Abstract
Objectives
To examine young people's awareness of and involvement with tobacco marketing and to determine the association, if any, between this and their smoking behaviour.
Design
Cross sectional, quantitative survey, part interview and part self completion, administered in respondents' homes.
Setting
North east England.
Participants
Stratified random sample of 629 young people aged 15 and 16 years who had “opted in” to research through a postal consent procedure.
Results
There was a high level of awareness of and involvement in tobacco marketing among the 15-16 year olds sampled in the study: around 95% were aware of advertising and all were aware of some method of point of sale marketing. Awareness of and involvement with tobacco marketing were both significantly associated with being a smoker: for example, 30% (55/185) of smokers had received free gifts through coupons in cigarette packs, compared with 11% (21/199) of non-smokers (P<0.001). When other factors known to be linked with teenage smoking were held constant, awareness of coupon schemes, brand stretching, and tobacco marketing in general were all independently associated with current smoking status.
Conclusions
Teenagers are aware of, and are participating in, many forms of tobacco marketing, and both awareness and participation are associated with current smoking status. This suggests that the current voluntary regulations designed to protect young people from smoking are not working, and that statutory regulations are required.
Introduction
The role of mass media advertising in encouraging smoking is now well established. Econometric studies, which model the effects of advertising expenditure on aggregate consumption, generally show that prevalence increases as the amount of advertising increases and reduces when advertising is banned.1 Consumer studies show that young people who smoke are more likely to appreciate and to be aware of tobacco advertising,2–12 sponsorship,13–15 and merchandising.16–19 Furthermore, cohort studies have shown that awareness and involvement with these forms of marketing predicts future smoking behaviour among young people.20
However, less is known about young people's experiences of other marketing devices, such as point of sale promotion, coupon schemes, brand stretching (the attachment of tobacco brands to non-tobacco products), or the internet. This study presents data from a cross sectional study of young people's experiences with the full range of such devices. While it cannot prove causal effects, it does show the scope and reach of tobacco marketing and provides support for tight and comprehensive regulation.
This is particularly relevant at present, as the detailed provisions of the UK government's primary legislation to ban tobacco advertising and promotion are currently being reviewed.21
Methods
The research examined young people's awareness of and involvement with a broad range of tobacco marketing activities. In line with previous studies on tobacco advertising, sponsorship, and merchandising, we expected that young people would be aware of and involved in other forms of tobacco marketing, and that this awareness and involvement would be positively associated with smoking status.
Setting and data collection
A random sample of 15 year olds, stratified by sex and postcode sector, was drawn from the patient registration database of a health authority in the north of England. Ethics committee approval was granted but required that names and addresses be passed to the researchers only after potential respondents had consented. Initially, therefore, a sample of 2400 was invited to participate in the research, which it was hoped would yield at least 280 smokers. Via their parents, all were sent an information sheet, questionnaire (to establish smoking status), consent form to be countersigned by a guardian, and a freepost return envelope. Two reminders were sent.
A total of 1062 young people consented, a response rate of 48% after redundant addresses were discounted. Other studies have shown that around one in five 15 year olds smoke,22 and in our sample 214 (20%) were regular smokers; 825 (78%) were not regular smokers, and 23 (2%) did not state their smoking status. The consent process provided a more than adequate sample of young people who were not regular smokers so, to minimise costs, we used random numbers to reduce this portion of the sample by 373.
Ultimately 686 names and addresses were allocated to professional interviewers, who were briefed and instructed to make at least four attempts to contact and interview respondents. Interviewers were given no information concerning the smoking status of sample members. Parental permission was again obtained before the interview. Each respondent received a £5 gift voucher.
In all, 629 interviews were successfully completed. The time lapse between the initial sample selection and administering the survey meant that a third of respondents had reached age 16. Two respondents (ages 14 and 17) were excluded from the later analysis. Young women were overrepresented in the sample (table 1).
Table 1.
Profile of sample of young people consenting to survey of awareness of and involvement in tobacco marketing. Values are numbers (percentages)
| Characteristic | Total (n=629) | Boys (n=253) | Girls (n=376) |
|---|---|---|---|
| Age at survey (years) | |||
| 14 | 1 (<1%) | 0 (0) | 1 (<1%) |
| 15 | 407 (65) | 173 (68) | 234 (62) |
| 16 | 220 (35) | 80 (32) | 140 (37) |
| 17 | 1 (<1%) | 0 (0) | 1 (<1%) |
| Socioeconomic group | |||
| A, B, C1 | 265 (42) | 107 (42) | 158 (42) |
| C2, D, E | 364 (58) | 146 (58) | 218 (58) |
| Smoking status* | |||
| Non-smoker | 201 (32) | 89 (35) | 112 (30) |
| Tried smoking | 234 (37) | 88 (35) | 146 (39) |
| Current smoker | 185 (29) | 70 (28) | 115 (31) |
| Not stated | 9 (1) | 6 (2) | 3 (1) |
Non-smokers=“never tried smoking, not even a puff”; tried=“only ever smoked once” or “used to smoke sometimes but never smoke now”; current=“usually smoke more than 6 cigarettes per week”or “usually smoke between 1 and 6 cigarettes per week”or “sometimes smoke cigarettes now but not as many as 1 a week.”
Extensive exploratory research and qualitative piloting informed the development and refinement of a two part questionnaire. The first part was suitable for a face to face interview; the second sought information on smoking status and was completed by the respondent. Show cards and coded answering procedures were used to enable the young people to respond freely even if parents were present during the interview, as happened in 44% of cases. Analysis showed that parents' presence did not influence response.
Measures
The questionnaire examined awareness of and involvement with different types of tobacco marketing (box); smoking status; and other variables known to be related to adolescent smoking (including intentions for future smoking and education; smoking by peers, siblings, and parents; gender; and social class).
Marketing techniques used to promote smoking in Britain
Advertising: Billboards and press advertising
Sponsorship: Sports—Formula 1, snooker, golf, rugby; arts—Fringe Comedy Festival
Point of sale: Promotional material in shops—branded gantry, clocks, signage, staff clothing
Coupon schemes: Coupons included in packs of cigarettes that can be collected and exchanged for free gifts
Merchandising: Production of low cost items (pens, lighters, or T shirts); competitions; other free gifts, including free cigarettes
Special price offers: Short term offers of lower price advertised in-store, on pack flashes, or in packs
Promotional mail: Any communication to customers including offers of cheaper cigarettes, information about new brands, new coupon schemes or others
Brand stretching: Production of non-tobacco products with tobacco branding—Marlboro Classics clothes, Camel boots
Pack design: Carefully designed to communicate brand image and to add value
Internet sites: Websites promoting tobacco companies, cigarette brands, or smoking
Product placement: Paid-for placement of cigarette brands by celebrities or characters in films or television
Statistical analysis
We used bivariate analysis, including the χ2 test for trend and Kruskal-Wallis tests, to examine variations, by smoking status, in awareness of and involvement with tobacco marketing. Two logistic regression models were constructed to examine whether or not any association existed between awareness of tobacco marketing and smoking status, independently of other variables known to influence smoking. The first model examined marketing techniques separately; the second assessed their cumulative impact.
Results
Awareness of tobacco marketing communications
Young people are very aware of tobacco marketing. Table 2 shows “prompted” awareness of different marketing techniques—that is, respondents were asked whether they had come across specific, named types of marketing, such as advertisements in magazines or newspapers or special price offers for cigarettes.
Table 2.
Number (percentage) of 15 and 16 year olds aware of tobacco marketing
| Smoking status
|
P value (χ2 test for trend) | |||
|---|---|---|---|---|
| Non-smoker (n=199) | Tried smoking (n=234) | Current smoker (n=185) | ||
| Advertising | 188 (94) | 220 (94) | 176 (95) | 0.783 |
| Any advertising | ||||
| Advertisements for cigarettes in newspapers or magazines | 104 (52) | 136 (58) | 116 (63) | 0.055 |
| Advertisements for cigarettes on large posters or billboards on the street | 180 (90) | 207 (88) | 172 (93) | 0.287 |
| Point of sale marketing | ||||
| Any point of sale marketing | 199 (100) | 234 (100) | 185 (100) | — |
| Cigarette signs or posters on clocks inside shops | 76 (38) | 91 (39) | 93 (50) | 0.018 |
| Free gifts when people save coupons or tokens from inside cigarette packs | 105 (53) | 130 (56) | 138 (75) | <0.001 |
| Free gifts when people save parts of the cigarette packs | 38 (19) | 49 (21) | 74 (40) | <0.001 |
| Free gifts showing cigarette brand logos given out at events such as concerts, festivals, or sports events | 26 (13) | 30 (13) | 32 (17) | 0.410 |
| Free gifts from the shopkeeper when people buy cigarettes | 15 (8) | 17 (7) | 24 (13) | 0.114 |
| Special price offers for cigarettes | 93 (47) | 121 (52) | 112 (61) | 0.005 |
| Clothing or items with cigarette brand names or logos on them | 41 (21) | 41 (18) | 56 (30) | 0.035 |
| Promotional mail from cigarette companies being delivered to people's homes | 15 (7) | 36 (15) | 35 (19) | 0.001 |
| Competitions or prize draws linked to cigarettes | 28 (14) | 36 (15) | 36 (19) | 0.300 |
| New pack design or size | 34 (17) | 26 (11) | 54 (29) | 0.017 |
| Famous people in films or on television with a particular brand of cigarettes | 31 (16) | 48 (21) | 44 (24) | 0.132 |
| Internet sites for cigarettes or smoking | 8 (4) | 14 (6) | 7 (4) | 0.358 |
| Free trial cigarettes being given out or offers to send away for free cigarettes | 8 (4) | 18 (8) | 21 (11) | 0.013 |
| Average number of marketing techniques aware of | 6.4 | 6.7 | 8.1 | <0.001* |
One way analysis of variance: F=15.257, df=2, P<0.001.
Nearly all had seen cigarette advertising on billboards, and over half had come across it in the press. All had seen some form of advertising at point of sale, and around half were aware of coupon schemes and special price offers for cigarettes.
Other forms of promotion were less familiar. Around a fifth of the sample had come across brand stretching (clothing or other items with cigarette logos on), new pack designs or sizes, free gifts offered on packets, competitions, and famous people smoking in films and on television. There was also awareness, at a lower level, of free gifts from the shopkeeper, promotional mail from cigarette companies, internet sites, and the distribution of free cigarettes.
Young smokers were more aware of virtually all forms of tobacco marketing than were non-smokers or those who had tried smoking (table 2). This trend was particularly noticeable for free gifts, special price offers, promotional mail, and pack design.
Involvement with tobacco marketing
Involvement with tobacco marketing was broadly similar for both male and female respondents (table 3). Many had actively participated in tobacco marketing—for example, by using coupon schemes or receiving direct mail. Over half of current smokers had participated in tobacco marketing of one form or another, compared with around a quarter of non-smokers and those who had tried smoking. Almost a third of smokers had received free gifts through coupon schemes, over a quarter had received special price offers for cigarettes and around a tenth had received free gifts at events or had been exposed to promotional mail.
Table 3.
Number (percentage) of 15 and 16 year olds involved with tobacco marketing
| Smoking status
|
P value (χ2 test for trend) | |||
|---|---|---|---|---|
| Non-smoker (n=199) | Tried smoking (n=234) | Current smoker (n=185) | ||
| Received free gifts as a result of self or someone else collecting coupons or tokens from inside cigarette packs | 21 (11) | 38 (16) | 55 (30) | <0.001 |
| Received free gifts as a result of self or someone else saving parts of cigarette packs (eg pack fronts) | 11 (6) | 14 (6) | 31 (17) | <0.001 |
| Received special price offers for cigarettes | 7 (4) | 12 (5) | 51 (28) | <0.001 |
| Received promotional mail from cigarette companies | 6 (3) | 11 (5) | 16 (9) | 0.015 |
| Received free gifts showing cigarette brand logos given out at events such as concerts, festivals, or sports events | 6 (3) | 10 (4) | 16 (9) | 0.014 |
| Owned clothing or other items with a cigarette brand name or logo | 3 (2) | 9 (4) | 15 (8) | 0.002 |
| Looked at an internet site for cigarettes or smoking | 3 (2) | 5 (2) | 5 (3) | 0.415 |
| Received free gifts from the shopkeeper when buying cigarettes | 1 (<1) | 5 (2) | 5 (3) | 0.101 |
| Entered a competition that was linked to cigarettes | 2 (1) | 4 (2) | 10 (5) | 0.007 |
| Received free trial cigarettes | 0 (0) | 2 (1) | 10 (5) | <0.001 |
| Done any of these | 45 (23) | 65 (28) | 97 (52) | <0.001 |
Association between awareness of tobacco marketing and smoking status
Table 4 shows the association between awareness of each tobacco marketing technique and current smoking status when other variables that are known to be linked with teenage smoking were controlled for. Awareness of coupon schemes and brand stretching were both associated with the greater probability of being a current smoker, as was having friends, siblings, or a mother who smoked. In this model, having friends who smoke was most strongly associated with being a current smoker.
Table 4.
Logistic regression analysis of variables associated with odds of being a current smoker in relation to types of tobacco marketing
| Variable (reference category) | No | Odds ratio (95% CI) | P value |
|---|---|---|---|
| Awareness of coupon schemes: | |||
| Yes (no) | 395 | 1.90 (1.18 to 3.05) | 0.008 |
| Awareness of clothing or other items with cigarette logos on them: | |||
| Yes (no) | 139 | 1.78 (1.11 to 2.88) | 0.018 |
| Number of friends who smoke: | |||
| All of them (none of them) | 43 | 36.50 (9.33 to 142.81) | <0.0001 |
| Most of them (none of them) | 205 | 18.41 (5.49 to 61.78) | <0.0001 |
| About half of them (none of them) | 146 | 7.52 (2.18 to 25.97) | 0.001 |
| A few of them (none of them) | 126 | 2.08 (0.55 to 7.86) | 0.282 |
| Not sure (none of them) | 19 | 8.19 (1.54 to 43.42) | 0.013 |
| Any siblings who smoke: | |||
| Yes (no) | 185 | 2.78 (1.80 to 4.30) | <0.0001 |
| Not sure (no) | 47 | 2.71 (1.14 to 6.46) | 0.025 |
| Mother smokes: | |||
| Yes (no) | 231 | 1.91 (1.26 to 2.92) | 0.003 |
| No mother (no) | 9 | 3.48 (0.81 to 15.01) | 0.095 |
| Not sure (no) | 20 | 0.19 (0.03 to 1.00) | 0.050 |
| Constant | 0.013 | <0.0001 | |
Variables were included in the analyses in a forward stepwise procedure. A probability of 0.05 was used for a variable to enter the equation and a probability of 0.10 to be removed.
The dependent current smoker (1) was compared against non-smokers and tried smokers (0).
The independents included all marketing variables (advertising, point of sale, coupon schemes, sponsorship, promotions, special price offers, promotional mail, brand stretching, famous people in TV and films, new pack design or size, and internet sites) and all controls (including gender, age, friends' smoking, sibling's smoking, mother's smoking, father's smoking, socioeconomic group, marital status of parents, future education intentions, and parental presence during interview).
The number of tobacco marketing techniques of which young people were aware was positively related to current smoking status (table 5). Having friends, siblings, or a mother who smoked was associated with a greater probability of being a current smoker.
Table 5.
Logistic regression analysis of variables associated with odds of being a current smoker in relation to amount of tobacco marketing
| Variable (reference category) | No | Odds ratio (95% CI) | P value |
|---|---|---|---|
| Total number of tobacco marketing techniques of which aware | 1.13 (1.06 to 1.20) | <0.0001 | |
| Number of friends who smoke: | |||
| All of them (none of them) | 43 | 29.38 (7.56 to 114.12) | <0.0001 |
| Most of them (none of them) | 205 | 16.05 (4.82 to 53.50) | <0.0001 |
| About half of them (none of them) | 146 | 6.72 (1.95 to 23.07) | 0.002 |
| A few of them (none of them) | 126 | 1.92 (0.51 to 7.21) | 0.336 |
| Not sure (none of them) | 19 | 7.21 (1.37 to 37.92) | 0.020 |
| Any siblings who smoke: | |||
| Yes (no) | 185 | 3.01 (1.94 to 4.66) | <0.0001 |
| Not sure (no) | 47 | 2.93 (1.26 to 6.82) | 0.013 |
| Mother smokes: | |||
| Yes (no) | 231 | 1.97 (1.29 to 2.98) | 0.002 |
| No mother (no) | 9 | 3.26 (0.77 to 13.82) | 0.109 |
| Not sure (no) | 20 | 0.21 (0.04 to 1.13) | 0.069 |
| Constant | 0.01 | 0.010 | |
Variables were included in the analyses in a forward stepwise procedure. A probability of 0.05 was used for a variable to enter the equation and a probability of 0.10 to be removed.
The dependent current smoker (1) was compared against non-smokers and tried smokers (0).
The analysis included the following controls: gender, age, friends' smoking, sibling's smoking, mother's smoking, father's smoking, socioeconomic group, marital status of parents, future education intentions, and parental presence during interview.
Discussion
Young people aged 15-16 are aware of, and participating in, many forms of tobacco marketing, and this phenomenon is consistently associated with being a smoker. When other factors that are known to be linked with teenage smoking are held constant, awareness of coupon schemes and brand stretching, and tobacco marketing in general, are all independently associated with current smoking.
In some instances this may be explained by the greater exposure that young smokers are likely to have to certain forms of tobacco marketing (package design or price promotions, for example), but not in others (brand stretching and shop advertising). In any case, it is likely that young people, and especially young smokers, are getting some kind of benefit or reassurance from these different forms of tobacco marketing. Previous researchers have drawn a link between this type of reward and the reinforcement of smoking.20
This confirms the need for statutory controls on tobacco marketing; the current voluntary regulations designed to protect young people are clearly not working. It also suggests that the Tobacco Advertising and Promotion Bill should be comprehensive: it should outlaw not just the specific practices of couponing and brand stretching, but all forms of tobacco marketing.
Finally, flexibility is also likely to be important; there is a need to combat the marketing innovations that will undoubtedly emerge as the bill takes effect. The establishment of a Tobacco Regulatory Authority, as proposed by last year's Select Committee report,23 is the obvious way to achieve this.
What is already known about this topic
Tobacco advertising, sponsorship, and merchandising encourage teenage smoking
The effect of other forms of tobacco marketing, such as brand stretching or coupon schemes, is unknown
What this study adds
15-16 year olds are aware of and participate in these other forms of tobacco marketing, and this phenomenon is consistently associated with being a smoker
When other factors known to be linked with teenage smoking are held constant, awareness of coupon schemes, brand stretching, and tobacco marketing in general are all independently associated with current smoking
This suggests that young people, and especially young smokers, are getting some kind of benefit or reward from tobacco marketing
Acknowledgments
We thank the respondents and acknowledge the support of the fieldforce team and Newcastle and North Tyneside Health Authority.
Footnotes
Funding: This study was largely funded by the Cancer Research Campaign, with additional support from the Department of Health.
Competing interests: None declared.
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