well for workers. This has been a period where they’ve been in hot demand, and so their wages have been rising. And at the same time, they’ve gotten all these tips on top of that. And that’s been really great.

But it’s not clear that that’s true over the longer term. Over the long run, you could imagine that all of these businesses get to just raise wages more slowly, that tips sort of eat away at wages over time. And then if we ever see customers pull back a little bit, tip less, then all of a sudden, all of these workers could really suffer.

Basically, you’re describing a system in which the earnings are just more vulnerable, more dependent on the kindness of strangers.

Yeah. And more at risk if those strangers become a little less kind.

Yes. And this issue has become so much a part of the national conversation that it’s actually entered the presidential race. Both former President Trump and Vice President Kamala Harris have announced policy plans to help service workers. And essentially, they’re calling for no tax on tips.

Yeah, that’s right. So President Trump announced this several weeks ago as his big new “no taxes on tips” proposal. Kamala Harris followed up and basically endorsed that proposal, again, a little while later. We don’t have a lot of details on how this would work. But essentially, it would mean that if you earn tips, those tips are exempt at least from federal income tax.

What would that mean?

Let me tell you, economists hate this idea. Left-wing economists and right-wing economists, this is one point they can kind of all agree on.

And why do they hate it?

Because they say it’s unfair. It singles out this one group of workers for special treatment. The person who works at McDonald’s who doesn’t get tipped, they don’t benefit from this. The retail worker doesn’t benefit from this. It’s just this one group of workers who get this special treatment where they don’t have to pay taxes.

Right. Right.

But there’s also maybe an even more fundamental issue, which is that if you think you hate tipping now, if these proposals go through, you’re going to see so much more tipping.

Uh-oh, I’m holding on to my hat.

Because it’s basically a subsidy for tips.

As a worker, we said before, you don’t care whether you make, $25 an hour or $20 plus $5 an hour in tips, except that if some of that money isn’t taxed, you want more of that. You want more tips.

Basically, you want your entire salary to be a tip.

Ideally, right? And so that works great for the business perspective. Great, I don’t need to pay my workers.

[LAUGHS]: Wee!

It’s all tips now. Workers happy about that. What that means is you’re going to see more businesses looking for ways to have their workers count as tipped. Maybe you start to see tips in places that we’re not seeing them at all. Maybe you really do start to pay tips at a retail outlet, at a gas station.

Grocery store?

At a grocery store, why not? And the issue there, beyond just it being annoying for you and me, is that it further ingrains this system. All those problems that we were talking about in tipping now involves even more workers across the economy. And they’re even more vulnerable to that possibility that you and I start tipping a little bit less.

Ben, how would you describe where we are in this tipping moment? Is this just the new normal?

I think we’re still in a period of transition here. The fact that we’re having this conversation on some level tells you that we’re not totally in a new normal yet. You don’t leave a restaurant and say to yourself, man, I can’t believe I was asked to tip. But we’re still all the time having this conversation about, you wouldn’t believe I got asked to tip at the self-checkout.

Right. The bakery, for god’s sake.

It’s still a transition. It’s still happening. Over time, norms will develop. We’ll figure out the places where we tip and the places where we don’t, and how much and all of that.

But the dust hasn’t quite settled yet.

It hasn’t settled. But I think what we do know is that we’re not going back. We’re now going back to a world where we only tip in those set of circumstances where we used to. And remember, this whole transition has happened during a period of relative economic strength, when people have had money to go out and spend and to tip. The question is, what happens when that’s no longer true?

Right. When there’s a recession, people are going to be nervous about their pocketbooks and probably won’t be as generous.

Whenever we get to the next recession, it will be the first one in this new era of tipping.

And there’s a whole new group of workers who are going to lose out when that happens, who are dependent on tips and will suffer when customers start pulling those tips back.

Ben, thank you.

Sabrina, thank you so much. And the screen is just going to ask you a couple of questions at the end here.

[LAUGHS]: Ben, 30 percent.

Here’s what else you should know today. On Wednesday, at least 10 Palestinians were killed when hundreds of Israeli troops launched major raids overnight in the occupied West Bank, targeting Palestinian militants, after what Israel said was months of rising attacks. The operation, the largest since 2023, followed months of escalating Israeli raids in the occupied territory, where nearly three million Palestinians live under Israeli military rule.

And the Supreme Court maintained a temporary pause on a new plan by President Biden to wipe out tens of millions of dollars of student debt. The plan was part of the president’s approach to forgiving debt after the Supreme Court rejected a more ambitious proposal last year that would have canceled more than $400 billion in loans. The scaled-down plan was directed at certain types of borrowers, including people on disability and public service workers. The court’s decision leaves millions of borrowers enrolled in the new plan in limbo.

Today’s episode was produced by Mooj Zadie, Asthaa Chaturvedi, Eric Krupke, and Clare Toeniskoetter. It was edited by Lisa Chow and Brendan Klinkenberg, contains original music by Dan Powell, Marion Lozano, and Rowan Niemisto, and was engineered by Chris Wood. Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly.

[THEME MUSIC]

That’s it for “The Daily.” I’m Sabrina Tavernise. See you tomorrow.

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Hosted by Sabrina Tavernise

Featuring Ben Casselman

Produced by Mooj Zadie Asthaa Chaturvedi Eric Krupke and Clare Toeniskoetter

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Original music by Dan Powell Marion Lozano and Rowan Niemisto

Engineered by Chris Wood

Listen and follow ‘The Daily’ Apple Podcasts | Spotify | Amazon Music | YouTube | iHeartRadio

Tipping, once contained to certain corners of the economy, has exploded, creating confusion and angst. Now, it is even becoming an issue in the U.S. presidential campaign.

Ben Casselman, who covers the U.S. economy for The New York Times, cracks open the mystery of this new era of tipping.

On today’s episode

Ben Casselman , a reporter covering the U.S. economy for The New York Times.

Background reading

How to deal with the many requests for tips .

Former President Donald J. Trump called Vice President Kamala Harris a “copycat” over her “no tax on tips” plan.

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We aim to make transcripts available the next workday after an episode’s publication. You can find them at the top of the page.

The Daily is made by Rachel Quester, Lynsea Garrison, Clare Toeniskoetter, Paige Cowett, Michael Simon Johnson, Brad Fisher, Chris Wood, Jessica Cheung, Stella Tan, Alexandra Leigh Young, Lisa Chow, Eric Krupke, Marc Georges, Luke Vander Ploeg, M.J. Davis Lin, Dan Powell, Sydney Harper, Michael Benoist, Liz O. Baylen, Asthaa Chaturvedi, Rachelle Bonja, Diana Nguyen, Marion Lozano, Corey Schreppel, Rob Szypko, Elisheba Ittoop, Mooj Zadie, Patricia Willens, Rowan Niemisto, Jody Becker, Rikki Novetsky, Nina Feldman, Will Reid, Carlos Prieto, Ben Calhoun, Susan Lee, Lexie Diao, Mary Wilson, Alex Stern, Sophia Lanman, Shannon Lin, Diane Wong, Devon Taylor, Alyssa Moxley, Olivia Natt, Daniel Ramirez and Brendan Klinkenberg.

Our theme music is by Jim Brunberg and Ben Landsverk of Wonderly. Special thanks to Sam Dolnick, Paula Szuchman, Lisa Tobin, Larissa Anderson, Julia Simon, Sofia Milan, Mahima Chablani, Elizabeth Davis-Moorer, Jeffrey Miranda, Maddy Masiello, Isabella Anderson, Nina Lassam and Nick Pitman.

Ben Casselman writes about economics with a particular focus on stories involving data. He has covered the economy for nearly 20 years, and his recent work has focused on how trends in labor, politics, technology and demographics have shaped the way we live and work. More about Ben Casselman

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