The impact of retail cigarette marketing practices on youth smoking uptake

Objective: To examine the differential associations of cigarette retail marketing practices on youth smoking uptake. Design: Analyses from annual, nationally representative, cross-sectional surveys of 8th, 10th, and 12th graders in the United States. Setting: The February 1999 through June 2003 Monitoring the Future surveys involved 109 308 students and data on retail cigarette marketing collected from 966 communities in which the students reside, as part of the Bridging the Gap Initiative: Research Informing Practice and Policy for Healthy Youth Behavior. Participants: A total of 26 301 students were selected for this study. Main Exposures: Point-of-sale advertising, promotions, prices, and placement. Outcome Measure: Using a smoking uptake measure to account for stages that identify the process by which adolescents begin smoking, we calculated odds ratios and confidence intervals through generalized ordered logit analyses, with weighted data that controlled for demographic and socioeconomic characteristics and accounted for clustering at the community level. Results: Higher levels of advertising, lower cigarette prices, and greater availability of cigarette promotions were associated with smoking uptake. Advertising increased the likelihood of youth initiating smoking, price increased the likelihood of smoking at most levels of uptake, and availability of promotions increased the likelihood that youth will move from experimentation to regular smoking. Conclusions: Cigarette retail marketing practices increase the likelihood of smoking uptake. These findings suggest that specific restrictions on retail cigarette marketing may reduce youth smoking.