TOBACCO INDUSTRY PROMOTION CIGARETTES AND ADOLESCENT SMOKING

Context.-Whether tobacco advertising and promotion increases the likel ihood that youths will begin smoking has important public policy impli cations. Objective.-To evaluate the association between receptivity to tobacco advertising and promotional activities and progress in the sm oking uptake process, defined sequentially as never smokers who would not consider experimenting with smoking, never smokers who would consi der experimenting, experimenters (smoked at least once but fewer than 100 cigarettes), or established smokers (smoked at least 100 cigarette s). Design.-Prospective cohort study with a 3-year follow-up through N ovember 1996. Setting and Participants.-A total of 1752 adolescent nev er smokers who were not susceptible to smoking when first interviewed in 1993 in a population-based random-digit dial telephone survey in Ca lifornia were reinterviewed in 1996. Main Outcome Measure.-Becoming su sceptible to smoking or experimenting by 1996. Results.-More than half the sample (n=979) named a favorite cigarette advertisement in 1993 a nd Joe Camel advertisements were the most popular. Less than 5% (n=92) at baseline possessed a promotional item but a further 10% (n=172) we re willing to use an item. While having a favorite advertisement in 19 93 predicted which adolescents would progress by 1996 (odds ratio [OR] =1.82; 95% confidence interval [CI], 1.04-3.20), possession or willin gness to use a promotional item was even more strongly associated with future progression (OR=2.89; 95% CI, 1.47-5.68). From these data, we estimate that 34% of all experimentation in California between 1993 an d 1996 can be attributed to tobacco promotional activities. Nationally , this would be over 700 000 adolescents each year. Conclusion.-These findings provide the first longitudinal evidence to our knowledge that tobacco promotional activities are causally related to the onset of s moking.