Advertising and Promotion of Tobacco Encourage Smoking Among Youth: Study

B. Conclusions of the Food and Drug Administration

The Food and Drug Administration, having reviewed the same body of evidence discussed in this report, has come to the following conclusion:

“FDA recognizes that advertising may not be the most important factor in a child’s decision to smoke; however, the studies cited by the agency establish that it is a substantial, contributing, and therefore material, factor…. The proper question is not, ‘Is advertising the most important cause of youth initiation?’ but rather, ‘does FDA have a solid body of evidence establishing that advertising encourages young people’s tobacco use such that FDA could rationally restrict that advertising?’ The answer to this question is ‘yes.’” (emphasis in original)63

C. My own conclusions

My own conclusions are similar to those of the 1994 Surgeon General’s report and the Food and Drug Administration. The evidence reviewed in this report clearly indicates that tobacco advertising and promotion increase aggregate tobacco consumption, in part through a material effect on smoking by youth. The several lines of evidence that lead to these conclusions include:

o Time-series studies from several countries showing a relationship between tobacco consumption and tobacco advertising expenditures at the national level;
o Studies showing that countries with tobacco advertising bans have lower tobacco consumption (or slower increases in consumption) than those without bans;
o Studies showing that tobacco advertising and promotion reach children and adolescents;
o Numerous cross-sectional studies showing that smoking status and smoking initiation are correlated with awareness, recognition, and approval of tobacco advertisements and promotions; exposure to tobacco advertisements and promotions; “receptivity” to tobacco advertising and promotion; receipt or ownership of tobacco promotional items; and a feeling that cigarette ads make them want to smoke a cigarette;
o Two longitudinal studies showing that approval of cigarette advertising and “receptivity” to tobacco marketing predict the likelihood of taking up smoking or moving through the process of smoking initiation; and
o Studies showing relationships between cigarette brand preference among youth and the following variables: a) cigarette advertising expenditures for certain brands, b) the use of youth-oriented imagery in certain advertising (e.g., Joe Camel), and c) the degree to which teenagers “like” different ads.

Billboards are a special source of concern because: 1) they are a favorite medium for tobacco advertising; 2) they are intrusive and cannot be avoided; 3) they are in people’s neighborhoods and are constantly exposing youth and adults to unsolicited messages; and 4) billboards in urban, inner-city environments are more likely to carry tobacco and alcohol advertisements, often targeted to racial and ethnic minorities.

Because legislation prohibits the sale of tobacco to minors, because tobacco advertising and promotion encourage minors to buy and use tobacco products, and because tobacco billboards are a prime medium through which advertising and promotion accomplish these effects, I believe that implementation of legislation banning or limiting tobacco billboards in the City of Chicago will have a direct and material benefit on the welfare of the city and its children and adolescents.

VIII. References

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Appendix — Biographical Sketch for Ronald M. Davis, M.D.

Ronald M. Davis, M.D., became the director of the Center for Health Promotion and Disease Prevention of the Henry Ford Health System in September 1995. He was appointed Associate Medical Director of Health Alliance Plan of Michigan in September 1996. From 1991 to 1995, he served as Chief Medical Officer in the Michigan Department of Public Health. From 1987 to April 1991, Dr. Davis served as the director of the U.S. Centers for Disease Control’s Office on Smoking and Health. He completed the Epidemic Intelligence Service program and the preventive medicine residency program at CDC; received his M.D. and Master of Arts degree in Public Policy Studies from the University of Chicago; and a Bachelor of Science degree from the University of Michigan. Dr. Davis was elected as the first resident physician member of the American Medical Association’s Board of Trustees, and served in that capacity from 1984 through 1987. He was elected to the AMA Council on Scientific Affairs in June 1993, and became chair of the Council in June 1997.

Dr. Davis has published widely in peer-reviewed journals, and has received many award and honors, including the Surgeon General’s Medallion and the American Public Health Association’s Jay S. Drotman Memorial Award. He is a member of the World Health Organization’s Technical Advisory Group on Tobacco or Health; and is the editor of Tobacco Control: An International Journal, which was launched by the British Medical Association in March 1992.