摘要：Objectives. We examined young adult smoking patterns and receptivity to cigarette advertising to assess vulnerability to tobacco marketing strategies. Methods. We obtained data from a telephone survey of 12 072 Massachusetts adults. Results. Smokers aged 18 to 30 years were more likely than older adults to smoke only occasionally and to consume fewer than 10 cigarettes per day. They also were more receptive to cigarette marketing and were more likely to be frequent patrons of bars and clubs. Conclusions. Many young adult smokers are in the initiation phase of smoking and are likely to undergo a transition to either nonsmoking or heavier smoking. If unimpeded by regulation, tobacco promotion in bars and clubs is likely to lead to increased adult smoking prevalence. The 1998 agreement reached between the attorneys general of 46 states and the 5 major tobacco companies included a series of limitations on advertising and promotional activities. These limitations include a prohibition on youth targeting; a ban on the use of cartoons in advertising, marketing, or packaging; the elimination of billboards and transit advertising; and a ban on distribution of nontobacco items that contain brand names (i.e., promotional items). 1 These concessions by the tobacco companies have been made in the context of broad support for the notion that children should be protected from inducements to engage in unhealthy behavior. Equally important to public health practitioners is the observation that smoking initiation largely occurs before 18 years of age 2– 4 and the expectation that if young people can be prevented from becoming addicted to nicotine before 18 years of age, they are unlikely to ever start smoking. In other words, the belief is that restrictions on tobacco marketing to youth will result in lower smoking prevalence among adults. This belief rests on the assumptions that by the time people reach 18 years of age, (1) their smoking patterns will be well established and (2) they will be relatively invulnerable to the marketing and promotion of cigarettes. Evidence that the tobacco companies are refocusing their prodigious marketing resources on young adults through the use of promotional activities in bars and nightclubs highlights the importance of testing these assumptions. Several studies have documented the rapid increase in the number of tobacco company–sponsored advertisements of bars and clubs in the entertainment sections of weekly newspapers in many cities across the United States. 5, 6 During the summer of 2001, for example, RJ Reynolds advertised “Seven Pleasures of the Casbah” and provided free Camel cigarette samples, giveaways, and entertainment at adult-only clubs in 70 US cities. 7 Given evidence that the increase in cigar advertising was associated with an expansion in cigar smoking among young adult males, 8 it is likely that increased cigarette promotion to young adults will be similarly effective. We examined factors that could signal young adult vulnerability both to smoking initiation and to progression from low-level smoking to heavy smoking as a consequence of bar and club promotions. Using data from a population-based survey in Massachusetts, we compared smoking behaviors and attitudes of young adults between the ages of 18 and 30 years with those of older adults. We hypothesized that compared with older adults, (1) young adult smokers would be more likely to be in the initiation phase of smoking and more likely to be light, irregular smokers who smoke in response to social cues rather than to maintain their addiction, (2) young adults, regardless of smoking status, would be more likely to be receptive to tobacco advertising, and (3) young adults would be more likely to be exposed to tobacco promotions in bars and clubs.
