Exposure to tobacco advertising and pro-tobacco depictions in films, television, and videos more than doubles the odds that children under 18 will become tobacco users, according to a new study to be published in the December 2006 issue of the peer-reviewed Archives of Pediatrics and Adolescent Medicine.
"Approximately 1.4 million children under age 18 in the U.S. begin smoking cigarettes each year, and half of these do so as a direct result of their exposure to tobacco advertising," said study co-author Dr. Robert Wellman, of the University of Massachusetts Medical School and Fitchburg State College in Massachusetts. "We now have evidence that such exposure is a major-and avoidable-public health risk to children."
The tobacco industry claims that its marketing does not harm non-smokers, but only influences people who already use tobacco, write the authors. While previous studies have shown that youth exposed to marketing become more receptive to tobacco and more likely to smoke, the Wellman study is the first to assess the actual magnitude of the risk posed by youth exposure to pro-tobacco marketing.
The meta-analysis encompasses 51 studies conducted since 1981 that included 141,949 total participants. The researchers evaluated exposures to tobacco advertising, promotions or cigarette samples received, and pro-tobacco depictions in films, television or videos. The study, "The Extent to Which Tobacco Marketing and Tobacco Use in Films Contribute to Children's Use of Tobacco: A Meta-analysis" was funded by the Robert Wood Johnson Foundation's Substance Abuse Policy Research Program (SAPRP).
Psychological Involvement Key to Impact
Psychological involvement in tobacco marketing or media increases the odds of tobacco use almost three-fold, according to the study. The portrayal of tobacco use in a film, for example, may be more psychologically engaging than a cigarette ad, and may have a bigger impact on the recipient's smoking attitudes and behavior.
"This elevated risk suggests that the interaction between exposure and an individual's psychological processes is powerful," Wellman said.
But even exposure that does not actively engage children has a substantial impact, increasing the odds of tobacco use by about 90 percent, the authors find. And, as a whole, exposed youth had approximately 50 percent greater odds of viewing tobacco use positively and intending to use it in the future.
Marketing and media also lead children who already smoke to smoke more heavily, increasing the odds of progression to heavier use by 42 percent.
Previous Measures to Curtail Marketing to Youth Ineffective
Thirty years ago the Federal Trade Commission raised concerns about tobacco industry targeting of young people, and eight years ago the Master Settlement Agreement between the industry and 46 U.S. states banned advertising on billboards and in youth-oriented magazines.
To assess the effectiveness of these measures in lowering the risk posed by marketing, the authors compared results from studies conducted between 1981 and 1990, between 1991 and 2000, and between 2001 and 2005. Rather than finding a downward trend, studies published since 2001 show a higher risk than do studies published in the 1990s.
"The tobacco industry has been masterful at avoiding the spirit of the restrictions imposed by the Master Settlement Agreement," Wellman said. "Their advertisements fill pages of magazines whose youth readership exceeds 20 percent, and tobacco use in movies is as pervasive as it was in the 1950s."
To perform their meta-analysis, the authors conducted a systematic literature search that yielded 51 studies for final inclusion. Each one reported on exposure to tobacco marketing and their outcomes in people younger than 18 years of age. The studies evaluated outcomes in terms of attitudes toward smoking, intentions to smoke among non-smokers, initiation of use, status as a nonuser or user, and progression to heavier use.
"Our findings suggest that half of all children who start smoking do so because of exposure to marketing and media," Wellman said. "These results provide policy makers with evidence they need to support measures that restrict children's exposure to tobacco marketing."
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The Substance Abuse Policy Research Program (www.saprp.org) of the Robert Wood Johnson Foundation is a $66 million program that funds research into policies related to alcohol, tobacco and illegal drugs.
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 30 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. Helping Americans lead healthier lives and get the care they need-the Foundation expects to make a difference in our lifetime. For more information, visit www.rwjf.org.
