title: Tobacco advertising, promotion, and sponsorship (TAPS) exposure, anti-TAPS policies, and students' smoking behavior in Botswana and South Africa.
abstract: We examined the change over time in tobacco advertising, promotion and sponsorship exposure and the concurrent changes in cigarette smoking behavior among students age 13 to 15years in two African countries with different anti-tobacco advertising, promotion and sponsorship policies. In South Africa, anti-tobacco advertising, promotion and sponsorship policies became more comprehensive over time and were more strictly enforced, whereas the partial anti-tobacco advertising, promotion and sponsorship policies adopted in Botswana were weakly enforced.
  
  
  
  We analyzed two rounds of Global Youth Tobacco Survey data from South Africa (1999, n=2342; 2011, n=3713) and in Botswana (2001, n=1073; 2008, n=1605). We assessed several indicators of tobacco advertising, promotion and sponsorship exposure along with prevalence of current cigarette smoking and smoking susceptibility for each data round. Logistic regression was used to examine changes over time in tobacco advertising, promotion and sponsorship exposure and smoking behavior in both countries.
  
  
  
  Between 1999 and 2011, South African students' exposure to tobacco advertising and sponsorship decreased significantly by 16% (p value, <0.0001) and 14% (p value, <0.0001), respectively. Exposure to tobacco promotion was lower and did not decrease significantly. Botswanan students' tobacco advertising, promotion and sponsorship exposure did not change significantly between 2001 and 2008. South African students' prevalence of cigarette smoking decreased over time (OR, 0.68) as did susceptibility to smoking (OR, 0.75), but declines did not remain significant after adjusting for parents' and friends' smoking. In Botswana, students' prevalence of cigarette smoking increased significantly over time (OR, 1.84), as did susceptibility to smoking (OR, 2.71).
  
  
  
  Enforcement of strong anti-tobacco advertising, promotion and sponsorship policies is a vital component of effective tobacco control programs in Africa. Such regulations, if effectively implemented, can reduce tobacco advertising, promotion and sponsorship exposure among adolescents and may influence cigarette smoking behavior.
authors.affiliation: Centers for Disease Control and Prevention, Office on Smoking and Health, 4770 Buford Highway N.E., Mailstop F-79, Atlanta, GA 30341-3717, USA. Electronic address: lenglish@cdc.gov.
authors.forename: Lorna McLeod
authors.initials: LM
authors.lastname: English
authors.affiliation: Centers for Disease Control and Prevention, Office on Smoking and Health, 4770 Buford Highway N.E., Mailstop F-79, Atlanta, GA 30341-3717, USA. Electronic address: zxx1@cdc.gov.
authors.forename: Jason
authors.initials: J
authors.lastname: Hsia
authors.affiliation: Centers for Disease Control and Prevention, Office on Smoking and Health, 4770 Buford Highway N.E., Mailstop F-79, Atlanta, GA 30341-3717, USA. Electronic address: aym8@cdc.gov.
authors.forename: Ann
authors.initials: A
authors.lastname: Malarcher
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000329:Advertising; D001902:Botswana / Q000453:epidemiology; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008297:Male; D057766:Policy; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D016540:Smoking Cessation / Q000379:methods; D000074606:Smoking Prevention; D013019:South Africa / Q000453:epidemiology; D013334:Students; D011795:Surveys and Questionnaires
keywords: Africa; Anti-tobacco policies; Promotion and sponsorship; Students smoking behavior; Tobacco advertising; Tobacco marketing