Implementation, reach, and impact of court-ordered tobacco corrective statement postings at the point-of-sale

PROJECT SUMMARY/ABSTRACT Tobacco use remains a leading cause of premature disease and death in the United States, including those attributable to cancer. In a landmark racketeering lawsuit filed by the US Department of Justice in 1999, several major tobacco manufacturers were found guilty of consumer fraud, which included deceptive tactics such as lying to consumers about the deadly effects of cigarettes, manipulating cigarettes to make them more addictive, and marketing their products to young people. To help remedy these actions, the court ordered the manufacturers to run a series of “corrective statements” in several communication channels in the US, including television, newspapers, and signage displays in stores at the point-of-sale. After nearly two decades of tobacco industry litigation to delay the corrective statement requirement in retail settings – one of the industry’s most valuable marketing channels – a 2022 court order finally mandated that the signs be posted from October 1, 2023 through June 30, 2025, a 21-month period. More than 200,000 retailers that have marketing agreements with the affected manufacturers – approximately 2 in 3 retailers nationwide – are required to display these large, eye-catching signs that inform consumers about the health risks of tobacco and the tobacco industry’s history of deception. While this historic retail-based intervention has the potential to positively impact public health, critical questions remain about the nature of its implementation, reach, and effects on consumers, including impacts on health equity. For example, it is unknown how implementation features of the signage (e.g., presence, number, placement) may vary by store type and neighborhood; if, and to what extent, consumers notice and retain the corrective messages; and whether exposure impacts tobacco knowledge, beliefs, intentions and behaviors (e.g., quit attempts). The finite window of intervention delivery offers a unique and time-sensitive opportunity to answer these questions, which may inform future large-scale tobacco information dissemination efforts, as well as identify subpopulations who may benefit from supplemental health education programs or other services. The specific aims of the study are to: (1) Characterize both implementation and reach by collecting detailed information about corrective statement implementation features through a retailer audit study. Supplemental analyses will calculate the prevalence/density of retailers required to display the statements across the United States. (2) Use eye- tracking methodologies to explore attention to the corrective statements (i.e., reach and impact) in the context of real-world exposures. (3) Field longitudinal surveys of adults and youth to examine reach and impact of the statements among a nationally representative sample, including reported exposures, message perceptions, and impact on tobacco knowledge, attitudes, intentions and behaviors.