Ellen C. Feighery

Is adolescent smoking related to the density and proximity of tobacco outlets and retail cigarette advertising near schools

OBJECTIVE To examine the quantity (density) and location (proximity) of tobacco outlets and retail cigarette advertising in high school neighborhoods and their association with school smoking prevalence. METHODS Data from the 135 high schools that participated in the 2005-2006 California Student Tobacco Survey were combined with retailer licensing data about the location of tobacco outlets within walking distance (1/2 mi or 805 m) of the schools and with observations about the quantity of cigarette advertising in a random sample of those stores (n=384). Multiple regressions, adjusting for school and neighborhood demographics, tested the associations of high school smoking prevalence with the density of tobacco outlets and retail cigarette advertising and with the proximity of tobacco outlets to schools. RESULTS The prevalence of current smoking was 3.2 percentage points higher at schools in neighborhoods with the highest tobacco outlet density (>5 outlets) than in neighborhoods without any tobacco outlets. The density of retail cigarette advertising in school neighborhoods was similarly associated with high school smoking prevalence. However, neither the presence of a tobacco outlet within 1000 ft of a high school nor the distance to the nearest tobacco outlet from school was associated with smoking prevalence. CONCLUSIONS Policy efforts to reduce adolescent smoking should aim to reduce the density of tobacco outlets and retail cigarette advertising in school neighborhoods. This may be achieved through local zoning ordinances, including limiting the proximity of tobacco outlets to schools.

Seventh graders' self-reported exposure to cigarette marketing and its relationship to their smoking behavior.

OBJECTIVES This study examined among youth the extent of their perceived exposure to cigarette marketing and the relationship of their perceptions to their smoking behavior. METHODS Surveys measuring exposure to cigarette advertisements and promotions were completed by 571 seventh graders in San Jose, Calif. RESULTS Eighty-eight percent of these 13-year-olds reported exposure to cigarette marketing: the majority often saw ads in magazines, on billboards, and at stores and events, and one quarter owned cigarette promotional items. After social influences to smoke were controlled for, exposure to cigarette marketing was related to self-reported smoking behavior. Likelihood of experimenting with smoking was 2.2 times greater among those who owned promotional items and 2.8 times greater among those who had received mail from a tobacco company. Seeing cigarette advertisements in magazines increased this likelihood by 21%, and seeing tobacco marketing in stores increased it by 38%. CONCLUSIONS Youth are daily and widely exposed to tobacco industry marketing efforts; this exposure is related to smoking behavior. More effective regulation is needed.

Seeing, wanting, owning: the relationship between receptivity to tobacco marketing and smoking susceptibility in young people

OBJECTIVE To assess the effect of the tobacco industry’s marketing practices on adolescents by examining the relationship between their receptivity to these practices and their susceptibility to start smoking. DESIGN Paper-and-pencil surveys measuring association with other smokers, exposure to tobacco industry marketing strategies, experience with smoking, and resolve not to smoke in the future. SETTING 25 randomly selected classrooms in five middle schools in San Jose, California. SUBJECTS 571 seventh graders with an average age of 13 years and 8 months; 57% were female. Forty-five per cent of the students were Asian, 38% were Hispanic, 12% were white, and 5% were black. MAIN OUTCOME MEASURES Exposure to social influences, receptivity to marketing strategies, susceptibility to start smoking. RESULTS About 70% of the participants indicated at least moderate receptivity to tobacco marketing materials. Children who are more receptive are also more susceptible to start smoking. In addition to demographics and social influences, receptivity to tobacco marketing materials was found to be strongly associated with susceptibility. CONCLUSIONS Tobacco companies conduct marketing campaigns that effectively capture teenage attention and stimulate desire for their promotional items. These marketing strategies may function to move young teenagers from non-smoking status toward regular use of tobacco. Our results demonstrate that there is a clear association between tobacco marketing practices and youngsters’ susceptibility to smoke. The findings, along with other research, provide compelling support for regulating the manner in which tobacco products are marketed, to protect young people from the tobacco industry’s strategies to reach them.

Cigarette advertising and promotional strategies in retail outlets: results of a statewide survey in California

OBJECTIVE To examine the extent and types of cigarette advertising materials in stores and to assess tobacco company compliance with the 1998 Master Settlement Agreement (MSA). DESIGN A cross-sectional analysis of a random sample of 586 stores that sold cigarettes. SETTING US state of California. MAIN OUTCOME MEASURES Trained data collectors classified cigarette advertising materials by type (signs, displays, functional items), location (interior or exterior), and placement (below 3 feet (1 m) or near candy). RESULTS California retail outlets featured 17.2 (SD 16.1) tobacco advertising materials on average, and 94% of stores featured at least some advertising. About 85% of these were within 4 feet (1.3 m) of the counter. About 50% of the stores had ads at or below 3 feet, and 23% had cigarette product displays next to candy. In violation of the MSA, 3% of stores featured signs with cartoons and 11% had large exterior signs. CONCLUSIONS Tobacco companies are aggressively using stores to market cigarettes. Moreover, the spirit of the MSA—to protect children from cigarette advertising—has not been realised. Future studies should monitor industry use of this venue and assess the impact of exposure to cigarette advertising materials in stores on adult smokers and youth.

Reaching youth at the point of sale: cigarette marketing is more prevalent in stores where adolescents shop frequently

Objective: Although numerous studies describe the quantity and nature of tobacco marketing in stores, fewer studies examine the industry’s attempts to reach youth at the point of sale. This study examines whether cigarette marketing is more prevalent in stores where adolescents shop frequently. Design, setting, and participants: Trained coders counted cigarette ads, products, and other marketing materials in a census of stores that sell tobacco in Tracy, California (n  =  50). A combination of data from focus groups and in-class surveys of middle school students (n  =  2125) determined which of the stores adolescents visited most frequently. Main outcome measures: Amount of marketing materials and shelf space measured separately for the three cigarette brands most popular with adolescent smokers and for other brands combined. Results: Compared to other stores in the same community, stores where adolescents shopped frequently contained almost three times more marketing materials for Marlboro, Camel, and Newport, and significantly more shelf space devoted to these brands. Conclusions: Regardless of whether tobacco companies intentionally target youth at the point of sale, these findings underscore the importance of strategies to reduce the quantity and impact of cigarette marketing materials in this venue.

An Evaluation of Four Measures of Adolescents' Exposure to Cigarette Marketing in Stores

This study evaluates four measures of exposure to retail cigarette marketing in relation to adolescent smoking behavior. The measures are (a) shopping frequency in types of stores known to carry more cigarette advertising than other store types, (b) shopping frequency in specific stores that sell cigarettes in the study community, (c) the amount of exposure to cigarette brand impressions in stores where students shopped, and (d) perceived exposure to cigarette advertising. The study combined data from classroom surveys administered to 6th-, 7th-, and 8th-grade students in three California middle schools, and direct store observations quantifying cigarette marketing materials and product placement in stores where students shopped. Logistic regression models were used to examine how each exposure measure related to the odds of ever smoking and susceptibility to smoke, controlling for grade, gender, ethnicity, school performance, unsupervised time, and exposure to household and friend smoking. Frequent exposure to retail cigarette marketing as defined by each of the four measures was independently associated with a significant increase in the odds of ever smoking. All but the measure of exposure to store types was associated with a significant increase in the odds of susceptibility to smoke. Four measures of exposure to retail cigarette marketing may serve equally well to predict adolescent smoking but may vary in cost, complexity, and meaning. Depending on the outcomes of interest, the most useful measure may be a combination of self-reported exposure to types of stores that contain cigarette marketing and perceived exposure to such messages.

An examination of trends in amount and type of cigarette advertising and sales promotions in California stores, 2002-2005

Background: Cigarette companies spend more of their marketing dollars in stores than in any other venue. In 2005, they spent 88% of a total of

The perceived influence of cigarette advertisements and smoking susceptibility among seventh graders

13.1 billion to advertise and promote product sales in stores. Aim: The purposes of this study were to identify how the amount and types of cigarette advertising and sales promotions have changed in stores in California between 2002 and 2005, and to assess neighbourhood influences on cigarette marketing in stores. Methods: Four observational assessments of cigarette advertising were conducted in approximately 600 California stores that sold cigarettes from 2002 to 2005. Trained observers collected data on the amount and type of cigarette advertising, including signs, product shelving and displays and functional items, and presence of sales promotions on these items. Longitudinal analyses were performed to estimate trends over time and identify correlates of change in the amount and type of tobacco advertising. Results: The mean number of cigarette advertisements per store increased over time from 22.7 to 24.9. The percentage of stores with at least one advert for a sales promotion increased from 68% to 80%. The amount of advertising and proportion of stores with sales promotions increased more rapidly in stores situated in neighbourhoods with a higher proportion of African–Americans. Conclusion: The results indicate increasing use of stores to market and promote cigarette sales. Further, these increases are disproportionately accelerating in neighbourhoods with more African–Americans. Legislative strategies should be pursued to control the marketing of tobacco products and promotional strategies used to reduce prices in stores.

Community Mobilization to Reduce Point-of-Purchase Advertising of Tobacco Products:

A perceptual bias, the third person effect, has been observed where individuals believe themselves to differ from others regarding the perceived influence of media messages. Given the frequency with which youth encounter prosmoking messages and the reported negative effects of these messages, it is of value to study whether youth perceive cigarette advertisements to influence themselves and their friends and peers. This study examined the associations between exposure to social and information prosmoking environments, the perceived influence of cigarette advertisements on self, best friends, and other youth, and smoking susceptibility. A sample of 571 seventh graders completed surveys on tobacco advertisements and promotions. Using Students-t, chi-square, ANOVA tests and proportional odds models, we found significant associations between perceived influence of cigarette advertisements and exposure to social and information prosmoking environments as well as smoking susceptibility. These data suggest that youth be taught that everyone is vulnerable to the tobacco industrys strategies and be given skills to resist prosmoking advertising.

Retail trade incentives: how tobacco industry practices compare with those of other industries.

This project was designed to address the problem of point-of-purchase tobacco advertising through media advocacy and community mobilization. Precampaign assessment revealed a considerable amount and density of tobacco advertising and promotions in more than 100 stores sampled in San Jose, California. After sharing the results with community activists and other residents, a community mobilization campaign was instigated to capitalize on an existing sign control ordinance that limits store window coverage and sidewalk signs. Through presentations and media advocacy efforts, community residents were mobilized to file complaints with the citys code enforcement office when neighborhood stores were shown to be noncompliant with ordinance provisions. Relative to the baseline, significant reductions in campaign-related tobacco advertising variables were seen in the San Jose stores after the sign law campaign. No changes were seen in four smaller reference communities. Differences were noted between stores close to and farther away from schools. These results demonstrate that mobilization of community residents to activate enforcement of laws originally designed for other purposes can have a significant impact on one aspect of tobacco point-of-purchase advertising.