Some of these examples illustrate the tobacco industry��s agility

Some of these examples illustrate the tobacco industry��s agility at circumventing marketing regulations. Because comprehensive bans are not an option for all countries due to constitutional and legal constraints, the industry��s circumventing practices are a central Article 13 implementation barrier. We have seen that countries�� efforts to ban marketing have prompted the industry to redirect resources to other vehicles and venues. Current trends in redirection include sponsoring events in social and entertainment venues. With increasing media marketing restrictions, high-, middle-, and low-income countries have seen promotions in bars, cafes, and nightclubs (e.g., Biener, Nyman, Kline, & Albers, 2004; Gilpin, White, & Pierce, 2005; Sepe, Ling, & Glantz, 2002; Shahrir et al., 2011).

Promotions include free cigarettes, drink offers or discounts, event sponsorships, and decoration funding (Shahrir et al., 2011). Additionally, in some countries tobacco product placement in entertainment media is widespread. Given substantial evidence that exposure to movie smoking is causally related to adolescent smoking initiation (NCI, 2008)��including recent evidence among youth (Sargent & Hanewinkel, 2009; Thrasher et al., 2009) and adults (Viswanath, Ackerson, Sorensen, & Gupta, 2010) from countries outside the United States��limiting product placement and other smoking imagery in movies, television programs, and other entertainment media has become a priority. For example, India recently strengthened its marketing regulations by prohibiting product placement in new films and programs; scenes with product brands will be masked or blurred in older films.

It also prohibited promotional materials from showing tobacco products or their use, and required strong editorial justification for displaying tobacco products in films or programs (��India �C New regulations on depictions of tobacco products in films and on TV,�� 2011). In the United States, films have seen a decline in tobacco portrayals��due, in part, to advocacy efforts and MSA rules prohibiting industry influence��yet there is evidence that this downward trend may be reversing (Glantz, Iaccopucci, Titus, & Polansky, 2012). Innovations in tobacco products are complicating the issue of both marketing and minor access restrictions.

Products such as waterpipes or hookahs are increasingly popular among youth, likely because of their affordability, their flavoring, and the social aspect of waterpipe smoking (Martinasek, McDermott, & Martini, 2011). In some countries, waterpipe consumption is more prevalent than cigarette smoking: 2005 Global Youth Tobacco Survey (GYTS) data showed that among Lebanese students, waterpipe Entinostat smoking rates were 4 times higher than cigarette smoking rates (Saade, Warren, Jones, Asma, & Mokdad, 2008).

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