Perceptions of tobacco advertising and marketing that might lead to smoking initiation among Chinese high school girls

More than 320 million of China's 1.3 billion people are smokers (66.9% of all men and 4.2% of all women ⩾15 years old).¹ Although Chinese men have been the subject of considerable research,²,³,⁴ little is known about smoking initiation among women. Our preliminary tobacco document research suggests significant female market segmentation and brand development by transnational tobacco companies (TTCs) in China. To understand the influence of these factors, we conducted a pilot study on susceptibility among young women in Beijing.

We assembled five focus groups of high school girls aged 16–19 years (n = 27) during summer 2006. After obtaining informed consent, a trained, female medical student conducted focus groups to ascertain knowledge, attitudes, behaviours, beliefs and intentions to smoke. Thirteen subjects reported smoking experience (smoked 100 lifetime cigarettes or smoked in past 30 days). In‐depth questions identified themes such as knowledge of brand identities, influences and information about smoking among women (table 1).

Table 1 Thematic perceptions on smoking reported by focus group participants (n = 27), Beijing, 2006.

Themes		Percentage agreement*
Television and advertising seen		85
Able to name female brands		74
Marketing and promotion observe		56
Approve smoking by celebrities		52
Smoking identifies women as independent		56
Friends who smoke		63
Seen teacher smoking on campus		78
Smoking is a risk for heart disease		0

*Percentages indicate percentage of group who agreed to questions presented in focus group thematic groups.

Explicit cigarette advertisements are banned by law, but subjects noted the appearance of cigarette brand logos on television. Most subjects agreed that female cigarettes were long, slender, and pretty, with beautiful packaging. Subjects noted that female cigarettes were expensive and that people who bought them were usually white collar, successful and glamorous. They also were aware that TTCs manufacture most female brand cigarettes. Many subjects were aware that cigarettes were advertised at sporting events. “Baisha sponsors Liu Xiang” (the Chinese 110 metre hurdle Olympic gold medallist); “Marlboro tobacco advertisements are on F1 racing cars”; “555 sponsored a professional basketball game.” Cigarette sports promotion has evaded restrictions imposed by the government on tobacco advertisements on television.

Many subjects' favourite actors and singers are smokers, and they reported that they believe these celebrities are more glamorous and elegant when they smoke. Smoking in movies contributes to images of increased female glamour and sophistication.

Most smokers agreed that smoking is a way to break with antiquated social restrictions. “Smoking is quite normal—if men can smoke, then why can't women?” Many subjects agreed that smoking is used as a social tool. “When my classmates smoke, I do too.”

Students reported smoking among teachers and students in schools, despite legal restrictions. “Once there was a teacher during class who wanted to take a 10 minute break in the middle of class, clearly because he wanted to go smoke. When I told him that break time had not arrived yet, he said well let's just take a five minute break then.” Subjects stated that it was not uncommon to see high school teachers “smoking in their offices.”

Although relatively knowledgeable about the health risks of smoking, many misconceptions of the health effects of smoking existed. None of the students were aware that smoking causes damage to the cardiovascular system. In addition, an 18 year old non‐smoker stated that smoking can help smokers by “stimulating their spirits.” “Smoking could inspire people and increase creativity when composing music.”

This study suggests that concepts of femininity, independence, style and sophistication are recognised by young women in China as part of the already embedded smoking culture. These themes reflect the brand segmentation research conducted in the 1990s by TTCs.⁵ Our study is limited by a single small urban population sample. However, other research among adolescents in China⁶,⁷ confirms the vulnerability of young Chinese women. While smoking prevalence among women overall is still quite low, it appears to be increasing in urban areas, and there is a clear trend towards younger age of initiation. Our study and these reports suggest that additional, in‐depth research⁸ is needed to understand changes in knowledge, attitudes, behaviours and beliefs of young Chinese women in order to develop appropriate prevention measures.

Acknowledgements

We thank Zhang Shangzhu, PUMC medical student, for her contributions as focus group discussion leader.