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Explanation:
INTRODUCTION: MAINTAINING THE MARKET
Every day, children and youths in the United States are exposed to a wide array of persuasive, carefully crafted commercial messages encouraging the use of tobacco products. In 1991 the tobacco industry spent $4.6 billion—more than $12.6 million a day, $8,750 a minute—on advertising and promoting* cigarette consumption, and over $100 million on advertising and promoting smokeless tobacco products.1 During the past 15 years, the tobacco industry has nearly quadrupled** its marketing expenditures, at a time when tobacco consumption has been declining. Each day, approximately 3,500 Americans quit smoking and an additional 1,200 tobacco customers and former customers die of smoking-related illness; therefore, maintaining current levels of tobacco use and revenues requires that approximately 5,000 new smokers be recruited every day (about 2 million a year).2 Children and youths constitute the most likely source of new smokers. The 1991 National Household Surveys on Drug Abuse data reveal that the large majority (89%) of persons ages 30-39 who ever smoked daily tried their first cigarette by age 18, and 62% by age 16; over three quarters (77%) were smoking daily before age 20.3 At least 3 million American teenagers smoke regularly and 3 million people who regularly use smokeless tobacco are under age 21.4
Three trends have caused a growing number of public health professionals to call attention to the role of marketing (advertising and other promotional approaches) in making tobacco use attractive to children and youths and in encouraging them to use cigarettes and smokeless tobacco. First, boys and girls are beginning to use tobacco at ever younger ages. The average age at which boys and girls initiate smoking has declined over the past 4 decades by 2.4 years overall for whites, 1.3 years overall for African Americans, and 5.4 and 4.6 years for white girls and African-American girls, respectively.5 The trend for girls to begin smoking at an earlier age began between 1955 and 1966,6 and the likelihood of becoming a daily smoker at an earlier age increased sharply in the early to mid-1970s both for boys and girls.7 During the same period, a second alarming trend in tobacco use has been noted: more and more, youths began using smokeless tobacco products. Half of the nation's 6 million smokeless tobacco users are under the age of 21, and several national surveys show an increase in prevalence, especially among boys.8 A third trend, which has occurred over the past 10 years, entails a slowing down of the rate at which smoking prevalence by youths had been decreasing. Between 1977 and 1981, daily smoking among high school seniors dropped a total of about 9% (from 29% to 20%), an average of 2.25 percentage points per year. Yet during the following 11 years, 1981 to 1992 (during which time the tobacco industry more than doubled its advertising and promotion expenditures) smoking by high school seniors fell by only a total of about 3% (to 17.2%), or only 0.26 percentage points per year. Among college students, from 1980 to 1992, the decrease in daily smoking was about the same as for high school seniors, except that for 1989-1992 there was a slight upward trend in prevalence of cigarette use.9 Notably, during this same period (19811991), the per capita cigarette consumption fell 28% among adults.10
What factors have contributed to stable smoking rates and to increased rates of smokeless tobacco use among children and youths, but have proven to be less effective in sustaining tobacco use by adults? Public health advocates suggest that youths have a heightened sensitivity to image advertising and promotion themes at a time in their lives when they are struggling to define their own identities. Adolescence is characterized by three major types of developmental challenges: (a) physical maturation, (b) cultural pressures to begin the transition to adult roles and emotional independence from parents, and (c) establishment of a coherent self-concept and values.11 Cigarette advertisements are often evocative and play off these challenges in addition to being positioned to appeal to specific groups defined by social class and ethnic identity. Early adolescence (ages 11-14) in particular may be a time of increased susceptibility to the appeal of image advertising and promotions. The possible effects of marketing techniques on youths are considered below, following a brief review of shifting trends in the appropriation of tobacco marketing dollars.