Tobacco Advertising and Adolescent Smoking Initiation

programmes฀and฀ilms฀Fig.฀ 13.6 .฀Watching฀just฀3฀ilmsweek฀gives฀an฀annual฀total฀of฀ 150฀ilms฀ [22] .฀These฀ilms฀include฀a฀large฀number฀of฀smoker฀scenes฀featuring฀ilm฀stars฀of฀ both฀sexes,฀and฀adolescents฀are฀also฀enticed฀into฀cigarette฀smoking฀by฀these฀role฀models฀ Fig.฀ 13.6 ฀ [22] ,฀with฀socio-demographic฀factors฀and฀social฀inluences฀determining฀future฀ behaviour. Susceptibility฀to฀tobacco฀advertising฀was฀determined฀in฀a฀telephone฀campaign฀in฀3,536฀ adolescent฀never-smokers.฀The฀survey฀was฀designed฀to฀discover฀the฀adolescents’฀attitudes฀ towards฀possessing฀tobacco-related฀promotional฀items฀and฀their฀recognition฀of฀advertising฀ messages฀and฀preferred฀brands.฀The฀survey฀also฀examined฀the฀extent฀to฀which฀the฀adoles- cents฀were฀exposed฀to฀a฀smoking฀environment฀ [56] .฀The฀key฀inding฀was฀that฀adolescents฀ are฀twice฀as฀likely฀to฀start฀smoking฀if฀they฀grow฀up฀in฀a฀smoking฀environment฀own฀family฀ members฀or฀peers฀as฀in฀a฀smoke-free฀environment.฀The฀extent฀of฀their฀own฀receptivity,฀ e.g.฀to฀advertising,฀was฀a฀reinforcing฀factor฀see฀Fig.฀ 13.7 ฀ [56] . One฀Scandinavian฀study฀has฀impressively฀demonstrated฀the฀role฀of฀the฀social฀environ- ment฀parents,฀siblings,฀friends฀for฀the฀future฀smoking฀behaviour฀of฀15-year฀olds:฀90฀of฀ the฀adolescents฀smoked฀where฀those฀around฀them฀smoked,฀compared฀with฀only฀3฀where฀ those฀around฀them฀did฀not฀smoke฀ [67] .฀According฀to฀another฀study,฀the฀risk฀of฀becoming฀a฀ smoker฀was฀dependent฀on฀factors฀such฀as฀ownership฀of฀promotional฀items฀catalogues,฀ coupons,฀ and฀ increased฀ 22-fold฀ if฀ adolescents฀ were฀ given฀ free฀ sample฀ packs฀ [68] .฀ An฀ assessment฀of฀non-susceptible฀and฀susceptible฀non-smokers฀has฀also฀clearly฀shown฀that฀ tobacco฀advertisements฀are฀similarly฀liked฀by฀smokers฀and฀by฀susceptible฀non-smokers,฀ suggesting฀that฀the฀tobacco฀industry’s฀advertisements฀should฀seek฀to฀convert฀uncommitted฀ non-smokers฀into฀smokers฀ [69] . Fig. 13.7 ฀฀฀Susceptibility฀to฀smoking฀initiation฀as฀a฀function฀of฀receptivity฀to฀advertising฀and฀exposure฀ to฀smokers฀ [56] The฀available฀studies฀indicate฀that฀it฀is฀primarily฀adolescents฀who฀are฀enticed฀to฀become฀ smokers฀because฀of฀advertising฀campaigns.฀The฀intensity฀of฀advertising฀increases฀cigarette฀ consumption. In฀each฀year฀between฀1988฀and฀1998,฀advertising฀and฀promotional฀activities฀by฀the฀US฀ tobacco฀companies฀generated฀193,000฀additional฀adult฀smokers฀who฀began฀smoking฀as฀ adolescents.฀That฀decade฀of฀tobacco฀advertising฀and฀promotions฀also฀resulted฀in฀46,400฀ smoking-attributable฀deaths฀per฀year฀and฀698,400฀years฀of฀potential฀life฀lost,฀which฀trans- lates฀ into฀ approximately฀ US฀ 21.7–US฀ 33.3฀ billion฀ in฀ total฀ medical,฀ productivity฀ and฀ mortality-related฀costs฀ [70] .฀If฀all฀tobacco฀industry฀advertising฀and฀promotional฀activities฀ were฀banned฀for฀the฀next฀25฀years,฀60,000฀smoking-attributable฀deaths฀per฀year฀could฀be฀ avoided,฀ saving฀ 900,000฀ life-years,฀ US฀ 2.6฀ billion฀ in฀ excess฀ medical฀ expenses฀ and฀ between฀US฀28฀billion฀and฀US฀43฀billion฀in฀mortality฀costs฀ [70] .

13.5 Advertising with “Light” Cigarettes

Following฀the฀advent฀of฀light฀and฀ultralight฀cigarettes,฀many฀smokers฀who฀were฀ready฀to฀quit฀ smoking฀switched฀to฀these฀brands฀because฀they฀believed฀that฀this฀represented฀a฀albeit฀poor฀ compromise฀ between฀ health-consciousness฀ and฀ cigarette฀ dependence.฀ On฀ the฀ other฀ hand,฀ young฀men฀and฀women฀are฀enticed฀to฀start฀smoking฀with฀these฀“much฀milder”฀฀cigarettes.฀ However,฀the฀fact฀remains฀that฀these฀cigarettes฀are฀implicated฀in฀many฀additional฀deaths฀ [71] . Tobacco฀manufacturers฀encourage฀women฀to฀smoke,฀based฀on฀promises฀of฀glamour฀and฀ attractiveness฀and฀the฀assurance฀that฀such฀behaviour฀is฀desirable฀ [72] .฀In฀its฀attempts฀to฀ reach฀women,฀the฀tobacco฀industry฀uses฀women’s฀magazines฀as฀channels฀for฀its฀unbeliev- able฀messages฀in฀which฀smoking฀is฀associated฀with฀glamour,฀cultivated฀lifestyle,฀enjoy- ment,฀romance,฀sexual฀attractiveness,฀sport,฀sociability,฀relaxation,฀youth,฀emancipation,฀ femininity,฀readiness฀to฀take฀risks฀and฀a฀slim฀igure฀ [73] .฀In฀the฀EU,฀promotional฀cam- paigns฀for฀light฀cigarettes฀are฀overwhelmingly฀successful฀with฀middle-aged฀women. Light฀cigarettes฀are฀sold฀mainly฀to฀health-conscious฀smokers฀because฀they฀are฀looking฀ for฀less฀harmful฀cigarettes฀ [74] .฀These฀cigarettes฀are฀most฀popular฀with฀women฀Table฀ 13.1 .฀ The฀tobacco฀industry฀Marlboro฀also฀believes฀that฀women฀associate฀these฀cigarettes฀with฀ “independence”฀and฀“zest฀for฀life.”฀In฀Germany,฀the฀market฀share฀for฀Marlboro-Light฀is฀ 10.5,฀though฀these฀cigarettes฀are฀less฀widely฀smoked฀by฀younger฀women. In฀ the฀ report,฀ “The฀ Changing฀ Cigarette,”฀ smoking฀ cigarettes฀ with฀ low฀ condensate฀ values฀was฀classiied฀as฀reducing฀the฀risk฀of฀lung฀cancer,฀but฀only฀on฀the฀assumption฀that฀ Age฀group Men Women 15–24 29 36 25–44 29 48 45–64 33 60 65– 46 57 Total 31 48 Table 13.1 ฀฀฀Percen- tage฀proportions฀of฀ smokers฀of฀light฀ cigarettes฀in฀the฀EU,฀ classiied฀by฀age฀ 1995฀ [76] the฀number฀of฀cigarettes฀smoked฀did฀not฀increase฀ [75] .฀According฀to฀one฀survey฀in฀the฀ USA,฀only฀1฀smoker฀in฀10฀knows฀that฀light฀cigarettes฀contain฀just฀as฀many฀toxic฀sub- stances฀as฀“regular”฀cigarettes฀ [74] .฀Despite฀this,฀these฀cigarettes฀can฀be฀marketed฀more฀ easily฀ to฀ “health-conscious”฀ smokers฀ and฀ are฀ more฀ readily฀ accepted฀ by฀ women฀ [74] .฀ Nevertheless,฀surveys฀have฀revealed฀that฀where฀smokers฀are฀aware฀of฀the฀true฀informa- tion฀regarding฀light฀and฀ultralight฀cigarettes,฀the฀decision฀to฀quit฀smoking฀is฀taken฀more฀ rapidly฀ [74] . The฀market฀share฀of฀these฀low-condensate฀and฀low-nicotine฀cigarettes฀will฀not฀increase฀ markedly,฀and฀yet฀action฀must฀be฀taken฀to฀counter฀the฀misleading฀advertising.฀According฀ to฀the฀European฀Commission฀report฀ [76] ,฀more฀than฀50฀of฀female฀smokers฀in฀seven฀EU฀ countries฀ Sweden,฀ Austria,฀ Italy,฀ Denmark,฀ Ireland,฀ Finland฀ and฀ France฀ smoke฀ light฀ cigarettes,฀and฀in฀Sweden,฀the฀percentage฀igure฀is฀actually฀75฀ [76] .

13.6 Tobacco Smuggling

Tobacco฀ smuggling฀ is฀ “worthwhile”฀ because฀ the฀ taxes฀ on฀ tobacco฀ products฀ are฀ high฀ Fig.฀ 13.8 ,฀ even฀ though฀ considerable฀ differences฀ exist฀ between฀ the฀ various฀ European฀ countries฀range:฀57–82.฀Quasi-legal฀trade฀takes฀the฀form฀of฀sales฀in฀duty-free฀shops฀ where฀cigarettes฀are฀available฀tax-free.฀In฀total,฀45,000฀million฀cigarettes฀corresponding฀ to฀0.8฀of฀all฀cigarettes฀worldwide฀were฀sold฀through฀these฀channels฀in฀1997฀ [77] .฀The฀ European฀region฀led฀the฀way฀with฀69,฀followed฀by฀the฀Asia-Paciic฀region฀with฀18.฀The฀ World฀Health฀Organization฀is฀extremely฀interested฀in฀suppressing฀or฀abolishing฀this฀form฀ of฀sales฀Protocol฀of฀the฀International฀Convention฀on฀the฀Simpliication฀and฀Harmonization฀ of฀Customs฀Procedures,฀1999. Illegal฀forms฀of฀“tobacco฀trade”฀are฀bootlegging฀and฀large-scale฀organised฀smuggling.฀ Bootleggers฀limit฀themselves฀to฀buying฀cigarettes฀in฀countries฀with฀lower฀tobacco฀taxes฀ and฀driving฀them฀by฀car฀to฀countries฀with฀higher฀tobacco฀tax฀levels฀without฀declaring฀these฀ cigarettes฀when฀crossing฀national฀borders฀ [78] .฀Large-scale฀organised฀smuggling฀is฀typical฀ 90 80 70 60 50 40 30 20 10 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 USA Brazil Billion of cigarettes Fig. 13.8 ฀฀฀Exports฀of฀ cigarettes฀smug- gling฀from฀USA฀ and฀from฀Brazil฀to฀ Belgium.฀Source:฀ US฀Department฀of฀ Agriculture฀ [80]