Brand logo recognition by children aged 3 to 6 years. Mickey Mouse and Old Joe the Camel

OBJECTIVE--Little is known about the influence of advertising on very young children. We, therefore, measured product logo recognition by subjects aged 3 to 6 years. DESIGN--Children were instructed to match logos with one of 12 products pictured on a game board. Twenty-two logos were tested, including those representing children's products, adult products, and those for two popular cigarette brands (Camel and Marlboro). SETTING--Preschools in Augusta and Atlanta, Ga. PARTICIPANTS--A convenience sample of 229 children attending preschool. RESULTS--The children demonstrated high rates of logo recognition. When analyzed by product category, the level of recognition of cigarette logos was intermediate between children's and adult products. The recognition rates of The Disney Channel logo and Old Joe (the cartoon character promoting Camel cigarettes) were highest in their respective product categories. Recognition rates increased with age. Approximately 30% of 3-year-old children correctly matched Old Joe with a picture of a cigarette compared with 91.3% of 6-year-old children. CONCLUSION--Very young children see, understand, and remember advertising. Given the serious health consequences of smoking, the exposure of children to environmental tobacco advertising may represent an important health risk and should be studied further.     

上海市儿童电视食品广告的暴露现况

 目的   了解上海市儿童电视食品广告的覆盖现况,评价新广告法的实施成效,为制定优化儿童广告环境的政策提供依据,以促进儿童健康饮食行为。方法    2018年2至3月,选取3个最受儿童喜欢的电视频道,对6∶00—22∶00的直播节目(工作日2天、周末2天)进行4天的录制。对所有广告的频道、日期、时间和产品种类进行编码,记录食品广告的主要产品、食品种类和营销手段,并与2012年对应的研究数据进行比较分析。结果    2018年与2012年相比,电视广告总数减少(5763条vs.6018条),其中食品广告占比减少(19.7%vs.25.7%)。总体电视广告覆盖率,食品广告覆盖率,核心、非核心与混杂食品广告覆盖率均出现下降。含糖饮料广告覆盖率在收视率高峰和非高峰时段均有下降(P<0.05),非核心食品(除外含糖饮料)广告覆盖率在收视率高峰和非高峰时段有所上升,但差异无统计学意义。食品广告中营销手段的使用比例大幅下降(5.1%vs.52.6%),核心食品使用营销手段的比例显著上升(P<0.001),非核心食品使用营销手段的比例大幅下降(P<0.001)。2018年核心食品广告中营销角色的出现频率高于非核心食品(P<0.05)。结论    针对儿童的电视食品广告有所改善,但是非核心食品广告在收视率高峰时段覆盖率高于其他类别的食品广告,建议对收视率高峰时段非核心食品广告进行限制。     

The Surgeon General's warnings in outdoor cigarette advertising. Are they readable?

Outdoor advertising media represent a major vehicle by which cigarette companies promote their products. We investigated the readability of the Surgeon General's warning in cigarette advertisements (ads) in two outdoor media: billboards and taxicab ads. In an experiment in metropolitan Atlanta under typical driving conditions, observers were able to read the entire health warning on 18 (46%) of 39 street billboards but on only two (5%) of 39 highway billboards. In contrast, the content of the ads (ie, brand name, other wording, and notable imagery) could be recognized under the same conditions on more than 95% of the billboards. In a similar study of 100 taxicab cigarette ads in New York City, observers were unable to read the health warning in any of the ads but were able to identify the brand name in all ads and notable imagery in 95% of the ads. Significant differences between the readability of the warning and identification of the advertising content persisted even when partially read warnings were considered to have been read. We conclude that the Surgeon General's warning is not readable in its current form in the vast majority of billboard and taxicab ads. Factors contributing to unreadability include the small size of the letters, the excessive length of the warnings, the distance between the viewers and the ads, and movement between the viewers and the ads.     

US college students' use of tobacco products: results of a national survey

CONTEXT: Adults aged 18 to 24 years, many of whom are in college, represent the youngest legal targets for tobacco industry marketing. Cigarette smoking has been described among college students, but little is known about non-cigarette tobacco use by college students or cigar use by adults of any age. OBJECTIVES: To assess the prevalence of all forms of tobacco use (cigarettes, cigars, pipes, and smokeless tobacco) among US college students and to identify student- and college-level factors associated with use of each product. DESIGN: The Harvard College Alcohol Survey, a self-administered survey conducted in 1999. SETTING: One hundred nineteen nationally representative US 4-year colleges. SUBJECTS: A total of 14,138 randomly selected students (60% response rate). MAIN OUTCOME MEASURES: Self-report of current (in the past 30 days), past-year, and lifetime use of cigarettes, cigars, pipes, smokeless tobacco, and all tobacco products. RESULTS: Nearly half (45.7%) of respondents had used a tobacco product in the past year and one third (32.9%) currently used tobacco. Cigarettes accounted for most of the tobacco use (28.5% current prevalence), but cigar use was also substantial (37.1% lifetime prevalence, 23.0% past-year prevalence, and 8.5% current prevalence) and combinations of the 2 were common. Total tobacco use was higher in men than in women (37. 9% vs 29.7%; P<.001), despite nearly identical current cigarette smoking rates between the sexes (28.5% for women vs 28.4% for men), because of greater use of cigars (current prevalence, 15.7% vs 3.9%; P<.001) and smokeless tobacco (current prevalence, 8.7% vs 0.4%; P<. 001) by men. Tobacco use was significantly higher among white students (P<.001), users of other substances (alcohol and marijuana) (P<.001), and students whose priorities were social rather than educational or athletic (P<.05). Among students who had used both cigars and cigarettes, only 8.9% smoked cigars at an earlier age than they had smoked cigarettes. CONCLUSION: Our study indicates that tobacco use is common among college students and is not limited to cigarettes. College appears to be a time when many students are trying a range of tobacco products and are in danger of developing lifelong nicotine dependence. National efforts to monitor and reduce tobacco use of all types should expand to focus on college students and other young adults. JAMA. 2000;284:699-705     

Respiratory effects of non-tobacco cigarettes

Data from the Tucson epidemiological study of airways obstructive disease on smoking of non-tobacco cigarettes such as marijuana were analysed to determine the effect of such smoking on respiratory symptoms and pulmonary function. Among adults aged under 40, 14% had smoked non-tobacco cigarettes at some time and 9% were current users. The prevalence of respiratory symptoms was increased in smokers of non-tobacco cigarettes. After tobacco smoking had been controlled for men who smoked non-tobacco cigarettes showed significant decreases in expiratory flow rates at low lung volumes and in the ratio of the forced expiratory volume in one second to the vital capacity. This effect on pulmonary function in male non-tobacco cigarette smokers was greater than the effect of tobacco cigarette smoking. These data suggest that non-tobacco cigarette smoking may be an important risk factor in young adults with respiratory symptoms or evidence of airways obstruction.     

Changes in tobacco advertising in Western Australian newspapers in response to proposed government legislation

The number of cigarette and tobacco advertisements in the major Western Australian newspapers was counted for the six-month period June to November in the years 1981 and 1983. The latter period covered the introduction of the Western Australian Government's Tobacco (Promotion and Sales) Bill 1983 and the debate surrounding it. The change in the volume of cigarette advertising in Western Australia in those two years was compared with that which occurred in comparable Queensland papers in the same period. Three major factors emerged: (i) the volume of cigarette advertising was much higher in Western Australia in 1983 compared with 1981; (ii) the volume of advertising increased markedly in Western Australia when legislative action was threatened, and remained at very high levels until the Bill failed; and (iii) the number of cigarette advertisements placed in the Queensland papers surveyed fell between 1981 and 1983. The findings are presented in support of the view that the tobacco industry made a powerful and organized attack to defeat the proposed legislation; the means it adopted to do this are discussed.     

Who profits from tobacco sales to children?

It is estimated that more than 3 million American children under 18 years of age consume 947 million packs of cigarettes and 26 million containers of smokeless tobacco yearly. These tobacco products account for annual sales of $1.26 billion. Approximately 3% of tobacco industry profits ($221 million in 1988) derive directly from the sale of cigarettes to children, an activity that is illegal in 43 states. Approximately half of the tobacco industry's profits, or $3.35 billion annually, derives from sales to people who became addicted to nicotine as children. Tax revenues to the federal ($152 million) and state ($173 million) governments from cigarette sales to children dwarf governmental expenditures on smoking and health. We describe how dozens of communities have effectively enforced laws that prohibit the distribution of tobacco to children and offer some suggestions for increasing efforts to prevent nicotine addiction.     

"Generic" packaging--a possible solution to the marketing of tobacco to young people

Creating a brand image is a key part of marketing tobacco products. It makes subtle promotion of a product possible in spite of national and State barriers (such as advertising bans) through print advertising and televised coverage of international sponsored sporting events. This article argues for the introduction of mandatory generic packaging of all tobacco products as an essential component of a complete ban on tobacco advertising and promotion. The rationale for such a move is that tobacco should be treated as the toxic, addictive and ultimately lethal substance that it is, and responsible governments should not allow cleverly designed and enticing packaging to promote a product if they have decided to end promotion of that product.     

Sports sponsorship by cigarette companies influences the adolescent children's mind and helps initiate smoking: results of a national study in India

To estimate the effect of large scale tobacco sponsorship of cricket, a study was conducted on children's knowledge and perceptions about smoking and their impact on subsequent smoking uptake. Twelve nations played 36 matched in the Wills World Cup-1996 cricket series over one month during which Wills (a cigarette brand) was extensively advertised by live broadcast to a 2-billion viewers with WILLS logo on the players' T-shirts and playground, newspapers, magazines, and hoardings. An anonymous structured questionnaire including 4 knowledge based questions about tobacco, 4 about perceptions directly promoted by Wills and 10 questions related to wrong perceptions about smoking was administered by class teachers six months after the series. A total of 5822 children (65% boys and 35% girls) in Grade 10, aged 13-17 years (median 14) were selected. Smokers increased from 137 (2.4%) before the series to 649 (11.1%) after the series. The smoking initiation rate was 2.04% (13/636) in children with full knowledge and no wrong perceptions, 7.8% (48/618) among those with less knowledge and no wrong perceptions. Among those with less knowledge but believing in at least 2 of Wills related perceptions and 3 of the smoking related perceptions the rate for smoking initiation was 20.55% (127/618). The sponsorship appeared to have a similar effect on initiation rates in both sexes despite the strong social taboo against girls smoking in India. Wrong perceptions about smoking promoted by tobacco sponsorship increases smoking initiation amongst both boys and girls even when they are aware of the risks involved. The study suggests that education, without bans on advertisements is unlikely to stop initiation of smoking among children.     

Tobacco Industry Promotion of Cigarettes and Adolescent Smoking

Context.— Whether tobacco advertising and promotion increases the likelihood that youths will begin smoking has important public policy implications. Objective.— To evaluate the association between receptivity to tobacco advertising and promotional activities and progress in the smoking uptake process, defined sequentially as never smokers who would not consider experimenting with smoking, never smokers who would consider experimenting, experimenters (smoked at least once but fewer than 100 cigarettes), or established smokers (smoked at least 100 cigarettes). Design.— Prospective cohort study with a 3-year follow-up through November 1996. Setting and Participants.— A total of 1752 adolescent never smokers who were not susceptible to smoking when first interviewed in 1993 in a population-based random-digit dial telephone survey in California were reinterviewed in 1996. Main Outcome Measure.— Becoming susceptible to smoking or experimenting by 1996. Results.— More than half the sample (n=979) named a favorite cigarette advertisement in 1993 and Joe Camel advertisements were the most popular. Less than 5% (n=92) at baseline possessed a promotional item but a further 10% (n=172) were willing to use an item. While having a favorite advertisement in 1993 predicted which adolescents would progress by 1996 (odds ratio [OR] =1.82; 95% confidence interval [CI], 1.04-3.20), possession or willingness to use a promotional item was even more strongly associated with future progression (OR=2.89; 95% CI, 1.47-5.68). From these data, we estimate that 34% of all experimentation in California between 1993 and 1996 can be attributed to tobacco promotional activities. Nationally, this would be over 700000 adolescents each year. Conclusion.— These findings provide the first longitudinal evidence to our knowledge that tobacco promotional activities are causally related to the onset of smoking.      

Cigarette smoking in Australian schoolchildren

Six thousand, four hundred and fifty-one schoolchildren who were aged nine to 15 years completed a questionnaire about their patterns of cigarette use, as part of the nation-wide Health and Fitness Survey of Australian Schoolchildren which was conducted in 1985. The survey yielded figures for the prevalence of cigarette smoking by age, sex, socioeconomic status and ethnic origin. It also provided data on the relationship between parental smoking and smoking in children. By the age of 15 years, 32.4% of the girls and 26.0% of the boys in the study sample had smoked at least one cigarette in the seven days before they were surveyed. In some of the age-groups, the average number of cigarettes that were consumed by girl smokers equalled or exceeded that of their male counterparts. There were no significant differences in the prevalence of current cigarette smoking with differences in socioeconomic status. This finding contrasts with the pattern of use in adults. Ethnic origin was a statistically-significant predictor of smoking behaviour in children. Significantly-fewer children of Asian ethnic origin were current smokers. Parental smoking status also appeared to be an important determinant of smoking behaviour in schoolchildren. This influence was more important for girls than for boys, particularly when the mother was a smoker. The over-all findings suggest that many features of the adult pattern of cigarette use are established by the age of 15 years. The findings also supported the trend towards increased cigarette consumption by girls compared with boys that was noted by earlier researchers. These findings should encourage a serious reappraisal of the role of cigarette advertising in the promotion of smoking in young persons.     

Would a medium-nicotine, low-tar cigarette be less hazardous to health?

Smoking behaviour and exposure to carbon monoxide, nicotine, and tar were studied in 19 middle-tar smokers. All smoked their own brands for three weeks and then switched to either a conventional low-nicotine, low-tar brand (control) or a medium-nicotine, low-tar cigarette for a further three weeks, the order then being reversed. The medium-nicotine, low-tar brand also had a low delivery of carbon monoxide. With the medium-nicotine, low-tar cigarette mouth-level delivery and intake of nicotine was similar to that with the smokers' usual brands, and significantly greater than with the control low-tar cigarette. Intake of carbon monoxide from the medium-nicotine, low-tar cigarette was significantly less than with either own or control brands. With both low-tar brands mouth-level exposure to tar was reduced relative to smokers' usual cigarettes. There was no evidence, however, that the reduction in tar exposure was greater with the medium-nicotine brand than with the control low-tar cigarette. Both low tar brands were "'oversmoked" relative to subjects' usual middle-tar cigarettes. The medium-nicotine, low-tar cigarette was marginally more acceptable than the control brand, and the particular design used in the study resulted in a lower intake of carbon monoxide. In terms of reducing mouth-level exposure to tar, however, the medium-nicotine, low-tar cigarette had no advantage over the control low-tar product. In part this was because of the ratio of tar to nicotine delivery obtained by human smokers was not the same as that obtained by smoking machine.     

Smoke exposure in pipe and cigar smokers. Serum thiocyanate measures

Pipe or cigar smoking traditionally has been considered a less risky alternative to cigarette smoking. Some surveys and experimental studies have suggested, however, that former cigarette smokers who switch to cigars and/or pipe (CP) are more likely to inhale then CP users who never smoked cigarettes; but this relationship has not been consistently noted. To clarify smoke-exposure levels from CP smoking, smoking histories and serum thiocyanate (SCN) levels were studied in 9,106 adults aged 25 to 74 years in population-based surveys of seven upper Midwestern communities. Analyses of the 306 male CP smokers indicated a significantly higher SCN level in the ex-cigarette-smoking CP users vs the CP users who never smoked cigarettes. Serum thiocyanate levels of both CP groups were significantly higher than those of nonsmokers and lower than cigarette-only smokers. However, the number of pipe bowls or cigars smoked per day was also significantly related to SCN levels, and this could account for much of the association between SCN and previous cigarette smoking status. Individuals currently smoking four or more pipe bowls or four or more cigars per day had an elevated smoke exposure equivalent to about ten cigarettes per day, whether or not they previously smoked cigarettes. Because of these findings and because former cigarette smokers were more likely to report heavy CP usage, cigarette smokers should be advised to quit rather than to switch to a pipe or cigar.     

Tobacco and the Third World: the growing threat

Over the past 2 decades, the Third World has become the site for growing tobacco production and consumption. Between 1960-75, tobacco production increased 5-fold in Africa, 46-fold in Latin America, but only 13-fold in Europe. Of the world's 10 top tobacco producers, 5 are in developing countries. Similarly, consumption of cigarettes is increasing twice as fast in developing as in developed countries. In some parts of India, Latin America, and the Philippines, over 70% of people smoke. This pattern can be expected to reproduce an epidemic of smoking-related diseases in the Third World before the end of the century, including lung cancer and coronary heart disease. Smoking also can be expected to affect stillbirth and infant mortality rates. For many Third World countries, tobacco is a valuable cash crop and an important source of foreign exchange. Fertile lands are used to expand tobacco cultivation rather than to produce food for local populations. The Third World tobacco industry is dominated by Wester tobacco companies based in the US, UK, and South Africa. Much of their profit comes from tobacco exports to developing countries and from their subsidiaries there, especially in light of increased awareness in developed countries of the hazards of smoking. Western governments should pressure international tobacco companies to reduce and eventually stop exports to the Third World. Third World Governments should be urged not to depend on tobacco growth and to substitute it for food crops. Health Departments should undertake surveys to determine the prevalence of smoking and, on the basis of study results, introduce appropriate health education measures. Physicians should recommend to governments legislative measures to control smoking. Finally, there should be a ban on advertising, health warnings on cigarette packets, a ban on smoking in public places, and restrictions on the sale of cigarettes to children.     

Legibility of health warnings on billboards that advertise cigarettes

At present only subjective criteria exist to determine the legibility of health warnings on billboards that display advertisements for cigarettes. We constructed a set of objective standards and used them to assess the legibility of warnings on a sample of 37 billboards in Perth, Western Australia. The three features that were analysed were the apparent size of the letters, the colour contrast between the letters and their background, and the obliqueness of the message. We also compared the size and legibility of the health warning with that of the brand name. Health warnings were not legible to passing motorists in 51% of cases and not legible to motorists who were stopped at nearby intersections in 74% of cases, whereas almost all the brand names could be read easily. These results indicate that the present system of voluntary regulation of advertisements for cigarettes has failed to ensure that health warnings on billboards are legible. For health warnings on advertisements to have any useful effect it is essential that they are legible. The only way to ensure legibility is to adopt objective requirements for it.     

Un-health promotion: results of a survey of alcohol promotion on television

To estimate how widely and to whom alcoholic drinks are promoted 1258 television advertisements were studied over a 10 week period that included the Christmas and New Year holidays in 1986-7. A total of 156 advertisements (12%) promoted alcohol, and this percentage increased significantly over the holiday period to 17%. These advertisements were longer than those advertising other products, and just over half (56%) occupied the first position in commercial breaks. During sports programmes and between the hours of 1800 and 1900 there was an increase in the number of advertisements for alcohol, but there was no difference before and after 2100. It was found that the extent and influence of the promotion of alcohol were great and that such advertising is seen by many children and adolescents.     

公立医院和民营医院营销理念的分析

目的比较上海地区公立医院和民营医院营销理念引入和运用的差异。方法采用问卷调查和实地采访相结合的方式进行调查,内容主要包括对营销理念的理解、对医院广告的看法、医院品牌和顾客满意度等。结果公立医院的营销理念和意识较民营医院淡薄,营销投入和营销管理尚不及民营医院。结论公立医院要转变观念,正确认识营销,提高营销管理的能力。民营医院要掌握营销的适度性,正确处理营销、盈利和发展的关系。     

Methodologic quality and relevance of references in pharmaceutical advertisements in a Canadian medical journal.

OBJECTIVE: To evaluate the methodologic quality and relevance of references in pharmaceutical advertisements in the Canadian Medical Association Journal (CMAJ). DESIGN: Analytic study. DATA SOURCE: All 114 references cited in the first 22 distinct pharmaceutical advertisements in volume 146 of CMAJ. MAIN OUTCOME MEASURES: Mean methodologic quality score (modified from the 6-point scale used to assess articles in the American College of Physicians' Journal Club) and mean relevance score (based on a new 5-point scale) for all references in each advertisement. MAIN RESULTS: Twenty of the 22 companies responded, sending 78 (90%) of the 87 references requested. The mean methodologic quality score was 58% (95% confidence limits [CL] 51% and 65%) and the mean relevance score 76% (95% CL 72% and 80%). The two mean scores were statistically lower than the acceptable score of 80% (p < 0.05), and the methodologic quality score was outside the preset clinically significant difference of 15%. The poor rating for methodologic quality was primarily because of the citation of references to low-quality review articles and "other" sources (i.e., other than reports of clinical trials). Half of the advertisements had a methodologic quality score of less than 65%, but only five had a relevance score of less than 65%. CONCLUSIONS: Although the relevance of most of the references was within minimal acceptable limits, the methodologic quality was often unacceptable. Because advertisements are an important part of pharmaceutical marketing and education, we suggest that companies develop written standards for their advertisements and monitor their advertisements for adherence to these standards. We also suggest that the Pharmaceutical Advertising Advisory Board develop more stringent guidelines for advertising and that it enforce these guidelines in a consistent, rigorous fashion.     

Ending smoking at the Johns Hopkins Medical Institutions. An evaluation of smoking prevalence and indoor air pollution

An empiric evaluation of a policy ending smoking in a large urban medical center was conducted. The study included a prospective cohort tracking of employees to measure changes in smoking behavior, environmental fires, smoking-related litter, and environmental tobacco pollution exposure. A 25% decrease in employee smoking prevalence was found (21.7% vs 16.2% before vs after policy implementation, respectively). The daily number of cigarettes reportedly smoked by employees who continued smoking and the total number smoked at work decreased across all occupational categories by an average of 25%. Significant reductions were noted in the level of public smoking and the amount of cigarette remnants. Nicotine vapor concentrations decreased significantly in all areas except restrooms. These findings suggest that visible smoking and environmental tobacco smoke exposure can be markedly decreased by instituting a policy eliminating smoking in a large medical center.     

Reduced tar, nicotine, and carbon monoxide exposure while smoking ultralow- but not low-yield cigarettes

An unresolved public health issue is whether some modern cigarettes are less hazardous than others and whether patients who cannot stop smoking should be advised to switch to lower-yield cigarettes. We studied "tar" (estimated by urine mutagenicity), nicotine, and carbon monoxide exposure in habitual smokers switched from their usual brand to high- (15 mg of tar), low- (5 mg of tar), or ultralow-yield (1 mg of tar) cigarettes. There were no differences in exposure comparing high- or low-yield cigarettes, but tar and nicotine exposures were reduced by 49% and 56%, respectively, and carbon monoxide exposure by 36% while smoking ultralow-yield cigarettes. Similarly, in 248 subjects smoking their self-selected brand, nicotine intake, estimated by blood concentrations of its metabolite cotinine, was 40% lower in those who smoked ultralow but no different in those smoking higher yields of cigarettes. Our data indicate that ultralow-yield cigarettes do deliver substantial doses of tar, nicotine, and carbon monoxide, but that exposures are considerably less than for other cigarettes.