Effect of Tobacco Industry Advertising Messages

messages฀“wash฀over฀them”฀as฀they฀grow฀older.฀Adolescents฀absorb฀these฀messages฀very฀ much฀more฀avidly฀because,฀while฀en฀route฀to฀developing฀their฀adult฀identities,฀they฀monitor฀ very฀much฀more฀sensitively฀everything฀that฀occurs฀in฀the฀adult฀world฀ [13,฀53] . A฀sample฀of฀229฀children฀aged฀3฀to฀6฀years฀was฀tested฀with฀ads฀featuring฀“Old฀Joe฀Camel”:฀ 30฀of฀the฀3-year฀olds฀and฀91.3฀of฀the฀6-year฀olds฀correctly฀matched฀the฀“Old฀Joe”฀logo฀ to฀the฀Camel฀cigarette฀brand฀ [54] .฀It฀is฀concluded฀that฀intensive฀promotion฀of฀this฀cigarette฀ brand฀resulted฀in฀this฀high฀recognition฀rate฀ [54] .฀In฀a฀similarly฀designed฀study,฀recognition฀of฀ the฀“Old฀Joe”฀logo฀was฀compared฀in฀adolescents฀and฀adults:฀the฀children฀were฀better฀able฀ than฀adults฀97฀vs.฀58฀to฀match฀the฀logo฀to฀the฀cigarette฀brand฀ [45] .฀However,฀of฀much฀ greater฀interest฀is฀the฀promotional฀effect฀of฀the฀3-year฀advertising฀campaign:฀Camel’s฀share฀ of฀the฀children’s฀cigarette฀market฀was฀initially฀0.5,฀rising฀to฀32.8฀3฀years฀later฀ [45] . Similarly,฀interviews฀conducted฀in฀5,040฀adolescents฀and฀24,296฀adults฀from฀California฀ revealed฀that฀perception฀of฀cigarette฀advertising฀was฀higher฀among฀adolescents฀than฀adults฀ [55] .฀Whereas฀only฀47฀of฀adults฀named฀Marlboro฀and฀Camel฀as฀the฀most฀advertised฀brands,฀ the฀igure฀was฀70฀among฀adolescents.฀The฀12–13-year฀olds฀recognised฀Camel฀most฀often,฀ whereas฀the฀16–17-year฀olds฀recognised฀Marlboro฀most฀often฀ [55] .฀Adolescent฀non-smokers฀ from฀the฀same฀setting฀were฀interviewed฀about฀tobacco฀industry฀advertising฀messages.฀Even฀ though฀they฀had฀no฀involvement฀in฀smoking,฀84฀of฀the฀sample฀was฀also฀able฀to฀remember฀ one฀or฀more฀advertising฀messages฀ [56] .฀The฀Camel฀advert฀depicted฀in฀Fig.฀ 13.5 ฀is฀directed฀ at฀ adolescents฀ and฀ adults฀ who฀ are฀ already฀ attuned฀ and฀ receptive฀ to฀ sexual฀ innuendo.฀ Nevertheless,฀this฀advertising฀message฀operates฀at฀a฀thought฀provoking฀level. One฀recent฀study฀sought฀for฀an฀association฀between฀the฀number฀of฀cigarette฀promotional฀ items฀CPIs฀owned฀and฀smoking฀behaviour.฀The฀two฀variables฀were฀studied฀in฀10–19-year- old฀students,฀using฀multivariate฀regression฀analysis.฀Smokers฀were฀deined฀as฀students฀who฀ had฀previously฀smoked฀100฀cigarettes฀or฀more฀in฀their฀lifetime,฀while฀other฀students฀were฀ classed฀as฀never-smokers฀or฀experimental฀smokers฀ [57] .฀Out฀of฀the฀1,265฀students,฀406฀ owned฀CPIs:฀211฀owned฀one,฀82฀owned฀two,฀57฀owned฀three,฀24฀owned฀four,฀23฀owned฀ive฀ and฀7-owned฀six฀CPIs.฀The฀study฀also฀investigated฀associations฀with฀educational฀level฀and฀ family฀smoking฀behaviour.฀Smoking฀prevalence฀was฀11.2฀for฀students฀not฀owning฀a฀CPI,฀ 41.5฀for฀those฀owning฀two฀CPIs฀OR฀=฀3.4;฀95฀CI:฀1.9–5.9฀and฀58.5฀OR฀=฀8.4;฀95฀ CI:฀5.0–14.2฀for฀those฀owning฀four฀CPIs฀ [57] .฀From฀this,฀it฀is฀evident฀that฀promotional฀ Fig. 13.5 ฀฀฀“Camel฀–฀a฀ pleasure฀whatever฀the฀ position”:฀blending฀smoking฀ with฀sexual฀innuendo?฀ Camel฀advert,฀issued฀in฀ Germany฀in฀2000 items฀supplied฀by฀the฀tobacco฀industry฀encourage฀smoking฀behaviour฀ [57] .฀Conversely,฀ consistently฀implemented฀tobacco฀control฀programmes฀clearly฀reduce฀the฀smoking฀behaviour฀ of฀children,฀as฀has฀emerged฀from฀analyses฀in฀various฀US฀states฀ [58] . Furthermore,฀susceptible฀adolescents฀tend฀to฀overestimate฀the฀social฀beneits฀of฀smok- ing฀and฀underestimate฀its฀risks฀ [59] ,฀a฀phenomenon฀that฀may฀also฀be฀termed฀the฀“invulner- ability฀syndrome”฀ [60] ฀and฀is฀not฀unknown฀in฀adults.฀The฀sheer฀weight฀of฀advertising฀is฀ virtually฀bound฀to฀pre-programme฀misconceptions฀into฀adolescents’฀thinking฀so฀that฀they฀ start฀to฀smoke฀and฀then฀are฀unable฀to฀free฀themselves฀from฀the฀habit฀ [32] .฀Adolescents฀are฀ not฀as฀capable฀as฀adults฀at฀effectively฀resisting฀these฀attempts฀of฀persuasion฀see฀ Chap.฀12 ,฀ life฀skills฀techniques฀and฀consequently฀are฀more฀vulnerable฀than฀many฀adults฀to฀advertis- ing฀strategies฀and฀sales฀tactics฀ [33] .฀Adolescents฀are฀always฀looking฀for฀something฀novel฀ and฀are฀also฀willing฀to฀try฀new฀experiences฀ [61] .฀Adolescents’฀own฀insecurity฀and฀their฀ tendency฀to฀look฀to฀a฀group฀or฀a฀leader฀igure฀provokes฀an฀opportunistic฀response฀because฀ their฀recognition฀within,฀or฀sense฀of฀belonging฀to,฀the฀group฀may฀depend฀on฀this฀ [11,฀62] . A฀great฀many฀ilms฀from฀the฀USA฀and฀Germany฀portray฀actors฀smoking.฀One฀US฀study฀ scrutinised฀every฀scene฀from฀25฀cinema฀box-ofice฀hits฀per฀year฀between฀1988฀and฀1997.฀ Those฀actors฀who฀smoke฀on฀screen฀encourage฀the฀current฀tobacco฀epidemic฀among฀young฀ people.฀Cigarette฀and฀cigar฀smoking฀in฀the฀movies฀contribute฀to฀the฀characterisation฀of฀ certain฀types:฀actresses฀who฀smoke฀often฀portray฀disreputable฀women฀embroiled฀in฀sexual฀ affairs,฀involved฀in฀illegal฀activities฀andor฀driving฀automobiles฀recklessly;฀male฀actors฀ who฀smoke฀tend฀to฀portray฀tough฀guys฀who฀are฀frequently฀violent฀and฀relish฀dangerous฀ situations฀ [63] .฀One฀surprising฀inding฀was฀that฀these฀numerous฀smoker฀scenes฀account฀for฀ only฀2–3฀of฀the฀footage฀ [63] . According฀to฀another฀analysis฀of฀US฀ilms,฀42฀of฀actresses฀in฀starring฀roles฀smoked,฀ whereas฀only฀24฀of฀18–44-year-old฀US฀women฀are฀smokers.฀Movie฀smoking฀preva- lence฀was฀just฀as฀high฀in฀ilms฀for฀young฀people฀as฀in฀ilms฀intended฀for฀adult฀viewing.฀ The฀actresses฀generally฀use฀cigarettes฀in฀stressful฀situations฀that฀they฀wish฀to฀keep฀under฀ control฀ [64] .฀This฀movie฀exposure฀encourages฀young฀girls฀to฀accept฀and฀imitate฀these฀ actresses฀as฀role฀models.฀Even฀Disney฀studio฀cartoon฀ilms฀intended฀solely฀for฀children’s฀ viewing฀depict฀tobacco฀and฀alcohol฀scenes฀just฀as฀frequently฀as฀ever,฀to฀judge฀from฀a฀ comparison฀with฀a฀report฀from฀1964.฀In฀1996฀and฀1997,฀all฀cartoon฀ilms฀featured฀scenes฀ of฀tobacco฀use.฀No฀ilm฀offered฀any฀verbal฀message฀highlighting฀the฀harmful฀effects฀of฀ smoking฀ [63] . In฀October฀1999,฀British฀Telecom฀BT฀apologised฀for฀its฀error฀of฀judgement฀in฀supply- ing฀pagers฀for฀a฀Marlboro฀cigarette฀promotion฀aimed฀at฀young฀people.฀BT฀has฀subsequently฀ condemned฀such฀campaigns฀designed฀to฀promote฀sales฀of฀tobacco฀products฀ [65] .฀The฀back- ground฀ to฀ BT’s฀ decision฀ was฀ that฀ the฀ Marlboro฀ Company,฀ in฀ its฀ promotional฀ campaign฀ “Found฀on฀the฀Streets”฀targeted฀at฀young฀people,฀was฀offering฀them฀leisure฀goods฀if฀they฀ purchased฀80-packs฀of฀cigarettes฀within฀a฀speciied฀period฀ [65] .฀In฀return฀for฀their฀names฀and฀ addresses,฀young฀people฀age฀฀18฀years฀at฀nightclubs฀were฀offered฀a฀free฀pack฀of฀Marlboro฀ cigarettes,฀and฀later฀were฀sent฀glossy฀brochures฀on฀cigarette฀lighters,฀Lorus฀wristwatches,฀ White฀Stuff฀leisure฀wear,฀Sanyo฀CD฀players฀and฀Nikon฀cameras฀ [65] .฀Marlboro฀invited฀ participants฀to฀“look฀around฀town”฀and฀“ind฀themselves฀something฀useful.”฀The฀young฀ people฀were฀also฀encouraged฀to฀get฀their฀friends฀to฀telephone฀the฀Marlboro฀customer฀service฀ department.฀The฀callers฀had฀to฀conirm฀their฀age฀in฀writing฀and฀attach฀proof฀of฀purchase฀ to฀ the฀ order฀ form.฀ In฀ some฀ cases,฀ the฀ companies฀ supplying฀ the฀ products฀ on฀ offer฀ only฀ discovered฀via฀the฀press฀that฀the฀campaign฀had฀been฀linked฀with฀Marlboro฀ [65] .฀In฀terms฀of฀ reprehensible฀advertising฀campaigns฀aimed฀at฀young฀people,฀it฀is฀my฀personal฀opinion฀that฀ this฀represents฀the฀tip฀of฀the฀iceberg:฀after฀smoking฀1,600฀cigarettes฀there฀is฀a฀high฀degree฀of฀ certainty฀that฀many฀participants฀in฀the฀scheme฀would฀have฀become฀dependent฀smokers.

13.4 Tobacco Advertising and Adolescent Smoking Initiation

It฀is฀evident฀from฀the฀preceding฀remarks฀that฀the฀critical฀time฀window฀determining฀whether฀ a฀person฀will฀become฀a฀smoker฀or฀remain฀a฀non-smoker฀is฀the฀period฀between฀10฀and฀12฀ years฀of฀age.฀Cigarette฀advertising฀has฀to฀impact฀this฀age฀group฀if฀it฀wishes฀to฀generate฀future฀ customers.฀According฀to฀a฀survey฀conducted฀in฀571฀7th-grade฀students฀13-years฀old,฀the฀ likelihood฀of฀experimenting฀with฀smoking฀was฀2.2฀times฀greater฀among฀those฀who฀owned฀ CPIs฀and฀2.8฀times฀greater฀among฀those฀who฀received฀mail฀from฀a฀cigarette฀company฀ [66] . Adolescents฀also฀start฀smoking฀in฀response฀to฀social฀events฀and฀the฀media฀have฀a฀pivotal฀ role฀ to฀ play฀ here฀ [21,฀ 22] .฀ Adolescents฀ in฀ the฀ USA฀ spend฀ 2–3฀ h฀ daily฀ watching฀ TV฀ 50 45 40 35 30 25 20 15 10 5 0–50 51–100 101–150 150 Tried smoking Number of occurences of tobacco use viewed in films seen Age years: 9–11 12 13 14–15 Fig. 13.6 ฀฀฀Association฀between฀exposure฀to฀use฀of฀tobacco฀in฀ilms฀and฀prevalence฀of฀trying฀smoking฀ by฀ age฀ [22] .฀ Included฀ were฀ middle฀ schools฀ in฀ New฀ Hampshire฀ and฀ Vermont.฀ The฀ average฀ participation฀by฀school฀was฀92.5.฀The฀inal฀sample฀consisted฀of฀4,919฀schoolchildren฀9–15฀years฀ of฀age.฀The฀authors฀counted฀occurrences฀of฀smoking฀in฀each฀of฀601฀popular฀contemporary฀ilms,฀ and฀they฀asked฀respondents฀whether฀they฀had฀seen฀50฀ilms฀randomly฀selected฀from฀the฀larger฀pool.฀ On฀the฀basis฀of฀the฀ilms฀that฀adolescents฀reported฀seeing,฀the฀number฀of฀occurrences฀of฀smoking฀ seen฀by฀each฀survey฀respondent฀was฀calculated 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]