The Effect of Advertising on Attitudes toward Tobacco Use and Decisions about Smoking among Virginia Adolescents

Purpose:This study seeks to determine 1) whether the type of advertising exposure is associated with adolescent health perceptions of tobacco use, and 2) whether the type of media exposure is associated with initiation plans (non-smokers) or quitting plans (smokers).

Methods:  This was a cross-sectional survey of middle school students (n=11,128).  Psychosocial variables were knowledge of the risks of tobacco use (range:  3-15) and benefits of being tobacco free (range:  7-35) with higher scores indicating greater understanding.  Intentions to quit or initiate were construed as binary variables.  Exposure variables were tobacco advertisements or anti-tobacco media messages.  Covariates were gender, race, grade level, and parental closeness.  The data were analyzed using SAS, version 9.1 and hierarchical regression  was used to account for random effects of students nested within organizations.
 
Results:  Exposure to tobacco advertising was associated with higher knowledge (12.6 v. 12.4, p<0.0001). Exposure to anti-tobacco messages was associated with higher benefits (27.5 v. 26.1, p<0.0001), but exposure to tobacco advertising and benefits were not significantly associated (27.0 v. 27.1, p=0.0879).  Among 8th graders, exposure to tobacco messages was associated with higher percentages planning to initiate (19.7 v. 16.2, p=0.008) whereas anti-tobacco exposure was associated with lower percentages (16.3 v. 20.3, p=0.024).   Exposure to more than one anti-tobacco message was associated with higher knowledge and benefit. 

Conclusions:   Counter-advertising can make adolescents more aware of health benefits of remaining tobacco free.  Placing tighter restrictions on tobacco advertising directed at adolescents is warranted. The “dose-response” suggests disseminating anti-tobacco messages in many venues.