The association between tobacco marketing practices and youth smoking attitudes, beliefs and behavior

Existing evidence suggests tobacco remains the least regulated consumer product in the U.S. and childhood experimentation with cigarettes and progression to regular use remains a public health concern. Therefore, the purpose of the present study was to examine the association of tobacco point-of-purchase (POP) marketing practices on youth smoking behavior using a nationally representative sample of adolescents.; The study used cross-sectional data collected during a five-year period (1999 through 2003) from a nationally representative sample of 8th , 10th and 12th grade students and the communities in which they reside. For the five years of data, there are a total of 109,308 students and 966 community areas. Students were surveyed about their smoking attitudes, beliefs and behavior and tobacco marketing retail information on cigarette placement, advertising, promotions, and prices, as well as tobacco store density, and industry sponsored and health-related tobacco control signage was collected from the communities. Because students were clustered within communities, a generalized estimating equations (GEE) approach was used for empirical analyses with weighted data. All analyses controlled for demographic and socioeconomic characteristics.; Lower cigarette prices, less self-service placement, increased levels of tobacco store density, and advertising were found to be associated with more positive attitudes and beliefs about smoking. In addition, lower cigarette prices, self-service placement, higher levels of advertising, and promotions were found to be associated with increased youth smoking behavior. Results vary by attitudinal and behavioral outcome, but, overall, higher cigarette prices had the strongest impact on increasing disapproval and perceived harm, and decreasing prevalence and consumption. The impact of price on youth smoking behavior is conservative when compared to existing literature. However, analyses indicate by accounting for other important dimensions of tobacco marketing practices that previous research did not, may have resulted in the effects of price on youth smoking behavior being overstated. Results also suggest the tobacco retail environment works both directly and indirectly through attitudes and beliefs on behavior. Analyses indicate the tobacco retail environment does influence youth smoking attitudes, beliefs, and behavior, and additional research is need to help translate these findings into successful policies and tobacco control programs.