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

Emily Savell, Anna B Gilmore, Michelle Sims, Prem K Mony, Teo Koon, Khalid Yusoff, Scott A Lear, Pamela Seron, Noorhassim Ismail, K Burcu Tumerdem Calik, Annika Rosengren, Ahmad Bahonar, Rajesh Kumar, Krishnapillai Vijayakumar, Annamarie Kruger, Hany Swidan, Rajeev Gupta, Ehimario Igumbor, Asad Afridi, Omar RahmanJephat Chifamba, Katarzyna Zatonska, V Mohan, Deepa Mohan, Patricio Lopez-Jaramillo, Alvaro Avezum, Paul Poirier, Andres Orlandini, Wei Li, Martin McKee, Sumathy Rangarajan, Salim Yusuf, Clara K Chow

Research output: Contribution to journalArticle (Academic Journal)peer-review

27 Citations (Scopus)


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

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

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

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

Original languageEnglish
Pages (from-to)851-61G
JournalBulletin of the World Health Organization
Issue number12
Publication statusPublished - 1 Dec 2015


  • Advertising/methods
  • Asia, Western
  • Canada
  • Cross-Sectional Studies
  • Humans
  • Interviews as Topic
  • Logistic Models
  • Marketing
  • Residence Characteristics
  • Rural Population/statistics & numerical data
  • Social Environment
  • Socioeconomic Factors
  • South America
  • Sweden
  • Tobacco
  • Tobacco Industry
  • United Arab Emirates
  • Urban Population/statistics & numerical data


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