Association between tobacco advertising policies, health warning mandates and adolescents' exposure to tobacco advertising and warning labels in 80 countries.

Background: Implementation of tobacco advertising, promotion and sponsorship (TAPS) bans and of health warning mandates varies by country, and their impact on adolescents' exposure to tobacco-related messages is not well understood, particularly in low-income and middle-income countries.

Aim: To explore the association of the implementation of TAPS bans and health warning mandates with the proportion of adolescents exposed to tobacco advertisements and health warnings in 80 countries from 2016 to 2021.

Methods: The proportion of 11-17 years old exposed to tobacco advertising was assessed using Global Youth Tobacco Survey data (80 countries, n=428 347). We conducted country-level multivariable linear regressions to explore the association between these policies and the proportion of adolescents exposed by country.

Results: Of the 80 countries assessed, 39 had implemented a ban on advertising at points of sale, 54 had a ban on free distribution, 44 prohibited the use of tobacco brand names on non-tobacco products and 72 had laws mandating health warnings on cigarette packages. Banning point-of-sale advertisements was associated with 7.8% (95% CI -3.7% to -12.0%) lower exposure to point-of-sale advertisements. There was no significant association between mandating health warnings and the prevalence of exposure to health warnings. We did not find significant associations between bans on the free distribution of tobacco products or labelling non-tobacco products with tobacco brand names with exposure to tobacco advertisements.

Conclusions: We found that, in the context of varying implementation levels, bans on point-of-sale advertisements were associated with lower exposure to advertisements.