Teenagers who frequently encounter the Marlboro man whirling his lasso in the Wild West, or other familiar tobacco icons, may be more likely to get lured into lighting up, hints a new German study.
While it's not the first time researchers have tied cigarette advertisements to teen smoking, the new study makes the link more solid by showing that tobacco ads wield influence even when other advertising does not.
Researcher Dr James Sargent of Dartmouth Medical School, in Hanover, New Hampshire, said people have wondered whether previous studies had simply identified kids who were receptive to all kinds of behavioural prompts, such as advertising images in general.
"This study shows that it is the specific images from tobacco ads that predict smoking and not such a character trait," he said.
To make this distinction, Sargent and colleagues surveyed more than 2,000 teenagers who had never smoked. Participants were shown billboard advertisements for six different cigarettes and eight other commercial products, with all brand information removed.
The researchers then asked each teen how often they had seen each image and if they could identify the represented brand.
During the following nine months, about 13% of the teens began smoking, according to a report in Paediatrics. And the greater their exposure to cigarette advertisements in the past, the more likely they were to smoke.
Even after accounting for other factors that might increase a kid's risk for smoking - including age, sex, family's economic situation, school performance and having a parent or friend that smokes - the top third of teens in terms of exposure and brand recognition had nearly a 50% greater risk of lighting up, on average, compared to teens in the bottom third.
Meanwhile, exposure to ads for other products, including candies, toothpaste, mobile phones and cars, did not appear to make kids more susceptible to smoking.
"Tobacco companies know how to get kids attuned to the type of advertising that will change their behaviour," said Thomas Glynn of the American Cancer Society in Washington, DC, who was not involved in the current study.
Early adolescence is a common time for kids to take up the habit - nearly a quarter of all high school students in the US smoke cigarettes, according to the US Centres for Disease Control and Prevention (CDC) in Atlanta. It is also the period in which youths develop their own identities independent of parents and other role models, noted Sargent.
"They do this by 'trying on' things they see others doing, much like trying on clothes in a store. They try smoking, in part, because of the way they view other smokers and also in part because of what they think smoking might do for them," he said. "For example, a young male might adopt smoking to appear more manly - like the Marlboro man."
In addition to masculinity, tobacco advertisements may directly or subtly hint that smoking is tied to sex appeal, independence or thinness for girls.
Tobacco industry is clever
Of course, the tobacco industry has had to become increasingly clever at getting these messages across to kids, as more restrictions have come into place, said Glynn.
Cigarette advertisements are now banned from US billboards, televisions and radios, and have become rare in print magazines. Still, both the US and Germany lag behind several other countries such as Italy and New Zealand that have implemented total bans on cigarette advertising, according to the researchers.
"Any parent who takes a close look around their teenager's environment would be appalled by the amount of imagery that teenagers can and do get exposed to given that we have restrictions," Glynn added. "They don't see it on TV or hear it on radio, but it is everywhere."
Most advertising in the US now occurs at point-of-sale locations, such as grocery stores, and through direct marketing, William Shadel of RAND Corporation, in Pittsburgh, said.
Shadel noted that it would be important to know how readily findings based on billboard advertisements might translate to these other forms of advertisement.
Nearly a third of teen smokers will continue smoking and die early from a smoking-related disease, according to the CDC. "In this way, smoking causes more death than alcohol, obesity and illicit drug use combined," said Sargent. "Tobacco image advertising is one cause of smoking onset; this is why regulatory limits on such (ads) are necessary." - (Lynne Peeples/Reuters Health, January 2011)