Trends in exposure to pro-tobacco advertisements over the Internet, in newspapers/magazines, and at retail stores among U.S. middle and high school students, 2000–2012
Introduction
Tobacco use remains the leading preventable cause of death and disease in the United States, with nearly 443,000 deaths occurring annually from smoking-related diseases (U.S. Department of Health and Human Services, DHHS, 2012). Most tobacco use, including cigarette smoking, begins during youth. Among adults who become daily smokers, nearly all first use of cigarettes occurs by 18 years of age (88%), with 99% of first use by 26 years of age (U.S. DHHS, 2010).
The initiation and development of tobacco use among youths progress from forming attitudes and beliefs about tobacco, to experimenting with and maintaining the smoking behavior, to being addicted (U.S. DHHS, 2012). Tobacco promotional activities are important catalysts that can prompt smoking initiation among youth. Evidence indicates that tobacco companies have targeted youths with tobacco promotional activities by highlighting themes that appeal to youth, such as independence and adventure seeking (U.S. DHHS, 2010). The 2012 U.S. Surgeon General's report concluded that exposure to pro-tobacco advertising and promotional activities causes the initiation and progression of tobacco use among youths (U.S. DHHS, 2012).
Despite the 1998 Master Settlement Agreement between the attorneys general of 46 U.S. states and the 4 largest U.S. tobacco companies prohibiting the tobacco industry from taking “any action, directly or indirectly, to target youth… in the advertising, promotion or marketing of tobacco products” (King and Siegel, 2001, U.S. Department of Justice, Office of the Attorney General, 1998), research suggests that the tobacco industry has increased advertising in the retail sector to circumvent the restrictions imposed by the agreement (Curry et al., 2011, Pierce and Gilpin, 2004).
In addition, the Internet presents an unprecedented opportunity through which the tobacco industry can deliver well-targeted messages to specific audiences, including youth. Among U.S. adolescents aged 12–17 years and young adults aged 18–29 years, an estimated 93% use the Internet (Pew Research Center, 2010). This is further compounded by the fact that monitoring and regulation of Internet marketing is still limited. For example, while federal law bars tobacco advertisements on any medium of electronic communication, the Federal Communications Commission does not currently regulate the Internet or Internet service providers (U.S. FCC, 2012).
Because of the great potential that pro-tobacco advertisements over the Internet, in magazines/newspapers, and at retail stores have in reaching and influencing adolescents, reducing youth exposure to tobacco advertisements from these three sources is one of the targets of Healthy People, 2020 (Healthy People 2020, 2013). Therefore, to assess recent trends in youth exposure to pro-tobacco advertisements from these media, and to monitor progress made in meeting the Healthy People, 2020 objectives to reduce youth exposure to pro-tobacco advertisements, this study assessed the prevalence, trends, and correlates of pro-tobacco advertising over the Internet, in newspapers/magazines, and at retail stores among U.S. middle and high school students during 2000–2012, using data from the National Youth Tobacco Survey (NYTS).
Section snippets
Data source
The NYTS is a biennially repeated, anonymous, school-based national survey that collects information on key tobacco-related measures from middle school (grades 6–8) and high school (grades 9–12) students (Centers for Disease Control and Prevention, 2011, Starr et al., 2005). The NYTS research protocol was approved by the U.S. Office of Management and Budget; no ethics approval was sought for this study because only secondary data were used. We analyzed 7 consecutive waves of the NYTS, with
Over the internet
Among all U.S. middle and high school students, the overall prevalence of exposure to Internet pro-tobacco advertisements increased from 22.3% in 2000 to 43.0% in 2012 (APC = 3.7; P < 0.01 for linear trend) (Table 1, Fig. 1). Significant increases were also noted among both smokers (24.1% to 44.0%) and nonsmokers (21.6% to 42.9%); middle school (25.4% to 41.0%) and high school students (19.6% to 44.6%); as well as among both boys (22.5% to 39.4%) and girls (22.0% to 46.7%). Significant increases
Discussion
The findings indicate that the overall prevalence of exposure to Internet pro-tobacco advertisements increased significantly between 2000 and 2012, whereas the overall prevalence of exposure to advertisements in newspapers/magazines, and at retail stores declined significantly during the same time period. However, the prevalence of exposure to pro-tobacco advertisements among U.S. middle and high school students who reported use of the Internet in 2012 (44.7%) was higher than the Healthy
Conclusion
The findings from this study reveal that the overall prevalence of exposure to pro-tobacco advertisements over the Internet increased significantly between 2000 and 2012. The overall prevalence of exposure to pro-tobacco advertisements in newspapers/magazines and at retail stores declined significantly during the same time period, but remained high for both media with over two-thirds of all students reporting retail store exposure to pro-tobacco advertisements. The effective and sustained
Conflicts of interests
The authors declare that there are no conflicts of interests.
Acknowledgments
Rene Arrazola, Office on Smoking and Heath, National Center for Chronic Disease Prevention and Health Promotion; Francisca Abanyie, MD, MPH; Plucinski, Mateusz M. PhD; Epidemic Intelligence Service Officers, Centers for Disease Control and Prevention.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
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