CIGARETTE PROMOTIONAL ITEMS IN PUBLIC-SCHOOLS

Objectives: To assess the prevalence of ownership of cigarette promoti onal items (CPIs) by rural northern New England students and to examin e the association be tween CPI ownership and smoking behavior. Design and Setting: Voluntary, self-administered survey of 1265 sixth-through 12th-grade students representing 79% to 95% of all students attending 5 rural New Hampshire and Vermont public schools in October 1996. We examined the association between ownership of a CPI and smoking behavi or through regression models and conducted a sensitivity analysis on t he findings. Main Outcome Measures: Adjusted odds of being a smoker (l ifetime use of 1100 cigarettes) and, among never smokers and experimen tal smokers, adjusted cumulative odds of having higher levels of smoki ng uptake given CPI ownership. Results: One third of students owned a CPI. Prevalence of ownership did not vary by grade or sex, but was hig her among poor-to-average school performers (45.0% vs 21.0% for excell ent school performers, P<.001) and children whose friends and family m embers smoked (43.4% vs 13.8% for students with no family members or f riends smoking, P<.001). Cigarette promotional items included articles of clothing (T-shirts, hats, backpacks, and jackets), smoking paraphe rnalia (lighters and ashtrays), camping gear, and electronics. More th an half of CPIs (58.2%) bore the Marlboro logo, and almost one third ( 31.7%) bore the Camel logo. These items were obtained directly from ca talogs or vendors 22.4% of the time. Whereas only 4.5% of students rep orted bringing a CPI to school with them the day of the survey, 44.5% reported seeing such an item at school the day of the survey. After co ntrolling for confounding factors, such as having friends who smoke, s tudents who owned CPIs were 4.1 times more likely to be smokers than t hose who did not own CPIs (95% confidence interval [CI], 3.1-5.5). Nev er and experimental smokers (n=1008) who owned CPIs were more likely t o be in a higher category on the smoking uptake index in grades 6 (cum ulative odds ratio [OR] = 5.7, 95% CI, 1.9-16.8), 7 (OR=1.8, 95% CI, 0 .9-3.7), 8 (OR=2.3, 95% CI, 1.1-4.8), and 9 (OR=2.1, 95% CI, 1.1-3.9), periods when children are most vulnerable to initiating cigarette use . A sensitivity analysis indicated that an unmeasured confounder of CP I ownership and smoking was unlikely to alter our conclusions. Conclus ions: Cigarette promotional items are owned by one third of students i n these rural northern New England schools. These items are highly vis ible in the public school setting, and their ownership is strongly ass ociated with initiation and maintenance of smoking behavior. These dat a lend support to a ban on CPIs to be included in US Food and Drug Adm inistration regulations to prevent tobacco use among US youth.