Advertising and Promotion of Tobacco Encourage Smoking Among Youth: Study

An important role for an epidemiologist — and a physician specializing in preventive medicine — is to identify the antecedents or determinants of disease. Eliminating or reducing those antecedents will then reduce the incidence or prevalence of disease. In this case, we know that smoking is a major antecedent in the causation of numerous diseases, including cancer, heart disease, emphysema, and stroke. We can extend this process further by assessing the antecedents or determinants of behavioral risk factors for disease, such as smoking. As indicated by the evidence reviewed in this report, exposure to tobacco advertising and promotion is an antecedent in the initiation of smoking among youth.

II. How tobacco advertising and promotion affect tobacco consumption

The 1989 Surgeon General’s report “The Health Consequences of Smoking: 25 Years of Progress”1 reviewed the mechanisms by which tobacco advertising and promotion may affect tobacco consumption. Four direct mechanisms by which advertising and promotion may increase tobacco consumption were discussed:

1. Advertising and promotion could encourage children or young adults to experiment with tobacco products and initiate regular use;
2. Advertising and promotion could increase tobacco users’ daily consumption of tobacco products by serving as a cue to tobacco use.
3. Advertising and promotion could reduce current tobacco users’ motivation to quit.
4. Advertising and promotion could encourage former smokers to resume smoking.

The Surgeon General’s report also discussed several indirect mechanisms by which advertising and promotion might increase tobacco consumption. One of these is that “the ubiquity and familiarity of tobacco advertising and promotion may contribute to an environment in which tobacco use is perceived by users to be socially acceptable, or at least less socially objectionable and less hazardous than it is in fact.”

The report reviewed the evidence bearing on these effects. Although it concluded that no single study would be likely to provide a definitive answer to the question of whether advertising and promotion increase the level of tobacco consumption, the report noted that “The most comprehensive review of both the direct and indirect mechanisms concluded that the collective empirical, experiential, and logical evidence makes it more likely than not that advertising and promotion activities do stimulate cigarette consumption.”

Substantial research on the effects of cigarette advertising and promotion has been conducted and published since the release of that report in 1989. As a result, the Surgeon General and the U.S. Department of Health and Human Services have extended and strengthened their conclusions about the effects of advertising and promotion on smoking behavior, particularly in regards to children and adolescents. These stronger and more recent conclusions were published in the Surgeon General’s 1994 report on smoking and youth (see Section VI (A) below)2 and by the U.S. Food and Drug Administration in documents related to its rule-making on tobacco sales and marketing.3,4

My own conclusions are similar to those of the Surgeon General, the Department of Health and Human Services, and the Food and Drug Administration. Tobacco advertising and promotion do indeed stimulate cigarette consumption, especially among youth.

III. Evidence that advertising and promotion affect overall tobacco consumption

Several time-series studies have assessed the relationship between tobacco consumption and tobacco advertising expenditures. Simply put, time-series analysis is the study of observations taken in a series of instances over time. It often uses statistical techniques such as multiple regression, a method for distinguishing among competing and simultaneous influences on the end result (tobacco consumption, in this case). It has been used to assess the relationship between tobacco advertising expenditures and tobacco consumption over time, taking into account (”controlling for”) other potential influences on consumption such as price and income.

The Economics and Operational Research Division of the British Department of Health (in the “Smee Report”) analyzed the results of 19 time-series studies of cigarette advertising, including seven in the U.S., seven in the United Kingdom, two in New Zealand, and one each in Australia and West Germany.5 They found that 13 studies showed positive results (i.e., that higher advertising expenditures are associated with higher tobacco consumption), one showed negative results, and five showed both positive and negative results. The main findings of their review were as follows: