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Cigarette smoking continues to be the number one preventable cause of death in the United States. Historically, more than 80% of all smokers began prior to age 18. Extensive research has been conducted on factors influencing the initiation and maintenance of smoking in adolescence, in hopes of identifying ways to decrease smoking behavior in the United States. However, adolescent rates of smoking have remained relatively stable since the mid-1970s, although rates of smoking have been declining slowly since 1997. Research suggests that, every day, an average of 3,000 adolescents become regular smokers, and 6,000 adolescents experiment with smoking.

The role that advertising plays in adolescent initiation of smoking has been an issue since the surgeon general's original report on the dangers of smoking in 1964. A number of studies have been conducted on the role of pro-tobacco advertising on general levels of smoking as well as the influence of tobacco advertising and promotions on adolescent initiation of smoking. At the same time, policymakers have realized that advertising may play an important role in countering smoking behavior. There have been two national antismoking advertising campaigns. The first was in the late 1960s. The second is the ongoing Truth campaign that is being conducted by the American Legacy Foundation. In addition, many states have utilized advertising in their anti-smoking campaigns.

Pro-Smoking Advertising

The amount spent on tobacco marketing increased twofold between 1998 and 2003. In 2003, the tobacco industry spent more than $41 million per day, for a total of more than $15 billion, on tobacco marketing in the United States alone. This spending includes advertising, price discounts, promotional allowances to retailers and wholesalers, bonus cigarettes in cigarette packs, and coupons. Indeed, in terms of money spent in 2003, advertising was not among the top five promotional activities undertaken by the tobacco industry.

The influence of tobacco advertising on tobacco use has long been a concern of policymakers. Critics charge that the tobacco industry has targeted children and adolescents with their advertising campaigns and that these campaigns have resulted in many adolescents becoming smokers. The tobacco industry, on the other hand, argues that their advertising campaigns are aimed at keeping smokers loyal to their brand or convincing other smokers to switch to their brand of cigarettes.

On January 2, 1971, a partial ban on cigarette advertising went into effect in the United States, with cigarette ads banned on television and radio. Many other countries have partial or complete bans on cigarette advertising as well. Additional restrictions were placed on tobacco advertising in the United States in 1998 when the Master Settlement Agreement (MSA) was signed between the tobacco industry and the attorneys general of the 46 states that had sued the tobacco industry. This settlement sought to stop the tobacco industry from targeting children and adolescents. In addition, the agreement resulted in the creation of the American Legacy Foundation, which was charged with establishing a nationwide anti-smoking campaign.

Despite the restrictions on advertising and promotions by the tobacco industry, children and adolescents continue to be exposed to cigarette promotions. In a study in New Hampshire and Vermont in the mid-1990s, approximately a third of the high school students owned a cigarette promotional device such as an ashtray, cigarette lighter, or article of clothing. Students who owned these promotional devices were four times more likely to be smokers. A more recent survey conducted in 2001 found that approximately one third of 12-to-17-year-olds reported seeing a print ad for cigarettes in the last month, and a little more than 40% of the adolescents reported exposure to some form of promotion in the last month. Interestingly, only 7% of students in this study reported owning tobacco promotional items, which indicates that the MSA is having some effect on adolescents' exposure to tobacco marketing. However, a disturbing and understudied trend is the use of the Internet to market tobacco products. In 2002, 42.7% of middle school students and 33.5% of high school students reported seeing tobacco products advertised on the Web. In 2004, the percentage of middle school students seeing tobacco products advertising on the Web had dropped to 34.1%, but the percentage of high school students had climbed to 39.2%.

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