National Study Looks at Tobacco Advertising and Susceptibility to Use Tobacco Among Youth

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Among 12- to 17-year-olds who have never used tobacco products, nearly half were considered receptive to tobacco marketing if they were able to recall or liked at least one advertisement, report a coalition of behavioral scientists in a new national study. Receptivity to tobacco ads is associated with an increased susceptibility to smoking cigarettes in the future.

Led by researchers at University of California San Diego Moores Cancer Center and Dartmouth’s Norris Cotton Cancer Center, the researchers analyzed data from the Population Assessment of Tobacco and Health (PATH) Study, which included interviews with 10,751 adolescents who reported having never used any type of tobacco product. Risk to use a tobacco product in the future was the researchers’ main point of interest. The findings are published in the May 22 issue of Pediatrics.

"Tobacco marketing restrictions differ by product with only e-cigarettes allowed to be advertised on television,” said John P. Pierce, PhD, Professor Emeritus in the Department of Family Medicine and Public Health at UC San Diego School of Medicine and Moores Cancer Center and lead author on the study. "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.”

In this analysis of the first wave of data from the PATH Study, respondents were considered susceptible to tobacco or committed to never using these products based on responses to three questions assessing their curiosity about the product, intention to try it in the near future, and likely response if a best friend were to offer them the product. Only those with the strongest rejection to all three questions were categorized as committed to never use. All others were susceptible. This index has been validated in multiple studies.

Participants were shown 20 tobacco ads chosen randomly from 959 ads representing all available recent commercials used in print, direct mail, internet or television advertisements. Each respondent was asked initially to name his or her favorite tobacco ad and then shown a random set of five ads for each of the following products: cigarettes, e-cigarettes, cigars and smokeless products. For each ad presented, they were asked if they had seen the ad in the past 12 months and whether they liked the ad. Aided recall was classified as low receptivity while image-liking or favorite ad was considered to be higher.

A high proportion of under-aged adolescents in the United States are still exposed to tobacco advertising. The study found that 41 percent of 12- to 13-year-olds, and about half of both 14- to 15-year-olds and 16- to 17-year-olds were receptive to any type of tobacco advertising.

"Six of the top 10 most recognized tobacco ads by adolescents were for e-cigarettes, four of which were aired on TV," said James Sargent, MD, director of the C. Everett Koop Institute at Dartmouth and co-author. "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."

Receptivity to advertising was highest for e-cigarettes with 28 to 33 percent across age groups, followed by 22 to 25 percent for cigarettes and 15 to 21 percent for cigars. E-cigarette advertising is of interest to researchers because of its presence on television and because showing people vaping is very similar to showing people smoking, said Pierce.

The proportion who were susceptible to using tobacco products increased with the level of receptivity. Fifty percent of respondents considered to have low receptivity, 65 percent who were moderately receptive and 87 percent of youth who were deemed highly receptive were susceptible to use tobacco products.

“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.”

Co-authors include: Martha White, David R. Strong, Eric Leas, Madison Noble, Dennis Trinidad, Karen Messer, UC San Diego; Nicolette Borek, David B. Portnoy, Blair N. Coleman, US Food and Drug Administration; Victoria R. Green, National Institutes of Health and Kelly Government Solutions; Annette R. Kaufman, National Cancer Institute; Cassandra A. Stanton, Westat and Georgetown University Medical Center; Maansi Bansal-Travers, Andrew Hyland, Roswell Park Cancer Institute; Jennifer Pearson, Johns Hopkins University and Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative; Meghan B. Moran, Johns Hopkins University; and Charles Carusi, Westat.

This research was funded by the National Institute on Drug Abuse, National Institutes of Health, and the Food and Drug Administration, Department of Health and Human Services, under a contract to Westat, which collected data using Audio-Computer-Assisted Self Interviews.