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标题：Adolescent Smoking and Exposure to Tobacco Marketing Under a Tobacco Advertising Ban: Findings From 2 Norwegian National Samples
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作者：Marc T. Braverman ; Leif Edvard Aarø
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2004
卷号：94
期号：7
页码：1230-1238
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined the extent to which adolescents in Norway have been exposed to tobacco marketing despite an existing ban, and whether exposure is related to their current smoking or expectations they will smoke in the future. Methods. Questionnaires were administered to nationally representative systematic samples of Norwegian youths aged 13 to 15 years in 1990 (n = 4282) and 1995 (n = 4065). Results. About half in each cohort reported exposure to marketing. Youths reporting exposure were significantly more likely to be current smokers and to expect to be smokers at 20 years of age, after control for important social influence predictors. Conclusions. Adolescents’ current smoking and future smoking expectations are linked to marketing exposure even in limited settings, suggesting the need for comprehensive controls to eliminate the function of marketing in promoting adolescent smoking. The control of tobacco advertising and promotion is a pivotal policy area in the effort to prevent adolescent smoking. 1, 2 Nonsmoking adolescents who are aware of cigarette advertising and can identify specific advertisements are more likely to progress toward smoking over time. 3– 7 Exposure to tobacco promotional campaigns and ownership of promotional items such as clothing with cigarette brand logos are associated with greater susceptibility to and actual use of tobacco. 3, 8– 13 As a result of these findings and other evidence linking tobacco marketing activities to youth smoking initiation, 14– 18 there has been widespread support among public health advocates for legislated controls on tobacco advertising and promotion. 19– 23 The 1998 Master Settlement Agreement, under which the tobacco industry agreed to restrict the content of print advertisements, eliminate billboard advertising, and limit certain categories of promotional activities, has changed many aspects of tobacco marketing in the United States but has not resolved fundamental concerns about the overall extent of industry marketing activities and their potential impact. 24– 27 There are doubts about the effectiveness of the implementation of the Master Settlement Agreement’s restrictions 24, 25, 27 and, more generally, concerns about the success that can be achieved by limiting some but not all forms of tobacco marketing, given the past record of industry resourcefulness in response to legislative restrictions. 28 In fact, overall cigarette marketing expenditures in the United States rose from $4.9 billion in 1995 to $9.5 billion in 2000, with most of the expenditures being used for promotional allowances, special offers, and gifts. 29 Early investigations of the post–Master Settlement Agreement environment have found that advertising also appears to have increased in magazines, especially those with high youth readership, 30– 32 and at point-of-sale displays in stores. 32– 34 The policy environment pertaining to controls on tobacco marketing is in significant transition in the rest of the world as well. Numerous countries have instituted partial or comprehensive marketing bans. 29 In late 2002, the 15-nation European Union approved a ban on tobacco advertising through newspapers, magazines, radio, and the Internet, to take effect in 2005. 35 The ban is not comprehensive, since advertising will still be allowed on posters and billboards, in cinema, and through indirect sources such as clothing. This is a critical consideration, because partial bans result in industry resources being shifted to the remaining venues, and thus partial bans have been found to be far less effective than comprehensive bans in reducing tobacco consumption. 36– 39 Most significant, in May 2003, the World Health Assembly adopted the Framework Convention on Tobacco Control, an international treaty that will require participating countries to implement, among other provisions, comprehensive bans on tobacco advertising and promotion. 19, 40– 44 Currently, the process of achieving treaty ratification by the requisite 40 World Health Organization member nations is underway. At present, there is very little research on the patterns of young people’s exposure to tobacco advertising and promotion under conditions of a legislated ban. Relevant studies on US adolescent populations over the past decade have of necessity been conducted under conditions of high saturation of advertising content. For example, surveys from the late 1990s show that virtually all US teenagers have been exposed to some form of tobacco advertising, 1, 45, 46 and adolescents’ advertising exposure worldwide tends to be very high as well. 47 Furthermore, the impact of advertising under restricted conditions is unexplored. If health advocates are successful over the coming years in reducing the exposure of adolescents to advertising and other forms of promotion, new research questions will emerge that pertain to the changing social environment. Research is needed on the degree to which relatively limited exposure to tobacco marketing is associated with young people’s tobacco use and with psychosocial variables that usually predict use. If associations are still found between marketing exposure and smoking behavior, the advisability of relying on partial rather than strong comprehensive bans will be called into question as a tobacco control strategy. The present study addresses these issues by examining the marketing exposure of adolescents in Norway, as well as the relationship of that exposure to their current smoking and future smoking expectations, using data from 1990 and 1995 national surveys conducted by Norway’s National Council on Tobacco and Health (now the Department for Tobacco Control). Norway passed legislation banning the advertising and promotion of tobacco in 1975, which included the advertising of all types of tobacco products as well as the use of tobacco products in connection with advertisements for other types of items. Several exceptions to the prohibition were allowed, including newspapers and other printed materials that were imported into Norway as well as indirect publicity in movies and television broadcasts (e.g., sporting events). Thus, despite the relatively comprehensive nature of the ban, the presence of tobacco marketing was not completely eliminated because of some channels not addressed by the legislation and others that proved difficult to control. 48 The 1975 Norwegian legislation has been considered a strong success. 48– 50, 51 For example, smoking rates declined steadily among adolescents and young adults through the 1980s (including a decrease among 13- to 15-year-olds from 45.5% in 1975 to 23.6% in 1990 52 ), before leveling off during the 1990s. Nevertheless, one goal of Norway’s nationwide survey of adolescents was to gauge the degree of penetration of marketing into the country, despite the ban, from the perspective of its youth. Another was to determine whether the tobacco marketing with which the youth came into contact, though limited, was related to their tobacco use. The ban was strengthened by new legislation in 1996, but its conditions were unchanged for the 1990 and 1995 survey cohorts. The dependent variables we examine include the adolescents’ current smoking status and their expectations about whether they will smoke at 20 years of age. Future expectations to smoke or not smoke is a consistent predictor of transitions pertaining to smoking behavior 4, 51, 53– 55 and adds an important dimension to the understanding of adolescents’ cognitions regarding smoking. Altogether, 3 primary questions are investigated: (1) To what degree have Norwegian adolescents been exposed to tobacco marketing, despite the ban? (2) Are adolescents’ present smoking habits related to their exposure to marketing? (3) Are adolescents’ future smoking expectations related to their exposure to marketing? The examination of these questions can help to shed light on the Norwegian experience as a case study of a nation that has instituted a relatively comprehensive advertising ban.