Emily Savell, University of Bath, Bath, England
Anna B. Gilmore, University of Bath, Bath, England
Michelle Sims, University of Bath, Bath, England
Prem K. Mony, St John's Medical College and Research Institute, Bangalore, India
Teo Koon, Hamilton Health Sciences and McMaster University, Hamilton, Canada
Khalid Yusoff, Universiti Teknologi MARA, Shah Alam, Malaysia
Scott A. Lear, Simon Fraser University, Burnaby, Canada
Pamela Seron, Universidad de La Frontera, Temuco, Chile
Noorhassim Ismail, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
K Burcu Tumerdem Calik, Marmara University, Istanbul, Turkey
Annik Rosengren, University of Gothenburg, Gothenburg, Sweden
Ahmad Bahonar, Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran
Rajesh Kumar, Post-Graduate Institute of Medical Education and Research, Chandigarh, India
Krishnapillai Vijayakumar, Dr Somervell Memorial CSI Medical College, Karakonam, India
Annamarie Kruger, North-West University, Potchefstroom, South Africa
Hany Swidan, Dubai Health Authority, Dubai, United Arab Emirates
Rajeev Gupta, Fortis Escorts Hospital, Jaipur, India
Ehimario Igumbor, University of the Western Cape, Cape Town, South Africa
Asad Ali Khan Afridi, Aga Khan UniversityFollow
Omar Rahman, Independent University Bangladesh, Dhaka, Bangladesh
Jephat Chifamba, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
Katarzyna Zatonska, Wroclaw Medical University, Wroclaw, Poland
V Mohan, Madras Diabetes Research Foundation, Chennai, India
Deepa Mohan, Madras Diabetes Research Foundation, Chennai, India
Patricio Lopez-Jaramillo, Universidad de Santander, Bucaramanga, Colombia
Alvaro Avezum, Dante Pazzanese Institute of Cardiology, São Paulo, Brazil
Paul Poirier, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
Andres Orlandini, ECLA Foundation, Rosario, Santa Fe, Argentina
Wei Li, Chinese Academy of Medical Sciences, Beijing, China
Martin McKee, London School of Hygiene & Tropical Medicine, London, England
Sumathy Rangarajan, Hamilton Health Sciences and McMaster University, Hamilton, Canada
Salim Yusuf, Hamilton Health Sciences and McMaster University, Hamilton, Canada
Clara K. Chow, University of Sydney, Australia

Document Type



Community Health Sciences



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.


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.


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.


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.


Bulletin of the World Health Organization

Creative Commons License

Creative Commons Attribution 3.0 License
This work is licensed under a Creative Commons Attribution 3.0 License.