Tobacco Advertising and Tobacco Use Susceptibility Among Adolescents
by Lynn Hetzler
Exposure to advertisements for e-cigarettes and other non-tobacco products may make adolescents more susceptible to cigarette smoking, according to a new study.
While tobacco use among teenagers has declined, according to the Centers for Disease Control and Prevention (CDC), but cigarette smoking rates remain high. Two of every 100 middle school students reported smoking cigarettes within the previous 30 days, while more than nine in 100 high school kids have confessed to lighting up in the past month. For each day of the year, more than 3,200 teenagers smoke their first cigarette.
Tobacco use causes a number of chronic and life-threatening health conditions, including lung cancer and emphysema. At the current rate of smoking among youth, 5.6 million of people currently under the age of 18 will die early from a smoking-related illness.
The U.S. Food and Drug Administration (FDA) regulates tobacco advertising on television, but non–cigarette tobacco marketing faces fewer regulations. This lack of regulations may increase adolescent exposure to advertisements for e-cigarettes and similar products, and increased exposure can make youngsters more likely to use tobacco products in the future.
“Tobacco marketing restrictions differ by product with only e-cigarettes allowed to be advertised on television,” said lead author John P. Pierce, PhD, in a press release. Pierce is Professor Emeritus in the Department of Family Medicine and Public Health at UC San Diego School of Medicine and Moores Cancer Center. “Previous studies have linked receptivity to cigarette advertising with susceptibility to smoke cigarettes among youth. What we’re seeing in this study is that even being receptive to marketing of non-cigarette tobacco products, including e-cigarettes, is associated with susceptibility to smoke cigarettes.”
Receptivity to Advertising Increases Likelihood of Product Use
Individuals who are receptive to an ad are more likely to use the product depicted in the advertisement. As such, receptivity to tobacco ads is associated with an increased likelihood of using tobacco products in the future, even among those who did not use tobacco products when they saw the advertisements.
The researchers in this study wanted to assess adolescent risk for using a tobacco product in the future by evaluating their receptivity and susceptibility to tobacco advertisement. The scientists considered adolescent participants as receptive if the teens were able to recall at least one tobacco advertisement or said that they liked at least one ad.
Researchers from Dartmouth’s Norris Cotton Cancer Center and University of California San Diego Moores Cancer Center analyzed data from the Population Assessment of Tobacco and Health (PATH) Study. The researchers extracted information from interviews with 10,751 adolescents who had never used any type of tobacco product.
The researchers in the PATH study initially asked participants to name their favorite tobacco ad. The PATH researchers then showed participants a random assortment of five advertisements each for cigarettes, smokeless products, e-cigarettes, and cigars. The investigators of the PATH study selected each participant’s assortment from 959 recent tobacco advertisements appearing in print, direct mail, internet and television advertisements. For each ad presented, the researchers asked if the participant had seen the ad within the preview 12 months and if he or she had liked it.
Aided recall is a research technique in which scientists show subjects an advertisement then ask the participant if he or she has seen the ad before. Aided recall is associated with low receptivity, while liking an image has higher receptivity. In other words, simply remembering a tobacco ad may not make an adolescent more susceptible to purchasing a tobacco product but admiring a tobacco ad does increase susceptibility.
The scientists also asked the participants three questions regarding the adolescents’ curiosity about the product, intention to try the product in the near future, and likely response if a best friend were to offer the product to them. Even participants who were mildly curious, suggested an intention to try the product or thought they would accept the product from a friend, were susceptible to using tobacco in the future, while only those subjects that expressed the strongest rejection to all three questions were committed to never using.
The Findings: Half of All Older Adolescents are Receptive to Tobacco Marketing
Published in the May 22, 2017 issue of Pediatrics, the findings show that 41 percent of 12- and 13-year-olds were receptive to at least one ad for a tobacco product and that half of older adolescents expressed receptivity to tobacco marketing. In all age groups, receptivity to advertising was highest for e-cigarettes at 28 to 33 percent. Twenty to 25 percent of adolescents were receptive to cigarette ads, 15 to 21 percent to smokeless tobacco marketing, and 8 to 13 percent of youths were receptive to cigar ads.
Of all forms of advertising for all products, e-cigarette ads on television had the highest recall, which TV e-cigarette advertising has the greatest potential for receptivity among adolescents.
“Six of the top 10 most recognized tobacco ads by adolescents were for e-cigarettes, four of which were aired on TV,” said co-author of the study, James Sargent, MD, who serves as director of the C. Everett Koop Institute at Dartmouth. “The PATH Study will continue to track these adolescents who have not used tobacco and will be able to identify if receptivity to marketing for different tobacco products during wave 1 of the study — particularly e-cigarette marketing — increases cigarette smoking one or two years later.”
Many U.S. adolescents who have never used tobacco are receptive to tobacco marketing, particularly television ads for e-cigarettes. Receptivity to this marketing increases the susceptibility to cigarette smoking in youths.
“Cigarette smoking is still a major problem and a major cause of lung cancer and other diseases,” said Pierce. “We’ve had big declines in the number of people who initiated smoking, but it is important that we maintain that reduction.”