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Youths' understandings of cigarette advertisements
Addictive Behaviors 34 (2009) 36–42
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Addictive Behaviors
Youths' understandings of cigarette advertisements Dan Freeman a,⁎, Merrie Brucks b, Melanie Wallendorf b, Wendy Boland c a b c
Department of Business Administration, University of Delaware, 117 Alfred Lerner Hall, Newark, DE 19716, USA Department of Marketing, University of Arizona, Tucson, AZ, USA Department of Marketing, American University, Washington D.C., USA
a r t i c l e
i n f o
Keywords: Children and adolescents Cigarette advertising Perceptions and comprehension Susceptibility to smoking
a b s t r a c t This study addresses two questions: (1) when youths are exposed to advertisements for cigarettes, do they primarily see advertisements for brands or products, and (2) is there a relationship between youths' understandings of cigarette advertisements and their susceptibility to smoking? A sample of 271 participants ranging in age from 7 to 12 viewed a series of print advertisements that included cigarette and non-tobacco-related ads. While viewing each ad, participants were asked to indicate what they thought the advertisement was trying to sell. Responses were coded into one of three categories reflecting important differences in participants' comprehension of each advertisement — no understanding, product category understanding, or brand understanding. Results show that youths typically understand the type of product an advertisement is promoting; however, the levels of brand understanding observed for cigarette advertisements were low in an absolute sense, and significantly lower than brand understanding of non-tobacco-related advertisements. Results also show that understanding cigarette ads as promoting specific brands of cigarettes is positively related to susceptibility to smoking. Taken together, these findings provide a glimpse of the psychological mechanisms that may underlie the well established link between exposure to cigarette advertising and youth smoking. © 2008 Elsevier Ltd. All rights reserved.
1. Introduction Tobacco companies have long argued that cigarette advertisements are intended “to get smokers of competitive products to switch” (Reynolds, 1984, p. 89) rather than increasing the number of individuals who smoke (Hamilton, Turner-Bowker, Celebucki, & Connolly, 2002; Pollay, et al., 1996). However, analyses of industry documents suggest that past practices included the intentional targeting of youth to encourage tobacco use initiation (Cummings, Morley, & Horan et al., 2002). In addition, numerous prospective and cross-sectional studies have shown that exposure to tobacco advertising is positively associated with tobacco use initiation by youth (Difranza, Wellman, & Sargent et al., 2006; Goldberg 2008). It is therefore disturbing to note that despite increasingly strict regulations and the WHO Framework (2003), children and adolescents continue to be exposed to cigarette advertising in magazines (King & Siegel, 2001; Lee, Taylor, & McGetrick, 2004), at the point-of-sale (Braverman & Aaro, 2004; Feighery, Ribisl, Clark, & Haladjian, 2003; Henriksen, Feighery, Schleicher, Haladjian, & Fortmann, 2004), through sponsorships (Siegel, 2001), and in interactive media (Ribisl, 2003). Moreover, in some developing countries, youths are exposed to tobacco advertising and promotion with little protection (Lando, Borrelli, Muramoto, & Ward, 2006; Sebrie & Glantz, 2006). At present, “only 5% of the world's population is covered by comprehensive bans on tobacco advertising, promotion, and sponsorship. Tobacco companies, meanwhile, continue targeting young people by falsely associating use of tobacco products with qualities such as glamour, energy and sex appeal,” (WHO, 2008).
⁎ Corresponding author. Tel.: +1 302 831 6158; fax: +1 302 831 4196. E-mail address: [email protected] (D. Freeman). 0306-4603/$ – see front matter © 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2008.08.007
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To maximize the effectiveness of tobacco use prevention programs and the persuasiveness of calls for advertising regulation, it is necessary to uncover the psychological mechanisms through which exposure to tobacco advertising contributes to smoking initiation by youths. For the tobacco industry argument about inducing brand switching to hold, youths would have to perceive cigarette advertisements as consisting of claims about specific brands only (which compete with other brands within the cigarette category) rather than consisting of claims about the benefits of smoking in general (implicitly competing with other lifestyle choices). Although many studies have addressed the link between exposure to tobacco advertising and smoking initiation, none have directly examined this issue. 1.1. Prior research pertaining to the mechanisms through which cigarette advertising influences youths' smoking behaviors Extant research has identified several psychosocial mechanisms through which exposure to cigarette advertising can influence youths' smoking behaviors. For example, Shadel, Tharp-Taylor, and Fryer (2008) show that youths who are wrought with selfconflict are more likely to be susceptible to influence from cigarette advertising than youths who have a better sense of who they are. Other research demonstrates that cigarette advertising (Pechmann and Knight 2002) and portrayals of smoking in the movies (Wills et al., 2007) can work in conjunction with peer influences to shape youths' smoking behaviors. Analyses of tobacco industry documents (Barbeau, Leavy-Sperounis, & Balbach, 2004; Goldberg 2008; Ling & Glantz, 2002) suggest that cigarette advertisements are often designed to take advantage of such psychosocial mechanisms by portraying cigarettes as providing self-identity-relevant and social benefits. In studies examining individual-level psychological processes, cigarette advertising has been implicated in creating high levels of brand awareness among young children (Fischer, Schwartz, Richards, Goldstein, & Rojas, 1991; Emri, Bagci, Karakoca, & Baris, 1998; Mizerski, 1995). Exposure to cigarette advertisements has also been shown to foster positive imagery about users of the brand (Donovan, Jancey, & Jones, 2002; Biener & Siegel, 2001), increase favorable thoughts towards smokers (Pechmann & Ratneshwar 1994), and create expectations about the instrumental value of smoking in meeting social, physical, and psychological needs (Bansal, John, & Ling, 2005; Biener & Siegel, 2001; Boyd, Boyd, & Greenlee, 2003; DiRocco & Shadel, 2007; Pollay, 1995). For example, exposure to a Benson & Hedges advertisement may create the perception that people who smoke the brand are relaxed, interesting, cool, and rich (see Donovan, Jancey, & Jones, 2002). As the preceding discussion illustrates, most of the individual-level studies of psychological processes suggest that the effects of cigarette advertising are brand-specific in nature. However, prior research has tended to utilize methods that cannot detect advertising's effects on youths' general perceptions of cigarette smoking. For example, studies examining children's interest in and exposure to tobacco advertising typically ask participants to match specific brands with product categories (Fischer et al., 1991; Emri et al., 1998; Mizerski, 1995), thereby forcing attention to brand information. Similarly, the examination of advertising effects on user imagery is likely to involve asking youths to describe the kind of people they think will smoke a given brand based on what they saw depicted in an advertisement (Donovan, Jancey, & Jones, 2002). Thus, although we can conclude that exposure to tobacco advertising leaves complex and positive traces in the minds of children and young adolescents, it remains unclear whether these effects are primarily brand-specific or whether they may relate to cigarette smoking in general. 1.2. Brand-specific vs. category level perceptions of smoking Any given cigarette advertisement may affect perceptions of the particular brand it is intended to promote as well as general perceptions of the product category (cigarettes). In considering the impact of cigarette advertising on youths, it is the degree to which such ads impact brand-specific (as opposed to category-general) perceptions that is of primary concern. At the extreme, if cigarette advertising affects youths' brand-specific perceptions without spillover to category perceptions, then each exposure to a cigarette advertisement would enhance the relative attractiveness of a particular brand of cigarettes with relatively little effect on category demand. Consequently, it should take many exposures to advertisements for a specific brand to render a youth susceptible to experimenting with smoking because each ad should have an independent influence on his or her beliefs about the value of smoking as a way to achieve psychosocial goals. On the other hand, to the extent that brand advertising builds general perceptions of cigarette smoking, then each exposure to a cigarette advertisement has much stronger potential to enhance the absolute attractiveness of smoking as a lifestyle choice. Specifically, ads that use lifestyle imagery and related brand claims would be expected to have a cumulative, synergistic impact on general perceptions regarding the desirability of smoking, suggesting that even small doses of cigarette advertising exposure might be dangerous in the long term. 1.3. Research questions This study aims to address two questions: (1) when youths are exposed to advertisements for cigarettes, do they primarily see advertisements for brands or products, and (2) is there a relationship between youths' understandings of cigarette advertisements and their susceptibility to smoking? Based on the cognitive development literature pertaining to the learning of categories (Johnson & Eilers, 1998; Johnson & Mervis, 1997; Love, Medin, & Gureckis, 2004) and prior investigations of children's awareness of brands (John, 1999), we expect that youths are likely to understand cigarette advertisements at the most basic, product category level (i.e., “this is an ad for cigarettes”) when they first begin to observe and interpret them. Then as they age and become susceptible to smoking, we expect youths to progress to finer, brand-specific levels of distinction (“this is an ad for Marlboro cigarettes”). To provide a point of reference, the study also examined understandings of non-tobacco advertisements.
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1.4. Age groups examined in the study Two age groups were selected for inclusion in the study: 7–8 year olds and 10–12 year olds. The rationale for including these groups was threefold. First, children's awareness of brands has been shown to change markedly from ages 7 to 12. Sometime around age 7, children begin to show considerable awareness of youth-oriented brands. Then, around age 12, they begin to demonstrate awareness of brands for adult-oriented products (John, 1999). Second, the age range of 7–12 is one in which youths can be expected to be particularly susceptible to influence from advertising. At this age, children have the ability to process advertising, albeit at a simplified level, but lack sufficient cognitive resources to discount for biases in advertising portrayals and glamorized media imagery (Brucks, Armstrong, & Goldberg, 1988; John, 1999). And third, research suggests that children as young as age 7 may begin to form lifestyle associations with cigarette smoking prior to reaching the ages typically associated with experimentation (Freeman, Brucks, & Wallendorf, 2005). 2. Method 2.1. Participants and procedures Active consent procedures were used to recruit a convenience sample of 271 participants from four public schools in the southwestern United States, including 100 — 7 to 8 year olds and 171 — 10 to 12 year olds. Gender was evenly split (49.8% male); 72.4% of participants were non-Hispanic Whites; 5.2% reported having tried a cigarette; and 35.3% reported living in a household with at least one smoker. Participants viewed and responded to a series of 5 advertisements, including 2 cigarette and 3 non-tobacco advertisements. The first ad in the series – a non-tobacco advertisement for Tropicana Juice – was the same for all participants and was used to familiarize participants with the ad understanding task (see 2.3.1). The remaining ads served as experimental stimuli. The second and fifth ads viewed by participants were for cigarettes; the third and fourth ads promoted non-tobacco-related products. This ordering of ad presentation was intended to mask the primary interest in participants' understandings of the cigarette advertisements. After responding to the advertisements, participants completed a measure of susceptibility to smoking. All study tasks were completed individually with the assistance of a research assistant who was trained to be non-directive and nonjudgmental. 2.2. Stimulus advertisements A total of 12 magazine advertisements, including 6 cigarette advertisements (e.g., Marlboro, Newport, Winston) and 6 nontobacco advertisements (e.g., Toyota trucks, Suave shampoo, Lays potato chips) were used as stimulus advertisements. Advertisements were considered for inclusion in the study if and only if they met four criteria: (1) the ad includes a product image (e.g., it shows a pack of cigarettes), (2) the ad includes at least two visual branding elements (e.g., it uses the brand name in an ad headline or tagline, it provides a clear depiction of the brand name on the product image), (3) the ad does not include images of children or adolescents and promotes a product that is not child-oriented per se, and (4) the ad portrays the product as having instrumental value in meeting social, physical, or psychological needs. Criteria #1 and #2 were utilized to ensure that participants could understand any given advertisement as promoting a specific brand even if they had little or no prior familiarity with the brand. Criterion #3 was used so that it would be appropriate to compare youths' understandings of cigarette ads against their understandings of the non-tobacco ads. Criterion #4 was intended to ensure that the sample of cigarette advertisements would be representative of the types of advertisements that youths may encounter. Cigarette and non-tobacco advertisements deemed by the researchers as meeting these criteria were matched to create 3 distinct sets of stimulus advertisements consisting of 4 ads each — 2 cigarette and 2 non-tobacco advertisements. Within each set, the cigarette and non-tobacco-related advertisements were visually and thematically similar. For example, one set contained cigarette and non-tobacco-related ads depicting social settings (i.e., friends talking, romance). Participants were randomly assigned to view 1 of the 3 ad sets.1 2.3. Measures 2.3.1. Ad understanding As each ad was shown, an interviewer asked: “This picture is an advertisement; what do you think it is trying to sell?” Participants' initial responses to this prompt were independently coded by two of the researchers using a three category coding scheme — no understanding, product category understanding, and brand understanding. This coding scheme was applied to the literal statements of participants; it was not interpretive. As such, it generated a high level of initial agreement (92.8%). The only sources of disagreement pertained to how to code potential synonyms (e.g. “smokes” for cigarettes) and mispronounced brand names (e.g., “Morelboro”). All disagreements were resolved through discussion.
1 Preliminary analyses detected no significant differences in brand understanding or susceptibility pertaining to the different ad sets, so this factor was not included in the final analyses.
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If a response failed to demonstrate at least a basic understanding of the type of product promoted in an ad, then it was coded as “no understanding.” For example, “clothes” and “eyeliner,” which were given as responses to cigarette advertisements, were coded as “no understanding.” Correct identification of the product being promoted is a necessary condition for advertising influence; therefore, responses coded as “no understanding” suggest that the advertisement could not affect youths' perceptions of smoking. All responses that successfully demonstrated a basic understanding of the type of product being promoted were coded as “product category understanding” or “brand understanding,” depending on whether they correctly noted the specific brand depicted in the ad. For example, “Marlboro cigarettes” and “Toyota trucks” were coded as demonstrating “brand understanding”; responses such as “cigarettes” and “trucks” were coded as reflecting “product category understanding.” Responses coded as “brand understanding” satisfy the necessary precondition for an advertisement to alter brand-specific perceptions rather than general perceptions of the product category (e.g., cigarettes). Each participant viewed and responded to cigarette and non-tobacco advertisements. Therefore, the application of the coding scheme produced six measures of ad understanding — no understanding, category understanding, and brand understanding of 2 cigarette advertisements; no understanding, category understanding, and brand understanding of 2 nontobacco advertisements. Scores for each measure ranged from 0 to 2. Given that the study was intended to determine the extent to which youths perceive cigarette advertisements as promoting specific brands (as compared to smoking in general) and to examine the relationship between brand understanding and susceptibility to smoking, subsequent analyses focused on the brand understanding measures. 2.3.2. Susceptibility to smoking Two items adapted from Pierce, Choi, Gilpin, Farkas, and Merritt (1996) were used to classify participants as either susceptible or non-susceptible to smoking: (1) do you think you might try a cigarette soon?; and (2) if one of your favorite friends offered you a cigarette, do you think you might try one? Participants responded to each item using a 4-point scale — “yes,” “maybe,” “I don't think so,” or “no way.” Participants (N = 39; 14.4% of the sample) who failed to choose the strongest possible negative responses for the items (i.e., “no way”) were classified as susceptible to smoking. 2.4. Analysis To address the question of whether youths primarily see cigarette advertisements as promoting specific brands, a repeated measures ANOVA was conducted. Brand understanding of the different advertisement types (cigarette ads, non-tobacco ads) served as the within subject repeated measure. Age group (7–8 years old, 10–12 years old) served as a between-subjects independent variable and presence of a smoker in the household (1 = yes, 0 = no) served as a covariate. To provide a complete picture of the level at which participants understood the cigarette and non-tobacco advertisement, descriptive statistics were calculated for the no understanding and product category understanding measures. Logistic regression analysis was used to assess the relationship between susceptibility to smoking and brand-level understandings of cigarette advertisements. Susceptibility to smoking (1 = yes, 0 = no) served as the dichotomous dependent variable. Brand understanding of cigarette advertisements and age group served as the primary predictors. To control for participants' general tendencies to be sensitive to brand cues in advertisements, brand understanding of non-tobacco advertisements was included as a covariate. Presence of a smoker in the household was also included as a covariate. 3. Results 3.1. Brand understanding by age group and advertisement type The repeated measures ANOVA detected two main effects and a significant interaction. Both ad type (F[1, 268] = 38.2, p b .01) and age group (F[1,268] = 33.3, p b .01) were found to significantly influence mean levels of brand understanding. Both of these effects were qualified by a significant ad type by age level interaction (F[1, 268] = 8.1, p b .01). As Fig. 1 illustrates, the main effects are attributable to the observation of higher levels of brand understanding for non-tobacco as compared to cigarette ads and higher levels of brand understanding among 10–12 year olds as compared to 7–8 year olds. The significant interaction is attributable to a greater age group related increase in brand understanding of non-tobacco advertisements as compared to cigarette advertisements. Whereas the mean level of brand understanding of cigarette ads increased from .06 (or 3%) for 7–8 year olds to .30 (or 15%) for 10– 12 year olds, mean levels of brand understanding for non-tobacco ads increased from .23 (or 11.5%) to .70 (or 35%). 3.2. Category and no understanding by age group and advertisement type Among 7–8 year olds, the mean level of category understanding of cigarette advertisements was 1.48 (or 74%, SD = .69); the mean level of category understanding of non-tobacco advertisements was 1.29 (or 64.5%; SD = .69). For 10–12 year olds, the mean level of category understanding of cigarette ads was 1.63 (or 81.5%; SD = .60); the mean level of category understanding of nontobacco ads was 1.18 (or 59%; SD = .82). Among 7–8 year olds, the mean level of no understanding of cigarette advertisements was .46 (or 23%; SD = .69); the mean level of no understanding for non-cigarette ads was .48 (or 24%; SD = .64). For 10–12 year olds, the mean level of no
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Fig. 1. Average percentages of brand understanding by age group and ad type.
understanding for cigarette ads was .06 (or 3%; SD = .29); the mean level of no understanding for non-tobacco ads was .12 (or 6%; SD = .32). 3.3. Susceptibility to smoking Logistic regression analysis detected significant effects of age group (B = .97, SE = .44, Wald = 4.81, p = .03), brand understanding of non-tobacco advertisements (B = − .66, SE = .31, Wald = 4.68, p = .03), and brand understanding of cigarette advertisements (B = 1.04, SE = .39, Wald = 7.07, p b .01) on susceptibility to smoking. For each cigarette advertisement that participants perceived as promoting a specific brand of cigarettes, there was a 182% increase in their likelihood of being susceptible to smoking. 4. Discussion Advertising is typically intended to persuade a target audience to buy a particular brand of a product (Belch & Belch, 2003). To accomplish this objective, audience members must: (1) understand the type of product being promoted in an advertisement, and (2) notice that the ad is intending to sell a specific brand. If only the former requirement is met, then advertising will tend to influence perceptions of the product category and affect general demand for the product. 4.1. Cigarette advertisements tend to be perceived as promoting smoking in general The low levels of no understanding observed for cigarette advertisements suggest that study participants generally understood that such ads are meant to promote smoking. Importantly, the percentages of brand understanding for cigarette advertisements were also low in an absolute sense and in comparison to non-tobacco advertisements, suggesting that cigarette advertisements are unlikely to be perceived as intending to sell specific brands. Rather, such ads appear likely to be viewed by those ages 12 and younger as promoting cigarette smoking in general. If so, then the primary mechanism through which exposure to cigarette advertisements can have a negative influence on children and tweens is by affecting their lifestyle associations with smoking and their general beliefs about the instrumental value of smoking in meeting social, physical, and psychological needs. In combination with prior research showing that children and adolescents are interested in cigarette advertising (Arnett, 2001; Charlton, 1986) and understand the positive user imagery portrayed therein (Biener & Siegel, 2001; DiRocco & Shadel, 2007; Donovan, Jancey, & Jones, 2002), these findings suggest that the cumulative result of exposure to cigarette advertising is a complex network of positive associations with the behavior of smoking that may render youths susceptible to smoking. 4.2. Susceptibility and brand understanding are positively related Susceptibility to smoking was found to be positively related to understanding cigarette advertisements as promoting specific brands. This finding is based on cross-sectional data. As such, it is inappropriate to make strong claims about causality. However, from a theoretical standpoint, it is difficult to conceive of an explanation for why youths would begin to attend to the brand cues contained in cigarette advertisements without implicating at least some degree of interest in the possibility of experimenting with cigarettes in the future. Thus, this finding appears to be consistent with the notion that susceptibility to smoking can increase youths' sensitivity to the brand-specific information contained in cigarette advertising, but longitudinal research is needed to provide definitive evidence about the veracity of this proposition.
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4.3. Psychological mechanisms linking exposure to cigarette advertisements with elevated risk of smoking initiation A wealth of prior research has demonstrated a positive link between exposure to cigarette advertising and youth smoking (Difranza et al., 2006; Goldberg 2008). Susceptibility to smoking has also been shown to affect smoking onset among youths (Forrester, Biglan, Severson, & Smolkowski, 2007; Pierce et al., 1996). This study offers a partial glimpse of the psychological mechanisms that may underlie these effects. If youths initially tend to understand cigarette advertisements as promoting the product category, then each exposure to an advertisement should have a cumulative influence on their perceptions of the attractiveness of smoking in general. In other words, initial exposures to cigarette advertising (and the positive portrayals of smoking contained therein) should increase youths' willingness to experiment with cigarette smoking (i.e., their susceptibility). Then, once they become susceptible to smoking, youths may begin to attend more readily to brand information. If so, then later exposures to cigarette advertising should affect decisions about which brand(s) to experiment with and smoke regularly. Studies demonstrating a positive association between cigarette ad spending and market shares among adolescents and young adults are consistent with this proposition (Difranza et al., 2006; Pollay et al., 1996). 4.4. Limitations and further research The present study suggests that much of the negative influence of cigarette advertising on youths' initial smoking behaviors may be attributable to its effects on general perceptions of smoking (see Freeman, Brucks, & Wallendorf, 2005), rather than brandspecific perceptions. However, much work remains if we are to gain a full understanding of the psychological mechanisms that link exposure to cigarette advertising with youth smoking. One limitation of the present study is that it involves a convenience sample from a narrow geographic region within the United States. Thus, further research is needed to examine how cigarette advertising is perceived in other locales, especially those wherein youths enjoy few protections (Lando et al., 2006). Since at least some of the developmental factors involved in consumer socialization and category learning (e.g., cognitive ability) are not readily affected by environment (Johnson & Eilers, 1998), it seems reasonable to expect the finding that youths tend to initially understand cigarette advertisements as promoting smoking in general rather than specific brands of cigarettes to generalize to a considerable degree. However, environmental factors such as the strictness of advertising regulation (Assunta & Chapman, 2004; Givel & Glantz, 2001) clearly affect youths' exposure to cigarette advertising and may also affect the extent to which they understand cigarette advertisements as promoting particular brands rather than smoking in general. The study was also limited in terms of the stimulus advertisements and the exposure paradigm used to elicit participants' understandings of the selling intent of cigarette advertisements. In attempting to match cigarette advertisements with a thematically and visually comparable set of non-tobacco advertisements, ads for some popular youth brands (e.g., Camel) were excluded from the study. In addition, participants did not view the ads as they would in marketplace settings (e.g., in magazines or at the point-of-sale), and no measures of youths' comprehension and encoding of the product claims contained in the ads were administered. Given these limitations, further research is needed to determine how youths are affected by a full range of cigarette advertisements when they encounter the ads in everyday situations. For example, how would a young girl perceive a cigarette advertisement (e.g., for Camel No. 9) if she encountered it while looking through a Vogue or Cosmopolitan magazine (Medical News Today, 2007) or visiting a convenience store (Feighery, Henriksen, Wang, Schleicher, & Fortmann, 2006)? And what perceptions of the brand and category would she encode into memory? Most of what is known about the impact of cigarette advertising on youths' perceptions of smoking is based on the use of exposure paradigms – like the one used herein – whereby participants have no choice but to view and process the advertisements (c.f., DiRocco & Shadel, 2007; Donovan, Jancey, & Jones, 2002). Although exposure context seems unlikely to affect youths' understanding of the selling intent of cigarette ads per se, it almost certainly influences how long any particular ad would be viewed and the extent to which an advertisement's claims and imagery would affect product category and brand perceptions. We note with concern that magazine and point of sale advertisements are not the only sources of pro-tobacco messages to which youths may be exposed. Movies, music videos, and other media also contain positive portrayals of cigarette smoking (Glantz, Kacirk, & McCulloch, 2004; Gruber, Thau, Hill, Fisher, & Grube, 2005; Harper & Martin, 2002; Wills et al., 2007). Compared to advertisements, brand information is likely to be less prominent in such portrayals. Therefore, it seems reasonable to expect that children and young adolescents would also perceive pro-tobacco messages in these media as promoting smoking in general (rather than particular brands of cigarettes), which would again suggest that exposure would have a cumulative influence on the perceived appeal of smoking and youths' predispositions toward experimentation. Further research is needed to examine this possibility. Acknowledgements This research was supported by a grant from the Arizona Disease Control Research Commission (Grant #9803). The authors are solely responsible for the study's design, conduct, analysis, and interpretation of results; there are no competing interests to disclose. Opinions expressed are those of the authors and do not necessarily reflect those of the sponsoring institution. The authors gratefully acknowledge the assistance of Suzanne Martin and the many additional members of our research team who participated in data collection and coding.
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Contents lists available at ScienceDirect
Addictive Behaviors
Youths' understandings of cigarette advertisements Dan Freeman a,⁎, Merrie Brucks b, Melanie Wallendorf b, Wendy Boland c a b c
Department of Business Administration, University of Delaware, 117 Alfred Lerner Hall, Newark, DE 19716, USA Department of Marketing, University of Arizona, Tucson, AZ, USA Department of Marketing, American University, Washington D.C., USA
a r t i c l e
i n f o
Keywords: Children and adolescents Cigarette advertising Perceptions and comprehension Susceptibility to smoking
a b s t r a c t This study addresses two questions: (1) when youths are exposed to advertisements for cigarettes, do they primarily see advertisements for brands or products, and (2) is there a relationship between youths' understandings of cigarette advertisements and their susceptibility to smoking? A sample of 271 participants ranging in age from 7 to 12 viewed a series of print advertisements that included cigarette and non-tobacco-related ads. While viewing each ad, participants were asked to indicate what they thought the advertisement was trying to sell. Responses were coded into one of three categories reflecting important differences in participants' comprehension of each advertisement — no understanding, product category understanding, or brand understanding. Results show that youths typically understand the type of product an advertisement is promoting; however, the levels of brand understanding observed for cigarette advertisements were low in an absolute sense, and significantly lower than brand understanding of non-tobacco-related advertisements. Results also show that understanding cigarette ads as promoting specific brands of cigarettes is positively related to susceptibility to smoking. Taken together, these findings provide a glimpse of the psychological mechanisms that may underlie the well established link between exposure to cigarette advertising and youth smoking. © 2008 Elsevier Ltd. All rights reserved.
1. Introduction Tobacco companies have long argued that cigarette advertisements are intended “to get smokers of competitive products to switch” (Reynolds, 1984, p. 89) rather than increasing the number of individuals who smoke (Hamilton, Turner-Bowker, Celebucki, & Connolly, 2002; Pollay, et al., 1996). However, analyses of industry documents suggest that past practices included the intentional targeting of youth to encourage tobacco use initiation (Cummings, Morley, & Horan et al., 2002). In addition, numerous prospective and cross-sectional studies have shown that exposure to tobacco advertising is positively associated with tobacco use initiation by youth (Difranza, Wellman, & Sargent et al., 2006; Goldberg 2008). It is therefore disturbing to note that despite increasingly strict regulations and the WHO Framework (2003), children and adolescents continue to be exposed to cigarette advertising in magazines (King & Siegel, 2001; Lee, Taylor, & McGetrick, 2004), at the point-of-sale (Braverman & Aaro, 2004; Feighery, Ribisl, Clark, & Haladjian, 2003; Henriksen, Feighery, Schleicher, Haladjian, & Fortmann, 2004), through sponsorships (Siegel, 2001), and in interactive media (Ribisl, 2003). Moreover, in some developing countries, youths are exposed to tobacco advertising and promotion with little protection (Lando, Borrelli, Muramoto, & Ward, 2006; Sebrie & Glantz, 2006). At present, “only 5% of the world's population is covered by comprehensive bans on tobacco advertising, promotion, and sponsorship. Tobacco companies, meanwhile, continue targeting young people by falsely associating use of tobacco products with qualities such as glamour, energy and sex appeal,” (WHO, 2008).
⁎ Corresponding author. Tel.: +1 302 831 6158; fax: +1 302 831 4196. E-mail address: [email protected] (D. Freeman). 0306-4603/$ – see front matter © 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2008.08.007
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To maximize the effectiveness of tobacco use prevention programs and the persuasiveness of calls for advertising regulation, it is necessary to uncover the psychological mechanisms through which exposure to tobacco advertising contributes to smoking initiation by youths. For the tobacco industry argument about inducing brand switching to hold, youths would have to perceive cigarette advertisements as consisting of claims about specific brands only (which compete with other brands within the cigarette category) rather than consisting of claims about the benefits of smoking in general (implicitly competing with other lifestyle choices). Although many studies have addressed the link between exposure to tobacco advertising and smoking initiation, none have directly examined this issue. 1.1. Prior research pertaining to the mechanisms through which cigarette advertising influences youths' smoking behaviors Extant research has identified several psychosocial mechanisms through which exposure to cigarette advertising can influence youths' smoking behaviors. For example, Shadel, Tharp-Taylor, and Fryer (2008) show that youths who are wrought with selfconflict are more likely to be susceptible to influence from cigarette advertising than youths who have a better sense of who they are. Other research demonstrates that cigarette advertising (Pechmann and Knight 2002) and portrayals of smoking in the movies (Wills et al., 2007) can work in conjunction with peer influences to shape youths' smoking behaviors. Analyses of tobacco industry documents (Barbeau, Leavy-Sperounis, & Balbach, 2004; Goldberg 2008; Ling & Glantz, 2002) suggest that cigarette advertisements are often designed to take advantage of such psychosocial mechanisms by portraying cigarettes as providing self-identity-relevant and social benefits. In studies examining individual-level psychological processes, cigarette advertising has been implicated in creating high levels of brand awareness among young children (Fischer, Schwartz, Richards, Goldstein, & Rojas, 1991; Emri, Bagci, Karakoca, & Baris, 1998; Mizerski, 1995). Exposure to cigarette advertisements has also been shown to foster positive imagery about users of the brand (Donovan, Jancey, & Jones, 2002; Biener & Siegel, 2001), increase favorable thoughts towards smokers (Pechmann & Ratneshwar 1994), and create expectations about the instrumental value of smoking in meeting social, physical, and psychological needs (Bansal, John, & Ling, 2005; Biener & Siegel, 2001; Boyd, Boyd, & Greenlee, 2003; DiRocco & Shadel, 2007; Pollay, 1995). For example, exposure to a Benson & Hedges advertisement may create the perception that people who smoke the brand are relaxed, interesting, cool, and rich (see Donovan, Jancey, & Jones, 2002). As the preceding discussion illustrates, most of the individual-level studies of psychological processes suggest that the effects of cigarette advertising are brand-specific in nature. However, prior research has tended to utilize methods that cannot detect advertising's effects on youths' general perceptions of cigarette smoking. For example, studies examining children's interest in and exposure to tobacco advertising typically ask participants to match specific brands with product categories (Fischer et al., 1991; Emri et al., 1998; Mizerski, 1995), thereby forcing attention to brand information. Similarly, the examination of advertising effects on user imagery is likely to involve asking youths to describe the kind of people they think will smoke a given brand based on what they saw depicted in an advertisement (Donovan, Jancey, & Jones, 2002). Thus, although we can conclude that exposure to tobacco advertising leaves complex and positive traces in the minds of children and young adolescents, it remains unclear whether these effects are primarily brand-specific or whether they may relate to cigarette smoking in general. 1.2. Brand-specific vs. category level perceptions of smoking Any given cigarette advertisement may affect perceptions of the particular brand it is intended to promote as well as general perceptions of the product category (cigarettes). In considering the impact of cigarette advertising on youths, it is the degree to which such ads impact brand-specific (as opposed to category-general) perceptions that is of primary concern. At the extreme, if cigarette advertising affects youths' brand-specific perceptions without spillover to category perceptions, then each exposure to a cigarette advertisement would enhance the relative attractiveness of a particular brand of cigarettes with relatively little effect on category demand. Consequently, it should take many exposures to advertisements for a specific brand to render a youth susceptible to experimenting with smoking because each ad should have an independent influence on his or her beliefs about the value of smoking as a way to achieve psychosocial goals. On the other hand, to the extent that brand advertising builds general perceptions of cigarette smoking, then each exposure to a cigarette advertisement has much stronger potential to enhance the absolute attractiveness of smoking as a lifestyle choice. Specifically, ads that use lifestyle imagery and related brand claims would be expected to have a cumulative, synergistic impact on general perceptions regarding the desirability of smoking, suggesting that even small doses of cigarette advertising exposure might be dangerous in the long term. 1.3. Research questions This study aims to address two questions: (1) when youths are exposed to advertisements for cigarettes, do they primarily see advertisements for brands or products, and (2) is there a relationship between youths' understandings of cigarette advertisements and their susceptibility to smoking? Based on the cognitive development literature pertaining to the learning of categories (Johnson & Eilers, 1998; Johnson & Mervis, 1997; Love, Medin, & Gureckis, 2004) and prior investigations of children's awareness of brands (John, 1999), we expect that youths are likely to understand cigarette advertisements at the most basic, product category level (i.e., “this is an ad for cigarettes”) when they first begin to observe and interpret them. Then as they age and become susceptible to smoking, we expect youths to progress to finer, brand-specific levels of distinction (“this is an ad for Marlboro cigarettes”). To provide a point of reference, the study also examined understandings of non-tobacco advertisements.
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1.4. Age groups examined in the study Two age groups were selected for inclusion in the study: 7–8 year olds and 10–12 year olds. The rationale for including these groups was threefold. First, children's awareness of brands has been shown to change markedly from ages 7 to 12. Sometime around age 7, children begin to show considerable awareness of youth-oriented brands. Then, around age 12, they begin to demonstrate awareness of brands for adult-oriented products (John, 1999). Second, the age range of 7–12 is one in which youths can be expected to be particularly susceptible to influence from advertising. At this age, children have the ability to process advertising, albeit at a simplified level, but lack sufficient cognitive resources to discount for biases in advertising portrayals and glamorized media imagery (Brucks, Armstrong, & Goldberg, 1988; John, 1999). And third, research suggests that children as young as age 7 may begin to form lifestyle associations with cigarette smoking prior to reaching the ages typically associated with experimentation (Freeman, Brucks, & Wallendorf, 2005). 2. Method 2.1. Participants and procedures Active consent procedures were used to recruit a convenience sample of 271 participants from four public schools in the southwestern United States, including 100 — 7 to 8 year olds and 171 — 10 to 12 year olds. Gender was evenly split (49.8% male); 72.4% of participants were non-Hispanic Whites; 5.2% reported having tried a cigarette; and 35.3% reported living in a household with at least one smoker. Participants viewed and responded to a series of 5 advertisements, including 2 cigarette and 3 non-tobacco advertisements. The first ad in the series – a non-tobacco advertisement for Tropicana Juice – was the same for all participants and was used to familiarize participants with the ad understanding task (see 2.3.1). The remaining ads served as experimental stimuli. The second and fifth ads viewed by participants were for cigarettes; the third and fourth ads promoted non-tobacco-related products. This ordering of ad presentation was intended to mask the primary interest in participants' understandings of the cigarette advertisements. After responding to the advertisements, participants completed a measure of susceptibility to smoking. All study tasks were completed individually with the assistance of a research assistant who was trained to be non-directive and nonjudgmental. 2.2. Stimulus advertisements A total of 12 magazine advertisements, including 6 cigarette advertisements (e.g., Marlboro, Newport, Winston) and 6 nontobacco advertisements (e.g., Toyota trucks, Suave shampoo, Lays potato chips) were used as stimulus advertisements. Advertisements were considered for inclusion in the study if and only if they met four criteria: (1) the ad includes a product image (e.g., it shows a pack of cigarettes), (2) the ad includes at least two visual branding elements (e.g., it uses the brand name in an ad headline or tagline, it provides a clear depiction of the brand name on the product image), (3) the ad does not include images of children or adolescents and promotes a product that is not child-oriented per se, and (4) the ad portrays the product as having instrumental value in meeting social, physical, or psychological needs. Criteria #1 and #2 were utilized to ensure that participants could understand any given advertisement as promoting a specific brand even if they had little or no prior familiarity with the brand. Criterion #3 was used so that it would be appropriate to compare youths' understandings of cigarette ads against their understandings of the non-tobacco ads. Criterion #4 was intended to ensure that the sample of cigarette advertisements would be representative of the types of advertisements that youths may encounter. Cigarette and non-tobacco advertisements deemed by the researchers as meeting these criteria were matched to create 3 distinct sets of stimulus advertisements consisting of 4 ads each — 2 cigarette and 2 non-tobacco advertisements. Within each set, the cigarette and non-tobacco-related advertisements were visually and thematically similar. For example, one set contained cigarette and non-tobacco-related ads depicting social settings (i.e., friends talking, romance). Participants were randomly assigned to view 1 of the 3 ad sets.1 2.3. Measures 2.3.1. Ad understanding As each ad was shown, an interviewer asked: “This picture is an advertisement; what do you think it is trying to sell?” Participants' initial responses to this prompt were independently coded by two of the researchers using a three category coding scheme — no understanding, product category understanding, and brand understanding. This coding scheme was applied to the literal statements of participants; it was not interpretive. As such, it generated a high level of initial agreement (92.8%). The only sources of disagreement pertained to how to code potential synonyms (e.g. “smokes” for cigarettes) and mispronounced brand names (e.g., “Morelboro”). All disagreements were resolved through discussion.
1 Preliminary analyses detected no significant differences in brand understanding or susceptibility pertaining to the different ad sets, so this factor was not included in the final analyses.
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If a response failed to demonstrate at least a basic understanding of the type of product promoted in an ad, then it was coded as “no understanding.” For example, “clothes” and “eyeliner,” which were given as responses to cigarette advertisements, were coded as “no understanding.” Correct identification of the product being promoted is a necessary condition for advertising influence; therefore, responses coded as “no understanding” suggest that the advertisement could not affect youths' perceptions of smoking. All responses that successfully demonstrated a basic understanding of the type of product being promoted were coded as “product category understanding” or “brand understanding,” depending on whether they correctly noted the specific brand depicted in the ad. For example, “Marlboro cigarettes” and “Toyota trucks” were coded as demonstrating “brand understanding”; responses such as “cigarettes” and “trucks” were coded as reflecting “product category understanding.” Responses coded as “brand understanding” satisfy the necessary precondition for an advertisement to alter brand-specific perceptions rather than general perceptions of the product category (e.g., cigarettes). Each participant viewed and responded to cigarette and non-tobacco advertisements. Therefore, the application of the coding scheme produced six measures of ad understanding — no understanding, category understanding, and brand understanding of 2 cigarette advertisements; no understanding, category understanding, and brand understanding of 2 nontobacco advertisements. Scores for each measure ranged from 0 to 2. Given that the study was intended to determine the extent to which youths perceive cigarette advertisements as promoting specific brands (as compared to smoking in general) and to examine the relationship between brand understanding and susceptibility to smoking, subsequent analyses focused on the brand understanding measures. 2.3.2. Susceptibility to smoking Two items adapted from Pierce, Choi, Gilpin, Farkas, and Merritt (1996) were used to classify participants as either susceptible or non-susceptible to smoking: (1) do you think you might try a cigarette soon?; and (2) if one of your favorite friends offered you a cigarette, do you think you might try one? Participants responded to each item using a 4-point scale — “yes,” “maybe,” “I don't think so,” or “no way.” Participants (N = 39; 14.4% of the sample) who failed to choose the strongest possible negative responses for the items (i.e., “no way”) were classified as susceptible to smoking. 2.4. Analysis To address the question of whether youths primarily see cigarette advertisements as promoting specific brands, a repeated measures ANOVA was conducted. Brand understanding of the different advertisement types (cigarette ads, non-tobacco ads) served as the within subject repeated measure. Age group (7–8 years old, 10–12 years old) served as a between-subjects independent variable and presence of a smoker in the household (1 = yes, 0 = no) served as a covariate. To provide a complete picture of the level at which participants understood the cigarette and non-tobacco advertisement, descriptive statistics were calculated for the no understanding and product category understanding measures. Logistic regression analysis was used to assess the relationship between susceptibility to smoking and brand-level understandings of cigarette advertisements. Susceptibility to smoking (1 = yes, 0 = no) served as the dichotomous dependent variable. Brand understanding of cigarette advertisements and age group served as the primary predictors. To control for participants' general tendencies to be sensitive to brand cues in advertisements, brand understanding of non-tobacco advertisements was included as a covariate. Presence of a smoker in the household was also included as a covariate. 3. Results 3.1. Brand understanding by age group and advertisement type The repeated measures ANOVA detected two main effects and a significant interaction. Both ad type (F[1, 268] = 38.2, p b .01) and age group (F[1,268] = 33.3, p b .01) were found to significantly influence mean levels of brand understanding. Both of these effects were qualified by a significant ad type by age level interaction (F[1, 268] = 8.1, p b .01). As Fig. 1 illustrates, the main effects are attributable to the observation of higher levels of brand understanding for non-tobacco as compared to cigarette ads and higher levels of brand understanding among 10–12 year olds as compared to 7–8 year olds. The significant interaction is attributable to a greater age group related increase in brand understanding of non-tobacco advertisements as compared to cigarette advertisements. Whereas the mean level of brand understanding of cigarette ads increased from .06 (or 3%) for 7–8 year olds to .30 (or 15%) for 10– 12 year olds, mean levels of brand understanding for non-tobacco ads increased from .23 (or 11.5%) to .70 (or 35%). 3.2. Category and no understanding by age group and advertisement type Among 7–8 year olds, the mean level of category understanding of cigarette advertisements was 1.48 (or 74%, SD = .69); the mean level of category understanding of non-tobacco advertisements was 1.29 (or 64.5%; SD = .69). For 10–12 year olds, the mean level of category understanding of cigarette ads was 1.63 (or 81.5%; SD = .60); the mean level of category understanding of nontobacco ads was 1.18 (or 59%; SD = .82). Among 7–8 year olds, the mean level of no understanding of cigarette advertisements was .46 (or 23%; SD = .69); the mean level of no understanding for non-cigarette ads was .48 (or 24%; SD = .64). For 10–12 year olds, the mean level of no
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Fig. 1. Average percentages of brand understanding by age group and ad type.
understanding for cigarette ads was .06 (or 3%; SD = .29); the mean level of no understanding for non-tobacco ads was .12 (or 6%; SD = .32). 3.3. Susceptibility to smoking Logistic regression analysis detected significant effects of age group (B = .97, SE = .44, Wald = 4.81, p = .03), brand understanding of non-tobacco advertisements (B = − .66, SE = .31, Wald = 4.68, p = .03), and brand understanding of cigarette advertisements (B = 1.04, SE = .39, Wald = 7.07, p b .01) on susceptibility to smoking. For each cigarette advertisement that participants perceived as promoting a specific brand of cigarettes, there was a 182% increase in their likelihood of being susceptible to smoking. 4. Discussion Advertising is typically intended to persuade a target audience to buy a particular brand of a product (Belch & Belch, 2003). To accomplish this objective, audience members must: (1) understand the type of product being promoted in an advertisement, and (2) notice that the ad is intending to sell a specific brand. If only the former requirement is met, then advertising will tend to influence perceptions of the product category and affect general demand for the product. 4.1. Cigarette advertisements tend to be perceived as promoting smoking in general The low levels of no understanding observed for cigarette advertisements suggest that study participants generally understood that such ads are meant to promote smoking. Importantly, the percentages of brand understanding for cigarette advertisements were also low in an absolute sense and in comparison to non-tobacco advertisements, suggesting that cigarette advertisements are unlikely to be perceived as intending to sell specific brands. Rather, such ads appear likely to be viewed by those ages 12 and younger as promoting cigarette smoking in general. If so, then the primary mechanism through which exposure to cigarette advertisements can have a negative influence on children and tweens is by affecting their lifestyle associations with smoking and their general beliefs about the instrumental value of smoking in meeting social, physical, and psychological needs. In combination with prior research showing that children and adolescents are interested in cigarette advertising (Arnett, 2001; Charlton, 1986) and understand the positive user imagery portrayed therein (Biener & Siegel, 2001; DiRocco & Shadel, 2007; Donovan, Jancey, & Jones, 2002), these findings suggest that the cumulative result of exposure to cigarette advertising is a complex network of positive associations with the behavior of smoking that may render youths susceptible to smoking. 4.2. Susceptibility and brand understanding are positively related Susceptibility to smoking was found to be positively related to understanding cigarette advertisements as promoting specific brands. This finding is based on cross-sectional data. As such, it is inappropriate to make strong claims about causality. However, from a theoretical standpoint, it is difficult to conceive of an explanation for why youths would begin to attend to the brand cues contained in cigarette advertisements without implicating at least some degree of interest in the possibility of experimenting with cigarettes in the future. Thus, this finding appears to be consistent with the notion that susceptibility to smoking can increase youths' sensitivity to the brand-specific information contained in cigarette advertising, but longitudinal research is needed to provide definitive evidence about the veracity of this proposition.
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4.3. Psychological mechanisms linking exposure to cigarette advertisements with elevated risk of smoking initiation A wealth of prior research has demonstrated a positive link between exposure to cigarette advertising and youth smoking (Difranza et al., 2006; Goldberg 2008). Susceptibility to smoking has also been shown to affect smoking onset among youths (Forrester, Biglan, Severson, & Smolkowski, 2007; Pierce et al., 1996). This study offers a partial glimpse of the psychological mechanisms that may underlie these effects. If youths initially tend to understand cigarette advertisements as promoting the product category, then each exposure to an advertisement should have a cumulative influence on their perceptions of the attractiveness of smoking in general. In other words, initial exposures to cigarette advertising (and the positive portrayals of smoking contained therein) should increase youths' willingness to experiment with cigarette smoking (i.e., their susceptibility). Then, once they become susceptible to smoking, youths may begin to attend more readily to brand information. If so, then later exposures to cigarette advertising should affect decisions about which brand(s) to experiment with and smoke regularly. Studies demonstrating a positive association between cigarette ad spending and market shares among adolescents and young adults are consistent with this proposition (Difranza et al., 2006; Pollay et al., 1996). 4.4. Limitations and further research The present study suggests that much of the negative influence of cigarette advertising on youths' initial smoking behaviors may be attributable to its effects on general perceptions of smoking (see Freeman, Brucks, & Wallendorf, 2005), rather than brandspecific perceptions. However, much work remains if we are to gain a full understanding of the psychological mechanisms that link exposure to cigarette advertising with youth smoking. One limitation of the present study is that it involves a convenience sample from a narrow geographic region within the United States. Thus, further research is needed to examine how cigarette advertising is perceived in other locales, especially those wherein youths enjoy few protections (Lando et al., 2006). Since at least some of the developmental factors involved in consumer socialization and category learning (e.g., cognitive ability) are not readily affected by environment (Johnson & Eilers, 1998), it seems reasonable to expect the finding that youths tend to initially understand cigarette advertisements as promoting smoking in general rather than specific brands of cigarettes to generalize to a considerable degree. However, environmental factors such as the strictness of advertising regulation (Assunta & Chapman, 2004; Givel & Glantz, 2001) clearly affect youths' exposure to cigarette advertising and may also affect the extent to which they understand cigarette advertisements as promoting particular brands rather than smoking in general. The study was also limited in terms of the stimulus advertisements and the exposure paradigm used to elicit participants' understandings of the selling intent of cigarette advertisements. In attempting to match cigarette advertisements with a thematically and visually comparable set of non-tobacco advertisements, ads for some popular youth brands (e.g., Camel) were excluded from the study. In addition, participants did not view the ads as they would in marketplace settings (e.g., in magazines or at the point-of-sale), and no measures of youths' comprehension and encoding of the product claims contained in the ads were administered. Given these limitations, further research is needed to determine how youths are affected by a full range of cigarette advertisements when they encounter the ads in everyday situations. For example, how would a young girl perceive a cigarette advertisement (e.g., for Camel No. 9) if she encountered it while looking through a Vogue or Cosmopolitan magazine (Medical News Today, 2007) or visiting a convenience store (Feighery, Henriksen, Wang, Schleicher, & Fortmann, 2006)? And what perceptions of the brand and category would she encode into memory? Most of what is known about the impact of cigarette advertising on youths' perceptions of smoking is based on the use of exposure paradigms – like the one used herein – whereby participants have no choice but to view and process the advertisements (c.f., DiRocco & Shadel, 2007; Donovan, Jancey, & Jones, 2002). Although exposure context seems unlikely to affect youths' understanding of the selling intent of cigarette ads per se, it almost certainly influences how long any particular ad would be viewed and the extent to which an advertisement's claims and imagery would affect product category and brand perceptions. We note with concern that magazine and point of sale advertisements are not the only sources of pro-tobacco messages to which youths may be exposed. Movies, music videos, and other media also contain positive portrayals of cigarette smoking (Glantz, Kacirk, & McCulloch, 2004; Gruber, Thau, Hill, Fisher, & Grube, 2005; Harper & Martin, 2002; Wills et al., 2007). Compared to advertisements, brand information is likely to be less prominent in such portrayals. Therefore, it seems reasonable to expect that children and young adolescents would also perceive pro-tobacco messages in these media as promoting smoking in general (rather than particular brands of cigarettes), which would again suggest that exposure would have a cumulative influence on the perceived appeal of smoking and youths' predispositions toward experimentation. Further research is needed to examine this possibility. Acknowledgements This research was supported by a grant from the Arizona Disease Control Research Commission (Grant #9803). The authors are solely responsible for the study's design, conduct, analysis, and interpretation of results; there are no competing interests to disclose. Opinions expressed are those of the authors and do not necessarily reflect those of the sponsoring institution. The authors gratefully acknowledge the assistance of Suzanne Martin and the many additional members of our research team who participated in data collection and coding.
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