Research articleProgression to established smoking: The influence of tobacco marketing
Introduction
After 30 years of sustained public education about the health effects of smoking, adolescents are the only age group that continues to take up smoking in significant numbers in the United States. 1 Throughout the early 1990s, a major increase in the prevalence of adolescent smoking was observed in a number of studies. 2, 3 For instance, between 1996 and 1997 cigarette smoking prevalence for 12th graders increased from 34% to nearly 37%. 4
Several studies have attributed changes in tobacco-marketing practices as a contributing factor to the increase in smoking among adolescents. 5, 6, 7, 8 In addition, recent surveys have found that the brand choices of adolescent smokers were heavily concentrated on those brands with the largest advertising budgets. 9, 10 In addition to these studies linking tobacco advertising to smoking initiation, other studies have discussed potential reasons to expect tobacco advertisement sensitivity among adolescents prior to its recent restrictions. First, children and adolescents are not isolated from tobacco advertising’s attractiveness and inducements. Therefore, commercials and advertising that have an impact on adults cannot be assumed to leave an adolescent unaffected. 7 Second, the pervasiveness and ubiquity of cigarette advertising in multiple media and forms make cigarettes a cultural commonplace, which creates a benign taken-for-granted attitude that Marlboro’s advertising agent called “friendly familiarity.” 7 Finally, adolescents have biased perceptions and judgments. They tend to overestimate the prevalence of smoking among both peers and adults; the degree of this overestimation has been shown to be a predictor of smoking initiation. 11 Adolescents also tend to underestimate the negative attitudes of peers and the risks to which they are personally exposed should they smoke, which creates doubts about whether their smoking is in any sense an informed choice or decision. 12
Major relevant psychological theories, such as social learning theory and the health belief model, predict that the level of perceived harm of experimentation with a product will be a major determinant of the likelihood that any given individual will experiment. 13 Similarly, we hypothesize that the influence of tobacco industry advertising and promotion on the progression from experimentation to established smoking may be affected by an adolescent’s perceived ability to quit.
In this article, we consider adolescents who were experimenters at baseline in 1993, and examine predictors of progression to established smoking (smoking at least 100 cigarettes in lifetime) by follow-up in 1996. Specifically, we investigate the influence of receptivity to tobacco advertising and perceived ability to quit on the progression from experimentation to established smoking. In addition, we explore other potential variables that may affect the relationship between receptivity to tobacco advertising and adolescent smoking.
Section snippets
Sample
We report data on a representative sample of California adolescents aged 12 to 17 years at baseline in 1993. These adolescents were identified using random-digit-dialed, computer-assisted telephone interview (CATI) methodology as part of the California Tobacco Surveys (CTSs). 14
In 1993, Westat, Inc., enumerated the members of a total of 30,910 households in California and identified 6892 adolescents, who represented the baseline sample. With parental permission, in-depth interviews on tobacco
Results
Table 1 presents the demographic characteristics of adolescent experimenters according to their progression to established smoking. Overall, approximately 32% of adolescents who were experimenters at baseline progressed to established smoking by follow-up in 1996. Males (34.6%) and females (30.0%) had similar rates of progression to established smoking. Progression to established smoking was significantly more likely among Caucasians (37.3%) than among Hispanics (21.9%) or African-American
Discussion
The major finding of this study is that receptivity to tobacco advertising and promotions predicted progression from experimentation to established smoking. This finding is important when added to the earlier study, 5 because it shows that tobacco advertising influences not only smoking experimentation, but also progression from early smoking behavior to regular smoking. Furthermore, it adds credence to the previous studies’ conclusions by helping to rule out the possibility of a confounding
Acknowledgements
Preparation of this article was supported by the Robert Wood Johnson Foundation, grant RPG-98-263-01-PBP, funded by the American Cancer Society; and grant 7KT-0091, funded by the University of California Tobacco-Related Disease Research Program (WSC); National Cancer Institute grant CA87714 (KJH); National Cancer Institute award K07 CA90334 (KO); and Robert Wood Johnson Foundation Generalist Physician Faculty Scholars award 032586 (JSA).
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