Cigarette Advertising
and Adolescent Smoking
American Journal of Preventive Medicine
Online Early February 2, 2010
Reiner Hanewinkel, PhD, Barbara Isensee, PhD, James D. Sargent, MD, Matthis Morgenstern, PhD
Although most agree that the association between tobacco marketing and youth smoking is causal, few studies have assessed the specifıcity of this association.

This study aims to examine the specifıcity of the association between cigarette advertising and teen smoking.

A cross-sectional survey of 3415 German schoolchildren aged 10–17 years was conducted using masked images of six cigarette brands and eight other commercial products in 2008. The exposure variable was a combination of contact frequency (recognition) and brand names (cued recall). Sample quartile (Q) exposure to advertisement exposure was calculated in 2009. Outcome variables were ever tried and current (monthly) smoking, and susceptibility to smoking among never smokers.

The prevalence of ever smoking was 31.1% and that of current smoking was 7.4%, and 35.3% of never smokers were susceptible to smoking. Ad recognition rates ranged from 15% for a regionally advertised cigarette brand to 99% for a sweet. Lucky Strike and Marlboro were the most highly recognized cigarette brands (with ad recognition rates of 55% and 34%, respectively). After controlling for a range of established influences on smoking behaviors, the adjusted ORs for having tried smoking were 1.97 (95% CI1.40, 2.77) for Q4 exposure to cigarette ads compared with adolescents in Q1, 2.90 (95% CI1.48, 5.66) for current smoking, and 1.79 (95% CI1.32, 2.43) for susceptibility to smoking among never smokers. Exposure to ads for commercial products other than cigarettes was signifıcantly associated with smoking in crude but not multivariate models.

This study underlines the specifıcity of the relationship between tobacco marketing and youth smoking, with exposure to cigarette ads, but not other ads, being associated with smoking behavior and intentions to smoke. This fınding suggests a content-related effect of tobacco advertisements.
Related AJPM press release:
Cigarette Ads Fuel Teens’ Desire to Start Smoking
Note: Full text study and press release PDFs freely available from links immediately above.