摘要：Objectives. We investigated whether receptivity to tobacco advertising and promotions during young adolescence predicts young adult smoking 6 years later. Methods. Two longitudinal cohorts of adolescents drawn from the 1993 and 1996 versions of the California Tobacco Surveys were followed 3 and 6 years later. At baseline, adolescents were aged 12 to 15 years and were not established smokers. The outcome measure was established smoking at final follow-up. Receptivity to cigarette advertising and promotions was included in a multivariate logistic regression analysis along with demographic and other variables. Results. The rate of established smoking at follow-up was significantly greater among members of the 1993 through 1999 cohort (21.0%) than among members of the 1996 through 2002 cohort (15.6%). However, in both cohorts, having a favorite cigarette advertisement and owning or being willing to use a tobacco promotional item showed nearly identical adjusted odds of future adult smoking (1.46 and 1.84, respectively). Conclusions. Despite the success of tobacco control efforts in reducing youth smoking, tobacco marketing remains a potent influence on whether young adolescents become established smokers in young adulthood (18–21 years of age). There has been long-standing scrutiny of tobacco industry advertising and promotions targeted toward children and adolescents. 1 – 11 Historical data have related increases in smoking initiation among adolescents to the onset of new and novel cigarette advertising campaigns, with particular attention focused on Joe Camel, R.J. Reynolds’s cartoon character. 12 – 19 In addition, 9 relatively short-term longitudinal studies of adolescents with limited smoking experience consistently showed that exposure to tobacco advertising and promotions is predictive of future adolescent smoking behavior. 20 Particularly predictive was the availability of promotional items (e.g., clothing and gear with brand logos), a marketing strategy aggressively pursued through such programs as Camel Cash and Marlboro Miles. However, to our knowledge, no longitudinal study has addressed the longer-term association between young adolescents’ receptivity to tobacco advertising and promotions and their later smoking in young adulthood. Despite repeated tobacco industry denials, 21 – 23 internal documents made public as a result of lawsuits associated with the 1998 Master Settlement Agreement (MSA; the agreement between the attorneys general of 46 states and the major tobacco companies to recoup the costs to US states for treating smoking-related diseases) clearly indicate that the industry had focused advertising and promotions on young people. 24 – 28 One industry market research report noted that young smokers will become brand loyal if they smoke a brand 200 times (10 packs) and emphasized that retail-value-added incentives (e.g., promotional items) can encourage the purchase of the required number of packs. 29 On the basis of the evidence that cigarette advertising and promotions influenced smoking initiation, the MSA restricted such activities. Specifically, it prohibited billboard advertising and the use of cartoon characters in tobacco advertising and limited the distribution of promotional items to adult-only venues. Furthermore, most promotional items could no longer carry a brand logo or name. 24 Many state and national antitobacco efforts were initiated in the mid- to late 1990s. Thus, during that decade, young adolescents were exposed to 2 different environments: rampant tobacco advertising and promotions in the early 1990s and the curtailment of these practices along with increased tobacco control efforts in the late 1990s. Cross-sectional population surveys conducted in California in the 1990s indicated that adolescents’ receptivity to advertising and promotions was much higher in 1996 than it was in 1999. 30 In addition, results of these surveys showed that among adolescents who had never smoked, levels of several important risk factors for future smoking (e.g., having best friends who smoked and being susceptible to smoking) were higher in 1996 than in 1993. 31 Thus, these 1996 data from California suggested that adolescent smoking rates were poised to increase. Instead, subsequent cross-sectional surveys documented major declines in adolescent smoking behavior in 1999 and again in 2002. 32 We examined the effects of receptivity to tobacco advertising and promotions in 2 longitudinal cohorts of young adolescents followed over a period of 6 years. Members of the first cohort, from the 1993 California Tobacco Survey (CTS), were followed in 1996 33 , 34 and again as young adults in 1999. 35 Members of the second cohort, from the 1996 CTS, were followed in 1999 31 , 35 – 38 and again as young adults in 2002.
