UPFRONT

Volume 7, Number 2
March-April 2002

Vol. 7, Num. 2: Contents | Editorial | Up Front | Abstracts

From This Issue | Upcoming Conferences and Events | Internet Sources | Publications | Prescriptions

Vital Data

From This Issue

Research findings have indicated that receptivity to pro-tobacco media play an important role in adolescent cigarette smoking. To curb the increasing trend of cigarette smoking among our culturall y diverse youth population in the U.S., data of ethnic differences in receptivity to pro-tobacco media and its impact on cigarette smoking are needed for developing and tailoring tobacco control programs. In the first article in this issue of the Journal of Health Communication, Chen and colleagues reported their study on receptivity to pro-tobacco media and its relationship with self-reported cigarette smoking among adolescents by ethnicity. Data used for this analysis include 20,332 randomly sampled Californian boys and girls, 12 through 17 years of age. Four ethnic groups defined and used for the analysis were African American, Asian American, Hispanic Latino, and non-Hispanic White. Self-reported cigarette smoking in the past 30 days was used for measuring current smoking behavior. Four self-reported items were used for measuring receptivity to pro-tobacco media at individual level: 1) having favorite cigarette brand ads, 2) having ever received cigarette promotion items, 3) willingness to use cigarette promotion items, and 4) having formed a preference to cigarettes of particular brands. Statistical analysis indicated that levels of receptivity to pro-tobacco media, from low to high, were African Americans, Asian, Americans, Hispanic/Latinos and non-Hispanic Whites. Receptivity to pro-tobacco media was a strong predictor for past 30-day smoking for each of the four ethnic youth groups. The four media receptivity items each significantly predicted self-reported cigarette smoking. There was also a dose-response relationship between the receptivity to pro-tobacco media and self-reported cigarette smoking. Interestingly, adjusted odds ratio of receptivity to pro-tobacco media for self-reported past 30-day smoking was significant for adolescents with Hispanic/Latino (OR = 1.46, p < .01) and non-Hispanic White (OR = 1.38, p < .01) origins; and not significant for adolescents with African (OR = 1.05, p > .05) and Asian (OR = 1.17, p > .05) origins. This suggests the need for further studies on underlying cultural and behavioral mechanisms by which receptivity to pro-tobacco media impacts cigarette smoking for adolescents with different ethnic backgrounds. Although data used for this study are retrospective and cross-sectional in nature, this analysis systemat ically demonstrated the existence of ethnic differences in receptivity to pro-tobacco media as well as associations between media receptivity and cigarette smoking. According to this study, strengthening resistance to pro-tobacco advertisi ng, and limiting the pervasiveness of pro-tobacco advertisi ng activitie s with culturally appropriate programs, as well as in-depth studies on media receptivity ad cigarette smoking are necessary for a successful tobacco control among adolescent populations in California as well as in the rest of the U.S. Chen, X., Cruz, T., Schuster D., Unger, J., and Johnson, C. Receptivity to Pro-Tobacco Media and its Impact on Cigarette Smoking Ethnic Minority Youth in California. (p. 95)

There is good evidence that tobacco advertising and promotions are implicated as catalysts in the initiation of smoking among teenagers. Brand choices are usually made early during the life of a smoker, so that competition between cigarette companies is aimed at achieving market share among the young. Since billboard tobacco advertising was eliminated in the United States in 1999, the point of purchase environment has assumed new significance is being one of the few remaining avenues for tobacco advertising and promotions. In the second article of the Journal of Health Communication, Wakefield and colleagues examine the extent to which a higher prevalence of branded promotions and a higher brand share of advertisi ng at the point of purchase is associated with a higher prevalence of concordant brand choice among teenage smokers. The authors used nationally representative data from a survey involving 3,890 high school smokers with a usual brand. Onto these data, they merged records of tobacco advertising and promotions for Marlboro and Camel cigarettes from the 196 convenience stores nearest to the schools of the surveyed students. Wakefield et al. found that, compared with those who smoked other brands, students who smoked Marlboro as a usual brand were more likely to have convenience stores nearby offering a Marlboro gift with purchase and having a greater proportion of interior and exterior advertisi ng for Marlboro cigarettes. Reporting of Camel as a usual brand was associated with a greater percentage of interior advertising for Camel, but was unrelated to Camel gift with purchase promotions and negatively associated with a higher percentage of exterior advertisi ng for Camel. Limitations of the study included its cross-sectional nature and only one store per school being selected for observation. Although it was the store closest to the school, it may not be representative of in-store advertising for that community. A third limitation was that the measures of advertising and promotions were imprecise, reflecting simple counts and percentages of ads, rather than accounting for size and prominence. Notwithstandi ng these limitations, the results were consistent with the notion that Marlboro-specific advertising and promotions may influence choice of Marlboro as a usual brand to smoke among teens, but results for Camel were mixed and inconclusive. Better and more extensive measures of store advertising and promotions, as well as assessment of other sources of advertising in communities would be required to improve assessment of the relationship between brand share and brand choice by teenagers using this local area multilevel methodology. Wakefield, M.A., Ruel, E.E., Chaloupka, F.J., Slater, S.J., Kaufman, N.J. Association of point of purchase tobacco advertising and promotions with choice of usual brand among teenage smokers. (p. 113).

Despite declines in cigarette smoking prevalence over the past four decades, smoking remains the number one public health concern in the United States. In recent years, antismoking efforts have come to the forefront with the dissemination of mass media campaign messages and the infusion of monies from legislati on and tobacco settlements. Research studies, mostly based in laboratory experiments, have suggested various characteristics, such as the focus on addiction and secondhand smoking, that can make antismoking ads most effective, especially when it comes to youth audiences. Furthermore, recent research indicates that such youth audiences should be a primarily target of antismoking ads because the vast majority of smokers begin the habit by age 18 and because of the difficulty of smoking cessation. In the third article in this issue of the Journal of Health Communication, Beaudoin seeks out eight such characteristics in antismoking television advertisements and, thus, provides a descriptive understanding of antismoking mass media messages today. A content analysis was conducted on 197 antismoking television advertisements produced between 19991 and 1999. The focus of the analysis was on relationships between ad characteristics and whether ads have a youth
or adult orientation. The ad characteristics were as follows: industry manipulation, secondhand smoke, addiction, cessation, youth access, term of effects, romantic rejection, and ad appeals. The sampled ads were coded in almost equal thirds in terms of their target audience: youth, adult or general. In addition, of the adult-focused ads, 47% aimed to protect a minor from cigarette smoking or from secondhand smoke. Thus, it appears that ad producers are targeting the youth market in two ways: 1) a direct approach, with messages discouraging youth from cigarette smoking; and 2) a community-level approach, with messages encouraging adults to protect youth from secondhand smoke and discourage youth from cigarette smoking. The study found that ads with different target audiences have significantly different ad characteristics. For example, youth-oriented ads had youth characters, sociability and humor as common appeals, and social and short-term consequences. In contrast, adult-ori ented ads relied on fear appeals and long-term, health-realted consequences. The current study examines these ad foci and characteristics in terms of different mass media campaigns in the United States, including those of various state organizations and the CDC. In conclusion, the current findings suggest that antismoking advertisements are being produced and honed in a manner that fits well with the suggestions set forth by previous research. Beaudoin, C. E., Exploring Antismoking Ads: Appeals, Themes and Consequences. (p. 123)

A major issue in current tobacco control debates is the wisdom or misguidedness of focusing on youth smoking, as opposed to focusing on working toward a smoke-free society. Adherents of a youth centered approach argue that because most smokers take up the habit in their teens, this group should be the focus of public health efforts. Opponents of the youth-centered approach argue that it has the unintentional effect of positioning smoking as an adult practice, rendering it more attractiv e to adolescents and playing into the hands of the tobacco industry by suggesting that smoking is just a ``youth issue.’’ Because media have an important role in shaping behavior, and because high school newspapers are a major medium produced by and for youth, how tobacco is covered in high school newspapers may offer clues for resolving these debates. In what may be the first study ever conducted of how high school journalists cover tobacco, Malone, Wenger and Bero surveyed a national sample of high school journalists and conducted content and frames analyses of tobacco articles from their publications. ``Kids’’-framed articles were less likely to mention health effects and less likely to be favorable toward tobacco control policies than ``killer’’-framed articles. In addition, many ``kids’’ articles included ``resistance statements’’ congruent with viewing tobacco use as rebellion and/or in-dependence. The results of this study, in the context of the successes of public health campaigns that make tobacco industry behavior a focus, show that a ``kids’’-only approach may indeed have unintended negative consequences for tobacco control efforts. The authors suggest directions for media advocacy with youth journalists. Lack of a consistently used frame has been identified as a barrier to effective tobacco control. Tobacco control media and advocacy should focus on developing frames that are easily communicated, consistently used, and compatible with the developmental tasks of adolescents. Malone, R.E., Wenger, L.D., Bero, L.A. High School Journalists’ Perspectives on Tobacco (p. 139)

Upcoming Conferences and Events

The 4th World Congress on Tuberculosis will be held in Washington, DC on June 3-5, 2002. The meeting will evaluate the state of the global tuberculosis epidemic since the last TB World Congress held in 1992, review the status of TB research and identify research gaps. Topics covered will include fundamental, translati onal and operational research. Attendance should be of interest to global TB control officials, TB researchers, health systems services researchers, policymakers and funders, as well as infectious disease and pulmonary physicians. For registration information e-mail: tbcon-gress@niaid.nih.gov or call 1-202-973-8666.

The National Institutes of Health’s Office of Medical Applications of Research (OMAR) will sponsor a three-day symposium for journalists titled, ``Medicine in the Media: The Challenge of Reporting on Medical Research.’’ The symposium is presented in collaboration with the University of Missouri - Columbia School of Journalism and will be held in Bethesda, Maryland, June 23 - 25, 2002 at the Bethesda Marriott. The challenges and opportunities inherent in the process of communicating the results of medical research to the public will be examined. Stressing an evidence-based approach and re-examining conventional beliefs about medicine, the symposium prepares participants for the crucial task of evaluating research findings, selecting stories that convey meaningful messages for readers and viewers, and identifying and adding context. For registration information call Emily DeVoto at 301-496-6615. http://odp.od.nih.gov/omar/symposium/overview.html

The theme of the XIV Internati onal AIDS Conference to be held in Barcelona, Spain, July 7 - 12, 2002 is Knowledge and Commitment for Action. The theme was selected to reinforce the need that all involved sectors at all levels, including scientists, the community, people working in the field, and the public and private sectors, work together to review the knowledge gained through science and experience, and use this knowledge to commit to action. The conference received nearly 10,500 abstract submissions from the world’s leading scientists, clinicians, community representatives and people living with HIV/AIDS. This is the highest number of submissions ever received in the history of the series of international AIDS conferences. To registe r for the conference visit http://www.aids2002.com.

The Comprehensive Health Education Foundation will be holding the 7th Annual National Prevention Symposium, Empowering Youth to Thrive in Uncertain Times, in Seattle, Washington, July 31 - August 2, 2002 at the Renaissance Madison Hotel. Participants receive the latest research information on what works to reduce youth risk behaviors and
increase assets and resiliency in the areas of violence and school safety, sexuality, suicide and other injuries, and substance abuse (including tobacco). Learn about prevention programs that work, implementing and merging program models, state-of-the-art prevention science, specific strategies and activities, evaluation strategies and resources to boost current prevention efforts; and learn strategies and gain resources for program management, funding and student-driven instruction for prevention programs. For registrati on informat ion contact 1-800-323-2433 or visit http://www.chef.org/NPI.htm.

Internet Sources

A pilot program funded by the National Library of Medicine, with assistance from the Public Health Foundation and the National Network of Libraries of Medicine developed a Website to make information and evidence-based strategies related to the Healthy People 2010 objectives easier to find. The National Library of Medicine and the Public Health Foundation staff worked together to develop pre-formulated search strategies for selected Healthy People 2010 focus areas. These one-click strategies search PubMed, a database of the National Library of Medicine that provides access to over 11 million citations from MEDLINE and additional life science journals. http://nnlm.gov/partners/hp

The National Council on Patient Information & Education (NCPIE)’s Website is designed to help consumers make sound decisions about the use of medicines. The site raises awareness of communication’s role ``in promoting safe, appropriate use of medicines’’ since 1982. NCPIE’s site links to resources on medication utilization and/or compliance. http://www.talkaboutrx.org

The Office of Behavioral and Social Sciences Research, National Institutes of Health (NIH), in collaboration with four NIH Institutes, presented five lectures to recognize and honor the contributions of founding Associate Director Dr. Matilda White Riley. Each lecture can be viewed online at http://obssr.od.nih.gov/soaring/schedule.htm. Highlights include a presentation titled, ``Public Health Campaigns in the Age of Ubiquitous Media: Promise and Peril’’ by John R. Finnegan Jr., PhD., Professor and Associate Dean of the University of Minnesota School of Public Health. The lecture covers important lessons learned about public health campaigns in the context of media system changes, focusing especially on the issues of health disparities, the ``digital divide,’’ and the ``Knowledge Gap.’’ The presentation also addresses some of the communication issues confronting public health and the media as a result of the events of, and succeeding, September 11, 2001.

The American Council on Science and Health, Inc. (ACSH), a consumer education consortium concerned with issues related to food, nutrition, chemicals, pharmaceuticals, lifestyle, the environment and health, maintains a grouping of their tobacco document links on their Website. This collection includes press releases, publications, editorials, selected articles from their journal, Priorities For Health, and selected outside links. http://www.acsh.org/tobacco/index.html

Publications

The American Medical Association (AMA)’s work toward eliminating health disparities within the next decade is represented in the Cultural Competence Compendium, a 460-page resource guide to help physicians and other health professi onals communicate with patients and provide individualized, respectful, patient-centered care. Selected sections, such as Resources Emphasizing Communication Skills, are available for free download at http://www.ama-assn.org/ama/pub/category/4848.html, or the entire guide can be purchased by calling call Enza Messineo at 312 464-5333.

Communicating Science News, A Guide for Public Information Officers, Scientists and Physicians prepared and distributed by The National Association of Science Writers may be ordered by sending a check or money order for $8 to Diane McGurgan, P.O. Box 294, Greenlawn, NY 11740. More information is available on their Website as http://nasw.org.

Prescriptions

Chen, Cruz, Schuster, Unger and Johnson studied the receptivity to pro-tobacco media and its impact on adolescent cigarette smoking for African Americans, Asian Americans, Hispanic/Latinos, and Non-Hispanic Whites. The following are their findings and recommendations for tobacco research and control.

Receptivity to pro-tobacco media is associated with a higher prevalence of cigarette smoking among California youth from diverse ethnic backgrounds. Tobacco control efforts are needed to protect adolescents of all ethnic back-grounds from pro-tobacco and advertising influence. Improved measurement tools and theoretical frameworks are necessary to gain a more complete understanding of media receptivity as a risk factor for adolescent smoking across ethnic groups. -X. Chen, T. B. Cruz, D. V. Schuster, J. B. Unger, and C. A. Johnson

Wakefield, Ruel, Chaloupka, Slater, and Kaufman studied the extent to which advertising and promotions for Marlboro and Camel cigarettes in local convenience stores was related to choice of usual brand among teenage smokers. Results suggest that:

Brand-specific point of purchase tobacco advertising and promotions may influence teenage cigarette brand choice. Point of purchase tobacco advertising and promotions deserve attention as part of a comprehensive approach to reduce tobacco marketing to youth. Further research is required to explore and understand the role of point of purchase tobacco in teenage smoking marketing especially where other forms of tobacco advertising are regulated. -M. A. Wakefield, E. E. Ruel, F. J. Chaloupka, S. J. Slater, and N. J. Kaufman

Beaudoin studied various characteristics, such as the focus on addiction and secondhand smoking, that can make antismoking ads most effective, especially when it comes to youth audiences. His findings and recommendations follow.

Designers of antismoking television advertising should home their commercials with attention to the findings of related scientific research. These designers should focus their ads primarily on youth and, thus, fill the messages with appropriate characteristics and appeals. Researchers should continue to explore the nature of antismoking television ads and take the next step by testing the effects of specific and characteristics via experimental research. -C. E. Beaudoin

Malone, Wenger, and Bero surveyed high school journalists and analyzed content and framing in a sample of high school newspaper articles about tobacco. Results of this study suggest that:

High school journalists are covering tobacco issues, especially when they involve policy issues. A ``kids’’ framing strategy that focuses on youth smoking is likely to be ineffective in mobilizing youth support for tobacco control policies and may have the unintended effect of making tobacco use more attractive. A variant on ``kids’’ framing may be effective if it is youth driven, focuses on industry manipulation and is unaccompanied by the focus on smoking as an ``adult custom’’ the tobacco industry promotes. Tobacco control media advocacy should focus on developing frames that are easily communicated, consistently used, and compatible with the developmental tasks of adolescents. -R. E. Malone, L. D. Wenger, and L. A. Bero

If you would like to suggest material s for this section, please send your suggestions with your name, e-mail address, fax and phone numbers to:

Journal of Health Communication
The GW Center for International Health
Department of Internati onal Public Health
School of Public Health and Health Services
The George Washington University
2175 K Street, NW, Suite 820
Washington, DC 20037
Telephone: (202) 416-0426

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The Up Front section is edited by Wendy Meltzer, Assistant Editor, Journal of Health Communication.