5.15 Tobacco advertising and promotion targeted at young people

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5.1 Introduction

5.2 Stages in the uptake of smoking

5.3 Factors influencing uptake by young people—overview

5.4 Physiological aspects

5.5 Individual personality traits and psychiatric influences

5.6 Intentions, attitudes and beliefs

5.7 The home environment

5.8 The smoking behaviour of peers, and peer attitudes and norms

5.9 The educational environment: achievements, aspirations and 'school connectedness'

5.10 Other drug use

5.11 Accessibility of tobacco products to young smokers

5.12 Affordability of tobacco products

5.13 Opportunity to smoke

5.14 Cultural background

5.15 Tobacco advertising and promotion targeted at young people

5.16 Products and packaging created to appeal to new users

5.17 Factors influencing uptake of smoking later in life

5.18 Uptake—a concluding note

5.19 What is meant by prevention?

5.20 Approaches to youth smoking prevention

5.21 Mass media strategies/campaigns

5.22 Interactive technology and multimedia

5.23 School-based interventions

5.24 Peer influence and education

5.25 Parent/family/home targeted interventions

5.26 Reducing tobacco access and supply

5.27 Reducing product appeal

5.28 Promotion and visibility of tobacco

5.29 Denormalising smoking

5.30 Taxation and pricing of tobacco products

5.31 Harnessing predictors of uptake to prevent smoking

5.32 Preventing smoking in more 'at risk' groups

Acknowledgments

References

For more detailed discussion concerning the influence of tobacco advertising on children and teenagers, and the effects of advertising bans, refer to Chapter 11—Tobacco advertising and promotion.

Since around half of all regular tobacco users die from smoking,131 it is a marketing imperative for the tobacco industry to recruit new smokers in order to remain viable. Major scientific reviews of decades of published research have concluded that tobacco advertising and promotion directly influence uptake of smoking in young people.1, 7, 9, 132-134 In the most recent of these reviews, drawing on research published between 1966 and 2005, Di Franza et al conclude that the evidence satisfies all six standard statistical criteria[8] for determining that there is a causal relationship between exposure to tobacco advertising and the uptake of smoking in children.134 These criteria are:

• temporality—children are exposed to tobacco promotion prior to taking up smoking
• exposure—being exposed to advertising increases the risk of smoking over the non-exposed
• dose-response—the more exposed the population to advertising, the greater the likelihood of taking up smoking
• robust and consistent findings—observed across a large number of studies and populations, and controlled for confounding factors
• causality is theoretically and scientifically plausible
• no explanation other than causality fits the factual evidence

Most forms of tobacco advertising and promotion in Australian states and territories have been incrementally banned since 1973 by a range of federal and state legislation.[9] Tobacco manufacturers have adapted to restrictions by increasing activity in those areas where promotion may still occur, including at retail outlets, through events promotions, in movies and other mainstream media, and via new products and packaging.[10]
The internet has also become an important conduit for pro-tobacco messages.135-137
The following sub-sections provide brief discussion about these kinds of promotions; for more detail, refer to Chapter 11, Sections 11.6.1–11.6.5.

How the media may be used to help prevent smoking uptake is discussed in Section 5.21 below, and in greater detail in Chapter 14 .

5.15.1 Point of purchase displays

Point of purchase ('POP') or point of sale ('POS') displays are the visible showcases of tobacco products at retail outlets. Although regulated by provisions of the Tobacco Advertising Prohibition Act (1992) and individual legislation in Australian states and territories, point of sale displays remain prominent in retail outlets and commonly constitute an entry statement to supermarkets. Cigarettes are the most visible and widely available of all consumer products in Australia, including milk and bread.138

There is ample evidence that the tobacco industry has responded to restrictions on displays at point of sale by ensuring that their products are designed for maximum visual impact.139 Tobacco 'powerwalls' are typically eye-catching and brightly lit, forming bold blocks of colour. Part of their role is to provide reassurance to current smokers, as well as to recruit young non-smokers, who see these displays from an early age.139 Australian evidence shows that the POP displays serve as a cue to buy tobacco products and appear to undermine attempts to quit smoking.140 The Australian tobacco companies are actively engaged in ensuring that their products receive prominence in the retail setting by offering financial and other incentives to retailers141 (see also Chapter 10, Section 10.20.8 ).

Australian research suggests that POP displays may increase the perception among schoolchildren that cigarettes are easy to obtain, and influence recall of particular brands.142 In contrast, the vast majority of adult smokers do not appear to make their brand selection at the point of sale.143 Further regulation and the ultimate removal of POP displays remain options for future interventions to protect children. See also Chapter 11, Section 11.6.2 .

5.15.2 Event marketing

In Australia135 and overseas,144, 145 the tobacco industry has targeted young adults by sponsoring a range of events such as fashion shows, dance parties and music events, often staged in bars and nightclubs. Young adults provide a pool of experimenters and uncommitted smokers, making them of key importance to the industry.

Harper and Martin identify several ways in which event marketing is strategically important to the tobacco industry:135

• they promote brand loyalty
• they may tip the balance between an experimenter becoming an addict
• they provide a positive social context in which smoking can occur, serving to reinforce smoking as well as encourage new smokers
• co-sponsorship of events by other youth-oriented brands (such as sports drinks) normalises smoking behaviour
• they actively encourage participants (by offering incentives) to spread the word about the events and bring along more people, thereby extending the industry's reach.

Philip Morris Australia promoted its brand Alpine through young designer fashion shows and dance parties between 2000–02. These events were themed in Alpine colours and included roving cigarette sellers dressed in the Alpine colourway.135 Other events have featured accessories bearing brand logos, new packaging and 'special edition' product configurations, free drinks and discounts on cigarettes. The events have encouraged participants to sign on to an email database, providing the organisers with client contact details and profiles as well as facilitating publicity about future events.135

Although exposure to promotions of this kind predominantly reaches young adults in the first instance, their influence can also be expected to trickle down to younger adolescents, who are keen to emulate adult behaviour.

For further discussion, see Chapter 11, Section 11.6.1 .

5.15.3 Smoking imagery in movies, magazines and on television

Portrayal of smoking in the mainstream media is a major factor contributing to the normalisation of smoking behaviour. While viewing a movie was once a transient experience in the cinema, films may now be seen on broadcast and cable television, downloaded or rented, and have an indefinite shelf-life. Over many decades, they have also provided the tobacco industry with extended opportunities for advertising their products, used by some of the world's most famous celebrities in a kaleidoscope of situations and settings.

In a review examining the effects of depictions of smoking in the media (including smoking occurring in movies, television programming and news coverage, as well as traditional direct forms of tobacco advertising and promotion and pro-health messages) on young people, Wakefield et al identify several ways in which it may influence smoking behaviour (or the decision not to smoke):133

• by shaping and reflecting social values about smoking
• by communicating new information about smoking
• through offering models of behaviour
• by directly reinforcing smoking (or non-smoking) behaviour
• by prompting discussion and debate about smoking
• by influencing other 'intervening' factors that help shape the decision to smoke or not to smoke (for example by making older smokers less willing to give cigarettes to young people)
• by shaping societal attitudes and influencing the broader regulatory climate.

In the past[11] tobacco companies have paid to have their products used in movies and other forms of media as a way of increasing brand visibility, as well as generally promoting and reinforcing smoking behaviour.146 Strategic placement of cigarettes in the hands of actors and actresses, on and off the screen, has greatly contributed over the decades to the association of smoking with the full gamut of attributes from glamour, sexiness and romance through to rebelliousness, independence and machismo.[12] Smoking depicted in films tends not to feature aspects of tobacco use such as addiction, illness and death.4 Although smoking behaviour has become more commonly associated with the antagonists ('bad guys') in US movies,147 this does not necessarily make smoking unappealing. It is not even necessarily important that lead characters be shown smoking, since 'background' smoking still teaches adolescents about how, when and where to smoke.148

Research from the USA has shown that watching movies that portray smoking is a factor in initiation of smoking among young people, even after controlling for other variables known to influence the uptake of smoking behaviour.149-153 The most recent of these studies concluded that seeing smoking in movies even in early childhood could influence later uptake, and has estimated that at least one third of uptake of smoking in children in the USA may be attributed to exposure to smoking in movies.149

Studies examining the incidence of smoking in movies153-155 show that depiction of smoking has been frequent and increased during the 1990s. In more recent years, although the depiction of smoking has declined modestly,156, 157 one third of US movies continues to represent tobacco use as more widespread than is truly the case.157 Smoking is more commonly seen in 'R' rated movies (by USA ratings[13]), which are targeted at youth.147 Viewing 'R' rated movies, and having an supervised television in the bedroom, have also been shown to be significant predictors of smoking uptake in white adolescents.[14]158 Popular movies expose young people to many billions of smoking images at a time in their lives when they are particularly susceptible to social influences to smoke. The international market for the film industry exports these messages worldwide.159

Smoking is also featured in fictional TV shows and in music videos made with the youth market in mind.133 It is known that in the USA at least, tobacco companies have provided cigarettes to television actors and programs in order to encourage use of their brands on and off screen.146 Magazines also provide effective means for targeting young people with pro-smoking imagery.133, 160, 161 Even though specific brands may not be identified, positive imagery associated with smoking is powerful, reassuring, and helps reinforce smoker identity.160 Australian research has shown that smoking imagery increased in magazines following the federal advertising ban introduced in 1992. Later research on how incidental imagery of smoking in magazines might affect young people showed that seeing the imagery acted as a prompt to smoke and a reinforcement of smoking behaviour.161

Advertising of tobacco products and promotion of smoking behaviour in movies and other forms of mass media are discussed further in Chapter 11, Section 11.6 .

5.15.4 Internet promotions

The global and largely unregulated nature of the internet provides vast opportunities for the promotion of tobacco use in general, as well as for specific tobacco products. International pro-smoking websites celebrating a smoking culture and lifestyle are easily accessed by young people and feature glamorous and sometimes titillating content.136 Australian research has found that pro-smoking imagery is easily accessed on the popular video-sharing website YouTube. The authors of this study comment that given the ability for material to be posted anonymously, it is quite conceivable that the tobacco industry could exploit this medium for its own purposes as a way of evading advertising bans.137 For further discussion, refer to Chapter 11, Section 11.6.5 .

In Australia, the internet has been used to promote events sponsored by tobacco companies (see Section 5.15.2 above), a primary goal being to establish an email database to initiate direct marketing.135

Tobacco products can also be bought online from several Australian-based companies.[15] In May 2007 the Ministerial Council on Drug Strategy announced its intention to work toward restricting the advertising and sales of tobacco products over the internet and banning sales to people aged under 18.162

5.15.5 Anti-smoking advertising by the tobacco industry

Youth smoking prevention activities have been adopted by the tobacco industry internationally, in response to criticism that the industry has an interest in and has actively encouraged young people to smoke. In many countries these activities have taken the form of anti-smoking advertising, placed mainly on television and in magazines. There is strong evidence that these advertisements have provided a useful public relations service for the tobacco industry without threatening its livelihood by reducing intention to smoke.163, 164 In fact, industry anti-tobacco advertising may have fostered a more positive attitude towards the tobacco companies among young people,165, 166 and may have influenced teenagers in their senior high school years to
take up smoking.167 These campaigns are discussed in greater detail in Chapter 10, Section 10.13.3 .