This study comparing tobacco advertising in African American and Caucasian market areas demonstrated that, according to the available studies, tobacco signage was increased in African American markets in terms of both density and concentration. The odds that any given advertisement was smoking-related were 70% higher in African American areas vs. Caucasian areas, and there were 2.6 times as many tobacco advertisements per person in African American areas as compared with Caucasian areas.
The meta-analytic findings were consistent with relevant prior studies. For example, the two studies we identified that did not report sufficient data to be included in the density meta-analysis reported results consistent with our overall findings. Luke et al., who collected data on 1,239 billboards in St. Louis in early 1998, reported a statistically significant positive correlation between the percent of African American residents in a given geographic region and the proportion of tobacco billboards (r
Stoddard et al., who examined signage along the roadsides of African American and Caucasian neighborhoods in Los Angeles from 1990 to 1994, reported a tobacco advertisement density of 2.41/mile in African American neighborhoods compared with 0.46/mile in Caucasian neighborhoods (p
Our findings imply that African Americans may be special targets of the tobacco industry. Policy makers may wish to keep this disproportionate advertising in mind when designing future policies involving tobacco-related media. They would have good reason, for instance, to seek universally applicable limits on the concentration and/or density of tobacco advertising.
Our findings also suggest that this population may require disproportionate public health interventions to counter the effect of the disproportionate pro-tobacco promotion. Programs involving analysis of media messages—also known as media literacy programs—may be particularly effective in this population.29–31
Because this population is highly exposed to and familiar with media messages, techniques to analyze and evaluate these ubiquitous messages may be useful because of the direct relevance they provide. Finally, when addressing African Americans directly, medical practitioners (in both clinical and community settings) can emphasize the known disproportionate exposure of African Americans to pro-tobacco mass media. This knowledge of being targeted may motivate African Americans to refuse to fall prey to industry tactics, helping them to avoid smoking.
Research is necessary to determine more precisely the cause of this disproportionate advertising so that it can be effectively curtailed. Are tobacco marketers more aggressive when approaching minority neighborhoods? Are point-of-sale venues in African American neighborhoods more likely to seek out tobacco advertisements from the industry? Are other social, economic, or political factors involved? Researchers will also need to increase efforts to study this population's susceptibility to advertising, which will be of particular concern as we now know their exposure is disproportionately high. Future research should also continue to characterize specific techniques tobacco makers use to attract African Americans to co-opt those techniques for use in anti-tobacco social marketing programs.
Another important finding of this study was that, although we did search for data involving other media such as films, music, radio, Internet, promotions, or sponsorships, most published data in this area focused on billboards/signage and magazines. Billboards and magazines, however, are not currently the most important carriers of pro-tobacco media.32,33
The lessons these studies provide are still very relevant because the tobacco industry is remarkably adept at transitioning one type of advertising to another while still retaining its overall strategy.32,34
In the future, however, research involving the impact of tobacco advertising on African Americans should focus more on the forms of promotion currently and increasingly utilized by the tobacco industry. In 2003, for instance, 71.4% of tobacco industry expenditures went directly into such promotional activities as the distribution of free cigarettes.33
Future research should also address media such as smoking in movies, because it has now been established that as much as half of adolescent smoking initiation can be linked to watching smoking in movies.9
Do these forms of tobacco promotion target and affect African Americans in particular and/or more frequently? If so, in what particular way do they affect African Americans? These questions will be essential to address in the future to most effectively reduce health disparities related to tobacco.
This study had limitations worth noting. First, the only studies appropriate for meta-analysis involved billboards and signage. Although the tobacco industry is well-known to employ a consistent marketing strategy regardless of the specific medium used,32,34
it should be considered that studies involving other media may have different findings. However, this is an important finding of the study in itself, as it elucidates the need for future research investigating these same issues while focusing on emerging forms of promotion.
Second, the studies identified were relatively heterogeneous according to statistical analysis with a Q statistic. However, we responded appropriately to this issue by conducting the meta-analysis using a random effects model.23
Third, to assure a certain level of quality, we excluded unpublished studies from the analysis. Although this exclusion introduced potential publication bias, we did not detect publication bias using two statistical methods.
A final potential limitation involved the population denominators used to determine advertisement density. It should be considered that these population figures may not accurately reflect the market of a billboard because billboards are often positioned to be viewed by those who live outside of their vicinity. However, we felt these figures were the most appropriate approximations of the market population available.