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Baltimore City's landmark alcohol and tobacco billboard ban: an implementation case study
  1. Peter L Meisel,
  2. Alicia Sparks,
  3. Raimee Eck,
  4. David Jernigan
  1. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to David Jernigan, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 292, Baltimore, MD 21205, USA; djernigan{at}

Statistics from


Alcohol is the leading cause of death and disability globally among males aged 15–24 in all regions except the Eastern Mediterranean and females aged 15–24 in the wealthy nations and the Americas; much of this burden is from injury.1 Excessive alcohol use is the leading drug problem among young people in the USA,2 and the leading causes of alcohol-related deaths among young people in the USA are injury: MVCs, homicide, suicide, poisoning (not alcohol), child maltreatment and drowning comprise 95% of the approximately 4173 deaths caused by alcohol among persons under 21 annually.3 Exposure to alcohol advertising increases the likelihood that young people will hold positive beliefs about alcohol, intend to drink and consume alcohol.4–6 Longitudinal studies have consistently found that youth exposure to alcohol advertising in various settings—including broadcast, print, outdoor, point-of-purchase and at sporting events—correlates with earlier onset of drinking among non-drinkers and increased levels of drinking among youth already drinking.7 ,8 Adolescents who report exposure to and liking of ads in early adolescence (7th grade) are more likely later (10th grade) to report negative alcohol-related consequences, including getting into fights.9

Outdoor advertisements target pedestrian and motor vehicle traffic and appear in a wide array of formats and sizes. In the early 1990s, tobacco companies were the most prominent outdoor advertisers: in 1992, the tobacco industry spent $123 million on outdoor advertising and by 1996 six of the top ten outdoor advertisers were tobacco companies.10 Following the Master Settlement Agreement in 1998, outdoor advertising for tobacco fell precipitously, and expenditures on outdoor advertising for alcohol surpassed spending on tobacco ads. By 2002, the Anheuser-Busch Company was the largest outdoor advertiser in the USA, spending just under $50 million annually on outdoor advertisements.11

Saffer and Dave12 assessed the impact …

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