Exposure to cigarette promotions and smoking uptake in adolescents: evidence of a dose-response relation

Characterizing #Backwoods on Instagram: "The Number One Selling All Natural Cigar"

We sought to assess the proportion of Backwoods (Imperial Tobacco Group Brands LLC) cigar-related posts to Instagram that may contain misleading claims, nature-evoking imagery, and appealing flavors. Inclusion criteria for this study included an Instagram post with the hashtag “#backwoods” from 30 August to 12 September 2018. Rules were established to content analyze (n = 1206) posts. Categories included misleading packaging (i.e., the post contained an image of a Backwoods product with the descriptor “natural” on the packaging), misleading promo (i.e., the corresponding caption to the post contained hashtag(s) like “#natural”, “#authentic”, “#alwaystrue”), nature-evoking imagery (i.e., the post contained images of grass, water, and pastural views along with a Backwoods product), flavors (i.e., the post contained a Backwoods product with brand-specific flavors on the packaging), flavor promo (i.e., the corresponding caption to the post contained hashtag(s) of Backwoods’ brand-specific flavors), marijuana-related (i.e., the post contained an image of marijuana next to a Backwoods pack, rolled cigars visibly contained marijuana, or hollowed-out cigars next to marijuana), smoking (the post contained an image of smoke or a lit cigar), brand-specific promo (i.e., the post contained an image of a Backwoods t-shirt, sweatshirt, hat, etc.), and perceived gender. Among the posts analyzed, 645 (53.5%) were marijuana-related, 564 (46.8%) were flavors, 463 (38.4%) were misleading packaging, 335 (27.8%) were flavor promo, 309 (25.6%) were misleading promo, 188 (15.6%) were nature-evoking imagery, 165 (13.7%) were smoking, 157 (13.0%) were brand-specific promo, and 239 (19.8%) were perceived male gender. Backwoods cigar-related posts to Instagram often contained misleading images and promotions of a “natural” tobacco product, images of marijuana use (in the form of blunt-making), brand-specific flavors, smoking, and promotional merchandise. Misleading images and the depictions of marijuana use in addition to the variety of flavor options may increase product appeal to consumers. These results underscore the need for comprehensive regulation of cigar products similar to cigarettes.

Adolescent Smoking Susceptibility in the Current Tobacco Context: 2014-2016

OBJECTIVES

We examined perceptions and behaviors associated with smoking susceptibility among adolescents in the current tobacco landscape.

METHODS

Participants were 8th and 10th grade never-smokers of conventional cigarettes (N = 19,853) from Monitoring the Future surveys (2014-2016). Using weighted multivariable logistic regression, we examined risk factors for smoking susceptibility: alternative tobacco product use (e-cigarettes, large cigars, little cigars/cigarillos, and flavored little cigars/cigarillos), ownership of tobacco promotional items (TPIs), access to cigarettes, perceived influence of antismoking advertisements, and perceived addictiveness of conventional cigarette smoking.

RESULTS

Among never-smokers of conventional cigarettes, 16.7% were susceptible to smoking, 6.2% were past 30-day alternative tobacco product users, and 3.5% owned TPIs. Alternative tobacco product use, ownership of TPIs, and easy access to cigarettes were associated with increased likelihood of smoking susceptibility. Perceived great influence by antismoking ads and higher perceived addictiveness of conventional cigarette smoking were associated with lower odds of smoking susceptibility.

CONCLUSION

Alternative tobacco product use, ownership of TPIs, easy access to cigarettes, low influence by antismoking ads, and low perceptions of the addictiveness of conventional cigarettes are significant and actionable risk factors for smoking susceptibility among today's adolescents.

Engagement With Online Tobacco Marketing and Associations With Tobacco Product Use Among U.S. Youth

PURPOSE

Youth who engage with online tobacco marketing may be more susceptible to tobacco use than unengaged youth. This study examines online engagement with tobacco marketing and its association with tobacco use patterns.

METHODS

Cross-sectional analysis of youths aged 12-17 years who participated in wave 1 of the Population Assessment of Tobacco and Health Study (N = 13,651). Engagement with tobacco marketing was based on 10 survey items including signing up for email alerts about tobacco products in the past 6 months. Logistic regression was used to examine the association of online engagement with tobacco marketing and susceptibility to use any tobacco product among never-tobacco users, ever having tried tobacco, and past 30-day tobacco use.

RESULTS

An estimated 2.94 million U.S. youth (12%) engaged with ≥ one forms of online tobacco marketing. Compared with no engagement, the odds of susceptibility to the use of any tobacco product among never-tobacco users was independently associated with the level of online engagement: adjusted odds ratio (AOR) = 1.48 (95% confidence interval [CI], 1.24-1.76) for one form of engagement and AOR = 2.37 (95% CI, 1.53-3.68) for ≥ two forms of engagement. The odds of ever having tried tobacco were also independently associated with the level of online engagement: AOR = 1.33 (95% CI: 1.11-1.60) for one form of engagement and AOR = 1.54 (95% CI, 1.16-2.03) for ≥ two forms of engagement. The level of online engagement was not independently associated with past 30-day tobacco use.

CONCLUSIONS

Online engagement with tobacco marketing may represent an important risk factor for the onset of tobacco use in youth.

Tobacco Marketing Receptivity and Other Tobacco Product Use Among Young Adult Bar Patrons

PURPOSE

Use of other tobacco products (smokeless tobacco, hookah, cigarillo, and e-cigarettes) is increasing, particularly among young adults, and there are few regulations on marketing for these products. We examined the associations between tobacco marketing receptivity and other tobacco product (OTP) use among young adult bar patrons (aged 18-26 years).

METHODS

Time-location sampling was used to collect cross-sectional surveys from 7,540 young adult bar patrons from January 2012 through March of 2014. Multivariable logistic regression analyses in 2015 examined if tobacco marketing receptivity was associated (1) with current (past 30 day) OTP use controlling for demographic factors and (2) with dual/poly use among current cigarette smokers (n = 3,045), controlling for demographics and nicotine dependence.

RESULTS

Among the entire sample of young adult bar patrons (Mean_age = 23.7, standard deviation = 1.8; 48.1% female), marketing receptivity was consistently associated with current use of all OTP including smokeless tobacco (adjusted odds ratio [AOR]= 2.56, 95% confidence interval [CI] 2.08-3.16, p < .001), hookah (AOR = 1.97, 95% CI 1.58-2.43, p < .001), cigarillos (AOR = 3.00, 95% CI 2.21-4.08, p < .001), electronic cigarettes (AOR = 2.43, 95% CI 1.93-3.04, p < .001), and multiple tobacco products (AOR = 2.93, 95% CI 2.45-3.51, p < .001). Among current smokers, marketing receptivity was significantly associated with use of smokeless tobacco (AOR = 1.63, 95% CI 1.22-2.18, p < .01), cigarillos (AOR = 1.81, 95% CI 1.22-2.70, p < .01), and multiple tobacco products (AOR = 1.58, 95% CI 1.27-1.97, p < .001).

CONCLUSIONS

OTP use is common among young adult bar patrons, and it is associated with tobacco marketing receptivity. Efforts to limit tobacco marketing should address OTP in addition to cigarettes.

A Risk-Continuum Categorization of Product Use Among US Youth Tobacco Users

INTRODUCTION

To examine prevalence and correlates of five mutually exclusive tobacco-use patterns among US youth tobacco users.

METHODS

A nationally representative sample of tobacco users (N = 3202, 9-17 years) was classified into five product-use patterns. Weighted multinominal and multivariate logistic regression models were used to examine prevalence of product-use patterns by gender, race and ethnicity, and grade level; and associations between product-use patterns and perceived accessibility of tobacco products, exposure and receptivity to pro-tobacco marketing, social benefits of smoking, and tobacco-associated risks.

RESULTS

Dual use (ie, use of two product categories) was the most prevalent pattern (30.5%), followed by non-cigarette combustible only (26.7%), polytobacco (ie, use of three product categories; 17.5%), cigarette only (14.9%), and noncombustible only (10.4%) use. Product-use patterns differed by gender, race, and ethnicity. Compared to cigarette only users, dual and polytobacco users were more likely to be exposed to and be receptive to pro-tobacco marketing, and were less likely to acknowledge tobacco-use related risks (Ps < .05).

CONCLUSIONS

Curbing tobacco use warrants research on users of more than one tobacco-product categories according to the risk-continuum categorization.

IMPLICATIONS

We present a risk-continuum categorization of product-use patterns among tobacco users not older than 17 years. We classify tobacco users into five mutually exclusive product-use patterns: cigarette only users, non-cigarette combustible only users, noncombustible only users, dual use, and polytobacco use. This categorization overcomes limitations in current literature on tobacco-use patterns, which include exclusion of certain products (eg, e-cigarettes) and product-use patterns (eg, exclusive users of non-cigarette products), and inconsistent classification of tobacco users. It is parsimonious yet complex enough to retain differential characteristics of sub-tobacco users based on number (single, dual, polytobacco) and categories (cigarettes, non-cigarette combustibles, noncombustibles) of tobacco products consumed.

Receptivity to tobacco marketing and susceptibility to smoking among non-smoking male students in an urban setting in Lao PDR

BACKGROUND

Tobacco marketing is a contributing factor to adolescent smoking, and now targeting adolescents in low- and middle-income countries. Especially, promotional items with tobacco brand logos have a great impact on adolescent smoking.

OBJECTIVE

The authors evaluated whether receptivity to tobacco marketing is associated with susceptibility to smoking among non-smoking male students in Lao PDR.

METHODS

The authors conducted a cross-sectional study with self-administered questionnaires among 526 non-smoking male students in grades 8th and 11th (aged 12-19 years) in Vientiane Capital, Lao PDR. The authors investigated receptivity to tobacco marketing by three measurements: awareness of tobacco marketing, recognition of tobacco marketing messages and owning/being willing to use promotional items. The authors then conducted multiple logistic regression analysis to determine whether marketing receptivity had an independent association with smoking susceptibility, which is defined as the absence of a firm decision not to smoke.

RESULTS

About 20% of the participants were susceptible to smoking. Recognition of marketing messages was significantly associated with susceptibility to smoking (OR=1.76, 95% CI 1.01 to 3.08), as was any owning/being willing to use promotional items with recognition of marketing messages (OR=2.39, 95% CI 1.34 to 4.24). In contrast, any owning/being willing to use promotional items without any recognition of marketing messages was not significantly associated with susceptibility.

CONCLUSIONS

A significant association was detected between smoking susceptibility and marketing receptivity, which has been little explored in previous research in low-income countries. Owning/being willing to use promotional items was associated with smoking susceptibility only when there is also recognition of marketing messages.

Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours

BACKGROUND

The tobacco industry denies that their marketing is targeted at young nonsmokers, but it seems more probable that tobacco advertising and promotion influences the attitudes of nonsmoking adolescents, and makes them more likely to try smoking.

OBJECTIVES

To assess the effects of tobacco advertising and promotion on nonsmoking adolescents' future smoking behaviour.

SEARCH STRATEGY

We searched the Cochrane Tobacco Group specialized register, the Cochrane Central Register of Controlled Trials, MEDLINE, the Cochrane Library, Sociological Abstracts, PsycLIT, ERIC, WorldCat, Dissertation Abstracts, ABI Inform and Current Contents to August 2011.

SELECTION CRITERIA

We selected longitudinal studies that assessed individuals' smoking behaviour and exposure to advertising, receptivity or attitudes to tobacco advertising, or brand awareness at baseline, and assessed smoking behaviour at follow ups. Participants were adolescents aged 18 or younger who were not regular smokers at baseline.

DATA COLLECTION AND ANALYSIS

Studies were prescreened for relevance by one reviewer. Two reviewers independently assessed relevant studies for inclusion. Data were extracted by one reviewer and checked by a second.

MAIN RESULTS

Nineteen longitudinal studies that followed up a total of over 29,000 baseline nonsmokers met inclusion criteria. The studies measured exposure or receptivity to advertising and promotion in a variety of ways, including having a favourite advertisement or an index of receptivity based on awareness of advertising and ownership of a promotional item. One study measured the number of tobacco advertisements in magazines read by participants. All studies assessed smoking behaviour change in participants who reported not smoking at baseline. In 18 of the 19 studies the nonsmoking adolescents who were more aware of tobacco advertising or receptive to it, were more likely to have experimented with cigarettes or become smokers at follow up. There was variation in the strength of association, and the degree to which potential confounders were controlled for.

AUTHORS' CONCLUSIONS

Longitudinal studies consistently suggest that exposure to tobacco advertising and promotion is associated with the likelihood that adolescents will start to smoke. Based on the strength and specificity of this association, evidence of a dose-response relationship, the consistency of findings across numerous observational studies, temporality of exposure and smoking behaviours observed, as well as the theoretical plausibility regarding the impact of advertising, we conclude that tobacco advertising and promotion increases the likelihood that adolescents will start to smoke.

Tobacco use in Bollywood movies, tobacco promotional activities and their association with tobacco use among Indian adolescents

Background

Smoking in Hollywood movies is a known risk factor for teen smoking in the USA and Europe, but little is known about the association between exposure to tobacco use in Bollywood movies and teen tobacco use in India.

Methods

A cross-sectional sample of 3956 adolescents (eighth and ninth grades, ages 12–16 years) from 12 randomly selected New Delhi schools was surveyed in 2009, assessing tobacco use status, receptivity to tobacco promotions (based on owning or being willing to wear tobacco-branded merchandise) and exposure to tobacco use in movies. Quartiles of exposure to tobacco use in popular Bollywood movies released from 2006 to 2008 (n=59) were determined by content coding them for tobacco use and querying the adolescents whether they had seen each one. Logistic regression was used to control for covariates including age, gender, parent education, school performance, sensation-seeking propensity, family and peer tobacco use, and authoritative parenting.

Results

Altogether, the 59 movies contained 412 tobacco use occurrences. The prevalence of ever tobacco use among adolescents was 5.3%. Compared with low-exposure adolescents (quartile 1), the adjusted odds of ever tobacco use among high-exposure adolescents (quartile 4) was 2.3 (95% CI 1.3 to 3.9). Being receptive to tobacco promotions was also associated with higher adjusted odds of ever tobacco use, 2.0 (95% CI 1.4 to 3.0).

Conclusion

Watching tobacco use in Bollywood movies and receptivity to tobacco promotional activities were both independently associated with ever tobacco use among adolescents in India, with ORs being similar to the studies of adolescents elsewhere.

Corporate externalities: a challenge to the further success of prevention science

The full benefit of prevention science will not be realized until we learn how to influence organizational practices. The marketing of tobacco, alcohol, and food and corporate advocacy for economic policies that maintain family poverty are examples of practices we must influence. This paper analyzes the evolution of such practices in terms of their selection by economic consequences. A strategy for addressing these critical risk factors should include: (a) systematic research on the impact of corporate practices on each of the most common and costly psychological and behavior problems; (b) empirical analyses of the consequences that select harmful corporate practices; (c) assessment of the impact of policies that could affect problematic corporate practices; and (d) research on advocacy organizations to understand the factors that influence their growth and to help them develop effective strategies for influencing corporate externalities.

The Korean prediction model for adolescents' future smoking intentions

OBJECTIVES

The purpose of this study was to develop a prediction model for future smoking intention among Korean adolescents aged 13 to 15 in order to identify the high risk group exposed to future smoking.

METHODS

The data was collected from a total of 5940 students who participated in a self-administrated questionnaire of a cross-sectional school-based survey, the 2004 Korea Global Youth Tobacco Survey. Chi-square tests and logistic regression analyses were carried out to identify the relevant determinants associated with intentions of adolescents' future smoking. Receiver Operation Characteristic (ROC) assessment was applied to evaluate the explanation level of the developed prediction model.

RESULTS

8.4% of male and 7.2% of female participants show their intentions of future smoking. Among non-smoking adolescents; who have past smoking experience [odds ratio (OR) 2.73; 95% confidence interval (CI) 1.92 - 3.88]; who have intentions of smoking when close friends offer a cigarette (OR 31.47; 95% CI = 21.50 - 46.05); and who have friends that are mostly smokers (OR 5.27; 95% CI = 2.85 - 9.74) are more likely to be smokers in the future. The prediction model developed from this study consists of five determinants; past smoking experience; parents smoking status; friends smoking status; ownership of a product with a cigarette brand logo; and intentions of smoking from close friends' cigarette offer. The area under the ROC curve was 0.8744 (95% CI=0.85 - 0.90) for current non-smokers.

CONCLUSIONS

For efficiency, school-based smoking prevention programs need to be designed to target the high risk group exposed to future smoking through the prediction model developed by the study, instead of implementing the programs for all the students.

Policy statement--children, adolescents, substance abuse, and the media

The causes of adolescent substance use are multifactorial, but the media can play a key role. Tobacco and alcohol represent the 2 most significant drug threats to adolescents. More than $25 billion per year is spent on advertising for tobacco, alcohol, and prescription drugs, and such advertising has been shown to be effective. Digital media are increasingly being used to advertise drugs. In addition, exposure to PG-13- and R-rated movies at an early age may be a major factor in the onset of adolescent tobacco and alcohol use. The American Academy of Pediatrics recommends a ban on all tobacco advertising in all media, limitations on alcohol advertising, avoiding exposure of young children to substance-related (tobacco, alcohol, prescription drugs, illegal drugs) content on television and in PG-13- and R-rated movies, incorporating the topic of advertising and media into all substance abuse-prevention programs, and implementing media education programs in the classroom.

Cigarette advertising and adolescent smoking

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.

College students' exposure to tobacco marketing in nightclubs and bars

OBJECTIVE

to examine whether a college student's exposure to tobacco marketing in nightclubs and bars was affected by the presence of a smoke-free law.

PARTICIPANTS

a random sample (N = 478) of students participated in the survey (no smoke-free law, n = 240; smoke-free law, n = 238). The analysis was limited to students who reported being in nightclubs and bars (n = 171).

METHODS

a nonexperimental, cross-sectional, 2-group design was used.

RESULTS

students in the smoke-free law city were more likely to be approached by tobacco marketers (34.7% versus 20.2%, p = .02), offered free gifts (41.7% versus 24.2%, p = .02), and take free gifts for themselves (34.7% versus 19.2%, p = .02). They were more likely to be exposed to direct marketing strategies (1.83 versus 1.12, p = .02). There was no difference on indirect tobacco marketing by site.

CONCLUSIONS

tobacco marketing is pervasive in nightclubs and bars. Smoke-free laws may protect against exposure to secondhand smoke but not the "pro" smoking messages students encounter.

Does the Source Matter in the Communication of Anti-Smoking Messages to Youth?

This study examined ethnicity as a moderator of exposure to sources of anti-smoking communication and behavioral intentions among adolescents who have never tried smoking (i.e., never smokers) and those who previously experimented with smoking but are not yet regular smokers (i.e., experimental smokers). Responses from 1700 African American, Latino, and White youth who completed the Virginia Youth Tobacco Survey from September 2007 through April 2008 were analyzed. Ethnicity and smoking status moderated the association between exposure to sources of anti-tobacco communication and adolescents' intentions to smoke. For never smokers, media exposure was related to lower behavioral intentions among African Americans. For experimental smokers, exposure to both media and to health professionals was associated with lower intentions among African Americans. Exposure to parental anti-smoking communication was associated with reduced intentions among White adolescents. These findings suggest that prevention for smoking initiation among ethnically diverse youth might be enhanced with greater attention to the source of anti-smoking messages and prior smoking experience.

Exposure to sexually explicit Web sites and adolescent sexual attitudes and behaviors

PURPOSE

Mass media play an important role in the socialization of youth. Given its expanding nature and accessibility, the Internet may be at the forefront of this education. However, the extent of the Internet's impact on adolescent sexual attitudes and behaviors is not yet known.

METHODS

A total of 433 adolescents completed an anonymous survey at a health center in New York City. The cross-sectional survey assessed Internet accessibility, exposure to sexually explicit Web sites (SEWs), sexual behaviors, and sexually permissive attitudes.

RESULTS

Of the participants, 96% had Internet access, and 55.4% reported ever visiting a SEW. Logistic regression analyses revealed that adolescents exposed to SEWs were more likely to have multiple lifetime sexual partners (OR=1.8, CI=1.2, 2.9), to have had more than one sexual partner in the last 3 months (OR=1.8, CI=1.1, 3.1), to have used alcohol or other substances at last sexual encounter (OR=2.8, CI=1.5, 5.2), and to have engaged in anal sex (OR=2.0, CI=1.2, 3.4). Adolescents who visit SEWs display higher sexual permissiveness scores compared with those who have never been exposed (2.3 vs. 1.9, p <or= .001), indicating a more permissive attitude.

CONCLUSIONS

Exposure to Internet pornography has potential implications for adolescent sexual relationships, such as number of partners and substance use. SEWs can serve an educational purpose and create an opportunity for adults to engage adolescents in discussions about sexual health and consumption of Internet material. Longitudinal research is needed to evaluate how exposure to SEWs influences youth attitudes and sexual behaviors.

Comparing the effects of entertainment media and tobacco marketing on youth smoking in Germany

AIMS

To examine differential effects of smoking in films and tobacco advertising on adolescent smoking. We hypothesize that movie smoking will have greater effects on smoking initiation, whereas tobacco advertising receptivity will primarily affect experimentation.

DESIGN

Longitudinal observational study of adolescents.

SETTING

School-based surveys conducted in Schleswig-Holstein, Germany.

PARTICIPANTS

A total of 4384 adolescents age 11-15 years at baseline and re-surveyed 1 year later; ever smoking prevalence was 38% at time 1.

MEASUREMENTS

The main outcome variable combined two items assessing life-time and current smoking (alpha = 0.87). Baseline never smokers were analyzed separately from those who had tried smoking (ever smokers). Exposure to smoking in 398 internationally distributed US movies was modeled as a continuous variable, with 0 corresponding to the 5th percentile and 1 to the 95th percentile of exposure. Tobacco marketing receptivity consisted of naming a brand for a favorite tobacco advertisement. Ordinal logistic regressions controlled for socio-demographics, other social influences, personality characteristics of the adolescent and parenting style.

FINDINGS

Whereas 34% of ever smokers were receptive to tobacco marketing at time 1, only 6% of never smokers were. Among time 1 never smokers, exposure to movie smoking was a significantly stronger predictor of higher time 2 smoking level [adjusted proportional odds ratio = 2.76, 95% confidence interval (1.84, 4.15)] than was tobacco marketing receptivity (1.53 [1.07, 2.20]). Among time 1 ever smokers, both tobacco marketing receptivity and exposure to movie smoking predicted higher levels of time 2 smoking [2.17 (1.78, 2.63) and 1.62 (1.18, 2.23), respectively], and the two estimates were not significantly different.

CONCLUSIONS

In this longitudinal study, exposure to movie smoking was a stronger predictor of smoking initiation than tobacco marketing receptivity, which was more common among ever smokers. The results suggest that entertainment media smoking should be emphasized in programs aimed at preventing onset, and both exposures should be emphasized in programs aimed at experimental smokers.

Moderating roles of primary social influences in the relationship between adolescent self-reported exposure to antismoking messages and smoking intention

This study explores moderating roles of primary social influences in the relationship between adolescent triers' and experimenters' self-reported exposure to antismoking messages and their smoking intentions. The theoretical arguments are drawn from primary socialization theory, group socialization theory, and the social development model, and the data are from the 2004 National Youth Tobacco Survey. The tobit regression models demonstrate that, as a primary social influence, peer smoking seems to be a strong risk factor for all of the adolescent segments' smoking intentions, whereas parental monitoring can be a significant counter-risk factor for middle-schoolers' smoking intentions. In addition, school intervention programs and parental monitoring against smoking appear to play a moderating role in the relationship between high-school triers' self-reported exposure to antismoking messages and their smoking intentions. The findings seem to suggest that campaigners should make more efforts to incorporate primary social influences to prevent adolescent smoking. The findings also suggest that campaigners should tailor antismoking programs to fit specific target audiences. In particular, middle-school experimenters deserve more attention from antismoking campaigners because they seem most vulnerable to future smoking.

Comparing the effects of entertainment media and tobacco marketing on youth smoking

OBJECTIVES

To examine the concurrent effects of exposure to movie smoking and tobacco marketing receptivity on adolescent smoking onset and progression.

METHODS

Cross-sectional study of 4524 northern New England adolescents aged 10-14 in 1999 with longitudinal follow-up of 2603 baseline never-smokers. Cross-sectional outcomes included ever tried smoking and higher level of lifetime smoking among 784 experimenters. The longitudinal outcome was onset of smoking among baseline never-smokers two years later. Movie smoking exposure was modelled as four population quartiles, tobacco marketing receptivity included two levels-having a favourite tobacco advert and wanting/owning tobacco promotional items. All analyses controlled for sociodemographics, other social influences, personality characteristics of the adolescent and parenting style.

RESULTS

In the full cross-sectional sample, 17.5% had tried smoking; both exposure to movie smoking and receptivity to tobacco marketing were associated with having tried smoking. Among experimental smokers, the majority (64%) were receptive to tobacco marketing, which had a multivariate association with higher level of lifetime smoking (movie smoking did not). In the longitudinal study 9.5% of baseline never-smokers tried smoking at follow-up. Fewer never-smokers (18.5%) were receptive to tobacco marketing. Movie smoking had a multivariate association with trying smoking (receptivity to tobacco marketing did not).

CONCLUSIONS

The results suggest separate roles for entertainment media and tobacco marketing on adolescent smoking. Both exposures deserve equal emphasis from a policy standpoint.

Associations between tobacco marketing and use among urban youth in India

OBJECTIVES

To study if receptivity and exposure to tobacco marketing are correlated with tobacco use and psychosocial risk factors for tobacco use among a sample of urban Indian youth.

METHODS

Analysis of cross-sectional survey data from Project MYTRI, a group randomized intervention trial, in Delhi and Chennai, India, collected from sixth and eighth graders (n=11,642), in 32 schools in 2004.

RESULTS

Exposure to tobacco advertisements and receptivity to tobacco marketing were significantly related to increased tobacco use among students.

CONCLUSION

This association suggests the need to strengthen policy and program-based interventions in India to reduce the influence of such exposures.

Tobacco industry targeting youth in Argentina

BACKGROUND/AIM

Argentina has one of the highest cigarette smoking rates among both men and women in the Americas and no legislated restrictions on tobacco industry advertising. The tobacco industry has traditionally expanded markets by targeting adolescents and young adults. The objective of this study was to determine whether and how the tobacco industry promotes cigarettes to adolescents in Argentina.

METHODS

We conducted a systematic search of tobacco industry documents available through the internet dated between 1995 and 2004 using standard search terms to identify marketing strategies in Argentina. A selected review of the four leading newspapers and nine magazines with reported high readership among adolescents was completed. The selected print media were searched for tobacco images and these were classified as advertisements if associated with a commercial product or as a story if not.

RESULTS

The tobacco industry used market segmentation as a strategy to target Argentinean consumers. British American Tobacco (BAT) undertook a young adult psychographic study and classified them as "progressives", "Jurassics" or "conservatives" and "crudos" or "spoiled brats". BAT marketed Lucky Strike to the "progressives" using Hollywood movies as a vehicle. The tobacco industry also targeted their national brands to the conservatives and linked these brands with "nationalistic values" in advertising campaigns. Philip Morris promoted Marlboro by sponsoring activities directed at young people and they launched the 10 cigarettes packet as a starter vehicle.

CONCLUSIONS

The tobacco industry used psychographic segmentation of the population and developed advertising strategies focused on youth. Tobacco control researchers and advocates must be able to address these strategies in counter-marketing interventions.

The role of spending money and drinking alcohol in adolescent smoking

AIMS

Previous studies have shown inconsistent findings with regard to the association between amount of spending money and adolescent smoking. Drinking alcohol may be a mediator of the association between spending money and adolescent smoking. However, no studies have examined this potential role. The objective of this study was to investigate the association between amount of spending money and adolescent smoking and the potential mediation role of alcohol use in this association.

DESIGN

The 2003 Ontario Student Drug Use Survey of students in grades 7-12.

MEASUREMENTS

Multivariable logistic, probit and linear regression models were used to investigate the association between amount of spending money and smoking, and the contribution of drinking alcoholic beverages to this relationship.

FINDINGS

Spending money was associated positively with experimental smoking, current smoking and daily consumption of cigarettes (P < 0.01). The analysis adjusted for confounders showed that students with spending money > or =$20/week were significantly more likely to be experimental smokers, students with > or =$30/week were significantly more likely to be current smokers and students with > or =$60/week smoked significantly more cigarettes/day (P < or = 0.05), compared to students with <$10/week. Alcohol use was an important mediator, responsible for 81% of the association of spending money with experimental smoking, 38% with current smoking and 37% with daily consumption of cigarettes.

CONCLUSIONS

Amount of spending money was associated significantly and positively with smoking among adolescents, and alcohol use mediated this association. Integrated tobacco prevention programs may be more effective, and increasing taxes on cigarettes and alcohol would increase price sensitivity among youth and protect against adolescent smoking.

Teens, dating violence, and media use: a review of the literature and conceptual model for future research

Dating violence is highly prevalent among adolescents. Of importance, dating violence has been associated with negative physical and mental health outcomes for teens and high-risk behaviors such as unsafe sex practices. Although a growing body of research has examined the extent and nature of this problem, little research has considered aspects of the media that might be associated with risk for teen dating violence, such as time spent using media and effects of media content. This article provides an overview of the prevalence of teen dating violence, describes the potential for assessing media use as a risk factor, offers a conceptual model, and suggests ideas for future research.

Receptivity to tobacco advertising and promotions among young adolescents as a predictor of established smoking in young adulthood

OBJECTIVES

We investigated whether receptivity to tobacco advertising and promotions during young adolescence predicts young adult smoking 6 years later.

METHODS

Two longitudinal cohorts of adolescents drawn from the 1993 and 1996 versions of the California Tobacco Surveys were followed 3 and 6 years later. At baseline, adolescents were aged 12 to 15 years and were not established smokers. The outcome measure was established smoking at final follow-up. Receptivity to cigarette advertising and promotions was included in a multivariate logistic regression analysis along with demographic and other variables.

RESULTS

The rate of established smoking at follow-up was significantly greater among members of the 1993 through 1999 cohort (21.0%) than among members of the 1996 through 2002 cohort (15.6%). However, in both cohorts, having a favorite cigarette advertisement and owning or being willing to use a tobacco promotional item showed nearly identical adjusted odds of future adult smoking (1.46 and 1.84, respectively).

CONCLUSIONS

Despite the success of tobacco control efforts in reducing youth smoking, tobacco marketing remains a potent influence on whether young adolescents become established smokers in young adulthood (18-21 years of age).

History of childhood candy cigarette use is associated with tobacco smoking by adults

OBJECTIVE

We examined whether childhood candy cigarette use was associated with adult tobacco smoking.

METHODS

25,887 U.S. adults from the Harris Poll Online (HPOL) were surveyed about current smoking status from November 2005 to May 2006. Respondents were randomly assigned to a yes/no item or a dose-response scale to assess candy cigarette use. Data were weighted to reflect the U.S. adult population.

RESULTS

26.4% of respondents reported current smoking and 29.4% reported former smoking. Candy cigarette use was reported by 88% of both current and former smokers and 78% of never smokers (p<or=0.001). Logistic regression showed that the odds of smoking for those who used candy cigarettes was 1.98 (95% CI: 1.77, 2.21) for ever (current plus former) smokers and 1.83 (1.59, 2.10) for current smokers, compared to those who had not used candy cigarettes. Odds for current and ever smoking increased with increasing candy cigarette use.

CONCLUSION

History of candy cigarette use was associated with increased risk of ever and current smoking among this nationally representative online sample of adults. Odds of smoking increased as candy cigarette use increased; these relationships persisted when controlled for sociodemographics. Elimination of candy cigarettes may protect children from products that promote the social acceptability of smoking.

Characteristics of daily and occasional smoking among youths

OBJECTIVES

The purpose of this study was to develop a more detailed understanding of the characteristics of occasional smokers, and how the characteristics of occasional smokers differ from those of daily smokers. This information can then be used in youth smoking programmes to better address these differences in a manner that would target appropriate youth with appropriate cessation methods.

METHODS

A questionnaire was administered to 976 university students, aged between 18 and 25 years, in Ankara, Turkey. The topics covered included age, sex and tobacco use characteristics. Daily and occasional smokers were defined according to traditional definitions of smoking.

RESULTS

Among the 976 students surveyed, 482 (49.4%) reported being active smokers. Among these smokers, 199 (41.3%) were classified as occasional smokers and 283 (58.7%) were daily smokers using the traditional definitions of smoking. Many of the active smokers had relatives or friends who also smoked, specifically, 46.5% had a father who smokes, 13.3% had a mother who smokes, 26.8% had an older brother or sister who smokes, and 69.7% had two or more close friends who smoke. Although more than 51.3% of smokers planned on quitting smoking, only 26.1% had previously tried to quit smoking but 64.7% believed they could successfully quit. Daily smokers reported that they made fewer attempts to quit smoking than occasional smokers. More often than occasional smokers, daily smokers reported that they smoke because they like the image, they are addicted, smoking relieves stress and/or their friends smoke. Occasional smokers reported that they smoke less at home or at the university than in other places, and smoke more often with friends than when alone or with family members. This pattern is encouraged by the family structure in Turkish society, where smoking by adolescents at home in the presence of family members is frowned upon.

CONCLUSIONS

This study demonstrates substantial differences between occasional and daily smokers. If effective future smoking prevention and cessation programmes that target youth are going to be developed, data like those gathered in this study are critical. Basic information regarding cigarette consumption patterns, while important, is insufficient to understand behaviour and key factors that trigger smoking among the youth population.

The relationship between exposure to alcohol advertising in stores, owning alcohol promotional items, and adolescent alcohol use

AIM

This paper describes adolescents' exposure to alcohol advertising in stores and to alcohol-branded promotional items and their association with self-reported drinking.

METHODS

A cross-sectional survey was administered in non-tracked required courses to sixth, seventh, and eighth graders (n = 2125) in three California middle schools. Logistic regressions compared the odds of ever (vs. never) drinking and current (vs. ever) drinking after controlling for psychosocial and other risk factors for adolescent alcohol use.

RESULTS

Two-thirds of middle school students reported at least weekly visits to liquor, convenience, or small grocery stores where alcohol advertising is widespread. Such exposure was associated with higher odds of ever drinking, but was not associated with current drinking. One-fifth of students reported owning at least one alcohol promotional item. These students were three times more likely to have ever tried drinking and 1.5 times more likely to report current drinking than students without such items.

CONCLUSIONS

This study provides clear evidence of an association of adolescent drinking with weekly exposure to alcohol advertising in stores and with ownership of alcohol promotional items. Given their potential influence on adolescent drinking behaviour, retail ads, and promotional items for alcohol deserve further study.

Heterogeneity among adolescent non-daily smokers: implications for research and practice

Cluster analysis modeling was used to identify distinct smoking taxonomies among 4,473 smokers from 29 secondary schools (2000-2001) in Ontario, Canada. Analyses revealed a two-cluster solution (4,349 [97.2%] situational smokers and 124 [2.8%] ubiquitous smokers). Different psychosocial characteristics influenced the smoking behavior of these unique groups. Our findings are substantially different from the traditional definitions for non-daily and daily smoking used in the literature, which typically impose rules about smoking frequency or volume when defining smoking status. These findings suggest that more robust taxonomies of youth smoking are required in future tobacco control research. The study's limitations are noted.

The role of tobacco advertising and promotion: themes employed in litigation by tobacco industry witnesses

OBJECTIVES

To identify key themes related to tobacco advertising and promotion in testimony provided by tobacco industry-affiliated witnesses in tobacco litigation, and to present countervailing evidence and arguments.

METHODS

Themes in industry testimony were identified by review of transcripts of testimony in the Tobacco Deposition and Trial Testimony Archive (http://tobaccodocuments.org/datta) from a sample of defence witnesses, including three academic expert witnesses, six senior executives of tobacco companies, and one industry advertising consultant. Counterarguments to the themes embodied in defence testimony were based on information from peer-reviewed literature, advertising trade publications, government reports, tobacco industry documents, and testimony provided by expert witnesses testifying for plaintiffs.

RESULTS

Five major themes employed by defence witnesses were identified: (1) tobacco advertising has a relatively weak "share of voice" in the marketing environment and is a weak force in affecting smoking behaviour; (2) tobacco advertising and promotion do not create new smokers, expand markets, or increase total tobacco consumption; (3) the tobacco industry does not target, study, or track youth smoking; (4) tobacco advertising and promotion do not cause smoking initiation by youth; and (5) tobacco companies and the industry adhere closely to relevant laws, regulations, and industry voluntary codes. Substantial evidence exists in rebuttal to these arguments.

CONCLUSIONS

Tobacco industry-affiliated witnesses have marshalled many arguments to deny the adverse effects of tobacco marketing activities and to portray tobacco companies as responsible corporate citizens. Effective rebuttals to these arguments exist, and plaintiffs' attorneys have, with varying degrees of success, presented them to judges and juries.

Children, adolescents, and advertising

Advertising is a pervasive influence on children and adolescents. Young people view more than 40,000 ads per year on television alone and increasingly are being exposed to advertising on the Internet, in magazines, and in schools. This exposure may contribute significantly to childhood and adolescent obesity, poor nutrition, and cigarette and alcohol use. Media education has been shown to be effective in mitigating some of the negative effects of advertising on children and adolescents.

Operation storefront Hawaii: tobacco advertising and promotion in Hawaii stores

Our objective was to explore the nature and location of tobacco product advertising and promotion in retail stores in Hawaii. We performed a cross-sectional study of tobacco product store-based advertisements, including the number, location (indoor/outdoor; proximity to candy, toys, school), size, and brand of the ads. Trained youth (ages 12-19 years) collected data on 3,151 advertisements and promotions among 184 stores. We found that most ads appeared indoors, and the most heavily advertised brand was Kool. Kool is also the most heavily smoked brand among youth in Hawaii. This study underscores the high visibility of retail store advertising and promotions (both indoor and outdoor) in places that attract the attention of youth.

Longitudinal effects of pro‐tobacco and anti‐tobacco messages on adolescent smoking susceptibility

We examined the longitudinal impact of self-reported exposure to pro- and anti-tobacco media on adolescents' susceptibility to smoking, using in-school surveys from a culturally diverse sample. Ethnicity and acculturation also were examined as potential moderators. Middle-school students (N = 2,292) completed self-report questionnaires during the 6th, 7th, and 8th grades. Chi-square analyses were conducted to determine whether reported exposure to pro- and anti-tobacco media varied according to ethnicity, acculturation, and immigration status. Logistic regression models were used to examine whether pro- and anti-tobacco media exposure in 6th grade was associated with susceptibility to smoking by later grades. Recall of people smoking in television programs and pro-tobacco advertisements in stores was associated with adolescent smoking susceptibility. Exposure to anti-tobacco advertisements on television protected against susceptibility. No significant interaction effects between pro- and anti-tobacco media exposure on smoking susceptibility were found. Ethnicity and acculturation did not moderate these associations. Our longitudinal study provides evidence that pro-tobacco media and advertising increases susceptibility to smoking over time. More important, anti-tobacco advertisements are not sufficient to reduce the harmful effects of adolescent exposure to pro-tobacco media. Policy-level interventions such as restrictions in tobacco advertising may be necessary to prevent adolescent smoking.

Risky Business: What Primary Care Practitioners Need to Know About the Influence of the Media on Adolescents

Media can be powerfully prosocial, educational, and entertaining. Negative effects do exist, however, and they have been well documented. Despite the power of the new multinational media conglomerates and the intransigence of the entertainment industry,practitioners can make a difference in the future.

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

OBJECTIVE

We sought to determine whether there is evidence of a causal link between exposure to tobacco promotion and the initiation of tobacco use by children.

METHODS

We conducted a structured search in Medline, PsycINFO, and ABI/INFORM Global to identify relevant empirical research. The literature was examined against the Hill epidemiologic criteria for determining causality.

RESULTS

(1) Children are exposed to tobacco promotion before the initiation of tobacco use; (2) exposure increases the risk for initiation; (3) there is a dose-response relationship, with greater exposure resulting in higher risk; (4) the increased risk is robust; it is observed with various study methods, in multiple populations, and with various forms of promotion and persists after controlling for other factors; (5) scientifically plausible mechanisms whereby promotion could influence initiation exist; and (6) no explanation other than causality can account for the evidence.

CONCLUSIONS

Promotions foster positive attitudes, beliefs, and expectations regarding tobacco use. This fosters intentions to use and increases the likelihood of initiation. Greater exposure to promotion leads to higher risk. This is seen in diverse cultures and persists when other risk factors, such as socioeconomic status or parental and peer smoking, are controlled. Causality is the only plausible scientific explanation for the observed data. The evidence satisfies the Hill criteria, indicating that exposure to tobacco promotion causes children to initiate tobacco use.

How do psychological factors influence adolescent smoking progression? The evidence for indirect effects through tobacco advertising receptivity

OBJECTIVES

To determine whether novelty seeking and depressive symptoms had mediated or indirect effects on adolescent smoking progression through tobacco advertising receptivity.

METHODS

More than 1000 adolescents were monitored from 9th grade to 12th grade and completed annual surveys that measured demographic characteristics, smoking behavior, tobacco advertising receptivity, novelty-seeking personality, depressive symptoms, family and peer smoking, alcohol use, and marijuana use.

RESULTS

Latent growth modeling indicated that novelty seeking had a significant indirect effect on smoking progression through baseline tobacco advertising receptivity. For each 1-SD increase in novelty seeking, the odds of being more receptive to tobacco advertising increased by 12% (ie, being in a specific category or higher), which in turn resulted in an 11% increase in the odds of smoking progression from 9th grade to 12th grade. The indirect effect from depressive symptoms to smoking progression did not reach significance.

CONCLUSIONS

These findings may inform future research on other factors that influence tobacco advertising receptivity, as well as programs aimed at preventing adolescent smoking initiation and progression.

Ownership of alcohol-branded merchandise and initiation of teen drinking

BACKGROUND

The alcohol industry spends over $5 billion a year on marketing, much of which is accessible to children. The distribution of branded articles of clothing and other personal items is one aspect of alcohol marketing that has not been adequately studied. In this study, the prevalence of ownership of alcohol-branded merchandise (ABM) was determined in a sample of rural northern New England adolescents, and the relationship between ownership of such items and initiation of alcohol use was examined.

DESIGN/METHODS

Northern New England middle school students who had not yet initiated alcohol use were captured at baseline in a 1999 school-based survey, and ownership of an ABM item and initiation of alcohol use were determined 1 to 2 years later by telephone. The analysis controlled for demographics (gender, grade in school); characteristics of the child (school performance, sensation seeking, rebelliousness); parenting style; and peer alcohol use.

RESULTS

Of 2406 baseline never-drinkers, 15% had initiated alcohol use and 14% owned an ABM item by follow-up. ABM items consisted primarily of articles of clothing such as t-shirts and hats. ABM ownership was associated with higher grade in school, male gender, exposure to peer drinking, having tried smoking, poorer academic performance, higher levels of sensation seeking and rebelliousness, and less-responsive and restrictive parenting styles. Owners of ABM items at follow-up had higher rates of alcohol initiation compared with non-owners (25.5% vs 13.1%, respectively, p<0.001). After adjusting for the above confounders, students who owned an ABM item were significantly more likely to have initiated alcohol use compared with students who did not own one (adjusted odds ratio 1.5, 95% confidence interval, 1.1-2.0).

CONCLUSIONS

In this northern New England adolescent sample, ownership of alcohol-branded merchandise was prevalent and exhibited an independent cross-sectional association with onset of adolescent drinking. Further studies are necessary to determine whether the relationship is causal, and whether teen use of ABM items influences peer drinking norms and behavior.

Adolescents' perceptions about quitting and nicotine replacement therapy: findings from the California Tobacco Survey

We collected data from 5,857 adolescent (12-17 y) respondents in California to assess their perception about quitting smoking and nicotine replacement therapy use. In multivariate models, never smokers were less likely than established or experimenter smokers to believe that if they were to smoke they could quit anytime but were more likely to believe that nicotine replacement therapy is a sure way to quit.

Tobacco industry price-subsidizing promotions may overcome the downward pressure of higher prices on initiation of regular smoking

Real cigarette prices in the US increased from the early 1980s to early 1990s. Holding all else equal, adolescent initiation of regular smoking should have declined during this period. Using national population-based surveys (n = 336 343) conducted in the 1990s, we present trends (early 1960s to mid-1990s) in the initiation of regular smoking among 14-17-year-old adolescents and 18-21-year-old young adults. We also present trends in consumer-price-index-adjusted cigarette price and tobacco-industry expenditures for price-subsidizing promotions. We relate price and price-subsidizing tobacco industry expenditures to trends in initiation in the two age groups, using autoregressive integrated moving average models (ARIMA). From the model results, we conclude that price-subsidizing promotions may provide the tobacco industry with an effective way to segment the market. That is, they effectively offer lower prices to population subgroups that are more price-sensitive (e.g. young smokers not yet addicted), countering the depressing effect of general price increases on smoking. Thus, we find that the relationship of cigarette price to smoking behavior is more complex than previously described.

The dirty dozen: 12 myths that undermine tobacco control

Cigarette smoking is the leading cause of preventable death in the United States. The health risks of smoking are well documented, as is the effectiveness of clinical and public health interventions to prevent and reduce smoking. However, many myths about smoking either encourage people to begin or continue smoking or deter them from quitting. Some myths stem from a misapplied understanding of what might seem to be common sense; others are deliberately promulgated by the tobacco industry to induce people--especially children--to start smoking and to keep them smoking as adults. These myths undermine tobacco control. However, comprehensive tobacco control programs that include anti-smoking public education campaigns can effectively counter these myths and prevent illness and premature death.

Adolescent smoking and exposure to tobacco marketing under a tobacco advertising ban: findings from 2 Norwegian national samples

OBJECTIVES

We examined the extent to which adolescents in Norway have been exposed to tobacco marketing despite an existing ban, and whether exposure is related to their current smoking or expectations they will smoke in the future.

METHODS

Questionnaires were administered to nationally representative systematic samples of Norwegian youths aged 13 to 15 years in 1990 (n = 4282) and 1995 (n = 4065).

RESULTS

About half in each cohort reported exposure to marketing. Youths reporting exposure were significantly more likely to be current smokers and to expect to be smokers at 20 years of age, after control for important social influence predictors.

CONCLUSIONS

Adolescents' current smoking and future smoking expectations are linked to marketing exposure even in limited settings, suggesting the need for comprehensive controls to eliminate the function of marketing in promoting adolescent smoking.

Population receptivity to tobacco advertising/promotions and exposure to anti-tobacco media: effect of Master Settlement Agreement in California: 1992-2002

Tobacco marketing contributes to adolescent smoking initiation, and the Master Settlement Agreement (MSA), therefore, included relevant restrictions. We analyzed data from large population surveys of Californians, conducted in 1992 (11,905 adults, ages 18 years and older), 1993 (5,531 adolescents, ages 12 to 17 years), and 1996 (6,252 adolescents, 18,616 adults) before the MSA, and in 1999 (6,090 adolescents, 14,729 adults) and 2002 (5,857 adolescents, 20,525 adults) following its implementation. Camel lost favorite-advertisement popularity after 1996, and between 1999 and 2002, there were large increases in the percentages declining to name a favorite advertisement. Ownership of tobacco promotional items declined from its peak in 1996. Furthermore, in 2002, close to 90% of adolescents and young adults reported seeing anti-tobacco messages on television in the past month, significantly higher than 1996. These trends indicate less receptivity to tobacco advertising and promotions following the MSA but leave room for additional restrictions to further reduce receptivity.

Does adolescent perception of difficulty in getting cigarettes deter experimentation?

BACKGROUND

Considerable controversy surrounds tobacco control emphasis on youth-access-to-tobacco laws, as there is limited evidence that such enforcement reduces youth smoking. In California, access-law enforcement increased substantially in 1996 compared to earlier in the decade.

METHODS

Two longitudinal cohorts of adolescent never smokers from the large, population-based California Tobacco Surveys of 1993 and 1996 were followed-up 3 years later (1993-1996 [n = 1764] and 1996-1999 [n = 2119]). We examined transition to any smoking by follow-up with adolescent perception that cigarettes are easy or hard to get, during periods with less and more access law enforcement.

RESULTS

Transition to any smoking by follow-up among 12- to 15-year-old never smokers was identical in the 1993-1996 cohort, regardless of whether they perceived cigarettes as hard or easy to get (about 38%), but was lower in the 1996-1999 cohort for those who perceived that cigarettes were hard (25.9%) vs. easy (36.1%) to get. This differential effect was confirmed in multivariate analyses that adjusted for demographics, cohort, and other known predictors of adolescent smoking.

CONCLUSIONS

Increased enforcement of access laws may help protect young adolescents from experimenting with cigarettes by strengthening societal anti-tobacco norms. Such enforcement appears warranted as part of a comprehensive tobacco control program.

Lung cancer mortality patterns in selected Central, Eastern and Southern European countries

Significant changes in the prevalence of tobacco smoking have been observed in many European countries. EU candidate countries have also experienced major changes with respect to tobacco smoking, which have resulted in changes in the frequency of lung cancer. In men in the majority of these countries, a reduction of mortality rates has been observed recently, while in Hungary and Poland a deceleration of mortality increase was observed in the 1990s. The situation is much less favorable in females, where in the majority of countries a continuous increase of mortality rates has been observed, the only exceptions being Latvia, Lithuania and, to a lesser extent, Estonia. In Hungarian women, an acceleration of the increase rate was observed in the 1980s and 1990s (compared with the 1970s). Patterns of lung cancer mortality in analyzed countries are somewhat similar to those observed in EU member states. Recent analyses of time trends of lung cancer in EU countries showed, in general, a decreasing risk in the majority of male populations and an increase in several countries in women. If the decrease of mortality is to be achieved and maintained in the longer term, efforts have to be focused on young generations (entering adulthood now or in the near future). Despite all the difficulties present in reducing tobacco smoking in youth, it seems that one of the most important ways to reduce the future lung cancer burden in current and new EU member states is to strengthen efforts toward changing smoking attitudes in young generations.

Concurrent use of tobacco products by California adolescents

BACKGROUND

To describe patterns and correlates of tobacco product use other than cigarettes in adolescents 12-17 years of age.

METHODS

Adolescent respondents (N = 6090) to the 1999 California Tobacco Survey provided estimates of ever and current use (in last 30 days) of smokeless tobacco, cigars, and bidis, which were examined by cigarette smoking experience, demographics, and known predictors of cigarette use.

RESULTS

Only 3% of adolescents who never smoked cigarettes experimented with other tobacco products. Among ever smokers who were not current smokers, the rate was 35%. Nearly 60% of current cigarette experimenters had tried another tobacco product, but almost 90% of current established smokers had experimented with one. Over 40% of current established smokers used another tobacco product in the last 30 days. Factors predictive of cigarette smoking were also highly associated with other tobacco use. In ever cigarette smokers, having peers who used other tobacco products was most highly associated with other tobacco use. Problem or risky behaviors, beliefs that cigarettes are safe or beneficial, and receptivity to tobacco promotions were also independently associated with other tobacco product use.

CONCLUSIONS

Adolescent smokers who use other tobacco products may be prone to risky behavior and such use may hasten the development of nicotine tolerance.

Role of the media in influencing trajectories of youth smoking

This paper summarizes results of empirical studies on cigarette advertising and promotions, antismoking advertising, product placement in movies, on television and in music media and news coverage about smoking. In addition, we provide an overview of some of the theoretical literature relevant to the study of media uses and effects. Finally, we discuss empirical findings in the context of these theories to draw some conclusions about media influences on smoking and identify issues for further research. We conclude that (a) the media both shape and reflect social values about smoking; (b) the media provide new information about smoking directly to audiences; (c) the media act as a source of observational learning by providing models which teenagers may seek to emulate; (d) exposure to media messages about smoking also provides direct reinforcement for smoking or not smoking; (e) the media promote interpersonal discussion about smoking; (f) the media can influence "intervening" behaviors that may make teenage smoking less likely; and (g) antismoking media messages can also set the agenda for other change at the community, state or national level. We outline priorities for further research which emphasize the need for longitudinal studies, multi-level studies, an awareness of the probably dynamic relationship between tobacco advertising and antismoking advertising, the importance of determining appraisal of tobacco industry youth smoking prevention efforts and the dearth of research on news coverage about smoking.

Adolescent participation in tobacco promotions: the role of psychosocial factors

OBJECTIVES

To identify psychosocial factors that place adolescents at risk for participation in tobacco promotions, and to further investigate the hypothesis that psychosocial vulnerabilities have an indirect effect on smoking initiation among youth by way of involvement with tobacco promotions.

METHODS

Data were from a follow-up telephone survey of youth in Massachusetts. A subset of adolescents who were not established smokers, had not smoked cigarettes in the past 30 days, and did not own a promotional item at baseline in 1993 was used for the analyses (n = 468). Bivariate analyses were used to evaluate the association between psychosocial vulnerabilities and subsequent acquisition of cigarette promotional items. Logistic regression was conducted to identify the set of factors that best predict attainment of tobacco promotional items, and to examine the mediating influence of item acquisition on the relation of between psychosocial vulnerabilities and smoking initiation.

RESULTS

Adolescents who were academically disengaged at baseline were more likely to acquire a tobacco promotional item at follow-up. Academic disengagement was significantly associated with item acquisition, above and beyond the other psychosocial vulnerabilities. The direct effect of academic disengagement changed from marginally significant to nonsignificant when item acquisition was introduced.

CONCLUSIONS

This study provides evidence that receptivity to tobacco promotional items is greatest among youth who are disengaged from school.

Impact of tobacco advertising and promotion on increasing adolescent smoking behaviours

BACKGROUND

The tobacco industry denies that their marketing is targeted at young nonsmokers, but it seems more probable that tobacco advertising and promotion influences the attitudes of nonsmoking adolescents, and makes them more likely to try smoking.

OBJECTIVES

To assess the effects of tobacco advertising and promotion on nonsmoking adolescents' future smoking behaviour.

SEARCH STRATEGY

We searched the Cochrane Tobacco Group specialized register, the Cochrane Central Register of Controlled Trials, MEDLINE, the Cochrane Library, Sociological Abstracts, PsycLIT, ERIC, WorldCat, Dissertation Abstracts, ABI Inform and Current Contents to August 2002.

SELECTION CRITERIA

We selected longitudinal studies that assessed individuals' smoking behaviour and exposure to advertising, receptivity or attitudes to tobacco advertising, or brand awareness at baseline, and assessed smoking behaviour at follow-ups. Participants were adolescents aged 18 or younger who were not regular smokers at baseline.

DATA COLLECTION AND ANALYSIS

Studies were prescreened for relevance by one reviewer. Two reviewers independently assessed relevant studies for inclusion. Data were extracted by one reviewer and checked by a second.

MAIN RESULTS

Nine longitudinal studies that followed up a total of over 12,000 baseline nonsmokers met inclusion criteria. The studies measured exposure or receptivity to advertising and promotion in a variety of ways, including having a favourite advertisement or an index of receptivity based on awareness of advertising and ownership of a promotional item. One study measured the number of tobacco advertisements in magazines read by participants. All studies assessed smoking behaviour change in participants who reported not smoking at baseline. In all studies the nonsmoking adolescents who were more aware of tobacco advertising or receptive to it, were more likely to have experimented with cigarettes or become smokers at follow-up. There was variation in the strength of association, and the degree to which potential confounders were controlled for.

REVIEWER'S CONCLUSIONS

Longitudinal studies consistently suggest that exposure to tobacco advertising and promotion is associated with the likelihood that adolescents will start to smoke. Based on the strength of this association, the consistency of findings across numerous observational studies, temporality of exposure and smoking behaviours observed, as well as the theoretical plausibility regarding the impact of advertising, we conclude that tobacco advertising and promotion increases the likelihood that adolescents will start to smoke.

Applying genetic approaches to the treatment of nicotine dependence

To advance the science of tobacco control, an enhanced understanding of the bio-behavioral basis of nicotine addiction is needed. In this study, we provide an overview of data from investigations of genetic factors in smoking behavior, discuss potential bio-behavioral mechanisms and effect modifiers, and suggest avenues for pharmacogenetics research in the area of smoking cessation treatment. The evidence to date is very consistent with respect to the significance of genetic contributions to smoking behavior. However, attempts to elucidate the role of specific genetic variants have met with mixed success. Explanations for the lack of consistency in the results of genetic association studies include biases in ascertainment, ethnic admixture, lack of attention to co-variates or modifiers of genetic risk, and the need for more refined phenotypes. As the field of genetics and smoking research progresses, increasing attention is being devoted to gene-environment interactions, with particular attention to the identification of genetic variants that may modify the effects of pharmacological treatment for smoking. With advances in molecular biology and genomics technology, individualized tailoring of smoking cessation therapy to genotype is within our grasp. Such research has the potential to improve treatment outcome, thereby reducing morbidity and mortality from smoking-related disease.