Addicted to Nicotine
A National Research Forum

Section III: Nicotine-Environmental Risk Factors for Initiation
Nancy J. Kaufman, R.N., Chair

ADVERTISING AND PROMOTION

John P. Pierce, Ph.D.
Cancer Prevention and Control Program
University of California at San Diego

What We Know

Ever since the introduction of the first machine for mass-producing cigarettes, innovations in advertising and promotional techniques have been a trademark of the cigarette industry. Before the health effects of tobacco use were well known, leaders of the tobacco industry credited the large expansion in the number of people who smoked in the first half of the century to the effectiveness of the advertising and promotional campaigns. These campaigns achieved their effect in part by convincing 14- to 17-year-old adolescents to begin to smoke. In 1967 the tobacco industry introduced the first "woman's" cigarette, again with a large and innovative advertising campaign. Sales surged, but the only effect on attracting new smokers occurred in girls 14 to 17 years of age, and the effect was higher in those who received fewer years of formal education.

A long-term decline in trends of both per capita cigarette consumption and in the proportion of adolescents initiating smoking started in 1973, shortly after the advertising ban on the broadcast media. This decline was associated with an almost exponential increase in tobacco industry expenditure on advertising and promotion of cigarettes. Recently released confidential tobacco industry documents clearly indicate the concern of senior members of the tobacco industry shortly after this decline became manifest and reveal their solution to focus on the youth market.

The major innovative campaign, predicted by these confidential industry documents, was the Joe Camel campaign, which was launched in 1987. The size and nature of this campaign drew major comment in the advertising professional journals. This cartoon character was very attractive to young children as well as to young adolescents, and it was noted that increases in market share had occurred mainly in younger smokers. The unprecedented decline in adolescent smoking over a 12-year period was halted, and the incidence of initiation of smoking in the 14- to 17-year-old age group began to increase again.

These data add up to a strong circumstantial case that tobacco industry advertising and promotional activity encourages adolescents to smoke. The case is made stronger by the observation that the brand preferences of underage smokers are far more strongly linked to advertising expenditure than are the brand preferences of adults. Furthermore, the placement of advertising for these brands that are preferred by adolescents occurs differentially in magazines with a high adolescent readership and is considerably lower in magazines without a significant adolescent readership.

Simple awareness of specific popular advertising messages does not appear to be associated with later smoking behavior. However, advertising and promotions of persuasive communications aimed at increasing sales and awareness, by itself, is not a good measure of an individual's receptivity to persuasive messages. The literature on persuasive communications emphasizes the need to ensure that the target audience is exposed to the message, pays attention to the message, and understands the message. Optimally, the target audience develops a positive affect toward the message and positive cognition toward the product. However, marketers note that an additional incentive (such as a promotional item or a free sample) is often needed to achieve the increase in sales.

Two longitudinal studies reported that a single question probing receptiveness to advertising messages in general was strongly predictive of which adolescents became smokers. A cross-sectional analysis of California adolescents who had never smoked demonstrated that a measure of receptivity to advertising and promotion was associated with being susceptible to smoking. A longitudinal followup of adolescents in this study who were at the lowest risk to become smokers demonstrated that having a favorite cigarette advertisement or having or being prepared to use an industry promotional item was the major predictor of which adolescents progressed toward becoming a smoker. The analysis suggested that the promotional item category of receptivity was about 50 percent more influential than was the advertising item category. However, this is counterbalanced by the fact that many fewer adolescents were in this higher level of receptivity. After controlling for the influence of parents and peers who smoke, this study estimated that 34 percent of all experimentation could be attributed to tobacco advertising and promotional activities.

There is considerable evidence that tobacco industry advertising and promotion are one of the major influences on the uptake of smoking by the young. This evidence includes (1) studies of changes in adolescent initiation of smoking with the introduction of new campaigns, (2) studies of receptivity of adolescents to the messages and images in tobacco industry advertising and promotions, and (3) a longitudinal study demonstrating that receptivity to advertising and promotions predicted future smoking behavior in minimum-risk adolescents.

What We Need To Know More About

The above evidence presents a fairly convincing case that tobacco advertising influences adolescents to start smoking. How much evidence do we need in order to take public health action to protect adolescents and children?

• Future research should attempt to replicate the results of the longitudinal followup study of minimum risk adolescents.

• If public policy action is undertaken to remove this environmental influence encouraging adolescent initiation, then studies should document the effectiveness of the public policy on adolescent receptivity to advertising and promotion and demonstrate that a reduction in receptivity was associated with a reduction in smoking initiation.

If this evidence leads to restrictions in advertising and promotional practices, it will be very important to study whether such restrictions lead to a reduction in the receptivity of adolescents and children to industry messages and whether such restrictions are associated with a decline in smoking initiation.

Recommended Reading

Alexander, H.M.; Callcott, R.; Dobson, A.J.; Hardes, G.R.; Lloyd, D.M.; O'Connel, D.L.; and Leeder, S.R. Cigarette smoking and drug use in school children: IV- Factors associated with changes in smoking behavior. Int J Epidemiol 12:59-66, 1983.

Armstrong, B.K.; de Klerk, N.H.; Shean, R.E.; Dunn, D.A.; and Dolin, P.J. Influence of education and advertising on the uptake of smoking by children. Med J Aust 152:117-124, 1990.

King, C.; Siegel, M.; Celebucki, C.; and Connolly, G. Adolescent exposure to cigarette advertising in magazines. JAMA 279(7):516-520, 1998.

Pierce, J.P.; Choi, W.S.; Gilpin, E.A.; Farkas, A.J.; and Berry, C.C. Tobacco industry promotion of cigarettes and adolescent smoking. JAMA 279(7):511-515, 1998.

Pierce, J.P., and Gilpin, E.A. A historical analysis of tobacco marketing and the uptake of smoking by youth in the United States: 1890-1977. Health Psychol 14(6):500-508, 1995.

Pierce, J.P.; Gilpin, E.; Burns, D.M.; Whalen, E.; Rosebrook, B.; Shopland, D.; and Johnson, M. Does tobacco advertising target young people to start smoking: Evidence from California. JAMA 266(22):3154-3158, 1991.

Pollay, R.W.; Siddarth, S.; Siegel, M.; Haddix, A.; Merritt, R.K.; Giovino, G.A.; and Eriksen, M.P. The last straw? Cigarette advertising and realized market shares among youths and adults, 1979-1993. J Marketing 60(2):1-16, 1996.