摘要：Objectives. In light of the Smokeless Tobacco Master Settlement Agreement (STMSA) and the fact that smokeless tobacco advertising has received little attention, we examined industry data to assess smokeless tobacco advertising in popular magazines. Of particular interest was the level of advertising in magazines with high youth readership and the amount of reach and frequency that was generated among readers aged 12 to 17 years. Methods. We used readership data from Mediamark Research Inc, advertising expenditure data from TNS Media Intelligence, and Adplus, a media planning program from Telmar to document the composition of adult and youth readership of magazines in which smokeless tobacco products were advertised, industry expenditures on advertising, and adolescents’ exposure to smokeless tobacco advertising. Results. The STMSA appears to have had a limited effect on the advertising of smokeless tobacco products to youth; both before and after the agreement, smokeless tobacco companies advertised in magazines with high adolescent readership. Conclusions. Popular magazines with smokeless tobacco advertising reach a large number of adolescents through a combination of both youth-oriented and adult magazines. These exposure levels have generally increased since the STMSA. Previous studies have examined spending on cigarette advertising in popular magazines, and the subsequent high exposure rates among adolescents aged 12 to 17 years. 1 – 3 Little attention, however, has been paid to youths’ exposure to smokeless tobacco advertising and promotion and its potential impact on them. The fact that the smokeless tobacco industry is smaller than the cigarette industry helps explain why it has not been the focus of more interest. In 2001, the most recent year for which figures are available, $236.7 million was spent to promote smokeless products 4 compared with $11.2 billion for cigarettes. 5 Essentially, smokeless tobacco advertising and promotion have been under the radar for those studying tobacco advertising and promotion. Youths have fewer negative images of the consequences of smokeless tobacco use than they do of cigarette use. Kury et al., for example, found that among middle school students, smokeless tobacco can be seen as athletic and masculine. 6 Youths also believe that smokeless tobacco products are a safer alternative to smoking, 6 , 7 even though they are highly addictive and can lead to cancers of the mouth, pharynx, larynx, and esophagus; damage to gum tissue; loss of teeth; and a reduced ability to taste and smell. 8 A national survey conducted by the Centers for Disease Control and Prevention in 2005 found that 8.0% of high school students had used smokeless tobacco in the last 30 days. Prevalence was much higher among male (13.6%) than female (2.2%) students. Although the survey showed an overall decline in smokeless tobacco use since 1995, when it was 11.4%, it was higher than the 2003 rate of 6.7%. 9 Of the 12 to 14 million smokeless tobacco users in the United States, one third are younger than 21 years and more than half developed their habit before age 13. 7 Individuals observe and learn about behavior through images and symbols translated by the media. 10 – 14 Advertising and promotion make smokeless tobacco an attractive part of the American landscape and aim to influence youths. Although its precise impact on initiation of smokeless tobacco use among adolescents cannot be known because of environmental and individual factors that confound the determination of a specific relationship, smokeless tobacco advertising helps normalize behavior and create images that are highly appealing to youths by communicating that use of these products is desirable, socially acceptable, and prevalent. 15 Youths (persons under age 18 years) are more sensitive and responsive to tobacco advertising than are adults, and they actively search for cues in advertising that conform to peer relations, resulting in a “right” way to look and behave. 16 Repeated exposure to tobacco messages thus raises their prominence and creates favorable images. 17 For example, a 2004 American Psychological Association report that analyzed research on tobacco and alcohol advertising concluded that advertising is particularly effective with youths when it makes use of these products seem normal. 18 Similarly, an August 17, 2006, ruling by a US district court in United States of America et al. v Philip Morris USA concluded that cigarette advertising and marketing influence smoking among adolescents by legitimizing and normalizing smoking behavior. 19 We believe that the same holds true for smokeless tobacco products. Researchers have used criteria set down by a Food and Drug Administration (FDA) proposal and the Master Settlement Agreement (MSA) to examine whether youths are being exposed to cigarette advertising that appears in popular magazines. In an effort to limit cigarette advertising to youths, the FDA proposed that for any publication read by more than 2 million minors (younger than age 18 years), or in which minors make up more than 15% of the readership, tobacco advertising be limited to a text-only black and white format. 20 The proposal was not approved by Congress; however, the standard regarding percentage and number of youthful readers created a clear criterion for researchers to investigate whether magazines containing cigarette advertising reach youths. The MSA, which comprised 46 states and 5 territories (Florida, Minnesota, Texas, and Mississippi settled their tobacco cases earlier and separately) and the major cigarette producers, was signed in November 1998. The settlement called for the elimination of outdoor advertising that was not at a retail establishment; transit advertising; cartoons in any tobacco advertising, marketing, or packaging; product placement in the media; and tobacco merchandising (brand names cannot appear on any nontobacco item). 21 There was concern that limiting marketing practices in these areas would lead to increased spending in venues such as magazines that were not specifically mentioned in the MSA. The year 1999 therefore became important for determining whether cigarette manufacturers altered their magazine advertising practices in terms of reaching youths. Although the MSA is more widely known, a similar agreement, the Smokeless Tobacco Master Settlement Agreement (STMSA), was passed for the smokeless tobacco industry at the same time as the MSA. This agreement was reached between the state attorneys general and the US Smokeless Tobacco Company, which represents 58% of the smokeless tobacco market and was the only smokeless tobacco company to participate. 22 The marketing provisions of the STMSA are similar to those established in the MSA. 23 The FDA criterion regarding percentage and number of youth readers has been used by a number of researchers examining cigarette advertising exposure to adolescents. Their studies have examined the number of youths reached by cigarette advertising in popular magazines and the frequency with which they are reached. Magazines are one of only a few media outlets available to tobacco advertisers (others include newspapers and signs at the retail level), and most research investigating tobacco advertising aimed at adolescents has focused on this medium. Magazines lend themselves well to examination because of the availability of historical data on readership and expenditures, which enables researchers to track trends in tobacco advertising. Krugman and King 3 analyzed 1998 Mediamark Research Inc data on adolescent readership and constructed limited hypothetical media schedules to examine the extent to which adolescents are reached by popular consumer magazines that contain cigarette advertising. They found that tobacco marketers would reach nearly two thirds of adolescents by placing a single advertisement in each of the 14 magazines identified as having a high youth readership. King and Siegel 2 used a wider and more realistic data set to investigate advertising expenditures for 15 brands of cigarettes in 38 magazines during the period 1995 to 2000. Results indicated that in 2000, more than 80% of US adolescents were exposed to magazines carrying cigarette advertising an average of 17 times. Krugman et al. 1 employed a similar method to analyze cigarette advertising from 1993 to 2002. They found that cigarette advertising for youth brands (i.e., the 3 brands most used by youths) was sufficiently strong to reach youths at high reach and frequency levels. They estimated that in 2000, the 94% of adolescents who were exposed to cigarette ads each saw them approximately 52 times; however, a precipitous drop in such advertising was also found at the end of the period. To date, levels of adolescent exposure to smokeless tobacco advertising are largely unknown. Only 1 study, using a limited set of 9 magazines, examined expenditures for smokeless tobacco advertising before (1997–1998) and after (1999–2001) the STMSA. Results indicated that expenditures sharply increased during the latter period. 24 We report on the advertising and promotion of smokeless tobacco products (chewing tobacco, snuff, and tobacco packets) and their potential impact on adolescents. We analyzed 10 years of data from Mediamark Research Inc and TNS Media Intelligence (hereafter called TNS). In 2000, TNS acquired Competitive Media Reporting (whose data have been used in past studies investigating tobacco expenditures in magazines) to assess advertising for smokeless tobacco in popular magazines. We analyzed data from these 2 sources using Adplus, a media planning simulation program (Telmar, New York, NY). We examined the composition of adult and youth readership of magazines in which smokeless tobacco products were advertised, advertising expenditures, and adolescents’ exposure to smokeless tobacco advertising. The 10-year time frame allowed for an examination of readership and spending trends both before and after the STMSA and provided benchmark data for future research.
