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BOSTON, MA – Teenagers who are regularly exposed to anti-smoking messages on television are half as likely to start smoking than those not exposed, reports an article in the March issue of the American Journal of Public Health. A second study in the same journal has found that teenagers who can readily name a cigarette brand and who own a tobacco-sponsored promotional item – such as a gym bag or visor – are more than twice as likely to become established smokers than adolescents who do neither. The studies were funded by the Substance Abuse Policy Research Program (SAPRP) of The Robert Wood Johnson Foundation.
“These are the first long-term studies to investigate the effects of pro-tobacco and anti-smoking advertising, tracking the same group of teenagers over a four-year period,” said Michael Siegel, MD, MPH, Associate Professor at the Boston University School of Public Health and lead author of the study on anti-smoking advertising. “Both show that advertising techniques are effective whether you’re trying to promote tobacco use or prevent it.”
Other studies of anti-smoking campaigns have been small-scale or community focused. Today’s study on anti-smoking campaigns is significant because it is statewide and follows the smoking patterns of the same group of Massachusetts’ teenagers over four years. Little data is available on the national level. The tobacco marketing study is the first longitudinal study to quantify the impact of tobacco advertising and promotional activities on progression from nonsmoking or early experimentation to established smoking.
“The more tobacco advertising and promotional activities young people are exposed to the more smoking we can expect, unless we have increased counter-advertising,” said Lois Biener, PhD, Senior Research Fellow at the University of Massachusetts Boston and lead author of the study on tobacco marketing to adolescents.
The findings come at a time when nearly every state in the country is grappling with how to spend funds allocated under the 1998 tobacco settlement, which stipulates that tobacco companies spend $246 billion over the next 25 years to settle state health claims. Smoking has been on the rise among youths since 1991.
“Our results suggest that if states are serious about halting the rising rates of smoking among youth, they should consider allocating tobacco settlement funds for a comprehensive anti-smoking advertising campaign using television as a major medium,” said Siegel. “Anti-smoking advertising campaigns appear to be one of the most effective interventions available to reduce youth smoking.”
In the first study, which examined the effect of anti-smoking advertising on smoking initiation among youths, Siegel and Biener collected data in 1993, when the children were 12 to 15 years old, and again in 1997, when they were 15 to 20 years old. This research coincided with Massachusetts’ anti-smoking advertising campaign, also launched in 1993, on television, radio, and billboards.
To test the effectiveness of the media campaign, the authors compared the tendency to start smoking between youths who recalled or failed to recall exposure to anti-smoking messages on television, radio, and billboard advertisements in 1993. Based on 1993 telephone interviews with 592 teenagers who had not yet smoked 100 cigarettes, the researchers noted which children recalled anti-smoking messages. In follow-up phone surveys approximately four years later, the researchers noted which of the youths had become established smokers (defined as having smoked 100 or more cigarettes in their lifetime). The researchers controlled for peer pressure, parental and sibling smoking, and other factors that may also influence adolescents’ smoking behavior.
By the time of the follow-up calls, slightly more than 25 percent of teenagers had become established smokers. But among younger adolescents (those in the 12- to 13-year age range in 1993), those who had been exposed to the counter-advertising campaign on television were about half as likely to have become smokers than were those who had not been able to recall campaign advertisements. Recall of the anti-smoking television advertisements had no significant effect on progression to established smoking among older teenagers (in the 14- or 15-year age range in 1993).
“This may indicate that older adolescents are resistant to anti-smoking messages or that they have already established strong attitudes toward smoking,” said Siegel. “However, it would be premature to conclude that 14- and 15-year-olds cannot be influenced by anti-smoking advertising at all.”
The study also found that television was the most persuasive medium for communicating an anti-smoking message. The researchers found negligible effects from exposure to radio or billboard advertising. However, they note that television was the predominant medium used during the campaign, comprising 80 percent of the advertising budget, and that “one should not necessarily conclude that radio and outdoor anti-smoking advertisements are not effective.” They suggest that the adolescents’ exposure to the other forms of advertising wasn’t significant enough to cause changes in their behavior.
In the second study, which examined the effects of pro-tobacco advertising on smoking initiation among youths, Biener and Siegel tracked 529 adolescents who had never smoked or at most had experimented with one cigarette. The researchers gauged how receptive non-smoking adolescents were to promotional materials in 1993. Four years later, via telephone surveys, they compared the youths’ initial receptivity to promotion with their smoking status. Children who both owned an item emblazoned with a tobacco brand logo and who readily named a cigarette brand were labeled as “highly receptive” to advertising. Those who either owned an item or named a brand were scored as “moderately receptive,” and those who didn’t own an item or were unable to name a brand were considered having little receptivity.
When researchers re-interviewed the same group of teens in 1997, 21 percent had become established smokers. Forty-six percent of those who had been highly receptive to tobacco marketing had become smokers, while smoking among the moderate- and low-receptivity groups ranged between 18 and 14 percent, respectively.
“These findings show that the promotional activities and items are very attractive to some adolescents and that kids who obtain promotional items and hold on to them are more than twice as likely to become smokers,” said Biener. “The images in cigarette advertising campaigns are particularly attractive to adolescents who, for one reason or another, are looking for an identity that the images are carefully designed to offer.”
The findings in both studies are relevant to states as they search for ways to stem the rise in youth smoking. Annual tobacco-settlement payments to states begin on April 15 of this year. The U.S. Centers for Disease Control and Prevention recommends that states spend one-third of this money on tobacco control programs. At least seven states are conducting anti-smoking media campaigns currently. Until now, there has been little proof of their effectiveness. Massachusetts has dedicated $20 million of its first tobacco-settlement installment to expand its anti-smoking campaign.
The Substance Abuse Policy Research Program is a $54 million investigator-initiated research program that funds multidisciplinary research related to tobacco, alcohol, and illicit drug policy. The program is administered through the National Program Office at The Wake Forest University School of Medicine. It is funded by the Princeton, N.J.-based Robert Wood Johnson Foundation.
Established in 1873, Boston University School of Medicine is a leading academic and research institution, with an enrollment of nearly 630 students and nearly 1,000 full and part-time faculty members. It is known for its programs in arthritis, cardiovascular disease, cancer, human genetics, pulmonary disease and dermatology, among others. The School is affiliated with Boston Medical Center, its principal teaching hospital, and Boston Veterans Administration Medical Center. Along with Boston Medical Center and 14 community health center partners, the School of Medicine is a partner in Boston HealthNet, a consumer-driven urban health network.