Two New Studies Show: Ads Get Kids to Smoke [02/17-3]

Two new studies announced at a press conference today show that cigarette advertising does cause kids to start smoking.

Here is the statement describing the studies at presented at the press conference.

The results, and their public health implications are summarized at the end of the statement.

STATEMENT OF MICHAEL SIEGEL,
MD, MPH Assistant Professor,
Boston University School of Public Health February 17, 1998

The question of what effect cigarette advertising has on children is an important one.

In particular, this question is central to the current Congressional debate over tobacco legislation and a possible tobacco settlement.

There are two major questions:

(1)Does the tobacco industry specifically target youth in its cigarette marketing?

(2)Does tobacco marketing actually cause children to start smoking?

Today, it is my pleasure to present two new studies, appearing in this week's Journal of the American Medical Association, that go a long way toward answering each of these questions.

ADOLESCENT EXPOSURE TO CIGARETTE ADVERTISING IN MAGAZINES

The first study, which I co-authored, is entitled "Adolescent Exposure to Cigarette Advertising in Magazines: An Evaluation of Brand-Specific Advertising in Relation to Youth Readership."

I would first like to acknowledge the work of my co-authors: Dr. Charles King of Harvard Business School, and Drs. Greg Connolly and Carolyn Celebucki of the Massachusetts Department of Public Health.

This is the first study to systematically examine the relationship between brand-specific cigarette advertising and magazine readership.

The main question we asked in this study was: "Do cigarette companies specifically target youth in their magazine advertising?"

To answer this question, we looked at the top 39 U.S. magazines in 1994, and examined the relationship between the presence of advertising for different cigarette brands and the number of youth and adult readers in each magazine.

We defined youth readers as those between the ages of 12 and 17. Adult readers were those aged 18 and up.

We controlled for the total number of readers in each magazine and for the percentage of young adult readers (ages 18-24) in each magazine.

Rather than lumping all cigarette brands together, we looked separately at what we called youth cigarette brands and adult cigarette brands. Youth cigarette brands were those that are popular among youth smokers. Adult cigarette brands were those that are smoked almost exclusively by adults.

The youth brands were: Marlboro, Camel, Newport, Kool, and Winston. The adult brands were Salem, Virginia Slims, Benson & Hedges, Parliament, Merit, Capri, and Kent.

The percentage of youth readers for the 39 magazines ranged from a low of 4% (Family Circle) to a high of 34% (Sport).

The results of our analysis were striking:

Cigarette brands that are popular among youth are more likely to advertise in magazines with a higher percentage of youth readers.

In contrast, adult cigarette brands are less likely to advertise in magazines with higher levels of youth readership.

At the lowest youth readership level of 4%, youth brands are only ha@'as likely as adult brands to advertise in the magazine. But at the highest youth readership level of 34%, youth brands are 5 times more likely than adult brands to advertise in the magazine.

So what do these results mean?

This study demonstrates that cigarette companies specifically target youth in their magazine advertising.

This study adds to the growing body of evidence that the tobacco industry is marketing its deadly products to our nation's youth.

The tobacco industry has argued that it targeting young adults, the 18-24 year-old market, rather than youths. Our study demonstrates that this is simply not the case. Cigarette companies are preferentially advertising to reach 12-17 year-old kids.

To summarize the findings of this study:

1. Cigarette brands that are popular among youth are more likely to advertise in magazines with a higher percentage of youth readers. Cigarette companies are preferentially advertising to reach 12-17 year-old kids.

2. This study demonstrates that cigarette companies specifically target youth in their magazine advertising.

3. This study adds to the growing body of evidence that the tobacco industry is marketing its products to our nation's youth.

TOBACCO INDUSTRY PROMOTION OF CIGARETTES
AND ADOLESCENT SMOKING

The second study, conducted by Dr. John Pierce, Dr. Won Choi, Elizabeth Gilpin, Dr. Arthur Farkas, and Dr. Charles Berry at the University of California, San Diego, is entitled "Tobacco Industry Promotion of Cigarettes and Adolescent Smoking." Dr. Pierce is unable to be here to present his study, but asked me to present the study for him.

This is the first longitudinal study to examine whether exposure to cigarette advertising and promotion actually causes children to start smoking.

Previous studies have shown that children who smoke are more likely to report exposure to cigarette advertising and promotion than children who don't smoke. But because these are cross- sectional studies, conducted at a single point in time, we cannot tell whether it is the advertising exposure that causes children to start smoking, or whether children who start smoking are more likely to be exposed to and recall exposure to cigarette advertising.

The advantage of a longitudinal study, in which children are followed over a period of time, is that we can tell which came first: the exposure to the advertising or the initiation of smoking.

In this study, Dr. Pierce and colleagues followed a large sample of California adolescents over a three-year period to determine which children started smoking and whether their initial exposure to cigarette advertising and promotions was related to the probability of starting to smoke.

The sample consisted of about 1,700 adolescents who were between the ages of 12 and 17 in 1993. All were nonsmokers at that time. In addition, they were not considered susceptible to start smoking, meaning that they had no intention to smoke in the future.

The adolescents were followed up, using a random-digit-dial telephone survey, in 1996.

Dr. Pierce and colleagues determined which of the adolescents had become susceptible to smoking, meaning that they now expressed a possible intention to smoke in the future. Pierce also determined which of the adolescents had experimented with smoking, meaning that they had at least a few puffs on a cigarette. Finally, Pierce determined which adolescents progressed to become established smokers, defined as those who smoked at least 100 cigarettes in their life.

In the analysis, the researchers compared the probability that adolescents became susceptible to smoking, experimented with smoking, or became established smokers for those who were and were not exposed to cigarette advertising and promotion.

Exposure to cigarette advertising and promotion was based on whether a youth was able to recall the name of the brand of a cigarette they had seen advertised, whether they had a favorite cigarette advertisement, whether they owned a tobacco promotional item, such as a cap or t-shirt, and whether they were willing to use such a promotional item if they had one.

The analysis controlled for exposure to family members and peers who smoked. The findings of the study were as follows:

During the 3-year study period, about 17% of the adolescents became susceptible to smoking, 30% experimented with smoking, and 4% became established smokers.

Adolescents with moderate exposure to cigarette advertising and promotion were about twice as likely as those with minimal exposure to become susceptible to smoking, experiment with smoking, or become an established smoker.

Moderate exposure to advertising and promotion was defined as having a favorite cigarette advertisement. Thus, having a favorite cigarette advertisement doubled the risk of progression toward smoking.

Adolescents with high exposure to cigarette advertising and promotion were about 3 times more likely than those with minimal exposure to progress toward smoking.

High exposure to advertising and promotion was defined as owning or being willing to use a tobacco promotional item. Thus, owning or being willing to use a tobacco promotional item tripled the risk of progression toward smoking.

Exposure to family and friends who smoked had only a small effect on whether these adolescents progressed toward smoking, increasing their chances by only 20%.

Cigarette advertising and promotion was the single most important factor in predicting which adolescents progressed toward smoking. Cigarette advertising and promotion was far more important than exposure to family and peers who smoked.

So what do these results mean?

This study demonstrates that exposure to cigarette advertising and promotion causes kids to start the process of becoming addicted to cigarettes.

Cigarette advertising and promotion is the single most important predictor of smoking experimentation.

Based on these findings, the authors estimate that 34% of all smoking experimentation among 12-17 year-old adolescents is caused by exposure to cigarette advertising and promotion. This means that nationally, 700,000 kids each year experiment with smoking because of their exposure to cigarette advertising and promotion.

To summarize the findings of this study:

1. This study demonstrates that exposure to cigarette advertising and promotion causes kids to start the process of becoming addicted to cigarettes.

2. Cigarette advertising and promotion is the single most important predictor of smoking experimentation.

3. 700,000 kids each year experiment with smoking because of their exposure to cigarette advertising and promotion.

IMPLICATIONS OF THE STUDY FINDINGS FOR PUBLIC HEALTH POLICY

Taken together, these two studies provide strong new evidence that cigarette companies specifically target youth in their marketing and that this marketing is effective in causing kids to start the process of becoming addicted to cigarettes.

Given all of the evidence that cigarette companies deliberately recruit and addict youth smokers, it is unconscionable to even consider granting these companies immunity from wrongdoing as they are seeking in a Congressional tobacco settlement.

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