Prescription drug advertising proves more effective in reducing smoking rates

A new peer-reviewed study in the INFORMS journal Marketing Science finds that direct-to-consumer (DTC) advertising for prescription smoking-cessation drugs meaningfully reduces cigarette use. At the same time, the research found that advertising for over the counter (OTC) nicotine products does not reduce cigarette use.

The research highlights how advertising can either support or undermine public health goals when it comes to smoking cessation, depending on the type of cessation product being promoted.

The study, "Investigating the Impact of Advertising on Smoking Cessation: The Role of Direct-to-Consumer Prescription Drug Advertising," was authored by Erfan Loghmani of the University of Washington and Ali Goli of the University of Rochester.

The study authors examined nearly a decade of U.S. market-level data, combining advertising exposure with prescription records and retail sales of cigarettes, e-cigarettes and nicotine replacement therapies (NRTs).

They found that prescription ads do help reduce smoking. Chantix advertising-the leading prescription cessation drug-boosted prescriptions for both Chantix and Bupropion (an older prescription option) and led to lower cigarette sales across markets.

On the flip side, ads for OTC smoking cessation products did not reduce cigarette use. They shifted some smokers toward options such as nicotine patches, gums and lozenges and away from prescription therapies that have been shown to be more effective. This pattern suggests that OTC advertising may have unintended consequences for overall cessation efforts.

There were some spillover effects. Ads for prescription smoking cessation products spilled over to increased demand for alternative cessation methods, including Bupropion and even e-cigarettes.

Insurance coverage played a critical role in shaping how advertising influenced behavior. In markets where health plans offered strong coverage for prescription cessation drugs, advertising translated into higher declines in cigarette sales.

In contrast, in markets with limited coverage, the same advertising often pushed smokers toward OTC products or even e-cigarettes, which might be less effective at supporting long-term cessation. This finding underscores that the public health benefits of advertising depend on the accessibility and affordability of the promoted therapies, as well as the availability of substitutes. The same advertising investment yields very different public health outcomes depending on these structural factors.

We find that Direct-to-Consumer advertising for prescription smoking-cessation drugs reduces cigarette sales; there is no question. But direct-to-consumer advertising of OTC smoking-cessation products can have unintended consequences and shift some smokers away from prescription therapies that are shown to be more effective. This distinction is crucial for policymakers considering whether to restrict pharmaceutical advertising."

Erfan Loghmani, PhD Student, University of Washington

The research team analyzed advertising expenditures, prescription fills, and retail sales for cigarettes and cessation products across multiple U.S. markets between 2010 and 2020. Using econometric models, they estimated both direct effects (advertising on its target product) and indirect effects (spillovers to substitutes and complements).

They then conducted simulations to test the effect of reduced DTCA advertising on cigarette sales. They found that a 10% reduction in DTCA leads to a 0.23% increase in cigarette sales and an equivalent decrease of 21.3 million packs of cigarettes in total nicotine content consumption.

"Our analysis shows that prescription drug advertising reduces cigarette consumption through multiple pathways," said Goli. "The primary mechanism is increased prescriptions for the effective prescription cessation medications, but we also observe spillover effects to other cessation products. However, these spillovers vary in effectiveness, which is why insurance coverage matters so much - when people can access the prescription drugs, we see the strongest public health benefits."

This result adds to the ongoing debate on how DTCA of prescription drugs affects public health. Although policymaking bodies like the American Medical Association (AMA) have advocated for a ban on all DTCA, the study shows that DTCA is net positive for smoking cessation.