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Receptivity to Tobacco Advertising and Susceptibility to Tobacco Products

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Receptivity to Tobacco Advertising and Susceptibility to Tobacco Products John P. Pierce, PhD, a, b James D. Sargent, MD, c Martha M. White, MS, a Nicolette Borek, PhD, d David B. Portnoy, PhD, MPH, d ReceptivityVictoria R. Green, BA, e, f Annette R. Kaufman, to PhD,Tobacco MPH, g Cassandra A. Stanton, Advertising PhD, h, i Maansi Bansal-Travers, PhD,and j David R. Strong, PhD,a, b Jennifer L. Pearson, PhD, MPH, k, l Blair N. Coleman, PhD, MPH,d Eric Leas, MPH, a, b Madison L. Noble, MPH, a, b SusceptibilityDennis R. Trinidad, PhD, a, b Meghan B. Moran, to PhD, k CharlesTobacco Carusi, PhD, h Andrew Products Hyland, PhD, j Karen Messer, PhDa, b BACKGROUND AND OBJECTIVES: – abstract Non cigarette tobacco marketing is less regulated and may promote cigarette smoking among adolescents. We quantified receptivity to advertising for multiple tobacco products and hypothesized associations with susceptibility to cigarette METHODS: smoking. Wave 1 of the nationally representative PATH (Population Assessment of Tobacco and Health) study interviewed 10751 adolescents who had never used tobacco. A stratified random selection of 5 advertisements for each of cigarettes, e-cigarettes, smokeless products, and cigars were shown from 959 recent tobacco advertisements. Aided recall was classified as low receptivity, and image-liking or favorite ad as higher receptivity. The main RESULTS: dependent variable was susceptibility to cigarette smoking. Among US youth, 41% of 12 to 13 year olds and half of older adolescents were – – receptive to at least 1 tobacco advertisement. Across each age group, receptivity to – – advertising was highest for e-cigarettes (28% 33%) followed by cigarettes (22% 25%), smokeless tobacco (15% 21%), and cigars (8% 13%). E-cigarette ads shown on television – had the highest recall. Among cigarette-susceptible adolescents, receptivity to e-cigarette – advertising (39.7%; 95% confidence interval [CI]: 37.9% 41.6%) was higher than for cigarette advertising (31.7%; 95% CI: 29.9% 33.6%). Receptivity to advertising for each tobacco product was associated with increased susceptibility to cigarette smoking, with – no significant difference across products (similar odds for both cigarette and e-cigarette CONCLUSIONS: advertising; adjusted odds ratio = 1.22; 95% CI: 1.09 1.37). A large proportion of US adolescent never tobacco users are receptive to – tobacco advertising, with television advertising for e-cigarettes having the highest recall. Receptivity to advertising for each non cigarette tobacco product was associated with NIH susceptibility to smoke cigarettes. WHAT’S KNOWN ON THIS SUBJECT: The consensus that aCancer Prevention Program, Moores Cancer Center, and bDepartment of Family Medicine and Public Health, University of California, San Diego, La Jolla, California; cC. Everett Koop Institute, Norris Cotton Cancer Center, cigarette marketing is 1 cause of adolescent smoking is Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; dCenter for Tobacco Products, US Food and the basis for marketing constraints imposed on these Drug Administration, Silver Spring, Maryland; eNational Institute on Drug Abuse, National Institutes of Health, products in the United States and elsewhere. Little Bethesda, Maryland; fKelly Government Solutions, Rockville, Maryland; gTobacco Control Research Branch, is known about the influence of marketing for non– Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, cigarette tobacco products. National Institutes of Health, Rockville, Maryland; hWestat, Rockville, Maryland; iDepartment of Oncology, Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical WHAT THIS StUDY ADDS: Advertising for non–cigarette Center, Washington, District of Columbia; jDepartment of Health Behavior, Roswell Park Cancer Institute, Buffalo, tobacco products is reaching non–tobacco-using New York; kDepartment of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins US adolescents, especially through television. High l University, Baltimore, Maryland; and Schroeder Institute for Tobacco Research and Policy Studies at Truth percentages of non tobacco-using adolescents Initiative, Washington, District of Columbia – recognize tobacco ad images, including e-cigarette ads. Dr Pierce conceptualized and designed the study and drafted the initial manuscript; Dr Sargent Receptivity to these ads is associated with susceptibility conceptualized and designed the study including the study instruments and critically reviewed to future cigarette smoking. To cite: Pierce JP, Sargent JD, White MM, et al. Receptivity to Tobacco Advertising and Susceptibility to Tobacco Products. Pediatrics. 2017;139(6):e20163353 Downloaded from www.aappublications.org/news by guest on September 23, 2021 PEDIATRICS Volume 139, number 6, June 2017:e20163353 ARTICLE 16,17 Cigarette advertising has been smoking. Lower levels of to advertising for multiple tobacco causally linked with1 adolescent receptivity to advertising, such products and to summarize this smoking initiation, prompting as recall of ads without affective in a measure of receptivity to any marketing restrictions to2 reduce response, have been associated 18 tobacco advertising. We investigated smoking among minors. However, with later initiation of alcohol use. whether this general receptivity to these restrictions are not uniformly Furthermore, researchers who have tobacco advertising was associated “ ” applied across tobacco products. For combined recall and liking measures with susceptibility to use any tobacco example, e-cigarettes, introduced into an any receptivity construct product. Finally, we investigated in the past decade, are currently have identified associations19, 20with the associations of advertising allowed to3 be advertised on first use21 of both cigarettes and receptivity to each product with television. E-cigarette marketing4 alcohol . Visual prompting (aided susceptibility to cigarette smoking. budgets increased rapidly, with recall) is necessary22 to obtain valid METHODS a growing presence on television measures. We know of no study Adolescent Sample reaching 5youth and young adult that has sampled a substantial markets. The Centers for Disease6 proportion of all available tobacco Control and Prevention reports advertising and reported population that high school students in the estimates for aided recall of either Data are from wave 1 of the United States are increasingly using individual ads or ads for a product PATH study, which is a nationally e-cigarettes (2015 = 16.0%), whereas category. representative sample of the civilian, ≥ the decline in cigarette smoking noninstitutionalized US population, Susceptibility to smoking is a may have stalled (2015 = 9.3%). The aged 12 years between September validated measure that predicts 32,33 2015 high school use of cigars was 2013 and December 2014. the risk of smoking initiation as 8.6%, use of hookahs was 7.2%, and – With oversight from the National many as 3 to 4 years before first smokeless tobacco use was 6.0%. 23 25“ Institute of Drug Abuse and the Food experimentation. A series of In a randomized trial, exposure to ” and Drug Administration, Westat questions identifies committed – select television advertisements collected data with the use of audio- never users as those who have ’ (ads) for e-cigarettes increased the computer assisted self-interviews. 7 never been curious about use, have susceptibility to use e-cigarettes. Westat s Institutional Review Board strong intentions not to use, and who In 2014, Blu was the dominant approved the study design/protocol, would resist an offer to use from a e-cigarette brand that and the Office of Management and 5,8 best friend. All other never users are used television advertising. Its Budget approved the data collection. considered susceptible. Susceptibility ads often modeled vaping, which Households were identified by using and subsequent experimentation has many behavioral similarities to an address-based, area-probability vary across sociodemographic cigarette smoking. These similarities sampling method, and a screener variables, receptivity to tobacco have led to suggestions that these ads 16, 17 survey enumerated household marketing, exposure to other might promote cigarette smoking as 26 members (response rate = 54%). 9, 10 tobacco users, use of another well. 27 Generally, all youth aged 12 to 17 psychoactive substance, use of 28 years (maximum 2 per household) another tobacco product, and The effect of advertising on were selected for interview, and psychosocial variables such as adolescent smoking has been parental consent and youth assent externalizing problem behaviors investigated by using the 29 were obtained. Interviews were – (eg, rule-breaking, aggression), communication-persuasion completed for 78.4% of selected 11 13’ internalizing problem behaviors matrix, which states that an 30 youth. The data were weighted to (eg, depression, anxiety), and individual s receptivity to an ad can 31 adjust for the complex sample design sensation-seeking. be ordered hierarchically by items and nonresponse to allow population that query exposure, cognitive recall, This study explores levels of estimates. If the respondent did not and affective response14 (eg, liking, receptivity to the marketing of answer regarding their age, sex, having a favorite ad). At the height e-cigarettes, cigarettes, cigars, race, or Hispanicn ethnicity, these of popular cigarette marketing and smokeless tobacco products were obtained
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