Exposure to Court-Ordered Tobacco Industry Antismoking Advertisements Among US Adults

Importance: In 2006, US District Judge Gladys Kessler ordered tobacco companies to make corrective statements through paid advertisements informing the public of their deceptive practices. This landmark ruling and its subsequent execution represent the first time the tobacco industry sponsored a nationwide corrective advertising campaign against its own products. Objective: To assess the reach of the court-ordered antismoking advertisements within the US adult population, stratified by demographic characteristics and tobacco use. Design, Setting, and Participants: This nationally representative, population-based cross-sectional survey of US adults included respondents to the 2018 Health Information National Trends Survey 5, Cycle 2. Respondents were representatives of households selected by equal-probability sampling of the Marketing Systems Group database of addresses that included all nonvacant US residential addresses. Data collection was conducted from January to May 2018, and analysis took place from December 2018 to April 2019. Main Outcomes and Measures: Self-reported exposure to court-ordered antismoking advertisements. Results: The overall sample of 3484 respondents included 2054 women (weighted percentage, 50. 8%), 1976 non-Hispanic white respondents (weighted percentage, 59. 9%), 2952 respondents who lived in urban US areas (weighted percentage, 84. 9%), and 450 current smokers (weighted percentage, 15. 6%). Estimated exposure to court-ordered antismoking advertisements was 40. 6% (95% CI, 37. 5%-43. 7%) among the full sample and 50. 5% (95% CI, 41. 4%-59. 6%) among current smokers. Exposure was lowest among those aged 18 to 34 years (37. 4%; 95% CI, 28. 0%-46. 8%), those with a high school education or less (34. 5%; 95% CI, 29. 3%-39. 8%), and those with household annual income less than 35 000 (37. 5%; 95% CI, 32. 0%-42. 9%). Among current smokers, Hispanic respondents had lower exposure rates (42. 2%; 95% CI, 18. 5%-65. 9%) than non-Hispanic white respondents (51. 7%; 95% CI, 40. 4%-63. 1%). As the advertising campaign's duration increased, exposure rates increased. Individuals with a high school education or less had lower odds of antismoking advertisement exposure than those with college or postgraduate degrees (adjusted odds ratio, 0. 67; 95% CI, 0. 48-0. 94). Current smokers had higher odds of exposure than never smokers (adjusted odds ratio, 1. 81; 95% CI, 1. 17-2. 80). Among those exposed to antismoking advertisements, 70. 5% saw multiple antismoking messages. Conclusions and Relevance: Approximately 1 of 2 smokers reported exposure to the federal court-ordered antismoking advertisements. However, exposure was relatively lower among several subgroups, including individuals aged 18 to 34 years, only one-third of whom reported exposure. Increasing the duration of antismoking advertisements as well as expanding their coverage to youth-oriented media may increase their potential public health impact.