Introduction:
Comprehensive tobacco advertising, promotion and sponsorship (TAPS) bans are known to effectively reduce smoking prevalence. We aimed to study country-differences in self-reported exposure to tobacco advertising at different media (TV, radio, print, internet, billboards, point-of-sale) in relation to national TAPS legislation in six EU countries.

Methods:
We used data from the Wave 1 of the International Tobacco Control 6 European Country (ITC 6E) Project, comprising n=6000 adult smokers from Germany, Greece, Hungary, Poland, Romania and Spain. Country-specific prevalence and 95%-confidence intervals of tobacco ad exposure were examined in relation to national TAPS legislation. Sociodemographic and socioeconomic correlates were investigated using logistic regression in order to explore equity aspects.

Results:
Overall, 34% (95%-CI: 33-36) of smokers reported to have noticed things that promote smoking (including advertising) in the last 6 months, with exposure varying from 15% (13-18) in Hungary to 53% (50-57) in Germany. Among this sub-sample, self-reported exposure to tobacco ads was highest at the point of sale (52%, 50-54) and lowest on the radio (10%, 9-11), with wide variation across countries. Exposure was correlated with TAPS legislation, i.e. higher in countries with less comprehensive TAPS legislation and vice versa. Smokers who were younger, from urban areas, and less heavy smokers tended to be more likely to report exposure to tobacco ads.

Conclusions:
Exposure to tobacco ads varied widely between countries. Despite the cross-sectional design precluding causal conclusions, the findings indicate a negative association between comprehensiveness of TAPS legislation and exposure to tobacco ads. However, significant exposure was found even in countries with more comprehensive TAPS legislation, indicating a need for stronger enforcement and closing of loopholes.

Funding:
The Wave 1 of the ITC 6 European Country Project receives grant support from EUREST-PLUS, funded by the European Union’s Horizon 2020 Program (681109-Vardavas) and the University of Waterloo (118096).