Cigarette Advertising and Adolescent Smoking

doi:10.1016/j.amepre.2009.12.036

American Journal of Preventive Medicine

Volume 38, Issue 4, April 2010, Pages 359-366

https://doi.org/10.1016/j.amepre.2009.12.036 Get rights and content

Background

Although most agree that the association between tobacco marketing and youth smoking is causal, few studies have assessed the specificity of this association.

Purpose

This study aims to examine the specificity of the association between cigarette advertising and teen smoking.

Methods

A cross-sectional survey of 3415 German schoolchildren aged 10–17 years was conducted using masked images of six cigarette brands and eight other commercial products in 2008. The exposure variable was a combination of contact frequency (recognition) and brand names (cued recall). Sample quartile (Q) exposure to advertisement exposure was calculated in 2009. Outcome variables were ever tried and current (monthly) smoking, and susceptibility to smoking among never smokers.

Results

The prevalence of ever smoking was 31.1% and that of current smoking was 7.4%, and 35.3% of never smokers were susceptible to smoking. Ad recognition rates ranged from 15% for a regionally advertised cigarette brand to 99% for a sweet. Lucky Strike and Marlboro were the most highly recognized cigarette brands (with ad recognition rates of 55% and 34%, respectively). After controlling for a range of established influences on smoking behaviors, the adjusted ORs for having tried smoking were 1.97 (95% CI=1.40, 2.77) for Q4 exposure to cigarette ads compared with adolescents in Q1, 2.90 (95% CI=1.48, 5.66) for current smoking, and 1.79 (95% CI=1.32, 2.43) for susceptibility to smoking among never smokers. Exposure to ads for commercial products other than cigarettes was significantly associated with smoking in crude but not multivariate models.

Conclusions

This study underlines the specificity of the relationship between tobacco marketing and youth smoking, with exposure to cigarette ads, but not other ads, being associated with smoking behavior and intentions to smoke. This finding suggests a content-related effect of tobacco advertisements.

Introduction

Smoking typically begins during childhood¹ and will be responsible for more than 1 billion deaths worldwide during the 21st century if current patterns of smoking continue.² One way of controlling the smoking epidemic is to prevent youth from taking up the behavior. Adolescents initiate smoking primarily for social reasons.³ Tobacco marketing is one socializing agent linked with youth smoking, and this serves as the basis for controls on smoking marketing contained in the WHO Framework Convention on Tobacco Control,⁴ in which Article 13 recognizes that a comprehensive ban on tobacco marketing would reduce consumption.

After the Second World War, Germany was a “paradise” for the tobacco industry, with few effective tobacco control measures in place.⁵ The extent of the influence of the tobacco industry over German politics and scientists was profound.6, 7 For example, on two occasions, and partnering with multinational tobacco companies, the German government challenged European Union directives on tobacco advertising and sponsorship in the European Court of Justice in Luxembourg.⁸ Nevertheless, advertising restrictions were implemented gradually, beginning with a partial ban on tobacco marketing on TV and radio in 1975 and a ban on the distribution of promotional packages in 2004. On December 12, 2006, the Court of Justice dismissed the case, the result being a tobacco advertising ban in newspapers and magazines in Germany. Currently, tobacco advertising is allowed (1) at point of sale, (2) on billboards, and (3) in cinemas prior to movies that show after 6:00pm. Brand stretching is also legally possible.

The current study was conducted to assess the influence of tobacco advertising on smoking behavior among young people in a country with partial advertising restrictions. The association between tobacco advertising and promotion has been the subject of a substantial number of studies,9, 10, 11 but few have tested the effect of tobacco advertising compared with ads for other commercial products.12, 13 Thus, the relationship, although considered causal,10, 14 lacks evidence for specificity. The finding of an association between tobacco advertising and youth smoking behavior in a study that also included exposure measures for other products would make a strong case for the conclusion that it is exposure to tobacco advertising content, not general advertising receptivity, that prompts youth smoking behavior.

Section snippets

Sample Selection

The study sample was recruited in three states of Germany, in Schleswig-Holstein, Hamburg, and Brandenburg, and covers rural and urban as well as the eastern and western parts of Germany. From the official lists with a total of 744 schools, 120 schools were randomly drawn and invited for participation in May 2008 (Figure 1). The drawing was stratified by type of school, ensuring a balanced representation of all German school types. All sixth- to eighth-grade students of the respective schools

Description of the Sample

The final sample consisted of 3415 students, of whom 51.6% were girls. The mean age was 12.5 years (SD=1.06), with a range of 10–17 years and a median of 12 years. Forty-four percent of the students attended Gymnasium schools, which recruit students with higher academic skills and from higher-SES backgrounds; 56% attended other school types with lower academic requirements and lower-SES backgrounds.

Exposure to Advertisements

Table 1 gives recognition (how often the student had seen the ad) and cued recall (how often the

Discussion

The current study focuses primarily on specificity of the finding of an association between cigarette advertising and teen smoking. The question considered here is whether the advertising effect is simply a marker of an adolescent who is generally receptive to many forms of advertising or whether the effect is attributable to cigarette ad content specifically. An advertisement exposure measure was applied that involves ad recognition as well as cued brand recall in order to parse exposure to

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Research articleCigarette Advertising and Adolescent Smoking

Background

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Sample Selection

Description of the Sample

Exposure to Advertisements

Discussion

Lancet

Am J Prev Med

J Pediatr

Prev Med

Addict Behav

J Health Econ

Global youth tobacco surveillance, 2000–2007

MMWR Surveill Summ

Mortality from smoking in developed countries 1950–2000Indirect estimates from national vital statistics

Psychosocial factors related to adolescent smoking: a critical review of the literature

Tob Control

WHO Framework Convention on Tobacco Control: development of an evidence-based global public health treaty

Br Med J

Germany: tobacco industry paradise

Tob Control

Puffing away?Explaining the politics of tobacco control in Germany

Ger Polit

German tobacco industry's successful efforts to maintain scientific and political respectability to prevent regulation of secondhand smoke

Tob Control

Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours

Cochrane Database Syst Rev

Tobacco promotion and the initiation of tobacco use: assessing the evidence for causality

Pediatrics

Tobacco advertising and promotionTobacco in Australia: facts and issues

Recognition of cigarette brand names and logos by young children in Hong Kong

Tob Control

Recognition of cigarette brand names and logos by primary schoolchildren in Ankara, Turkey

Tob Control

The role of media in promoting and reducing tobacco use

Research article
Cigarette Advertising and Adolescent Smoking