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RESEARCH AND PRACTICE |
Lisa Henriksen, Yun Wang, and Stephen P. Fortmann are with the Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, Calif. Ellen C. Feighery is with the Public Health Institute, Oakland, Calif.
Correspondence: Requests for reprints should be sent to Lisa Henriksen, PhD, Stanford University School of Medicine, Stanford Prevention Research Center, Hoover Pavilion, 211 Quarry Rd, N229, Stanford, CA 94305-5705 (e-mail: lhenriksen{at}stanford.edu; amanda.dauphinee{at}stanford.edu).
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONMETHODSRESULTS AND DISCUSSIONReferences |
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A survey of 2125 middle-school students in central California examined adolescents’ exposure to tobacco marketing in stores and its association with self-reported smoking. Two thirds of sixth-, seventh-, and eighth-grade students reported at least weekly visits to small grocery, convenience, or liquor stores. Such visits were associated with a 50% increase in the odds of ever smoking, even after control for social influences to smoke. Youth smoking rates may benefit from efforts to reduce adolescents’ exposure to tobacco marketing in stores.
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTS AND DISCUSSIONReferences |
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The only study to correlate adolescents’ self-reported smoking with exposure to retail tobacco marketing found that experimentation was 38% more likely for seventh-grade students who said that they visited a convenience, liquor, or small grocery store at least weekly and remembered seeing advertisements for cigarettes sometimes or a lot.13 Because cigarette advertising is more noticeable to experimenters than to abstinent youths,14,15 this finding may be attributable to perceived exposure alone. Alternatively, store exposure may be associated with smoking for reasons other than the influence of advertising, such as a propensity for risk taking or lack of after-school supervision, which are established risk factors for smoking.11,16,17 After we controlled for such risk factors and social influences to smoke, we examined whether adolescent smoking is associated with exposure to stores that contain widespread tobacco marketing.
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METHODS |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTS AND DISCUSSIONReferences |
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Each survey included photographs and addresses of 12 retail tobacco outlets in the school catchment area that were identified by student focus groups as popular destinations for purchasing snacks. Exposure to retail tobacco marketing was coded for students who reported at least weekly visits to convenience, liquor, or small grocery stores, either in response to questions about the pictured stores or in response to questions about visiting any such stores in the past month. Exposure to other forms of tobacco marketing was coded for students who reported owning a cigarette promotional item, sometimes or often seeing tobacco advertisements in magazines in the past week, or sometimes or often seeing people smoking on television or in movies in the past week. Exposure to family and peer smoking was coded, separately, for students who reported having a parent or other household member who currently smokes and for students who reported having at least one friend who currently smokes. The survey also included self-reported grades, a 3-item risk-taking measure,11 and 4 items of the Authoritative Parenting Index18 that measure maternal supervision.
We used GLIMMIX for SAS, Version 8.0 (SAS Institute Inc, Cary, NC), to examine the potential effect of school clustering with multilevel modeling, but results did not differ from the standard multiple regression reported here. Odds ratios were computed to test the association between adolescents’ exposure to retail tobacco marketing and ever smoking a cigarette, even just a puff. This was the primary study outcome because the prevalence of current smoking was quite small: 2.6% of sixth-, 6.0% of seventh-, and 7.6% of eighth-grade students reported any cigarette smoking in the past 30 days.
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RESULTS AND DISCUSSION |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTS AND DISCUSSIONReferences |
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); about one fourth of the students reported visiting such stores practically every day. Exposure to retail tobacco marketing was more prevalent among boys; Latino youths; and students who reported low maternal supervision, high risk taking, exposure to social influences to smoke, and exposure to other forms of tobacco marketing.
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summarizes the bivariate and multivariate associations of ever smoking with demographic attributes and psychosocial risk factors. After we controlled for all other variables in the model, weekly or more frequent exposure to retail tobacco marketing was associated with a 50% increase in the odds of ever smoking—nearly as much as the effect of exposure to a parent or household member who smokes. Although Latino youths were more likely to be exposed to retail tobacco marketing, they had no greater risk for smoking when other variables were controlled.
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This cross-sectional study could not confirm a causal role for retail tobacco marketing in the uptake of smoking but provided stronger evidence for causality than previous studies have by controlling several potential confounds.
The effect of retail tobacco marketing on adolescent smoking may be particularly potent in states with comprehensive tobacco control programs where tobacco advertisements and promotions are more numerous at the point of sale.19,20 Because the tobacco industry has relatively few regulations on advertising in stores,21–25 further research, including longitudinal studies, is needed to determine how the proliferation of tobacco marketing in stores affects youths.
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Acknowledgments |
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We are grateful to Amanda Dauphinee for managing the data collection and project administration; to Harry Haladjian for managing the store observations; to Matthew Barton, Christopher Doyle, Allyson Fish, Shannon Quinlan Hurtz, Dominique Johnson, Lani Ream, and Diana Wu for collecting the data; and to the principals and teachers who supported the study.
Human Participant Protection
All students were required to return signed parental consent forms in order to participate in this study.
The parental consent forms explained the study protocol and participant rights. Students also were given a consent form to read and sign before survey administration. The use of human subjects was approved by the human subjects panel of Stanford University.
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Footnotes |
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Accepted for publication January 2, 2004.
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References |
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TOPABSTRACTINTRODUCTIONMETHODSRESULTS AND DISCUSSIONReferences |
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2. Celebucki CC, Diskin K. A longitudinal study of externally visible cigarette advertising on retail storefronts in Massachusetts before and after the Master Settlement Agreement. Tob Control. 2002;11(suppl 2):ii47–ii53.
3. Wakefield MA, Terry-McElrath YM, Chaloupka FJ, et al. Tobacco industry marketing at point of purchase after the 1998 MSA billboard advertising ban. Am J Public Health. 2002;92:937–940.
4. Point-of-Purchase Advertising Institute. The Point-of-Purchase Advertising Industry Fact Book. Englewood, NJ: The Point of Purchase Advertising Institute; 1992.
5. Chanil D. Profile of the convenience store customer. Convenience Store News. February 11, 2002:54–70.
6. MacFadyen L, Hastings G, MacKintosh AM. Cross sectional study of young people’s awareness of and involvement with tobacco marketing. BMJ. 2001;322: 513–517.
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21. A Bill to Protect the Public Health by Providing the Food and Drug Administration With Certain Authority to Regulate Tobacco Products, S2626, 107th Cong, 2nd Sess (2002).
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24. Lorillard Tobacco Co. v Reilly, 533 US 525, F Supp 2d 76,124 (US 2001).
25. Master Settlement Agreement. Washington, DC: National Association of Attorneys General; December 8, 1998.
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| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
