Smoking and preference for brand of cigarette among adolescents

Journal of Substance Abuse, 8(3), 347-359 (1996)

Smoking and Preference for Brand of Cigarette Among Adolescents

Robert J. Yolk The University of Texas Medical Branch at Galveston.

Dennis W. Edwards Robert A. Lewis

Purdue University.

John Schulenberg University of Michigan.

This study examined the association between having a preferred brand of cigarette and smoking in African American, Mexican American, and White 5th, 7th, 9th and l l th graders. The prevalence of having a preferred brand of cigarette increased with grade level, with over 20% of 11 th graders reporting having a preference. Brand preference was related to cigarette use in a dose-response fashion for all subgroups, with preference highest among African American students who smoked at least half a pack of cigarettes on a dally basis. There was a strong association between having a brand preference and current daily cigarette use, whereas preference also was related to intention to smoke cigarettes when older. These findings suggest that brand preference may play an important role in cigarette use acquisition and maintenance among adolescents.

T h e adver t is ing practices of the tobacco indus t ry are c o m i n g u n d e r increas ing scru t iny as a growing body of evidence accumula tes r ega rd ing the association of adver t is ing a n d cigaret te use (Aitken, Leathar, Scott, & Squair 1988; Fischer, Schwartz, Richards, Goldstein , & Rojas, 1991; M a d d e n & Grube , 1994; Pierce et al., 1991). Recen t research has shown that very y o u n g ch i ld ren recognize cigarette b r a n d logos at rates similar to those for r ecogn i t ion of popu l a r ca r toon characters (Fischer et al., 1991). T h e r e is also evidence that youth are a t t racted to tobacco p r o m o t i o n campaigns , a n d m a n y possess i tems p r o m o t i n g specific b r ands (Coeytaux, Al tman , & Slade, 1995). This is despite the tobacco indus t ry ' s r epea ted claims that they do n o t target ch i ld ren in their advert is ing a n d p r o m o t i o n a l cam-

Portions of this article were presented at the Annual Meeting of the Research Society on Alcoholism, June, 1994. This article was supported by a grant from the National Institute on Drug Abuse (Grant DA06514). We would like to acknowledge the assistance of Rose Anderson, Sue Cook, and Jennifer Pohlplatz in collecting the data, and Robert Jono, Carol Carlson, Jon McFather, and Kristy Smith in managing the data set.

Correspondence and requests for reprints should be sent to Robert J. Volk, Department of Family Medicine, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555-0853.

347

348 R. l- Volk, D. W. Edwards, Robert A. Lewis, and I. Schulenberg

paigns (Institute of Medicine, 1994). Of course, the very high rate of cigarette brand logo recognition suggests that it is not a specific risk factor for cigarette use, as both adolescent smokers and nonsmokers recognize the more popular brand logos. It seems, therefore, reasonable to consider other explanations for how brand of cigarette might be related to use by children and adolescents. In particular, brand preference or loyalty--the declared goal of tobacco advertising--may represent an important phase in the process of cigarette smoking acquisition and maintenance among youth.

Stage-based theories of cigarette smoking acquisition offer a conceptual frame- work for considering the association of having a preferred brand of cigarette with smoking (Aitken, Eadie, Hastings, & Haywood, 1991; Elder et al., 1990; Stern, Prochaska, Velicer, & Elder, 1987). Adolescents in the contemplative stage have begun to consider smoking, and associate certain positive connotations with cigarette use. In the action stage, adolescents have begun to smoke, and place greater emphasis on the positive aspects of smoking while being uncommitted about smoking in the future. The maintenance stage is characterized by more regular cigarette use, with no desire to stop and a commitment to smoking in the future.

Two national surveys have examined cigarette brand preference among adolescents. In 1989 the National Center for Health Statistics of the Centers for Disease Control and Prevention conducted the Teenage Attitudes and Practices Survey (TAPS), and in 1990 the National Cancer Institute surveyed ninth graders in 10 U. S. communities as part of the Community Intervention Trial for Smoking Cessation (COMMIT; Centers for Disease Control, 1992) evaluation. The TAPS study was repeated in 1993 (TAPS-II; Centers for Disease Control, 1993). Several conclusions were drawn from the COMMIT, TAPS, and TAP-II studies: Brand preference tends to be more concentrated among adolescents than among adults, with approximately 85% of adolescents preferring one of three brands (Marlboro, Camel, or Newport). African American adolescents preferred mentholated cigarettes, whereas Whites preferred Marlboro, and Hispanic adolescents preferred both types in about equal proportions. The recent (1989-1993) increase in preference for Camel and decrease in preference for Marlboro is explained in large part by changes in advertising expenditures over the same time period. The exception is Newport, where expenditures decreased but preference increased by 4.5%. How- ever, the COMMIT and TAPS studies reported preferred brands for only those adolescents who purchased their own cigarettes, about 70% of current smokers. Brand preference was not assessed for adolescents having other sources of cigarettes, such as peers, siblings, or parents. Furthermore, it was assumed in these studies that purchasing cigarettes necessarily implied a brand preference, which may not be the case for many adolescents.

The relationship of brand preference to patterns of use and intention to smoke when older has not been examined in previous studies. This study investigates the association between having a cigarette brand preference and cigarette use in a multiethnic, multiracial sample of primary and secondary students. The study had four purposes: (a) to determine the prevalence of cigarette brand preference as a function of grade level in the total sample, and in gender and racial/ethnic subgroups; (b) to examine sociodemographic predictors of having a cigarette brand

Teen Smoking and Brand Preference 349

preference; (c) to examine the association of having a cigarette brand preference with current cigarette use; and (d) to examine the association of having a cigarette brand preference with expected future cigarette use.

METHODS

The Youth Evaluation Study is a prospective mult icohort study of adolescent drug use initiation and sequencing, designed to determine similarities in initiation and sequencing for male and female adolescents of various ethnic and racial back- grounds. Using a cohort-sequential design, approximately 8,000 adolescents are being moni tored over a 3-year period. Data repor ted here come from the Fall of 1992 (the 2nd year of the project), for 5th, 7th, 9th and l l t h graders.

Subjects and Procedures

Lake County in northwestern Indiana and Cook County in northeastern Illinois were selected as target counties for sampling due to their representation of African American and Hispanic (primarily Mexican American) students in the school sys- tems. In addition, Lake County offered a mix of urban, suburban, and rural school corporations. These two counties are included in the Chicago-Gary-Lake County, IL-IN-WI Consolidated Metropolitan Statistical Area (CMSA). Two additional, con- tiguous rural counties also were targeted. To ensure sufficient representation of African American and Hispanic students in the study, schools were stratified by racial /ethnic composition using state school enrol lment figures. Schools were then selected from each strata for recrui tment based on anticipated likelihood of the school staying with the project for the full 5 years. This sampling scheme resulted in 31 elementary, 8 secondary/middle , and 8 high schools from seven corporations participating in the 2nd year of data collection. The numbers of participants com- pleting questionnaires from each racial /ethnic and sex subgroup, by grade, are given in Table 1 (these numbers do not include absentees or students withdrawn from the study by their parents).

Scannable, self-administered questionnaires were completed by students during class time set aside for the project. Repeat visits to participating schools were scheduled to minimize attrition due to absenteeism (824, or 10.1% of eligible students were lost to absenteeism). Parents were notified of the study and could withdraw their child from the study by returning a parental notification form to the project staff at each school (274, or 3.3% of students were withdrawn by parents). Standard questions on the frequency of cigarette, alcohol, and drug use were adapted from other national drug use surveys, including the Monitoring the Future project (Johnston, O'Malley, & Bachman, 1993). A Spanish version of the questionnaire was made available (30 students requested the Spanish version). In addition, data collectors offered to read items to students with such a preference (questionnaires were read to 15 students). Questionnaire administration generally took less than 50 min and was limited to allotted class time.

350 R. I. Volk, D. W. Edwards, Robert A. Lewis, and I. Schulenberg

Table 1. Sample Size Breakdown

Grade White African American Mexican American

5th Boys 321 295 275 Girls 316 320 281 n 637 615 556

7th Bo~ 271 277 269 Girls 305 258 286 n 576 535 555

9th Bo~ 424 206 240 Girls 419 205 264 n 843 411 504

l l th Boys 389 197 274 Girls 422 239 279 n 811 436 553

All Grades Bo~ 1405 975 1058 Girls 1462 1022 1110 n 2867 1997 2168

Note. Numbers represent surveys administered.

M e a s u r e s

R a c i a l / E t h n i c I d e n t i f i c a t i o n Des igna t i on o f r a c e / e t h n i c i t y was d e t e r m i n e d by r e sponses to the ques t ion , "How

d o you p r imar i ly desc r ibe yourself?." S tuden t s were a l lowed to e n d o r s e m o r e than o n e o p t i o n to a c c o u n t for s tuden t s o f m u l t i e t h n i c mul t i r ac ia l b a c k g r o u n d s , a n d an "o ther" ca t ego ry was inc luded . R a c e / e t h n i c i t y was c o d e d as Mexican A m e r i c a n i f the s t u d e n t i n d i c a t e d Mexican o r Mexican A m e r i c a n a n d n o o t h e r H i span ic e thn ic - ity (i.e., C u b a n o r C u b a n A m e r i c a n , P u e r t o Rican, o r o t h e r Lat in A m e r i c a n ) . R a c e / e t h n i c i t y was c o d e d as Afr ican A m e r i c a n if the s t u d e n t i n d i c a t e d Black o r Afr ican A m e r i c a n , a n d was n o t previously c o d e d as H i span ic o r Mexican A m e r i c a n . Finally, r a c e / e t h n i c i t y was c o d e d as Whi t e if the s t u d e n t i n d i c a t e d Whi t e o r Cauca- sian, a n d was n o t previous ly c o d e d as Hispan ic , Mexican Amer i can , o r Afr ican A m e r i c a n . O f the total sample , 73 s tuden t s (2% o f the total) e n d o r s e d m o r e than o n e r a c i a l / e t h n i c g r o u p a n d were ass igned to a s ingle r a c i a l / e t h n i c g r o u p us ing this c o d i n g scheme .

C iga re t t e U s e

Cigare t t e use status was eva lua ted us ing two ques t ions ( Johns ton et al., 1993). First, s t uden t s were asked, "Have you ever smoked?" with the fol lowing r e s p o n s e op t ions : never (i.e., l i fe t ime abs ta iners ) , once or twice, occasionally (but not regularly), regularly in thepast, and regularly now. Responses to this ques t ion were used to ident i fy l i fe t ime abs ta iners . T h e s e c o n d ques t ion asked, "How m u c h have you s m o k e d


cigarettes during the past 30 days?" with response options ranging from not at all to 2 or morepacks per day. Responses to this question were used to identify daily cigarette users. In addition, these items were used to identify cigarette use groups and the number of cigarettes used in the past 30 days for dose-response analyses.

Intention to Smoke Cigarettes When Older Students were asked, "Do you think you will smoke cigarettes when you are

older?" Response options included definitely yes, probably yes, probably no, and definitely no. Responses were collapsed to form dichotomous indicators of intention, with the first two coded yes and the latter two coded no.

Brand Preference Students responding never to the question about having ever smoked were in-

structed to skip the other questions about cigarette use. The remaining students were then asked about their preference for brand of cigarette, "Do you prefer your brand of cigarette over all others?" Students responding yes were coded as having a brand preference.

Parents' Education Educational at tainment of the mother and father was used as an indicator of

socioeconomic status. Responses to the question, '%Vhat is the highest level of school your mother completed" (repeated for father when possible) were collapsed to form an ordinal indicator of parents' education. The highest level of education attained by e/ther parent was used for students responding for both a mother and father. Three groups were identified: (a) parent not having graduated from high school; (b) parent having graduated from high school with no further training; and (c) parent having training beyond high school.

A~lyses

The prevalence of brand preference as a proportion of the total sample, lifetime cigarette users, and current users (smoked in past 30 days) was determined for each racial/ethnic and sex subgroup across grade level. To examine sociodemographic predictors of brand preference, logistic regression models were specified where cigarette brand preference was predicted by sex of student, grade in school, race/ethnicity, and parents' educational achievement. To control for different lifedme prevalence rates of cigarette use across racial/ethnic and sex subgroups, lifetime cigarette abstainers were excluded from these analyses. In addition, models were tested separately for boys and girls to reveal any sex by race/ethnicity interac- tions. Models were then estimated separately for each racial/ethnic group to test for effects of parents' educational achievement within racial/ethnic groups. Only 9th and 11 th graders were retained in these analyses as the proportion of lifetime users was expectedly small among the 5th and 7th graders.

Several approaches were taken in examining the association of having a brand preference with cigarette use. First, to test for a dose-response relationship between preference and use, the percentage of students with a preferred brand was esti-

352 R.J. Volk, D. W. Edwards, Robert A. Lewis, and I. Schulenberg

mated for each cigarette use group following responses to the question, "Have you ever smoked?" and then for the number of cigarettes smoked on a daily basis over the past 30 days (9th and l l t h graders were combined in these analyses).

Second, odds ratios and 95% confidence intervals were computed to estimate the relative likelihood of daily cigarette use for students with a brand preference compared to those without a preferred brand of cigarette. Models were estimated separately for each racial /ethnic and sex subgroup. Data for 9th and 1 l th graders were combined as the estimates differed little by grade. Once again, lifetime abstainers were excluded to control for different use rates by boys and girls from the three racial /ethnic groups represented in this study. Finally, the same strategy was used to estimate the reladve likelihood of intention to smoke cigarettes when older for students with, compared to those without, a brand preference.

RESULTS

Preva lence o f Brand P r e f e r e n c e

Figure 1 shows the prevalence of (a) lifetime cigarette use, (b) current use (past 30 days), and (c) having a preferred brand of cigarette for the total sample. The prevalence of having a brand preference was higher for each successive grade level, and closely paralleled the prevalence of current cigarette use. Among fifth graders, 7.3% of Mexican American boys indicated having a preferred brand, highest among the racial /ethnic and sex subgroups in the study. For 1 l th graders, 26.5% of White

7 0 -

6 0 - ~ . . ~ ""

50 "" s

P / - - - Current Smokers

- - --Lifetime Users [

• 40 / / m . Smokers wi th Brand r / Preference C /

• 30 / n /

f . . . . . - ' ° ° ' ° " t / _ . - . . . . 20 / . . _ _ _ __..----_____ .-- . -

f * * ° o * * ,~,

10 - " ~" • - ..--

0 5th 7th 9th t l t h

Grade Level

Figure 1. Prevalence of lifetime cigarette use, current cigarette use, and having a preferred brand of cigarette.


girls, 24.1% of White boys, and 27.5% of Mexican American boys reported having a preferred brand. In contrast, for l l t h graders, 12.4% of African American girls, 11.6% of African American boys and 15.8% of Mexican American girls reported having a preferred brand.

Sociodemographic Predictors of Brand Preference

Table 2 gives odds ratios, and 95% confidence intervals from logistic regression models, where grade level, race/ethnicity and parents' education served as predictors of having a cigarette brand preference (lifetime cigarette abstainers were excluded from these analyses, as were 5th and 7th graders because of the low prevalence of brand preference). Sex was a significant predictor of brand preference only among the Mexican American students. Grade level was a significant predictor among boys, and in particular, White boys. In the total sample, White students were more likely to have a brand preference than were African American students. In addition, Mexican American boys were more likely than African Ameri- can boys to have a brand preference, and White girls were more likely to have a brand preference than Mexican American girls (OR = 1.57, 95% CI = 1.14, 2.16). Finally, White students whose parents had not completed high school were almost twice as likely to have a brand preference than those students whose parents were at least high school graduates (parents' education was not significant in the two ethnic minority subsamples).

Association of Brand Preference and Current Use

The dose-response relationship between having a cigarette brand preference and cigarette use is depicted in Figure 2 (9th and l l t h grades; boys and girls were combined as no differences by sex were indicated). As Figure 2 shows, there is a strong association between having a preference and use for each racial/ethnic subgroup, with fewer than 13% of the adolescents having smoked cigarettes once or twice indicating a brand preference, compared to over 75% of current, regular cigarette smokers (i.e., regularly now group). Differences by racial/ethnic subgroup were suggested, with a//African Americans in the regularly now group indicating a preference.

Figure 2 also shows the dose-response relationship between the number of cigarettes smoked on daily basis in the past 30 days and having a cigarette brand preference. The percentage of student smokers having a preference increased with the number of cigarettes smoked per day. Over one third of students who smoked less than one cigarette per day indicated having preferences, whereas over 60% of pack-a- day smokers indicated having preferences. Again, differences by racial/ethnic subgroups were suggested, where a//African American students who smoked at least half a pack of cigarettes per day in the past 30 days indicated having a preferred brand.

Table 3 gives odds ratios and 95% confidence intervals for having a cigarette brand preference related to daily cigarette use (9th and 1 l th graders combined).1

*The observed prevalence of dally cigarette users among the African American adolescents in the study was expectedly low: 24 female and 20 male African American students were dally cigarette users.

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Teen 5moking and Brand Preference 355

A

d Once or twice Occasionally Regularly In pest Regularly now

Cigaret te Use Group

B

I I W h h

Q Ah'k:an- American

• Mexican- American

Less than 1 - S Half a Pack or 1 cigarette cigarettes pack per more per

per day per day day day

Number of Cigarettes Smoked in Past 30 Days

BWhite

C3N~sn. American

• Mexican- American

Figure 2. Prevalence o f having a cigarette brand prefe rence , by (A) cigarette use group and (B) quanti ty o f cigarettes smoked in past 30 days (as percentages, 9th and l l t h graders combined) .

Table 3. Likel ihood o f Daily Cigarette Use fo r Students with, C o m p a r e d to Those Without, a Brand Pre fe rence (Lifet ime Cigarette Abstainers Excluded)

n OR (95% ~)

Girls White 489 7.61 (5.13, 11.29) African American a 208 19.47 (6.04, 62.73) Mexican American 327 4.01 (2.41, 6.68)

Boys White 456 6.35 (4.45, 9.06) African American a 161 7.79 (3.39, 17.88) Mexican American 312 4.17 (2.83, 6.14)

Note. OR = odds ratio, 95% lower and upper confidence intervals (CIs) given in parentheses; data are combined for 9th and l l th graders. "24 female and 20 male dally cigarette users among Afiican American students.

356 R.I. Volk, D. W. Edwards, Robert A. Lewis, and I. Schulenberg

Table 4. Likelihood of Intention to Smoke Cigarettes When Older for Students with, Compared to Those without, a Brand Preference (Lifetime Cigarette Abstainers Exc luded)

n OR (95% CI)

Girls White 490 4.18 (3.05, 5.73) African American 209 2.96 (1.65, 5.33) Mexican American 327 2.51 (1.82, 3.46)

Boys White 456 6.02 (4.10, 8.83) African American 165 3.24 (1.71, 6.14) Mexican American 314 3.26 (2.33, 4.55)

Note. OR = odds ratio, 95% lower and upper confidence intervals (CIs) given in parentheses; data are combined for 9th and l l t h graders.

As Table 3 shows, there was an increased likelihood of daily cigarette use for adolescents with a brand preference, for each racial/ethnic and sex subgroup. Among Mexican American youth, boys and girls with a preferred brand were about four times as likely to smoke cigarettes on a daily basis than those without a preferred brand. For White adolescents, the likelihood of daily cigarette use for adolescents with a preferred brand was more than six times greater than for those without a preferred brand. Odds ratios were highest among African American adolescents (girls in particular), although the precision of these estimates is not great given the low prevalence of dally cigarette use.

Assoc ia t ion o f Brand P r e f e r e n c e and Intent ion to S m o k e W h e n O l d e r

Finally, Table 4 gives odds ratios and 95% confidence intervals for brand preference related to intention to smoke cigarettes when older. Having a cigarette brand preference increased the likelihood of intention to smoke when older, although these estimates were generally smaller than those for current cigarette use. The odds ratios were higher for White girls and boys than for African American and Mexican American students of either sex.

D I S C U S S I O N

Several preliminary conclusions are suggested by this study. First, the prevalence of having a cigarette brand preference increases with grade level, and tends to run parallel to the prevalence of current cigarette use. As would be expected, the higher cigarette-using subgroups (White boys and girls, and Mexican American boys) reported higher rates of having a brand preference. This pattern also was supported by results from logistic regression models, where sex was a significant predictor of having a brand preference for Mexican American students, but not for White or


African American students. Second, race/ethnicity is related to having a brand preference, but the association differs by sex of student. Among boys, White and Mexican American students are more likely than African American students to have a brand preference. Among girls, White students are more likely than both African American and Mexican American students to have a brand preference. Socioeco- nomic status appears to be a predictor of preference among White students whose parents did not graduate from high school.

Third, this study demonstrates a clear dose-response relationship between hav- i nga brand preference and quantity and recency of cigarette use (as indicated by cigarette use groups and number of cigarettes smoked in the past 30 days). The majority of current, regular smokers and those smoking at least a half pack a day in this study indicated having a preferred brand of cigarette, lending support to a stage-based argument for cigarette initiation and maintenance (Air.ken et al., 1991; Elder et al., 1990; Stern et ai., 1987). According to stage-based theories of cigarette use, smokers in the maintenance stage are characterized by more regular cigarette use with no desire to stop and a commitment to smoking in the future (i.e., intention to smoke when older). A similar association of brand preference and use for experimental smokers (smoking less than one cigarette per week), light smokers (less than one pack per week), and regular smokers was noted in a study of private senior high school students (Goldstein, Fischer, Richards, & Creten, 1987). Findings from this study further indicate that cigarette brand preference is related to an increased likelihood of intention to smoke when older. A similar association has been reported for cigarette advertising awareness and intentions to smoke when older in a study of Glasgow adolescents (Elder et al., 1990).

Racial/ethnic differences were suggested for cigarette brand preference and smoking, as all African American regular smokers indicated having a preferred brand (although the prevalence of regular cigarette use among African Americans was low). Cigarette use rates do not appear to explain these differences as African American adolescents are less likely to be daily cigarette users than are White or Hispanic youth based on national estimates (this is the case when only lifedme users and those having smoked during the past 30 days are considered; Bachman et al., 1991; Johnston et al., 1993). The TAPS and TAPS-II studies reported that a higher proportion of African American adolescents prefer a single brand (New- port, 70.4% in TAPS-II), whereas the top brands for White and Hispanic youths were preferred by smaller proportions (for Whites, 63.5% preferred Marlboro, and for Hispanics, 45.5% preferred Marlboro; Centers for Disease Control, 1993). So- ciocultural factors may explain this increased concentration of brand preference among African American adolescent smokers, and these factors should be further explored.

Despite using a large and ethnically diverse sample, this study is limited by the use of cross-sectional data. A reasonable argument could be made that preference and daily cigarette use may develop concomitantly, or preference may be acquired as a result of daily cigarette use. Although the evidence from this study comes from cross-sectional data, the relative dearth of information in the empirical literature on adolescents' preferences for brand of cigarette, and the relationship of brand preference to current use and intention to use in the future, suggests that this

358 R.I. Volk, D. W. Edwards, Robert A. Lewis, and I. Schulenberg

design provides an appropr ia te initial look at the association. Clearly, longitudinal studies are needed to identify the attributable risk, if any, of b rand preference on subsequent use and tobacco-related health outcomes.

This study does not address the impor tan t issue of cigarette advertising's impact on subsequent b rand preference and cigarette use by adolescents. Yet, there appears to be empirical suppor t for this contention. Although the relationship between advertising and cigarette use is complex, there are several areas where the l i terature seems to converge. First, young children and adolescents are aware of, and able to recognize, cigarette b rand logos and advertisements (Aitken & Eadie, 1990; Aitken et al., 1988; Chapman & Fitzgerald, 1982; Fischer et al., 1991). Fur thermore , adolescent smokers are more aware of cigarette advertisements than nonsmokers , and favorable responses to cigarette advertising are related to greater cigarette initiation (Armstrong, de Klerk, Shean, Dunn & Dolin, 1990; Chapman & Fitzgerald, 1982). Recent analyses using the National Heal th Interview Survey showed a correspondence of the tobacco industry's introduction of cigarette brands targeted at females, and increased cigarette initiation between 1967 and 1973 a m o n g girls less than 17 years old (Pierce, Lee, & Gilpin, 1988). It is less clear how advertising affects more f requent or daily cigarette use. At the same time, it should be recognized that b rand awareness will not be a powerful predictor of use as a majority of youth are aware of cigarette brands (i.e., most have the risk factor). In contrast, b rand preference may be an impor tan t stage in cigarette use.

The re is a strong association between having a b rand preference and smoking a m o n g pr imary and secondary school students. Although not all adolescent cigarette smokers have a prefer red brand, preference tends to increase with use in a dose- response fashion. This study provides descriptive evidence of the association of b rand preference and use, and suggests that b rand preference may represent an impor tan t %~ithin-drug" stage and may play an impor tan t role in cigarette use initiation and maintenance.

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Aitken, P.P., & Eadie, D.R. (1990). Reinforcing effects of cigarette advertising on under-age smoking. British Journal of Addictions, 85, 399-412.

Aitken, EE, Eadie, D.R., Hastings, G.B., & Haywood, A.J. (1991). Predisposing effects of cigarette advertising on children's intentions to smoke when older. British Journal of Addictions, 86, 383-390.

Aitken, EE, Leathar, D.S., Scott, A.L., & Squair, S.I. (1988). Cigarette brand preferences of teenagers and adults. Health Promotion, 2, 219--226.

Armstrong, B.K., de Klerk, N.H., Shean, R.E., Dunn, D.A., & Dolin, P.J. (1990). Influence of education and advertising on the uptake of smoking by children. Medical Journal of Australia, 152, 117-124.

Bachman, J.G., Wallace, J.M., O'Malley, EM., Johnston, L.D., Kurth, C.L., & Neighbors, H.W. (1991). Racial/ethnic differences in smoking, drinking, and illicit drug use among American high school seniors. American Journal of Public Health, 81, 372-377.

Centers for Disease Control. (1992). Comparison of the cigarette brand preferences of adult and teenaged smokers---United States, 1989, and 10 U.S. communities, 1988 and 1990. Morbidity and Mortality Weekly Report, 41, 169--173, 179-181.

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Chapman, S., & Fitzgerald, B. (1982). Brand preference and advertising recall in adolescent smokers: Some implications for health promotion. American Journal of Public Health, 72, 491--494.


Coeytaux, R.R., Altman, D.G., & Slade, J. (1995). Tobacco promotions in the hands of youth. Tobacco Contro4 4, 253-257.

Elder, J.E, De Moor, C., Young, R.L., Widley, M.B., Molgaard, C.A., & Golbeck, A.L. (1990). Stages of adolescent tobacco-use acquisition. Addictive Behaviors, 15, 449--454.

Fischer, P.M., Schwartz, M.P., Ricbards, J.W., Jr., Goldstein, A.O., & Rojas, T.H. (1991). Brand logo recognition by children aged 3 to 6 years. Journal of the American Medical Association, 266, 3145- 3148.

Goldstein, A.O., Fischer, P.M., Richards, J.W.,Jr., & Creten, D. (1987). Relationship between high school student smoking and recognition of cigarette advertisements. Journal of Pediatrics, 110, 488-491.

Institute of Medicine. (1994). Grow/ng up tobacco free: Preventing nicotine addiction in children and youths. Washington, DC: National Academy Press.

Johnston, L.D., O'Malley, RM., & Bachman, J.G. (1993). National survey results on drug use from the monitoring the f~ture study, 1975-1992: VoL 1. Secondary students. (NIH Publication No. 93-3597). Rockville, MD: National Institute on Drug Abuse.

Madden, P.A., & Grube, J.W. (1994). The frequency and nature of alcohol and tobacco advertising in televised sports, 1990 through 1992. AmeTicanJournal of Public Health, 84, 297-299.

Pierce,J.p., Gilpin, E., Burns, D.M., Whalen, E., Rosbrook, B., Shopland, D., &Johnson, M. (1991). Does tobacco advertising target young people to start smoking?Journal of the American MedicalAssociation, 266, 3154-3158.

Pierce, J.P., Lee, L., & Gilpin, E.A. (1988). Smoking initiation by adolescent girls, 1944-1988. Journa/of the American Medical Association, 271, 608-611.

Stern, R.A., Prochaska, J.O., Velicer, W.E, & Elder, J. (1987). Stages of adolescent cigarette smoking acquisition: Measurement and sample profiles. Addictive Behaviors, 12, 319-329.

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Smoking and preference for brand of cigarette among adolescents