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INTRODUCTION: MAINTAINING THE MARKET

Every day, children and youths in the United States are exposed to a wide array of persuasive, carefully crafted commercial messages encouraging the use of tobacco products. In 1991 the tobacco industry spent $4.6 billion—more than $12.6 million a day, $8,750 a minute—on advertising and promoting* cigarette consumption, and over $100 million on advertising and promoting smokeless tobacco products.1 During the past 15 years, the tobacco industry has nearly quadrupled** its marketing expenditures, at a time when tobacco consumption has been declining. Each day, approximately 3,500 Americans quit smoking and an additional 1,200 tobacco customers and former customers die of smoking-related illness; therefore, maintaining current levels of tobacco use and revenues requires that approximately 5,000 new smokers be recruited every day (about 2 million a year).2 Children and youths constitute the most likely source of new smokers. The 1991 National Household Surveys on Drug Abuse data reveal that the large majority (89%) of persons ages 30-39 who ever smoked daily tried their first cigarette by age 18, and 62% by age 16; over three quarters (77%) were smoking daily before age 20. At least 3 million

*As used in this report, "advertising" refers to expenditures for advertisements in newspapers and magazines and on billboards and transit systems; "promotions" refers to all other expenditures to promote tobacco consumption, especially point-of-sale displays, distribution of samples and specialty items, sponsorship of public entertainment, direct mail, coupons, and retail value-added products.

**All figures have been converted from nominal to real dollars with a base of 1991, the year for which the most recent data are available from the Federal Trade Commission.



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Page 105 INTRODUCTION: MAINTAINING THE MARKET Every day, children and youths in the United States are exposed to a wide array of persuasive, carefully crafted commercial messages encouraging the use of tobacco products. In 1991 the tobacco industry spent $4.6 billion—more than $12.6 million a day, $8,750 a minute—on advertising and promoting* cigarette consumption, and over $100 million on advertising and promoting smokeless tobacco products.1 During the past 15 years, the tobacco industry has nearly quadrupled** its marketing expenditures, at a time when tobacco consumption has been declining. Each day, approximately 3,500 Americans quit smoking and an additional 1,200 tobacco customers and former customers die of smoking-related illness; therefore, maintaining current levels of tobacco use and revenues requires that approximately 5,000 new smokers be recruited every day (about 2 million a year).2 Children and youths constitute the most likely source of new smokers. The 1991 National Household Surveys on Drug Abuse data reveal that the large majority (89%) of persons ages 30-39 who ever smoked daily tried their first cigarette by age 18, and 62% by age 16; over three quarters (77%) were smoking daily before age 20.3  At least 3 million *As used in this report, "advertising" refers to expenditures for advertisements in newspapers and magazines and on billboards and transit systems; "promotions" refers to all other expenditures to promote tobacco consumption, especially point-of-sale displays, distribution of samples and specialty items, sponsorship of public entertainment, direct mail, coupons, and retail value-added products. **All figures have been converted from nominal to real dollars with a base of 1991, the year for which the most recent data are available from the Federal Trade Commission.

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Page 106 American teenagers smoke regularly and 3 million people who regularly use smokeless tobacco are under age 21.4 Three trends have caused a growing number of public health professionals to call attention to the role of marketing (advertising and other promotional approaches) in making tobacco use attractive to children and youths and in encouraging them to use cigarettes and smokeless tobacco. First, boys and girls are beginning to use tobacco at ever younger ages. The average age at which boys and girls initiate smoking has declined over the past 4 decades by 2.4 years overall for whites, 1.3 years overall for African Americans, and 5.4 and 4.6 years for white girls and African-American girls, respectively.5 The trend for girls to begin smoking at an earlier age began between 1955 and 1966,6 and the likelihood of becoming a daily smoker at an earlier age increased sharply in the early to mid-1970s both for boys and girls.7 During the same period, a second alarming trend in tobacco use has been noted: more and more, youths began using smokeless tobacco products. Half of the nation's 6 million smokeless tobacco users are under the age of 21, and several national surveys show an increase in prevalence, especially among boys.8 A third trend, which has occurred over the past 10 years, entails a slowing down of the rate at which smoking prevalence by youths had been decreasing. Between 1977 and 1981, daily smoking among high school seniors dropped a total of about 9% (from 29% to 20%), an average of 2.25 percentage points per year. Yet during the following 11 years, 1981 to 1992 (during which time the tobacco industry more than doubled its advertising and promotion expenditures) smoking by high school seniors fell by only a total of about 3% (to 17.2%), or only 0.26 percentage points per year. Among college students, from 1980 to 1992, the decrease in daily smoking was about the same as for high school seniors, except that for 1989-1992 there was a slight upward trend in prevalence of cigarette use.9 Notably, during this same period (19811991), the per capita cigarette consumption fell 28% among adults.10 What factors have contributed to stable smoking rates and to increased rates of smokeless tobacco use among children and youths, but have proven to be less effective in sustaining tobacco use by adults? Public health advocates suggest that youths have a heightened sensitivity to image advertising and promotion themes at a time in their lives when they are struggling to define their own identities. Adolescence is characterized by three major types of developmental challenges: (a) physical maturation, (b) cultural pressures to begin the transition to adult roles and emotional independence from parents, and (c) establishment of a coherent self-concept and values.11 Cigarette advertisements are often evocative and play off these challenges in addition to being positioned to appeal to specific groups defined by social class and ethnic identity. Early adolescence (ages 11-14) in particular may be a time of increased susceptibility to the appeal of image advertising and promotions. The possible effects of marketing techniques on youths are considered below, following a brief review of shifting trends in the appropriation of tobacco marketing dollars.

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Page 107 SHIFTING TRENDS IN TOBACCO MARKETING Tobacco advertising and promotions are clearly on the rise in the United States. In 1991, expenditures ($4.65 billion) on advertising and promotion of tobacco products were almost four times the amount ($1.22 billion) invested in 1980 (figure 4-1). From 1990 to 1991 alone, expenditures increased 13%.12 The current annual expenditures amount to $18 for every man, woman, and child in the United States. Promotional activities take many forms and are the fastest growing mode of product marketing; they have been found to be effective in leading consumers to act once exposed to advertising.13 The tobacco industry's distribution of marketing expenditures over the past 2 decades represents a major shift in marketing trends; overall, the ratio of promotional expenditures to advertising expenditures has reversed. Whereas in FIGURE 4-1  Source: Federal Trade Commission. Report to Congress for 1991: Pursuant to the Federal Cigarette Labeling and Advertising Act. Washington, D.C.: Federal Trade Commission, 1994.

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Page 108 1970 advertisements represented 82%* of total spending on tobacco marketing,  they were down to 67% in 1980, 21%  in 1990, and 17% in 1991. Although advertising expenditures per se have decreased, overall spending on marketing (advertising plus promotional activities) has increased. Of the $4.6 billion spent annually on tobacco marketing, about $700 million is spent on advertising. The remaining $4 billion is spent on a variety of promotional activities designed to: (a) place cigarettes and chewing tobacco in the hands of prospective users, (b) position cigarettes and chewing tobacco in prominent locations in shops and other points of sale where they will be psychologically appealing and physically available to customers, and (c) create good will for the tobacco industry among the public, community leaders, and politicians. Promoting Tobacco Use to Consumers The goal of marketing is to increase the appeal and acceptability of a product as well as to make the product available to the potential consumer. Tobacco marketing strategies (a) establish attitudinal predispositions that lead nonusers to experiment with tobacco products and interpret their experience as positive and rewarding, (b) foster the perception that consumption of tobacco products in general and in particular contexts (places, times) is normative, (c) minimize concern about the potential risks associated with tobacco use, propagating the perception that there are ''safe" smoking options, and (d) reassure smokers and users of smokeless tobacco that possible risks are worth the benefits received from tobacco use. Marketing strategies promote both brand-specific and aggregate tobacco use. The impression that tobacco use is desirable and normative is conveyed through image advertising and promotions that make tobacco products highly visible in public spaces—if not by their presence, then by proxy in the forms of brand trademarks, insignia, logos, and items associated with preestablished brand images (for example, adventure scenarios). The major forms of marketing are highlighted below. 1. Retail value-added promotions and specialty items. Dramatically on the rise are retail value-added promotions such as multiple packs (buy one, get one free), cents-off coupons, and a free key chain or lighter blister-packed to a cigarette pack. Value-added promotions and coupons constituted the largest marketing expenditure (40% of total marketing expenditures) by the tobacco industry in 1991. Promotional items have special appeal to youths. Since youths have less disposable income and are more price-sensitive than adults, promotions such as discount buy-one-get-one-free schemes may be especially attractive to them. Coupons are easily accessible to youths through direct-mail promotions. (See figure 4-2 for expenditure data for this section.) *The 1970 figure includes radio and television advertising. Broadcast advertising was banned after January 1. 1971.

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Page 109 FIGURE 4-2  Note: "All Others" = Coupons and retail value-added items, direct mail, and audio-visuals. Source: Federal Trade Commission. Report to Congress for 1991 Pursuant to the Federal Cigarette Labeling and Advertising Act. Washington, D.C.: Federal Trade Commission, 1994.

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Page 110 Attractive specialty items—such as T-shirts, caps, calendars, and sporting goods—are distributed by the tobacco industry through the mail and at promotional events. These items, which sport a logo or brand name, become walking advertisements capable of penetrating areas of a child's world that might be offlimits to other forms of advertising. The ubiquity of such speciality items conveys the impression that tobacco use is the norm. Spending for specialty items accounted for 4% of expenditures in 1991. A 1992 Gallup survey found that half of all adolescent smokers and one-quarter of adolescent nonsmokers owned at least one promotional item from a tobacco company.14 Similar data were reported in a survey of almost 8,000 ninth graders in Erie County, New York: 65% of regular smokers, 48% of occasional smokers, and 28% of nonsmokers reported owning clothing with a cigarette brand logo.15 Although most youths seem to find logo clothing appealing, some high school students in focus groups (conducted under the auspices of the Committee) found them "tacky" and would not consider wearing them. Notably, however, these same teens save Marlboro Miles and Camel Cash coupons in order to acquire other types of goods. In a 1993 survey of 1,047 respondents ages 12-17, ownership of an average of 3.2 tobacco promotional items was reported by 10.6% of the sample. While 68.2% of current smokers reported participating in promotional campaigns, 28.4% of nonsmoking teens were also active participants. These promotional items carry no warning labels and provide free advertising.16 "My brother gets the Camel Cash. He's got stacks and stacks of them to get hats or whatever. " —adolescent in focus group 2. Promotional allowances constitute the second largest tobacco marketing expenditure—25% of all marketing-related expenditures. Through this form of promotion, tobacco companies pay retailers for shelf space, engage in cooperative advertising with retailers, and offer trade promotions to wholesalers, etc. Retailers are rewarded for stocking a wide variety of brands, even brands with low market demand. For example, a convenience store owner who sells 2,000 packs per week may be motivated to stock over 180 different brand packings (some having only 0.1% market share) in order to be eligible to receive incentive payments, which might be as high as $8,000 per year for a moderate-size retailer.17 As a result of trade incentives, cigarettes and other tobacco products are displayed prominently where adults as well as youths of all ages can see them. Self-service displays are an important source of tobacco products for minors.18 Cigarettes are commonly displayed near checkout counters, and flavored chewing tobacco has been reported to be displayed near candy racks in convenience shops. A survey in California of stores near high schools found chewing tobacco next to candy and snacks in 42% of the stores.19 In addition to catching the eye of a potential buyer who may not consciously be in the market for a tobacco

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Page 111 product, the positioning of tobacco with other commodities conveys subtle associational meanings. For example, when placed near liquor, as they often are, cigarettes come to be associated with adult status as well as with products promoted to shift one's consciousness away from the stress, strains, anxieties, and boredom of routine existence, as a means of providing some temporary release and relief. 3. Point-of-sale advertising showcases particular brands of cigarettes in shops to stimulate impulse purchases. Since the 1971 ban on broadcast advertising, tobacco companies have made marketing through distribution a major function of their sales forces, which numbered more than 9,000 industry wide in the early 1980s.20 This marketing technique places the tobacco products in convenient, visible racks, usually self-service, and in point-of-purchase displays. Point-of-sale promotions tend to involve the retailer, as well as the consumer, in a brand product. Support of brands through point-of-sale advertising helps to bolster the legitimacy of a brand in the eyes of retailers who make stocking decisions.21 Point-of-sale materials are coordinated with national advertising campaigns to tie retailers in with the image-building for the product. In this sense, point-of-sale advertising both influences product distribution and directly induces consumption.22 Point-of-sale advertising in retail establishments has been increasing and in 1991 represented 7.4% of advertising and promotional expenditures. 4. Magazine and newspaper advertising accounted for about 7% of marketing expenditures in 1991, when expenditures on newspaper ads reached an all-time low of 1.0%, a large drop since the 1980 high of 24.5%. Magazine ads were down to 6% of marketing dollars in 1991, from 21.4% in 1980. Nevertheless, expenditures on tobacco advertising in the print media do continue to be substantial and the decreases are not occurring at the same rate across all market segments; for example, while the number of ads per magazine issue has declined in men's and women's magazines, it has remained relatively stable in those magazines having substantial African-American and youth readerships.23 In addition, advertisements are often combined with interactive promotional items that appeal to children and youths. For example, many magazine advertisements feature giveaway, non-cigarette utility items (calendars, lighters, T-shirts, and "action products") associated with "cash coupon" catalogue offers. Magazines often inform potential customers to be on the lookout for additional information about these offers at point-of-sale locations. "They advertise a lot.  Every magazine I have—there's an ad for Camels, Marlboros, Newports." —high school girl in focus group

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Page 112 5. The tobacco industry was the number one spender for outdoor advertising in 1989;24 of the approximately 3 million billboards in the United States, 30% were allocated to tobacco and alcohol products.25 Advertising through the use of outdoor billboards and transit system signs accounted for 9.6% of all tobacco marketing expenditures in 1991. The industry has saturated African-American neighborhoods with cigarette billboards. Studies reveal that the intensity of cigarette billboard advertising is 2.6 times greater in African-American than in white neighborhoods in Columbia, South Carolina,26 and 3.8 times greater in Baltimore.27 Despite supposed industry standards to the contrary, billboards advertising tobacco products can be found next to homes, schools, churches, parks, playgrounds, health centers, stadiums, shopping centers, and along rural and city streets. More permanent than magazine advertising, and seen over and over again by youths, billboard ads expose children repeatedly to pro-tobacco messages and give the erroneous impression that smoking is pervasive and normative. 6. Sponsorship of sporting events and public entertainment associates tobacco with (a) all-American cultural events, such as music concerts and art exhibits, where fundamental social values are celebrated, and (b) high-risk sporting events, such as rodeos and car racing, where risks are socially approved and taken by individuals who brave the odds. The tobacco industry sponsors opera and ballet performances, and concerts of rock, rap, country and western, blues, jazz, and classical music, making tobacco products highly visible to diverse populations and strengthening the association between cigarettes, artistic expression, entertainment, glamour, and individuality. Expenditures on the promotion of sports and sporting events are growing. The 1994 surgeon general's report has called special attention to sponsorship of sporting events associated with a company's brand name and/or logo, noting that this constitutes one of the most effective means of covert advertising. Even during events that are not sponsored by the tobacco industry, tobacco products are permanently displayed: tobacco billboards are the dominant form of advertisement in many major professional stadiums. Youths attend such sporting events, and watch them on television; many seek to emulate sports superstars, such as baseball players, who visibly chew and spit tobacco during these sports events, thereby actually demonstrating the use of the products on the billboards. Each 3-second exposure of a billboard in a ballpark has a marketing impact similar to a 10-second TV commercial.28A widely cited example of just how much product exposure is realized through covert advertising during sporting events is the 1989 Marlboro Grand Prix: when the event was televised, the Marlboro logo could be seen for 46 of the 94 total minutes of this sport event's broadcast time.29 In the 1987 NASCAR Stock Race Circuit the Winston logo appeared for a total of 6 hours and 22 minutes—nonpaid covert advertising on the air valued at $7.5 million.30 In 1992, 354 motorsports broadcasts were quantitatively measured for estimates of product exposure value. The programs had a

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Page 113 total viewing audience of 915 million, 7% of whom were children and teens, and an overall tobacco product exposure value of $68 million ($41 million for Winston, $12 million for Marlboro, $7 million for Skoal, $4 million for Camel, and $4 million for others).31 Studies have found that youths accurately associate sporting events with tobacco brands.32 7. Distribution of free samples of cigarettes in public places, for "adults only," was at its highest percentage (about 7%) of total marketing dollars in the early 1970s, and has stayed about 2% since the late 1980s. Monitoring of who is given free samples has been poor, and tobacco companies who contract-out sample distribution have taken no responsibility for cited violations in which minors have been given samples. 8. Expenditures for direct-mail promotions are on the rise; $65 million was spent in 1991, an increase of 22% over 1990. All five major cigarette companies actively compile mailing lists of customers, largely from coupons, which ask for name, address, usual brand, etc; from promotion redemptions; from the return of "smoker surveys" in magazines; and from the return of more general consumer information questionnaires. The forms sometimes ask detailed questions about brand use and about demographic characteristics.  Brown & Williamson, Lorrilard, and American Brands use their lists occasionally to send out coupons. R. J. Reynolds Tobacco Company (RJR), Philip Morris Tobacco Company, and United States Tobacco Company (UST) have made more substantial use of their mailing lists. UST sends its listees a slick quarterly magazine, Heartland, which puts Skoal and Copenhagen in a pleasant context and contains various offers. RJR and Philip Morris mount regular mailings promoting a variety of brands, depending on the characteristics of the persons on the lists. RJR promotes Camel and discount brands, and sometimes sends out coupons good for any top-of-the-line RJR cigarette product. Philip Morris has distinct mail programs for Marlboro, Virginia Slims, Merit, and Benson & Hedges. Individuals on the Camel lists have received at least six mailings in the past year apart from any coupon redemptions. These direct-mail efforts are large undertakings. Philip Morris, in a letter to its retailers dated July 20, 1993, indicated that it had 26 million people on its mailing lists. While a large number of teenagers may be included on these mailing lists, the tobacco companies has no mechanism for purging minors from their lists. Slade and colleagues conducted a nationally representative, random-digit dial survey of 1,047 respondents aged 12 to 17 to assess participation in promotional activities.33 They found that 7.6% of the sample had received mail from a tobacco company. Extrapolating this figure to the entire 12- to 17-year-old population, they estimate that 1.6 million teens are on tobacco industry mailing lists. Direct mail may be a form of promotion that tobacco companies will pursue

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Page 114 more aggressively if restrictions on conventional advertising are adopted. The expenditure data show a continuing trend toward advertising and promotional practices that are not required to carry health warnings. Inhibiting Opposition to Tobacco Use The tobacco industry's spending on advertising inhibits dissemination of anti-tobacco messages. Billboard companies allegedly have expressed reluctance to rent space for antismoking ads because they are well paid to saturate African-American neighborhoods with smoking ads and believe that they cannot afford to lose tobacco conglomerate accounts. Magazines that receive sizable revenues for advertising tobacco are less likely to run articles that discuss the negative aspects of tobacco use than magazines not dependent on tobacco industry revenue.34 When articles are run that could potentially shed a negative light on tobacco use, they are toned down through editing.35 This practice, termed "latent censorship," gives the public a distorted view of the dangers of smoking. For example, during the first 7 years after cigarette ads were banned on television (in 1971), the only two magazines (Reader's Digest and The New Yorker) that carried accurate articles on the link between tobacco and disease refused to accept cigarette ads.36 A study of tobacco advertising in 99 magazines between 1959 through 1969 and 1973 through 1986 noted and confirmed a tendency toward latent censorship in women's magazines regarding the health effects of smoking as a result of their large amount of advertising income: "Magazines that did not carry advertisements for cigarettes were more than 40% more likely to cover the hazards of smoking than were magazines that carried cigarette advertisements. . . . women's magazines that did not carry cigarette advertisements were 2.3 times more likely to cover the risks of smoking." Magazines for African Americans have earned revenues from tobacco ads since at least 1950. A study of patterns of tobacco advertising in magazines from 1950 to 1965 found that African Americans were at first subject to less, then to more, advertising than whites.37 The greatest concentration of tobacco company advertising is in African-American publications such as Jet, Essence, and Ebony, but many small, local publications and other media serving the African-American community have found it extremely difficult to find other means of financial support, and might not survive without tobacco advertisements. A similar effect of "latent censorship" results when revenue for advertising comes from one of the numerous companies that belong to tobacco industry conglomerates (for example, Nabisco, General Foods, Kraft). In 1988, after the ad agency Saatchi and Saatchi prepared ads touting the no-smoking policy of its client Northwest Airlines, RJR/Nabisco cancelled an $80 million annual contract with that agency for advertising food products.38 A study of advertising executives found that they do fear economic reprisals from tobacco conglomerates should they print articles unfavorable to the tobacco industry.39

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Page 115 THE TOBACCO MARKET AND MARKET SEGMENTATION Tobacco has been aggressively marketed to the American public through a number of different channels and interactive modalities in order to foster demand for particular brands of tobacco products, create a more permissive environment in which to engage in tobacco use, and establish tobacco use as a norm of acceptable social behavior if not a "habit" to be emulated. Ever sensitive to social and cultural differences, the tobacco industry has gone to great pains to position tobacco products through market segmentation. Tobacco products are marketed to appeal to specific market niches; to existing smokers as well as potential smokers. Tobacco: A Mature and a Growth Market The tobacco industry claims that its primary, if not sole, purposes for advertising and promoting tobacco products are to (a) provide information to tobacco consumers regarding product choice, (b) capture brand share from competitors, and (c) maintain product loyalty in a mature market. Identifying a market as "mature" bears close examination for what the term both reveals and conceals. Some, but not all, products are categorized by marketing experts as constituting either a "mature" or "growth" market. In mature markets, awareness of a product is nearly universal and demand is relatively stable. Most of the market segment is already using the product, rises in product use are not dramatic, and expansion results from getting consumers to use a product more often or in new ways. In growth markets, new market segments are identified, new users are a source of significant market expansion, and rises in product use are significant.40 The cigarette market simultaneously displays characteristics of being both a mature and a growth market. The industry calls attention to the fact that cigarette sales have been fairly consistent over the last decade; however, it is clear that per capita consumption has decreased, and that the tobacco industry loses 2 million smokers a year—those who quit and those who die (about 44 million and 9 million, respectively, since 1964).41 Consequently, market expansion must be occurring to maintain total tobacco sales at a consistent level. Adults are not a likely population for that market expansion because few new smokers are adults. Furthermore, for three decades the trend among adults has been to quit smoking. In fact, most new smokers are youths: 77% of daily smokers are daily smokers by age 20. Market Segmentation to Reach Youths Considerable research on the part of the tobacco industry has resulted in the positioning of specific brands in different market segments. This entails vigilant

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Page 130 that advertising and promotion causally affect the decisions of young people to begin smoking. Many of the participants in this ongoing debate seem to assume that a definitive finding of causality is a necessary predicate for legislative action restricting tobacco promotion and advertising. In the Committee's view, however, requiring definitive proof of causality on issues of this nature would unjustifiably stymie sensible public health regulation. Indeed, the history of public health successes, from vaccination to cholera prevention and injury control, suggest that detailed causal understanding is apt to follow an intervention, rather than be a precondition for it. If youth smoking fell after advertising and promotion were eliminated, this would corroborate a hypothesis for which there is already ample, suggestive evidence—that such advertising and promotion is an important factor in the initiation of tobacco use by youths. This seems to be the lesson from the experiences reviewed in the New Zealand report. The inability to conduct case control studies in an environment free of tobacco marketing makes it impossible to discern the independent causal effect of advertising and promotion on tobacco consumption. It is difficult to disentangle the actual impact of marketing expenditures from the other social and cultural factors that affect tobacco use. Moreover, the influence of any of these environmental variables is mediated by, and interacts with, so many other variables affecting perceptions of and attitudes toward tobacco use that any statistical association between levels of promotional expenditures and levels of tobacco use is difficult to interpret. This is not to say that the relationship is not a causal one, only that any causal effect is inevitably obscured by layers of other factors, and that it is virtually impossible to quantify the causal effect in any definitive way. Indeed, when one takes into account the inherent difficulty of discerning a causal influence, the substantial convergent evidence that advertising and promotion increases tobacco use by youths is impressive and, in the Committee's view, provides a strong basis for legal regulation. Having said this, the Committee does not think that the argument for restricting the advertising and promotion of tobacco products must rest on a definitive or unequivocal finding that such activities causally influence levels of consumption. It is enough that the advertising and promotional activities described above in this chapter have the natural tendency to encourage initiation and maintenance of smoking by children and adolescents. There can be no doubt that the tobacco companies aim to portray smoking in a favorable light and to communicate messages that link use of tobacco products to positive feelings, images, and experiences. Even if the primary objective of those marketing expenditures is to preserve or expand market share among existing smokers, youngsters are routinely exposed to messages that encourage them to smoke. Tobacco advertising is characterized by images and themes that are especially appealing to adolescents, and some are appealing to children. In addition, a large proportion of promotional expenditures associate use of tobacco with

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Page 131 activities and products that are attractive to children and youths. The sheer amount of expenditures for advertising and promotion assures that young people will be exposed to these messages on a massive scale. It is clear that society's efforts to discourage young people from smoking are obstructed—and perhaps fatally undermined—by the industry's efforts to portray their dangerous products in a positive light.105 In sum, portraying a deadly addiction as a healthful and sensual experience tugs against the nation's efforts to promote a tobacco-free norm and to discourage tobacco use by children and youths. This warrants legislation restricting the features of advertising and promotion that make tobacco use attractive to youths. The question is not, ''Are advertising and promotion the causes of youth initiation?" but rather, "Does the preponderance of evidence suggest that features of advertising and promotion tend to encourage youths to smoke?" The answer is yes and this is a sufficient basis for action, even in the absence of a precise and definitive causal chain. RECOMMENDATIONS Policy Recommendations The images typically associated with advertising and promotion convey the message that tobacco use is a desirable, socially approved, safe and healthful, and widely practiced behavior among young adults, whom children and youths want to emulate. As a result, tobacco advertising and promotion undoubtedly contribute to the multiple and convergent psychosocial influences that lead children and youths to begin using these products and to become addicted to them. As already noted, the Committee believes that American society, through all organized social institutions, should take aggressive measures to discourage the use of tobacco products by children and youths. The message should be unequivocal—tobacco use is unhealthy and socially disapproved. In the context of this emergent social norm, the contradictory messages now conveyed by the tobacco industry can no longer be tolerated. The Committee therefore recommends a step-by-step plan to eliminate these commercial messages from the various media of mass communication. Realizing that implementation of this recommendation will require careful planning and a period of transition, the Committee proposes a sequential process for phasing in the necessary restrictions. First, Congress should repeal the federal law preempting state regulation of tobacco promotion and advertising that occurs entirely within the states' borders. This should be accomplished by the end of 1995. The repeal will have the effect of stimulating local interest in tobacco regulation and community participation in reviewing tobacco data and in drafting legislation aimed

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Page 132 at promotion, distribution, and use of tobacco products. Concordant with federal guidelines, a wide range of national experiments will take place, providing data on the effect of various programs. State and local regulation of cigarette advertising to a large extent has been foreclosed by federal law, which expressly prohibits states and localities from imposing "any requirement or prohibition based on smoking and health . . . with respect to the advertising and promotion of any cigarettes" that meet federal labeling requirements.106 To the extent that state and local regulation of tobacco advertising or promotion aims to promote public health objectives, it is curtailed by this sweeping federal preemption. It can be argued, however, that state and local governments retain the authority to ban advertising likely to reach a large audience of children because such action aims mainly to minimize violations of laws against youth access and is, therefore, not "based on smoking and health." Relying on this argument, transportation systems in the cities of Boston, Denver, Portland, New York, Seattle, and San Francisco, and in the state of Utah, have eliminated tobacco advertising on their vehicles.107 Whether those actions are lawful remains unclear. The communication and tobacco industries have legitimate interests in avoiding diverse and often incompatible state-by-state regulation of advertising and promotional activities occurring in national media. However, state and local governments should be free to circumscribe advertising and promotion that occur exclusively within the geographic boundaries of a single state in order to protect and promote the health and welfare of its citizens, subject only to the command of the first amendment. Therefore, Congress should modify the preemption provision so that the states have clear authority to restrict or ban advertising and promotion at the point of sale, on public transportation systems and vehicles, on billboards, in public arenas or sports facilities, or other locations located entirely within a state's boundaries. Second, after state regulatory authority has been clarified and restored, states and localities should severely restrict the advertising and promotion of tobacco products on billboards and other outdoor media, on vehicles, in facilities of public transportation, in public arenas and sports facilities, and at the point of sale. States and localities should either ban tobacco advertising and promotion altogether or should restrict such messages to a "tombstone" format. Tombstone advertising would limit commercial messages to information about the product and would forbid the use of images and pictures. This approach is designed to eliminate all the images that imply that tobacco use is beneficial and make it attractive, and that encourage young people to use tobacco products. The most common concept of tombstone advertising would allow only text in an advertisement. A broader concept of tombstone advertising would permit the use of slogans, scenes, or colors in tobacco advertisements or on tobacco packaging. Specific decisions regarding the type of information that would be permitted should be made by a regulatory authority.

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Page 133 Third, Congress should enact comprehensive legislation establishing a timetable for gradual implementation of a plan for restricting tobacco advertising and promotion in interstate commerce. Essential components of this plan, which should be enacted by the end of 1996 and should become fully effective by the year 2000, include: (a) restricting to a tombstone format the advertising of tobacco products in print media, including magazines and newspapers, or in other visual media, including videotape, videodisc, video arcade game, or film; (b) banning the commercial use of the registered brand name of a tobacco product, trademark, or logo, or other recognizable symbol for such a product in any movie, music video, television show, play, video arcade game. or other form of entertainment, or on any other product; and (c) banning the use of the registered brand name of a tobacco product, a trademark or logo, or other recognizable symbol for such a product, in any public place, or in any medium of mass communication for the purpose of publicizing, revealing, or documenting sponsorship of, or contribution to, any athletic, artistic, or other public event. These proposals represent essential components of the regulatory plan. By recommending these steps, the Committee does not mean to exclude other restrictions or to disapprove more restrictive steps, such as banning advertising altogether. The Committee has endorsed the tombstone format because this approach is necessary to eliminate those features of advertising that tend to encourage tobacco use by children and youths. No less restrictive approach would accomplish the legislative objective. The Committee is confident that state and federal legislation implementing these recommendations will substantially further the nation's compelling interest in preventing tobacco use by children and youths and that such legislation would survive constitutional challenges brought by the affected media or by the tobacco industry.108 Research Recommendations The Committee recommends: Research should be conducted that attends to ethnic, gender, and social class differences; that is sensitive to youths' responses to advertising and promotional messages; and that assesses the success as well as the failure of advertising campaigns. The research question to date has primarily been, "What does advertising do to people?" Research should now ask, "What do people do with advertising (and counter-advertising)?"109 As a result of the types of research methods used and the research questions asked, much of the literature on tobacco use and advertising attributes little agency to the public in general and to youths in particular; the public is consid-

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Page 134 ered to be rather passive and easily manipulated. While there is some truth to this view, it hardly expresses a complete picture of this complex, interactive phenomenon. Required are longitudinal and ethnographic accounts of tobacco use that are responsive to local context, studies that are notably absent in the smoking literature. In need of consideration are the ways in which: (a) advertising provides resources (images) for teen subgroup identity construction and social statement, (b) advertising is responsive to existing and emergent social uses of smoking among various subgroups, (c) tobacco use takes on meaning in response to anti-tobacco-use messages (generated by the tobacco industry as well as by public health advocates), that is, messages that are moralistic or focus attention on adult status, and (d) imagery of tobacco use is appropriated and transformed by teens themselves. REFERENCES 1. Federal Trade Commission. Report to Congress for 1991: Pursuant to the Federal Cigarette Labeling and Advertising Act. Washington, DC: Federal Trade Commission, 1994; Federal Trade Commission. Report to Congress: Pursuant to the Comprehensive Smokeless Tobacco Health Education Act of 1986. Washington, DC: Federal Trade Commission, 1993. 19, 26. 2. Centers for Disease Control and Prevention. Preventing Tobacco Use Among Young People. A Report of the Surgeon General, 1994. S/N 017-001-004901 -0. Washington, DC: U.S. Government Printing Office, 1994. 175. 3. Ibid., 65. 4. Ibid., 58, 230. 5. Centers for Disease Control. "Differences in the Age of Smoking Initiation Between Blacks and Whites—United States." Morbidity and Mortality Weekly Report 40:44 (1991): 754-757. 6. Centers for Disease Control and Prevention. Preventing Tobacco Use. 74. 7. Johnston, Lloyd D., Patrick M. O'Malley, and Jerald G. Bachman. Smoking, Drinking, and Illicit Drug Use Among American Secondary Students, College Students, and Young Adults, 19751991, Volume 1. NIH Pub. No. 93-3480. Rockville, MD: National Institute on Drug Abuse, 1992. 125. 8. Centers for Disease Control and Prevention. Preventing Tobacco Use. 230. 9. Johnston, Lloyd D., Patrick M. O'Malley, and Jerald G. Bachman. National Survey Results on Drug Use from The Monitoring the Future Study, 1975-1992, Volume 11. NIH Pub. No. 93-3598 Rockville, MD: National Institute on Drug Abuse, 1993. 14, 163-165. 10. Federal Trade Commission, 1994. 20. 11. Hooker, K. "Developmental Tasks." In Lerner, R. M., A. C. Peterson, and J. Brooks-Gunn. eds. Encyclopedia of Adolescence. New York: Garland Publishing, 1991. 228-231. 12. All spending amounts are from the Federal Trade Commission report, 1994. 13. Kotler, P., and G. Armstrong. Principles of Marketing. Englewood Cliffs, NJ: Prentice Hall, 1991. 14. Gallup International Institute. Teen-Age Attitudes and Behavior Concerning Tobacco. GII 9104. Princeton, NJ: The George H. Gallup International Institute, Sept. 1992. 15. Roswell Park Cancer Institute. Survey of Alcohol, Tobacco and Drug Use Among Ninth Grade Students in Erie County, 1992. Buffalo, NY: Roswell Park Cancer Institute, 1993.

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Page 135 16. Slade, John. "Teenagers Participate in Tobacco Promotions."  9th World Conference on Tobacco and Health. Paris. October 10-14, 1994. (Abstract.) 17. Comerford, Anthony W., and John Slade. "Selling Cigarettes: A Salesman's Perspective." Paper commissioned by the Committee on Preventing Nicotine Addiction in Children and Youths, 1994. 18. Roswell Park. 19. D'Onofrio, Carol N., and David G. Altman. "Children and Youths." In Houston, Thomas P., ed. Tobacco Use: An American Crisis. Washington, DC: American Medical Association, 1993. 32-42. 20. Comerford and Slade. 21. Schudson, M. Advertising: The Uneasy Persuasion. New York: Basic Books, 1984. 22. Comerford and Slade. 23. Freeman, Harold, Janet Delgado, and Clifford E. Douglas. "Minority Issues." In Houston, Thomas P., ed. Tobacco Use: An American Crisis. Washington, DC: American Medical Association, 1993. 43-47. 24. Fahey, Alison. "Outdoors Sets Limits." Advertising Age 61:26 (1990): 57. 25. Advocacy Institute. 5 Sept. 1990. 26. Mayberry, Robert M., and Patricia A. Price. "Targeting Blacks in Cigarette Billboard Advertising: Results From Down South." Health Values 17:1 (1993): 28-35. 27. "Other Side of the Billboard. III" News release. Washington, DC: Scenic America, November 1989. 28. Felgner, B. U.S. Tobacco and Candy Journal (28 December 1987): 16. Cited in Richards, John W., and Paul M. Fischer. World Smoking and Health 15:1 (March 1990): 12-14. 29. Blum, Alan. "The Marlboro Grand Prix: Circumvention of the Television Ban on Tobacco Advertising." New England Journal of Medicine 324:13 (28 Mar. 1991): 913-917. 30. Johnson, M. Dallas Morning News. (30 Dec. 1989). Cited in Richards, John W., and Paul M. Fischer. "Smokescreen: How Tobacco Companies Market to Children." World Smoking and Health 15:1 (Mar. 1990):12-14. 31. Slade, John. "Tobacco Product Advertising During Motorsports Broadcasts: A Quantitative Assessment." 9th World Conference on Tobacco and Health. Paris, October 10-14, 1994. (Abstract.) 32. Meier, Kathryn S. "Tobacco Truths: The Impact of Role Models on Children's Attitudes Toward Smoking." Health Education Quarterly 18:2 (June 1991): 173-182; Aitken, P. P., D. S. Leathar, and S. I. Squair. "Children's Awareness of Cigarette Brand Sponsorship of Sports and Games in the United Kingdom." Health Education Research 1:3 (1986): 203-211; Ledwith, Frank. "Does Tobacco Sports Sponsorship on Television Act as Advertising to Children?" Health Education Journal 43:4 (1984): 85-88. 33. Slade, "Teenagers." 34. Warner, K. E., L. M. Goldenhar, and C. G. McLaughlin. "Cigarette Advertising and Magazine Coverage of the Hazards of Smoking: A Statistical Analysis." New England Journal of Medicine 326:5 (1992): 305-309. 35. Minkler, M., L. Wallack, and P. Madden. "Alcohol and Cigarette Advertising in Ms. Magazine." Journal of Public Health Policy (June 1987): 164-179; Whelan, Elizabeth M., M. J. Sheridan, K. A. Meister, and B. A. Mosher. "Analysis of Coverage of Tobacco Hazards in Women's Magazines." Journal of Public Health Policy 2:1 (Mar. 1981): 28-35. 36. Smith, R. C. "The Magazines' Smoking Habit." Columbia Journalism Review (Jan/Feb 1978): 29-31. In Roemer, Ruth. Legislative Action to Combat the World Tobacco Epidemic. 2nd ed. Geneva, Switzerland: World Health Organization, 1982. 28. 37. Pollay, Richard W., Jung S. Lee, and David Carter-Whitney. "Separate But Not Equal: Racial Segmentation in Cigarette Advertising." Journal of Advertising 21:1 (1992): 45-57. 38. Warner et al., 1992. 39. Bishofsky, Steven. "Magazines Uneasy about Accepting Anti-Smoking Ads." University of Washington: Office of News and Information, 1993. (Thesis.)

OCR for page 105
Page 136 40. Ward, S. Testimony in Tobacco Issues (Part 2). In Hearings Before the Committee on Energy and Commerce. House of Representatives. Serial No. 101-126. 1989. 302-308. 41. Centers for Disease Control. "Cigarette Smoking among Adults—United States, 1991." Morbidity and Mortality Weekly Report 42:12 (1993): 230-233; Tye, Joe B., Kenneth E. Warner, and Stanton A. Glantz. "Tobacco Advertising and Consumption: Evidence of a Causal Relationship." Journal of Public Health Policy (Winter 1987): 492-508. 42. Pollay, Richard W., and Anne M. Lavack. "The Targeting of Youths by Cigarette Marketers: Archival Evidence on Trial." In McAlister, Leigh, and Michael L. Rothschild. eds. Advances in Consumer Research 20. Provo, UT: Association for Consumer Research, 1993. 266-271. 43. Basil, Michael D., Caroline Schooler, David G. Altman, Michael Slater, Cheryl L. Albright, and Nathan Maccoby. "How Cigarettes Are Advertised in Magazines: Special Messages for Special Markets." Health Communication 3:2 (1991): 75-91; Warner, Kenneth E. Selling Smoke: Cigarette Advertising and Public Health.  Washington, DC: American Public Health Association, 1986; Krupka, L. R., and A. M. Vener. "Gender Differences in Drug (Prescription, Non-Prescription, Alcohol and Tobacco) Advertising: Trends and Implications."  The Journal of Drug Issues 22:2 (1992): 339-360; and Hutchings. "A Review of the Nature and Extent of Cigarette Advertising in the United States." In Proceedings of the National Conference on Smoking and Health: Developing a Blueprint for Action. New York: American Cancer Society, 1981. 249-262. 44. Pierce, John P., Lora Lee, and Elizabeth Gilpin. "Smoking Initiation by Adolescent Girls. 1944 Through 1988." Journal of the American Medical Association 271:8 (23 Feb. 1994): 608-611. 45. DiFranza, Joseph R., John W. Richards, Paul M. Paulman, Nancy Wolf-Gillespie, Christopher Fletcher, Robert Jaffe, David Murray. "RJR Nabisco's Cartoon Camel Promotes Cigarettes to Children." Journal of the American Medical Association 266:22 (1991): 3149-3153. 46. Dubow, Joel. "Was Joe Camel Framed?" Food and Beverage Marketing (July 1993): 28ff. 47. Pierce, John P., A. Farkas, N. Evans, C. Berry, W. Choi, B. Rosbrook, M. Johnson, and D. G. Bal. Tobacco Use in California 1992. A Focus on Preventing Uptake in Adolescents. Sacramento, CA: California Department of Health Services, 1993. 48. Reed, O. Lee, and D. Whitman. "A Constitutional and Policy-Related Evaluation of Prohibiting the Use of Certain Nonverbal Techniques in Legal Advertising." Brigham Young University Law Review 2 (1988): 265-338. 49. Batra, Rajeev, and M. L. Ray. "How Advertising Works at Contact." In Alwitt, Linda, and A. Mitchell, eds. Psychological Processes and Advertising Effects. Hillsdale, NJ: L. Erlbaum Assoc., 1985; and Zajonc, R. B. "Feeling and Thinking: Preferences Need No Inferences." American Psychologist 35:2 (1980): 151-175. 50. Fishbein, Martin, and Icek Ajzen. Belief, Attitude, Intention and Behavior: An Introduction to Theory and Research. Reading, MA: Addison Wesley, 1975. 51. Donohue, Thomas R., Lucy L. Henke, and William A. Donohue. "Do Kids Know What TV Commercials Intend?" Journal of Advertising Research 20:5 (Oct. 1980): 51-57. 52. Fishbein, Martin. "Consumer Beliefs and Behavior with Respect to Cigarette Smoking: A Critical Analysis of the Public Literature." Report prepared for the Federal Trade Commission, May 1977. 53. Bandura, Albert. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall, 1986; Bandura, Albert. "Social Cognitive Theory of Mass Communication." In Bryant, Jennings, and D. Zillmann, eds. Media Effects: Advances in Theory and Research. Hillsdale, NJ: Lawrence Erlbaum, 1994. 61-92. 54. Comerford et al., 8. 55. Goldman, R. Reading Ads Socially. London: Rouledge, 1992: Wernick, Andrew. Promotional Culture: Advertising, Ideology, and Symbolic Expression. London: Sage Publications, 1991. 56. Wong-McCarthy, William J., and Ellen R. Gritz. "Preventing Regular Teenage Cigarette Smoking." Pediatric Annals 11:8 (1982): 683-689; Chassin, Laurie, Clark C. Presson, Steven J. Sherman, Eric Corty, and Richard W. Olshavsky. "Predicting the Onset of Cigarette Smoking in Adolescents: A Longitudinal Study." Journal of Applied Social Psychology 14:3 (1984): 224-243.

OCR for page 105
Page 137 57. DiClemente, C. Carlo, Scott K. Fairhurst, and Nancy A. Piotrowski. "The Role of Self-Efficacy in the Addictive Behaviors." In Maddux, James, ed. Self-Efficacy, Adaptation, and Adjustment: Theory, Research, and Application. New York: Plenum, 1994. (In press.) 58. Elkind, David, and R. Bowen. "Imaginary Audience Behavior in Children and Adolescents." Developmental Psychology 15:1 (1979): 38-44. 59. Chassin, Laurie, Clark C. Presson, Steven J. Sherman, Eric Corty, and Richard W. Olshavsky. "Self-Images and Cigarette Smoking in Adolescence." Personality and Social Psychology Bulletin 7:4 (Dec. 1981): 670-676; Grube, Joel W., Ivan L. Weir, Shelly Getzlaf, and Milton Rokeach. "Own Value System, Value Images, and Cigarette Smoking." Personality and Social Psychology Bulletin 10:2 (1984): 306-313. 60. Chassin, Laurie, C. C. Presson, and S. J. Sherman. "Social Psychological Contributions to the Understanding and Prevention of Adolescent Cigarette Smoking." Personality and Social Psychology Bulletin 16:1 (1990): 133-151; McCarthy, W. J., and E. R. Gritz. "Teenagers, Cigarette Smoking and Reactions to Selected Cigarette Ads." Los Angeles, CA: Western Psychological Association Meeting, April 16, 1984; and Grube et al. 61. Chassin et al., 1981. 62. Greenberg, Jeff, and Tom Pyszczynski. "Compensatory Self-Inflation: A Response to the Threat to Self-Regard of Public Failure." Journal of Personality and Social Psychology 49:1 (1985): 273-280. 63. Schudson, Michael. "Symbols and Smokers: Advertising. Health Messages, and Public Policy." In Rabin, Robert L., and Stephen D. Sugarman. Smoking Policy: Law, Politics, and Culture. New York: Oxford University Press, 1993. 216. 64. Pollay and Lavack, 268-269. 65. Ibid. 66. Chassin, Laurie, Clark C. Presson, and Steven J. Sherman. "'Constructive' vs. 'Destructive' Deviance in Adolescent Health-Related Behaviors." Journal of Youth and Adolescence 18:3 (1989): 245-262. 67. Jessor, Richard, and Shirley L. Jessor. Problem Behavior and Psychosocial Development: A Longitudinal Study of Youth. New York: Academic Press, 1977; Moshbach. Peter, and H. Leventhal. "Peer Group Identification and Smoking: Implications for Intervention." Journal of Abnormal Psychology 97:2 (1988): 238-245; Sussman, Steve, Clyde W. Dent, Alan W. Stacy, Catherine Burciaga, Anne Raynor, Gencie E. Turner, Ventura Charlin, Sande Craig, William B. Hansen, Dee Burton. and Brian R. Flay. "Peer-Group Association and Adolescent Tobacco Use." Journal of Abnormal Psychology 99:4 (1990): 349-352. 68. Moshbach and Leventhal. 69. Pollay, 1990. 70. Basil et al. 71. Blum, Alan, and Matt Myers. "Tobacco Marketing and Promotion." In Houston. Thomas P., ed. Tobacco Use: An American Crisis (1993): 63-71. 72. Aitken, P. P., D. S. Leathar, F. J. O'Hagan, and S. I. Squair. "Children's Awareness of Cigarette Advertisements and Brand Imagery." British Journal of Addiction 82 (1987): 615-622. 73. Glantz, Stanton A. "Removing the Incentive to Sell Kids Tobacco. A Proposal." Journal of the American Medical Association 269:6 (1993): 793-794. 74. Pollay and Lavack. 75. Ibid.; and Altman, David G., Michael D. Slater, Cheryl L. Albright, and Nathan Maccoby. "How an Unhealthy Product Is Sold: Cigarette Advertising in Magazines, 1960-1985." Journal of Communication 37:4 (1987): 95-106. 76. Burnett, L. Communications of an Advertising Man. Chicago: Burnett, 1961. 77. Pollay and Lavack, 1993. 78. Pollay, 1990. 24. 79. Wong-McCarthy and Gritz; and Gritz, E. R. "Cigarette Smoking by Adolescent Females: Implications for Health Care and Behavior." Women and Health 9:2/3 (1984): 103-115.

OCR for page 105
Page 138 80. Pollay. 1990. 9. 81. Federal Trade Commission, 1994. 12. 82. Pollay, 1990. 9, 27. 83. Centers for Disease Control. The Health Consequences of Smoking: Nicotine Addiction. A Report of the Surgeon General, 1988. USDHHS Pub No. (CDC) 88-8406. Washington, DC: U.S. Department of Health and Human Services, 1988. 84. Johnston, Lloyd D., Jerald G. Bachman, and Patrick M. O'Malley. "Monitoring the Future Study." Press release. The University of Michigan, Ann Arbor. (27 January 1994.) 85. Allen, Karen, Abigail Moss, Gary A. Giovino, Donald R. Shopland, and John P. Pierce. "Teenage Tobacco Use: Data Estimates From the Teenage Attitudes and Practices Survey, United States, 1989." Advance Data 224 (1 Feb. 1993): 1-20. 86. Amos, Amanda. "Youth and Style Magazines: Hooked on Smoking?" Health Visitor 66:3 (1993): 91-93. 87. Ibid. 88. McKenna, Jeffrey W., and K. N. Williams. "Crafting  Effective Tobacco Counter-advertisements: Lessons from a Failed Campaign Directed at Teenagers." Public Health Reports 108:S  (1993): 85-89. 89. Centers for Disease Control and Prevention. Preventing Tobacco Use, 195. 90. Aitken et al., 1987; Goldstein, Adam O., Paul M. Fischer, John W. Richards, and Deborah Creten. "Relationship Between High School Student Smoking Recognition of Cigarette Advertisements." Journal of Pediatrics 110:3 (1987): 488-491; Pierce et al., 1994; and Pierce, John P., Elizabeth Gilpin, David M. Burns, Elizabeth Whalen, Bradley Rosbrook, Donald Shopland, and Michael Johnson. "Does Tobacco Advertising Target Young People to Start Smoking?" Journal of the American Medical Association 266:22 (1991): 3154-3158. 91. For a review of exposure as an ambiguous construct, see: Klitzner, Michael, Paul J. Greunewald, and Elizabeth Bamberger. "Cigarette Advertising and Adolescent Experimentation with Smoking." British Journal of Addiction 86 (1991): 287-298. 92. Aitken, P. P., D. R. Eadie. G. B. Hastings, and A. J. Haywood. "Predisposing Effects of Cigarette Advertising on Children's Intentions to Smoke When Older." British Journal of Addiction 86 (1991): 383-390. 93. New Zealand Toxic Substances Board. Health or Tobacco: An End to Tobacco Advertising and Promotion. Wellington, New Zealand: Department of Health, 1989. xxix. 94. Ibid., xxiii, xxiv, 76. 95. Ibid., 76. 96. Ibid., 103. 97. Action on Smoking and Health. Tobacco Advertising: The Case for a Ban. London: ASH, 1991. Cited in Amos, Amanda. "Cigarette Advertising and Marketing Strategies." Tobacco Control 1 (1992): 3-4. 98. Warner, K. "Clearing the Airwaves: The Cigarette Ban Revisited."  Policy Analysis 5:4 (1979): 435-450. 99. Pollay, Richard W. "The Major Minor Issue: Children, Cigarettes and Advertising Self-Regulation in the Sixties." In Thorson, Esther, ed. Proceedings of the American Academy of Advertising. Columbia: University of Missouri, 1993. 2-11. 100. Federal Trade Commission. Report to Congress: Pursuant to the Federal Cigarette Labeling and Advertising Act. Washington, DC: Federal Trade Commission, 1968. 101. U.S. Congress. Hearings on HR2248 Before the Committee on Interstate and Foreign Commerce. House of Representatives, 89th Congress, 1st Session. Serial No. 89-1 1. Washington, DC: U.S. Government Printing Office, 1965. 102. Mazis, Michael B., Debra J. Ringold, Elgin S. Perry, and Daniel W. Denman. "Perceived Age and Attractiveness of Models in Cigarette Advertisments." Journal of Marketing 56:1 (Jan. 1992): 22-37.

OCR for page 105
Page 139 103. Tobacco Industry. "Cigarette Advertising Code." 5. 104. Comerford and Slade. 105. Pollay, 1990. 33-35. 106. 15 U.S.C. Par. 1334, cited in Shiffrin, Steven H. "Alcohol and Cigarette Advertising: A Legal Primer." Adolescent Medicine 4:3 (1993): 627. 107. Ibid. 108. See, for example, Gostin, Lawrence 0. and Allan M. Bandt. "Criteria for Evaluating a Ban on the Advertisement of Cigarettes." Journal of the American Medical Association 269 (17 February 1993): 904-909. 109. Chapman, S. "The Limitations of Econometric Analysis in Cigarette Advertising Study." British Journal of Addiction (1989): 1267-1274.

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