A study examined disparities in exposure to tobacco advertisements, marketing, or promotion on television and streaming platforms among U.S. adults.

The study found that 12.4% (95% confidence interval [CI] = 10.8%-14.2%) of adults reported exposure to tobacco content on television (TV) or streaming platforms in the past 3 months.

Demographic Disparities

Significant disparities were observed across various demographic groups.

More than 19% of Non-Hispanic Black or African American respondents reported exposure (95% CI = 15.4%-24.2%), compared with 16.4% of Hispanic respondents (95% CI = 12.9%-20.8%), 9.7% of Non-Hispanic White respondents (95% CI = 7.5%-12.4%), and 11.7% of respondents belonging to other racial/ethnic groups (95% CI = 6.6%-19.9%).

Respondents with a high school degree or less had a 16.4% rate of exposure (95% CI = 13.7%-19.6%), compared to 12.2% among those who had completed some college (95% CI = 9.5%-15.5%) and 9.4% among those with a college degree or more (95% CI = 7.7%-11.5%).

The rate of exposure among current smokers was 17.0% (95% CI = 11.4%-24.5%); it was 12.7% among former smokers (95% CI = 9.5%-16.8%) and 11.3% among never smokers (95% CI = 9.9%-13.0%).

By age, the rate of exposure among respondents aged 18 to 34 years was 12.8% (95% CI = 8.5%-18.7%); among those aged 35 to 49 years, it was 13.4% (95% CI = 10.8%-16.5%); among those aged 50 to 64 years, it was 11.0% (95% CI = 9.0%-13.3%); and among those aged 65 years or older, it was 12.3% (95% CI = 10.6%-14.3%).

By annual household income, exposure rates were:

• Less than $20,000: 17.6% (95% CI = 14.1%-21.9%)
• $20,000-$34,999: 17.0% (95% CI = 13.0%-22.0%)
• $35,000-$49,999: 10.5% (95% CI = 7.8%-14.1%)
• $50,000-$74,999: 9.5% (95% CI = 7.1%-12.5%)
• $75,000 or more: 11.4% (95% CI = 8.7%-14.7%).

Rate of exposure was similar between urban and rural residents; among urban respondents, it was 12.4% (95% CI = 10.7%-14.2%), and among rural respondents, it was 12.6% (95% CI = 9.2%-17.1%).

Methods

The HINTS 6 survey had a response rate of 28.1% and used a sample frame derived from the Marketing Systems Group database of addresses. High-minority strata were oversampled to enhance estimate accuracy for this population.

The researchers conducted multivariable logistic regression analyses to explore factors associated with exposure. Two models were used: one with individuals who did not report seeing advertisements on TV or streaming platforms as the reference group, and another using individuals who did not report seeing any tobacco product advertisements at all as the reference group.

Further Results

Results from the first model showed that non-Hispanic Black or African American respondents had 2.20 times higher odds of exposure (95% CI - 1.40-3.45) compared to non-Hispanic White respondents, and Hispanic respondents had 1.58 times higher odds of exposure (95% CI = 1.04-2.42) compared to non-Hispanic White respondents. Those with a high school education or less had 1.60 times higher odds of exposure (95% CI = 1.08-2.37) compared to college graduates or postgraduates. Current smokers had 1.85 times higher odds of exposure (95% CI = 1.06-3.25) compared to never smokers.

The second model, using individuals who did not report seeing any tobacco product advertisements as the reference group, showed similar results:

• Non-Hispanic Black or African American respondents: adjusted odds ratio (aOR) = 2.25 (95% CI = 1.40-3.60)
• Hispanic respondents: aOR = 1.65 (95% CI = 1.02-2.70)
• High school education or less: aOR = 1.57 (95% CI = 1.08-2.29)
• Current smokers: aOR = 1.85 (95% CI = 1.06-3.25).

The study also examined exposure among never smokers, finding that 11.3% (95% CI = 9.9%-13.0%) reported exposure to tobacco content on TV or streaming platforms. Among never smokers, exposure was highest for those aged 65 years or older (13.2%; 95% CI = 10.5%-16.5%), those with high school education or less (15.0%; 95% CI = 11.8%-18.9%), and non-Hispanic Black or African American respondents (17.5%; 95% CI = 13.1%-23.1%).

Study limitations included the low-response bias associated with HINTS 6; an inability to delineate exposure by specific streaming platform types; exclusion of adolescents from the sample; and the subjective nature of the survey question, which conflated promotion, advertising, and marketing into a single category.

The study authors concluded, "In this study of the prevalence of exposure to tobacco advertisements on TV or streaming platforms among U.S. adults, disparities in exposure by race or ethnicity, education level, and smoking status were identified. These findings underscore the need for targeted public health interventions and regulation to address these disparities and reduce the impact of tobacco advertisements on vulnerable populations."

One investigator reported receiving grants from the National Institutes of Health during the conduct of the study. No other disclosures were reported.