S U P P L E M E N T T O COMMUN1’19Y H E A L T H STL~LIIE‘S. V O L U M E X I , N U M B E R I . 1987

SMOKING HABITS A N D BELIEFS, A N D ATTITUDES TO CIGARETTE ADVERTISEMENTS, AMONGST GRADE 6 CHILDREN

Scott Davis, Stuart McLean

School of Pharmac,y, University of Tasmania, P.O. Bou 252C. Hobart, 7001.

Abstract The major finding of this study is that tobacco

promotion is reaching and presumably influencing very young children, contrary to the tobacco industry’s voluntary code of advertising.

Introduction In 1983 a Select Committee of :he Tasmanian

Legislative Council began an inquiry into a Private Member’s Bill t o prohibit the advertising of tobacco products. The bill was identical t o one which had been lost in the Western Australian Parliament after intensive lobbying by the tobacco indus t ry . ’ -3 D u r i n g t h e T a s m a n i a n Select Committee’s hearings, it became apparent that a key point was the evidence for a connection between tobacco advertising and the initiation of smoking, particularly amongst juveniles. The aim of our study was t o gather data on smoking behaviour and attitudes to tobacco advertisements amongst Hobart primary school chjldren.

Smoking habits and related health beliefs amongst Australian adults have recently been studied extensively4 and the smoking habits of Hobart secondary students were surveyed in 1971 and 1977,5 and again in 1982.0 The latter studies found that cigarette smoking was iin established habit amongst approximately one in five 13-year olds, indicating that attitudes favourable to smoking had developed a t a younger age. A survey of primary school children in Pcrth, Western Australia, disclosed a high level of awareness of cigarette advertising amongst 10 and 1 I year olds but did not investigate the smoking habits of the children.’ Our study is the first of smoking expe r i ence , a t t i t u d e s a n d beliefs, a n d t h e influences shaping them, amongst primary school children.

Methods The survey population consisted of 156

children in 5 Hobart State primary r;chools, all in grade 6 and aged I I or 12 years. The schools were geographically widely dispersed and ranged from

the lowest to highest index of need as determined by the Education Department of Tasmania. This index was used in our study to divide the study population into 3 socioeco,nomic categories (Table 1).

Visits t o each school were arranged with the teachers, and took place during August and September, 1984. The children were asked to fill in a questionnaire which they were told dealt with the patterns of cigarette smoking in older .primary school children. In only one school was parental permission sought beforehand, resulting in 4 children declining to participate (these were the only ones in the study t o d o so). The questicnnaire was administered by a n investigator (S.D.) together with the class teacher, one page a t a time, and it took about one hour to complete. Explanations were given to children who had trouble understanding questions. It was pointed out t o the children that their answers were anonymous and, therefore, confidential. An undramatic and non-judgemental atmosphere was maintained throughout each question session.

The questionnaire consisted of 25 multiple- choice questions, some of which had space for additional comments. Two examples are given below. The questions concerned each child’s own smoking paradigms and experience, knowledge of and attitudes to cigarette brands and their advertisements (including sports sponsorship), and views on smoking and its risks. In order t o maximize the reliability of the self-reporting of cigarette smoking, this question was placed ISth, following a series of non-contentious questions to provide a settling-in period.

Results

Smoking Experience Only about half the children, in all schools,

had never smoked. In answer to the question, “Have you ever smoked?”, 53 per cent answered “no”. ’To related questions on age of starting

TABLE 1

Sex and Socioeconomic Class Distribution of the Sample

Relative Neediness of School*

Males Females Total

High ( I school) Medium (2 schools) Low (2 schools)

21 24 45 30 23 53 34 24 58

Total 85 71 I56

*Determined by the Education Department of Tasmania

smoking and consumption rate, 50 per cent responded with the option, “I never smoke”. Thirty eight children (24 per cent) said they had smoked in the past 12 months, 17 ( 1 I per cent) had smoked in the past month, and 8 ( 5 per cent) in the past week. There were n o significant sex or class differences in smoking experience. Of the 74 children who had smoked, 62 per cent only admitted to a few puffs a t a t ime , b u t t h e r e m a i n i n g 38 pe r cen t acknowledged that they smoked one or more cigarettes on each occasion. The median age of first smoking was 10 years but I I children ( I 5 per cent of those who had smoked) started a t 7 years or younger.

Sixty one (39 per cent) children responded to the question, “If you smoke cigarettes, what brand or brands d o you prefer?” While 39 (64 per percent) of these 61 smokers used any brand, 18 (30 per cent) said they smoked Peter Jackson, which was the most popular brand in all 3 socioeconomic groups (x2 = 5.5, df = 2, p > 0.05). Sixty-one subjects answered a question about their source of cigarettes, which were obtained from friends in 43 per cent of cases, shops in 39 per cent and home in 18 per cent. It is illegal in Tasmania t o sell cigarettes t o children under 16 years of age.

Eighty nine (57 per cent) children indicated that someone a t home smoked and this group included all 8 children who had smoked in the past week. The proportion of children having a smoker a t home increased with the school index of need, f rom 36 per cent of the least needy children, t o 57 per cent of the middle group, t o 84 per cent of the most needy (x* = 24. I , df = 2, p < 0.001). Ninety

four (60 per cent) children had friends who were smokers, and this proportion was independent of socioeconomic class and sex.

Sport Asked to name the sport they most liked t o

watch, 84 (54 per cent) responded, giving cricket (35) and football (33) as equal favourites. Cricket was preferred a t the less needy schools (58 per cent) and football a t the more needy (56 per cent) ; (x* 3 . 3 , df =2 , p <0.01.) Every child could think of a sponsor for their sport: 90 per cent of the cricket fans named Benson & Hedges, and 54 per cent of the football followers nominated Winfield (both are brands of cigarette). N o errors were made. Nearly all (92 per cent) of the children surveyed thought that cigarette companies sponsored sport t o advertise their products; some(up to 29 per cent) also ticked altruistic motives, such as sport needing the money.

Knowledge of Brands The children were asked to write down the 3

most popular brands ofcigaretteand most (66 per cent) were able to name 3 brands, although the proportion who could name a t least one brand fell from the most needy group (98 per cent) through the middle group (91 per cent) t o the least needy (72 per cent), ( X I = 14.9, df = 2, p < O . O O l ) . There were n o significant sex differences, except that only 55 per cent of the girls in the least needy group were able to name 3 brands of cigarette. The most commonly named brands are shown in Table 2.

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TABLE 2

( A ) Most Popular Brands of Cigarettes, and (B) Recognition of Llnnamed Advertisements

A. KO. of nominations for the 3 most popular brands, by school index of need

B. No. of children recognizing each advertisement*+

Brand of cigarette High need Medium rieed Low need Total Xz P N = 156

df=2

Peter .lackwn Winfield Alpine Renson & Hedges Marlboro Black & White Ascot Camel Sterling Others

41 29

5 0 4

I I I I

I 0

10

36 36 I3 I I 7 3 3 4 0

20

24 24 I 6 16 10

I 0 6 5

I2

I 0 I 27.8 87 12.0 34 4 .4 27 14. I 21 I .5 15 16.5 14 19.6 I I t

5 t 42

< 0.001 < 0.005 > 0. I < 0.001 > 0.3 < 0.001 < 0.00 I t - t

133 (85%) 129 (83%) 144 (92%) 133 (85%) 119 (76%) - -

118 (76%) 123 (79%) -

fhe proportion of children correctly choosing each brand declined significantly ( p <0.05) with index of need for all brandsexcept X ? = 52.8. df = 2. p < 0.001).

The difference between brands in their recognition was significant (,y* = 22.5. df = 6. p < 0.001)

Numbcrs too small for significance testing

Alpine and Sterling. The total of correct identifications also declined with index of need

+

Peter Jackson and Winfield were the most popular brands in each socioeconomic group. Black & White and Ascot were more popular in the more needy schools, and Benson & Hedges and Sterling in the less needy. Asked to tick reasons why they thought their chosen brands were so popular. 62 per cent chose “enjoynient”, 47 per cent picked “more in each packet”, arid 45 per cent “cheaper”. Advertising was not listed as an option in the question and it was only mentioned by 13 (54 per cent) of the 24 children who wrote in the space provided for additional reasons.

In the final question, the children were asked to identify 7 cigarette advertisements. from which the brand names had been removed. All the advertisements were well recognised with an average of 82 per cent correct choices. This was inversely related to index of need, the most needy group getting 91 per cent correct, the rniddle group 87 per cent, and the least needy 72 pel- cent (Table 2). There was, however, no significant rank order correlation between advertisement recognition

and the brands nominated as the 3 most popular in Table 3 (Spearman coefficient = 0.607, n = 7, p > 0.05). T h i s m a y be p a r t l y because all advertisements were so very well recognised: the advertisement for even the least popular brand overall, Sterling, was correctly identified by 79 per cent of all children. However, it does seem that subjects could be familiar with an advertisement for a particular brand without perceiving the cigarette as being very popular.

Attitudes to Advertisements Several questions explored attitudes and

beliefs regarding cigarette advertisements. Most children agreed that cigarette advertisements aimed to:

( I ) “get people who don’t smoke to start smoking” (69 per cent agreed);

(2) cent agreed);

“encourage children t o start smoking” (69 per

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(3) from one brand to another (67 per cent agreed);

“get people who already smoke to change

(4) “make smoking seem better than not smoking” (63 per cent agreed); and

(5) agreed).

“make smoking look healthy” (57 per cent

In response t o another question, only 49 per cent overall agreed that advertisements were designed to appeal more t o adults than children but this opinion was held more strongly at schools with the lowest need (57 per cent) and intermediate need (53 per cent), than at the most needy (36 per cent), (x2 = 7.7, df = 2, p < 0.025.) The only difference amongst the children was in response t o question ( I ) above: more children from the least needy group(83 per cent) than the intermediate (57 per cent) or most needy groups (62 per cent) thought that advertisements were intended to recruit new smokers (x2 = 9.4, df = 2, p < 0.01).

Views on Why People Smoke Most children ( 5 8 per cent) thought that there

would not be as many people smoking if there were no cigarette advertising, while only 28 per cent disagreed. When asked to select from a list of 4 possible reasons (not mutually exclusive) for

children taking up smoking, the following responses were obtained.

( I ) “To look good”, 71 per cent

(2) smoke”, 41 per cent.

(3) per cent.

(4) cent.

Because “parents or other family members

Because “they have friends who smoke”, 76

“To have pleasure from smoking”, 22 per

Other reasons were invited, and of the 50 which were written-in, 38 (76 per cent) concerned image and peer pressure, and only 1 mentioned advertisements.

Option (4) in this question, the expectation of pleasure from smoking, was more popular with children in the middle class group (42 per cent) than the more needy (33 per cent) or less needy ( I 2 per cent), ( x 2 = 12.7, df = 2, p < 0.011.

Perceived Risks of Smoking The dose-dependence of risk from smoking

was well understood (Table 3). Interestingly, passive smoking was considered to be as risky as occasional smoking.

TABLE 3

Perceived Risk from Different Levels of Smoke Exposure

Smoke Exposure

Risk Category

Nit Slight Reasonable Great Total

I . “Breathing in other people’s smoke”* 17 (11%) 60 (40%) 46 (31%) 27 (18%) 150 2. “Smoking occasionally”*+ 21 (14%) 56 (37%) 61 (40%) 14 (9%) 152 3. “Smoking 1-20 per day”+ 3 (2%) 9 (6%) 45 (30%) 94 (62%) 151 4. “Smoking > 20 per day”+ 4 (3%) 2 (1%) 7 ( 5 % ) 139 (89%) 152

* +

Row I versus 2, x2 6.6, df = 3, p > 0.1. Rows 2-4 versus risk. x 2 = 237, df = 6, p < 0.001

Discussion Although the sample of 156 :;choolchildren

was small, it did consist of virtually all grade 6 children in 5 of the 41 State primary schools in the Hobart metropolitan area and covered high, middle and low socioeconomic groups. Therefore, it is unlikely that the sample was biased by unrepresentative selection of subjects and we believe that the results can be generalized.

Our study, like others, relied on self-reporting for information on cigarette-smoking experience. In order t o get the most truthful responses, this question was approached in a controlled manner, mid-way through the questionnaLre. Half the children answered that they had never smoked and this proportion was consistent in the following 7 questions which dealt with detail:; of smoking experience (numbers of cigarettes, brands and sources). This, and the fact that 60 per cent said they had friends who smoked, adds credence to the finding that half the children hed had some smoking experience, although rnostly of a n experimental nature. Regular smokers were few and their status could not be validated (except that their teachers were not surprised). Probably because the study failed to identify significant numbers of regular smokers, analysis of other variables by smoking status did not, in most cases, show associations.

Only 8 children had smoked in the past week, too few to investigate variables associated with regular smoking. The remainder of the 50 per cent of children who had tried smokingcould have been experimenters and were evenly spread throughout all categories.

The results show that I I and 12 year old children have a high level of awareness of, and knowledge a b o u t , t obacco s m o k i n g a n d promotion. These findings agree with those of a survey of 10 and I I year olds in Perth, Western Australia,' and illustrates the success of the tobacco industry in reaching young children with their message that smoking is a normal and desirable part of growing

Petcr Jackson was rated the most popular brand of cigarette by the children in our survey and was also virtually the only brand preference expressed by the smokers. It is interesting to consider why Peter Jackson should have become so popular amongst the surveyed children in Tasmania in 1984, ahead o f the four brands ( Winfield. Benson & HedRes. Marlboro and .4Ipine), found to be most popular in a national survey of adults in 1983.4 These same four brands had earlier been reported to be the most popular amongst Perth primary school children' and

N.S.W. adolescents.g

The Tasmanian Mail is a free weekly newspaper which is delivered t o all households in Tasmania. A regular feature has been a full-page colour advertisement depicting youngish people enjoying Peter Jackson cigarettes, with a caption indicating the cheapness of this brand. These advertisements were usually the brightest page in the paper and it seems likely that, coming into each home every week, they made Peter Jackson a household name and consequently the brand first thought of by the children surveyed.

T h e s y m b i o t i c r e l a t i o n s h i p b e t w e e n newspapers and tobacco advertisers has been documented in Australial" and the U.S.A.I ' A good example of this special relationship occurred in the issue of the Tasmanian Mail of 13th March, 1984. in which the State Health Department had placed a lift-out anti-smoking feature. Inserted inside it was a full-colour advertisement for Peter Jackson cigarettes!

Socioeconomic class differences in exposure to advertisements may, a t least in part, explain the variations found in brand popularity. This certainly seemed t o be the case with sports sponsorship. Children from the less needy srhools tended to follow cricket rather than football and to remember that it was sponsored by Benson & Hedges, a brand they rated the third most popular. Children from the most needy school preferred football (which they recalled was sponsored by Winfield) and none of them mentioned Benson & Hedges as a popular brand. Nearly all of the children believed that sports sponsorship is a form of advertising. I t is clearly a successful form, since the sponsoring brands were well-remembered and considered to be popular.

In response to direct questions, most children said they be1ieve.d that the aims of advertisements are t o recruit new smokers (children as well as adults) and that they portrayed a better. even healthier, image for smokers. They also thought that there would be fewer smokers without advertisements; that is, that the advertisements are successful. However, when asked why children take up smoking, advertisements were ignored as a reason in favour of image, peer pressure and family example. Thus, despite the evidence above that advertisements determine childrens' recall and perception of cigarette brands, the children seemed to be unaware of this influence on themselves although cognisant of its effect on others (presumably adults). Children may not be alone in this view that advertising influences other groups of people rather than themselves.

Although the children knew that increasing cigarette exposure carries an increasing health risk (Table 3), it is possible that they d o not apply this to themselves and future studies could explore this question.

As has been reported by others,4.6.7 the prevalence of smoking is inversely related to socioeconomic class. M o r e children from needy schools had a smoker a t home and this seemed to be an important precondition for smoking in this age group. Possibly both the example of smoking and the availability of cigarettes are important. Relatively few of the children from the most needy school (36 per cent) saw cigarette advertisements as

appealing more to adults than children, suggesting that they themselves find the advertisements interesting and are therefore a target for their message.

The major findings of this study were that I I and 12 year olds know a lot about cigarettes and their promotion, about half have tried smoking, and some are already regular smokers. Therefore effective anti-smoking programmes need to start with even younger primary school children. Attention should be given to countering the effects of advertisements, since the children appear t o underestimate the effect of advertising on their own attitudes to cigarettes.

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