The Impact of Retail Cigarette Marketing Practices on Youth Smoking Uptake

Objective:  To examine the differential associations of cigarette retail marketing practices on youth smoking uptake.

Design:  Analyses from annual, nationally representative, cross-sectional surveys of 8th, 10th, and 12th graders in the United States.

Setting:  The February 1999 through June 2003 Monitoring the Future surveys involved 109 308 students and data on retail cigarette marketing collected from 966 communities in which the students reside, as part of the Bridging the Gap Initiative: Research Informing Practice and Policy for Healthy Youth Behavior.

Participants:  A total of 26 301 students were selected for this study.

Main Exposures:  Point-of-sale advertising, promotions, prices, and placement.

Outcome Measure:  Using a smoking uptake measure to account for stages that identify the process by which adolescents begin smoking, we calculated odds ratios and confidence intervals through generalized ordered logit analyses, with weighted data that controlled for demographic and socioeconomic characteristics and accounted for clustering at the community level.

Results:  Higher levels of advertising, lower cigarette prices, and greater availability of cigarette promotions were associated with smoking uptake. Advertising increased the likelihood of youth initiating smoking, price increased the likelihood of smoking at most levels of uptake, and availability of promotions increased the likelihood that youth will move from experimentation to regular smoking.

Conclusions:  Cigarette retail marketing practices increase the likelihood of smoking uptake. These findings suggest that specific restrictions on retail cigarette marketing may reduce youth smoking.

Childhood experimentation with cigarettes and progression to regular use remains a public health concern. Research shows that initiating smoking at a younger age is associated with eventually smoking more cigarettes per day than initiating smoking at an older age, suggesting that delaying the onset of smoking may affect the likelihood of becoming addicted to cigarettes or becoming a heavy smoker. It is also estimated that adolescents who started smoking in the mid to late 1990s will smoke for at least 16 years if male and 20 years if female. Thus, smoking will be a long-term addiction for many current adolescent smokers. Furthermore, youth who initiate smoking at an early age are at an increased risk for developing long-term health consequences. Because increasing levels of smoking experience increase the likelihood of future smoking, many researchers have begun to use stages of smoking experience to predict the transition to future established smoking.

In an attempt to determine what is causing adolescents to progress toward regular smoking, several studies have linked tobacco industry marketing practices to adolescent susceptibility to smoke and progression toward established smoking. Existing evidence shows that initiation of daily smoking among youth seems to increase during periods of high promotional activity by the tobacco industry. Furthermore, a similar study examining smoking initiation trends in adolescent subgroups from 1979 to 1989, with trends in cigarette pricing and tobacco marketing expenditures, shows that although cigarette prices increased during the study’s time period, so did tobacco marketing expenditures for coupons, value-added items, and promotional allowances. This suggests the industry may have increased its promotional activity to offset the increasing cost of cigarettes. Furthermore, although provisions were agreed on to restrict certain types of marketing and youth access to tobacco as part of the 1998 Master Settlement Agreement (MSA), there is evidence the tobacco industry is turning more and more to retail stores as outlets for its marketing efforts. In fact, in 2003, the tobacco industry spent $14.2 billion on retail advertising and price and other promotions, which accounts for 94% of all its 2003 advertising and promotional spending.

In this study, we examine the influence of cigarette retail marketing strategies on the progression of adolescents from experimentation to established smoking using data collected from February 1999 through June 2003 in nationally representative samples of 8th-, 10th-, and 12th-grade students. To our knowledge, this is the first study to examine the differential effects of these retail marketing strategies on smoking uptake at the national level. The strengths of this study are that most of the data were collected after the implementation of the MSA provisions, allowing for an examination of the post-MSA retail cigarette environment; and its ability to simultaneously examine the impact that objectively collected measures of the cigarette retail environment have on youth smoking uptake.