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& .~///33 WHY DO JUVENILES START S44OKING?. AN INTERNATIONAL STUDY OF THE ROLE OF ADVERTISING & OTHER CONTRIBUTORY FACTORS IN ARGENTINA, AUSTRALIA, CANADA, HONG KONG, NORWAY, SPAIN, SWEDEN, SWITZERLAND, TURKEY, & THE UNITED KINGDOM. EDITED AND INTRODUCED BY: PROFESSOR J.J. BODDEWYN, Ph.D BARUCH COLLEGE, CITY UNIVERSITY OF NEW YORK Publ~ed by. INTONATIONAL ADVERTISING ASSOCIATION, New York Noveml~er 1987 O~, C~ C~ L~ O BatCo document for PFSFC 1 March 1999

A Report Prepared by: CHILDREN'S RESEARCH UNIT (CRU), London Sponsored by:. INFOTAB, Brussels Published by: INTERNATIONAL ADVERTISING ASSOCIATION, New York Cr', r~ O', BatCo document for PFSFC 1 March 1999

PREFACE The IAA is most interested in the eff~'ts of advertising on children, a so-called vulnerable group. For this reason, we pubLish this study as a valuable addition to the literature.. It is based on very careful research by a most q~ organization employing methodology which wc have examined thoroughly and found to be of the highest standards. It is also rese.a~h which has generated a comparable international data base. The IAA believes in the freedom to advertise all products and services which are legally sold and legally consumed. Further, the IAA beli~es that this freedom is indivis~le in the seine that restrictiom applied to one group of products inevitably lead to erosion of the freedom to advertise other products. These beliefs led us to publish"Tobacco Advertising Bans and Consumption in 16 Countries'(in 1983 and 1986), which clearly showed that the implementation of advertising bans was generally not followed by decreases in overall tobacco consumption. It would be convenient for those against advertising to indict it as a main cause in how and why people buy and consume products. But advertising is only one of the many variables affecting consumer choices. This ten-nation comparative study bears on all of these issues and should be an important addition to a growing literature on them. International Advertising Association World Headquarters 342 Madison Avenue, New York NY 10017, USA (212) 557-1133 0 Cr~ BatCo document for PFSFC 1 March 1999

CONTENTS 1. EDITOR'S INTRODUCTION 2. THE ISSUE 3. BASIC RESEARCH APPROACH 4. RESULTS OVERVIEW 5. KEY FINDINGS 6. JUVENILE SMOKING INCIDENCE 7. THE DIRECT IMPACT OF ADVERTISING ON JUVENILE SMOKING INITIATION 8. STARTING TO SMOKE: KEY FACTORS 9. CONCLUSIONS APPENDICES 9 I1 13 A : The Children's Research Unit (CRU) 18 B : Interviewing Children: G-~neral Comments 19 C : CRU's Research Methods Used in This Study 21 D : Smoking Frequency 23 E : Description of the Reported Surveys 24 F : Comparison of Restrictiom on Tobacco Advertising in Countries Covered in This Report 26 G : Review of the Literature 28 H : Refe~ncas 30 O', G', Lm ¢_m BatCo document for PFSFC 1 March 1999

1. EDITOR'S INTRODUCTION Whether tobacco advertising affects overall tobacco consumption is a complex problem. The bulk of research on this topic points to little or no relationship between the two. A subset of this issue concerns the impact of cigarette advertising on smoking initiation by thcyoung: do juveniles start to smoke because they have been exposed to print and broadcast advertisements? Important Evidence The 10-country comparison* report~ here provides strong evidence that adverr~ingpi~ys a miniscule role in the initiation of smoking by theyoung. Instead, parents, siblings and friends appear to be the determining factors when children start to smoke. New Evidence Such a point has been made and proved before. However, this recent study (1984-1987) provides not only corroborative evidence but also a new an#e by-foeusslng on nine countries where the control of cigarette advertising ranges from a ban (Norway) to rath~ Limited restrictions (Argentina, Hong Kong and Spain), with Australia, Canada, Sweden, Switzerland, Turkey and the United Kingdom standing in between. It establishes that family and peer influences appear to be the determining factors, irrespective of whether the young are exposed to cigarette advertising or not, with all nine countries reporting the similar overwhelming impact of social and cultural influences on juvenile smoking initiation. New Methodology This study also breaks new methodological ground in that, for the fwst time, an established Smoking Prevalence Estimator has been applied internationally to produce a comparable measure among countries with differing tobacco-advertising controls. Besides, instead of using diaries or impersonal questionnaires administered at school, as is common in this field, the present survey used personalinterviews conducted at home.** Again, this is a In'st international methodological breakthrough which has generated a comparable international database about juvenile smoking initiation and incidence. Great care was also exercised in adapting some of the questions to the particular locales, since customs vary from country to country. Finally, afar broader age range (7 to 15/16 years old) of respondems were interviewed than in most other studies, in order to provide a more comprehensive understanding of the factors involved. Implications The findings would seem to challenge the validity of fairly common assertions that the young start to smoke because they have been exposed to cigarette advertising. They also raise questions about the effectiveness oftobac, co advertising bans.*** In Norway, the subjects of the study were too young to have been influenced by cigarette advertising before a ban was imposed in 1975; indeed, some of the subjects ofthe study had not even been born. By contrast, all of the subjects of the study in Spain and Hong Kong had grown up in the presence of cigarette advertising, yet the incidence of smoking among the juveniles studied in Spain and Hong Kong was lower by far than the incidence of smoking among juveniles in Norway. Clearly, factors other than advertising are at play, and they even predominate, so that advertising should not be made into a scapegoat for juvenile smoking. Is the Evidence Believable? This study was initiated and financed by the tobacco industry. No one should question its right to engage in research, any more than research by the antismoking movement should be considered suspicious a priori. The test, instead, should be: "Is it good research?" "Ten countries are compared. 9 of which wet~ suaveyed by the CRU. British government data collected separately ate also included for comparati~ purpose~ ** In Canada, however, interviews were conduc"~-d in shopping-mall locations. **" See Tobacco Advertising Bans and Consumption in 16 Countries. New York: International Advertising Association. 1986. cr~ (=3 d2~ C", BatCo document for PFSFC 1 March 1999

The findings reported here were provided by the London-based Children's Research Unit (CRU), which is an experienced research house that has been employed by both business and govemmem (see Appendix A). CRU relied in part on the methods and findings of studies commissioned by the British Government in 1982 and 1984, but it also drew on its own extensive international research experience to improve on the British Government study's methodology (Appendices B and C detail the research methodology used in the nine country studies). I think that the methodology used by CRU was appropriate, and that the findings are credible - after all, other studies have reached similar conclusions. Particularly relevant in this respect arc the conclusions of a recent study of schoolchildren's smoking in four counmes, sponsored by the World Health Orgnnisation: "The lack of clear differences in smoking habits between countries probably reflects the selection of countries involved in the study in 1983-84. However, since Norway and Fh'dand am countries with restrictive legislation [actually, a ban] on advertising of tobacco products, and the other two countries [Austria and England] are not, a difference might have been expected. No suchsystematic d~fferences are found (emphasis added)." L.E. Aaro ¢t al., "Health Behaviour in School Children: A WHO Cross- national Survey," Health Promotion, I, l (May 1986"), p.32. In any case, readers should reach their own conclusions, with the new data presented here -- collected internationally -- and in a comparable manner, now available for discussing the issue of juvenile smoking initiation. Limitations This study emphasizes the differences among national tobacca>advertising controls. However, the present report also highlights various cultural habits, particularly in Hong Kong, Spain and Turkey. Whilst we need further studies of the role of other cultural factors in the initiation of smoking by the young, this very requirement also applies to those who advocate tobacco-advertising bans and other restrictions all over the world. They ignore or play down the varying impact of cultural values and customs when they propose the same solutions -- bans and restrictions -- everywhere. The findings reported here deal mainly with juvenile smoking initiation, and the survey did not investigate factors accounting for the continuation of smoking behaviour. Only additional research can explain the latter but, meanwhile, the Children's Research Unit's study can be considered to have thoroughly investigated factors influencing the initiation of smoking by youngsters on a cross-national basis. In my editorial role, I have asked the authors of this report to clarify their methods and findings, and to limit their interpretations to what can be reasonably inferred from the data. As such, the following study provides valuable evidence for researchers, policy-makers, advertising practitioners and concerned citizens. Jj. Boddewyn Professor of Marketing/International Business Barueh College, City University of New York 17 I.axing, ton Avenue, New York I0010, USA Tel. (212) 725-3295 j... BatCo document for PFSFC 1 March 1999

2. THE ISSUE There is a growing body ofnationalsmdics identifying factors accounting for "juvenile smoking initiation," that is, the conditions, motivations and pr~pitar.ing circumstances associated with children starting to smoke (see Appendix G for a review of that lit=mmre). Still, whether substantiated or not, there is a fairly widespread belief around the world that advertising constitutes a major factor in this initiation process. In contrast, there has been a lack of systematic cross-national r~earch to compare juvenile smoking initiation under different country conditions. Nations, of course, vary considerably in such factors as values, economic development, political systems and social stratification. Controlling for all of these factors is a daunting task indeed for any rtscaxchcr. However, considering that one common remedy has been proposed to combat juvenile smoking, namely, to ban or severely restrict tobacco advertising, it was highly desirable to compare countries that d~ffer aignfzcantly in terms of public policies, towards tobacco advertising, in order to determine the relative impact of tobacco advert~f~zg on why ~n#es s:an smol~g. . . - To this end, the tobacco industry's international information organisafion (INFOTAB) commissioned the Children's Research Unit (CRU- sec Appendix A) to determine the extent to which tobacco advertising influenced juvenile smoking initiation in a sample of countries selected for their diffetumt regulatory systems regarding the advertising of tobacco products (see Appendix F for further details about national regulatory systems). i: ,J! • iI li i ,i il !O'x r... !c-, G'x BatCo document for PFSFC 1 March 1999

3. BASIC RESEARCH APPROACH The programme of research reported here has involved independent investigations in nine countries, conducted during 1984 (Australia), 1985 (Norway), 1986 (Spain, Hong Kong, Canada and Argentina) and 1987 (Switzerland. Sweden and Turkey). However, UK data, collected by the British government, are also used for the purpose of comparison. Approximately I000 interviews were conducted in each of these nine countries with boys and girls aged 7-15/16 years according to a quota sample. In eight countries, personal interviews were conducted in-home with parental permission and the willing participation of the child. In Canada, respondents were recruited (via their parents) and personally interviewed in private locations within shopping malls (see Appendices C and E for further details). Fast of alL it was important to apply a reliable estimator of smoking prevaltnce so that countries with varying polities towards tobacco-advertising control could be meaningfully compared. CRU therefor¢ decided to apply Bcwley's Smoking Prevalence Estimator (see Appendix D), widely accepted in this field, throughout this interna- tional research project. Since the UK Office of Popular/on Cereuses and Surveys (OPCS) studies (Dobbs & Marsh I and 2* had also applied Bewley's modified estimator in 1982 and 1984, this enabled comparisons to be made between data from the United Kingdom (OPCS) and other countries (CRU studies). The nine countries were chosen as providing important comparisons in relation to the degree of media exposure allowed for tobacco advertising at the time of each survey, as summariscd below (further details are provided in Appendix F): U.K. 1984 Australia 19M Norway 1985 1986 No cigarette or roll-your-own advertising permitted on "IV or radio. Voluntary controls or restrictions exist for cinema, press, sponsorship and posters. No spe~c restrictions on point-of- sal= advertising. No'IV or radio advertising since 1976. Cinema advertising is restricted, but there are no specific restrictions on press, spomorship, posters and point-of-sale advertising. Complete ban on all kinds of tobacco advertising and sponsorship since 1975. HongKong 1986 Canada 1986 Some restrictions apply to "IV and radio advertising. No speci~c restrictions on press advertis- ing and sponsorship. Cinema unx,stricted except in Catalonia. There are also restrictions on posters, which are not allowed in Catalonia. Point-of-sale advertising is only allowed for domestic brands. Some restrictions apply to "IV and radio advertising, but there axe no specific restrictions on cinema, press, posters and point-of-sale advertising, or on sponsorships. No "IV or radio advertising since 1972. There am no restrictions on cinema or pi'ess advertising. Sponsorship is limited to the non-electronic media, and is being phased out of amateur sports. Restrictions apply to posters, but not to point-of-sale advertising. Argemina Some restrictions apply to TV, radio and cinema advertising. There are no rtstrictions on 1986 sponsorship, posters and point-of-sale advertising. Switzerland No TV advertising sinca 1964. Advertising expenditures for tobacco advertising on foreign "IV 1987 and radio stations broadcasting to Swiss audiences have been disallowed since 1982, by voluntary agreement. No specific restrictions apply to dmema advertising although self- imposed restrictiom by cinema distributors do exist. There are restrictions applying to press advertising, sponsorship and posters, but none on point-of-sale advertising. Sweden No commercial advertising for any product on TV and radio. Cinema tobacco advertising has 1987 been prohibited since 1979. There am restrictions on press advertising for tobacco products. Sponsorship and posters here have bccn prohibited since 1979. Restrictions also apply to point-of-sale advertising. Turkey No "IV or radio advertising. No restrictions on cinema advertising for tobacco products. Press 1987 advertising of tobacco products is allowed, as is sponsorship, except for football. No restrictions apply to posters and point-of-sale advertising. The OK OPCS studies provided the baseline essential for conducting this international research programme, and the rmults from all ten coumries (including the United Kingdom) are prtsented herr (in the United Kingdom, Ox there were three saparate studies which are treated here as one - see Appendices D and E). CZD * The numbers in pattmtheses t'd'er to entries in the bibliography (Appendix H) at the ~ of this report. Ox ""4 BatCo document for PFSFC 1 March 1999

The overall approach adopted in this report is to illustrate the picture which emerges from each national survey. It must be str~sed, however, that "r~ular smokers~ are always def'med in the same way as children who smoke at least one cigarette every week, and that'children" always means child~n of comparable age, when this appears to be important (see Appendix D). Against this background, this research report considers the national patterns of smoking, the ways in which smoking seems to start, and the part which advertising may play in this process, against the impact of the social and familial environments. With a study of this complex nature, ther~ are many possible analytical breakdowns of the statistics, such as boys versus girls, those who live in towns versus those who live in the country, and social and culmraJ factors. However, the purpose of the research was to examine differences among nine countries, and the data is therefore presented here by country of study, and, within this, by smokers against non-smokers, and often by age as wen. Further fragmentation would seem likely to bring confusion ra~er than enlightenment with.in the conte~ of this report. Further enquiries about this cross-national survey can be addressed to: Glen Smith, Chin ...... ". Children's Research Unit (CRLD - Albany House -- • Portslade Road London SW8 3DJ England Tel. 01-622 0286 Fax. 01-720 0537 Tlx. 8952387 .l I 'I I I I 5 BatCo document for PFSFC 1 March 1999

4. RESULTS OVERVIEW CRU's cross-national research concentrated on examining the smoking initiation process by juveniles. Particular attention was given to examining the role of advertising within and among countries with diffe~nt approaches to tobacco-advertising controls, ranging from countries with a few or many restrictions to one with a complete ~tver~ing ban (Norway). This comparative study found, in the face of the varying national patterns regarding the control of tobacco adverzising, that it was not possible to predict which country would have the lowest incidence of juvenile smoking. Conversely, juvenile smoking incidence statistics would not help predict which country has the strongest restrictions on tobacco advertising. Clearly, factors other than tobacco advertising and its regulator), control must have played a key role in juvenile smoking initiation and incidence. The research revealed key factors such as the circumstances in which children begin to experiment with smoking;, the role played by the smoking behaviour of parents, brothers, sisters and peers; the ch~enge of daredevilry, together with sodo-adtural factors. The data patterns which have emerged are remarkably similar on acountry-by-country basis, and they show that a combination of personal, family and social factors are the predominant reasons accounting for smoking initiation by juveniles. Such data patterns persist despite the presence or absence of tobacco advertishag. Advertising was also found to be an insignificant factor with respect to the list of reasons advanced by juvenile respondents for starting to smoke. [n all cases, it is apparent that tobacco advertising does not significantly influence the smoking initiation process as far as children and young people concerned Instead, the decision to start smoking involves mos@ a combination of personal, family and social factors. To summarise, the smoking initiation process and the role of advertising have been internationally examined within and between coumries with different approaches to tobacco-advertising controls. Advertising has bccn comistently found to bc irrelevant not only to the smoking initiation process by juveRilcs, but also regarding juvenile smoking incidence. 5. KEY FINDINGS I. Table I reveals that the proportions of 7-15-year-old children smoking at all, wcrc found to be fairly similar in all the countries surveyed, except for Hong Kong and Argentina, which have relatively few restrictions on tobacco advertising, and where a very high proportion of those children have never smoked. Overall, there were rather low levels of regular and occasional smoking (from I to 15 percent) amongst children aged 7-15 years. 2. In all countrias, "regular smokers" (those who smoked at least one cigareue per week) in the I 1-15-year age group ranged from 3% in Argentina and Hong Kong to 13% in England and Norway, and to [6% in Scotland (see Table 2). Again, the connection with tobacco-advertising controls is not evident st all. 3. Theinddenceofregularsmokingamong 15-year-olds (the older age group where comparable intemational dam arc available) was highest in Norway (36%), a country with a total advertising ban on tobacco products, and substantially lower in Hong Kong (1 I%), where there were relatively few restrictions on tobacco advertising. Switzerland had the lowest incidence of 15-year-old smokers (8%) of all the countries in this survey (refer to table on page 7). 4. The start of smoking was found to depend very much on the influence of family and friends, and the chances of a child smoking in a household where there were no other smokers were low (see Chapter 8). 5. The influence of advertising on smoking initiation was found to bc insignificant in relation to the overwhelming pressures of personal and social (family and friends) influences surrounding the potential smoker (see Chapter 7). BatCo document for PFSFC 1 March 1999

6. JLNENILE SMOKING INCIDENCE Tables 1 and 2 provide information for the total sample (7-15 years) and for 11-15-year-olds only, the latter being comparable with the United Kingdom surveys. For I I-I 5-year-olds in every country, with the exception of Argentina and Hong Kong, the position was similar:. about half to two-thirds said that they had never smoked, and about one-tenth to two-fLqhs said that they had tried once and never again. Bearing in mind that it is between these two groups (those who had never smoked and those who had tried once and never again) that all United Kingdom adjustments were made (see Appendix D), it was found that from 63% (Scotland) to 96% (Hong Kong) of children aged between I I and 15 years had never smoked more than once. On the other hand, in all countries, between less than one in thirthy-tb.r~ and approximately one in six or right juveniles -- lower in Hong Kong and Argentina (3%) and highest in Scotland (16%) and Norway (13%) -- said that they were now regular smokers, that is, that they smoked at least one ciga~tte a week (see Appendix D for a definition of a "regular smoker"). Argentina and Hong Kong strongly contrast with most other countries in that the proportion of children who smoked is lower, despite less stringent advertising controls than elsewhere. In Hong Kong, only 3% of children aged I 1-15 reported that they were regular smokers, against 85% who said they had never even had a single puff. In Argentina, another country with few ~ctions on tobacco advertising, "regular~ and "occasional" smokers both amounted to 3%. Pan of this difference is undoubtedly due to socio-cultural factors, which also affected whom the child was with and where they were at the time of the first ciga~tte (see Table 40 Although more boys than g£rls had"ever smoked" in Norway, Spain, Switzerland and Sweden, twice as many boys as gu-ls had ever smoked in the case of Hong Kong, .~,genlina and Turkey. This sex difference is also reflected in the smoking habits of parents, as will soon be seen. Naturally, there is a progression upwards, the older the child becomes. This increase is governed by a number of factors: as the child becomes older, adult aspirations and identi.Hcadon with adults increase, the child's peer group widens and includes peers with a g~amr variety of behaviour patterns, the child's mobility and spending power increase, and the age for legal purchase of the product approaches. Taking the two age extremes on which information is available, in all countries, we fred the following patterns for those smoking one or more cigarettes a week among ] I- and 15-year-olds: SMOKING ONE OR MORE CIGARETTES A WEEK At II At 15 Argentina 0% 8% Australia 1%* 19% Canada 4% 35% England 1% 28% Hong Kong 0% 11% Norway (ban country) 0% 36% Scotland3% 32% Spain 1% 27% Sweden I% 19% Switzcfland 0% 8% Turkey I% 14% Wales 1% 23% * 11-12-year-olds in Australia It is worth noting the higher incidence of smoking at age 15 in Norway, where a tobacco advertising ban has been in operation since 1975. Hong Kong and Switzerland have far fewer smokers at age 15. Even at 15, however, there is no country where juveniles have reached the smoking levels of their parents, as shown below: [i )) O'x CD r... cr~ cZ) BatCo document for PFSFC 1 March 1999

PERCENTAGES OF 15-YEAR-OLDS SMOKING AT LEAST ONCE A WEEK PERCENTAGE OF ALL CHILDREN SAMPLES REPORTING THAT THIS PARENT SMOKED * Father Mother Argentina 8% 52% 38% Australia 19% 40% 34% Canada 35% 49% 44% England 28% 44% 37% Hung Kong I I% 44% 4% Norway (ban country) 36% 51% 46% Scotland 32% 50% 48% Spain27% 69% 32% Sweden 19% 39% 37% Switzerland 8% 50% 34% Turkey 14% 70% 26% Wales23% 47% 43% * I 1-15-year-olds in the United Kingdom 7-1~-olds in Auswalia 7-15-year-olds in all other countries One final point: for the sake of simplicity in reporting these data, we have considered all smoking as equal, whether the number smoked per week is one, or forty, or even more. The classification used in all surveys allowed for this aspect, and more detailed breakdowns are shown in the following table: Argentina* 1 Australia Canada England Norway (ban country) Scotland Spain Sweden Switzerland Turkey Wales ll-15-YEAR-OLDS: PERCENTAGE SMOKING THIS NUMBER OF CIGARETTES PER WEEK 1~ %39 40+ 2% I% O% 3% 4% 2% 4% 6% 5% 3% 7% 3% 4% 6% 3% 4% 9% 4% 3% 3% I% 4% 5% I% 3% ~% 0% 2% 3% 1% 3% 6% 2% TOTAL PERCENTAGES OF I 1-15-YEAR-OLDS SMOKING AT LEAST ONCE A WEEK 3% 9% 15% 13% 13% 16% 7% lo% 4% 6% 11% Note: Hong Kong figures were too low to be broken down. " 12-15-year-olds :3x C3 u BatCo document for PFSFC 1 March 1999

7. THE DIRECT IMPACT OF ADVERTISING ON JUVENILE SMOKING INITIATION The extent to which'outside messages"from the tobacco industry have made their mark on the young can only be considered against the smoking patterns de~'ribed above. The nine country surveys revealed that the major -- indeed the overwhelming -- influence on the start of smoking behaviour among young people was the related behaviour of friends and family, and the importance of this factor was very similar in all the countries studied. In all surveys outside the United Kingdom, direct questions were asked about potential irdluences. Children were shown a list of items which might have influenced them.* Their answers with regaxcl to what might have influenced them most are discussed in greater detail in the next section, but what is shown below are references to advertising as prompted responses (that is, from a list shown by the interviewers): Argentina Canada Hong Kong Norway Spain Sweden Switzerland Turkey PERCENTAGES IN THESE COUNTRIES SAYING THAT, IN STARTING TO SMOKE, ADVERTISING WAS: FIRST MOST IMPORTANT REASON I% 2% 1% O% O% 1% 2% 1% In Australia, no boys and I% of girls answered "advertising" in reply to a differently-phrased but similar question (see bottom of Table 3 on page 16). Few adults believe that they axe ever ~y influenced by advertising. However, there is a good deal of evidence (3,4,5,6,7) that children are less likely to be coy or self-deceiving in this respect-- .certainly, in ~e case. of many o~er products, they will happily admit to advertising pressure. In such a context -- indeed even t~ we ao assume tnat children are as reticent as adults --, the similar very low percentages reported in the above table imply little advertising influence. As this study concentrated on investigating tobacco issues, there was insufficient scope for similarly investigating other products such as alcohol and confectionery. However in order to put the tobacco results into context, respondents were questioned about their brand awareness of cigarettes, alcohol and confectionery (interpreted respectively as "beer" and "chocolate'). In Australia, advertising awareness about these other products was not investigated. In the case of Norway, Spain, Hong Kong, Canada and Argenlina, respondents were asked specifically about leading brands.** In the case of Switzerland, Sweden and Turkey, a more general, somewhat broader, question was put to respondents.*** The t'mdings were as follows: In Norway (where there is no advertising of cigarettes), 70% mentioned the leading brand of cigarette, against 71% who mentioned the leading brand of chocolate, and 77% the leading brand of beer. .: Respondents were shown a list of pos3ibk reasor~ for start/rig to smoke (s~ Table 3 on. p.a~. 16 ~ Ap.pend~.C):. ...... Question wording in Norwsy, Spain, Hong Kong, Cama" and Argmfir~: "t-u~t ol alL ~g ox cnocoJate. I runr~g oz me auxcmnc brands of chocolate that then: ate, which ones can you think of?." " ....... not advertised *** Question wording in Switzer ,hind: Sw~len and Turkey: "There are some products winch, people ~ ouy, win. cn are at all. Other producm have adverting in different sons of place~ Have you ever seen any mvermmg ior cnocotate:- C~ BatCo document for PFSFC 1 March 1999

In Spain, the pattern was quite different, with 77% mentioning the leading brand of cigarette, 63% the leading brand of chocolate, and 49% the leading brand of beer. In Hong Kong, 77% mentioned the leading brand of cigarette, 87% the leading brand of chocolate, and 91% the leading brand of beer. In Canada, 86% of respondents claimed to have seen cigarette advertising, against 90% who claimed to have seen advertising for chocolates and 93% for beer. In Argentina, 96% of respondents claimed to have seen dgarette advertising, against 95% who claimed to have seen advertising for chocolates and 99% for wine.* In Switzerland, 84% of respondents claimed to have seen cigarette advertising, against 87% who claimed to have seen advertising for chocolates and 92% for beer. In Sweden, 65% of respondents claimed to have seen dgarette advertising, against 84% who claimed to have seen advertising for chocolates and 55% for beer. In Turkey, 56% of respondents claimed to have seen cigarette advertising, against 90% who claimed to have seen advertising for chocolates and 66% for beer. In Australia, at least 87% said that they had seen dgarette advertising, but as the full Australian report comments: "Awa~ness, then, of dgarette advertising was high amongst all age groups. This finding essentially reflects children's awareness of many adult products -- for example, kettles, soap powder, petfood, etc. -- rather than a motivation to purchase these products." In other words, brand awareness of cigarettes was quite high in all the countries surveyed, irrespective of whether advertising is allowed or not. This is also true regarding non-tobacco products and even those whw.h the young do not use (for example, kettles, petfoods and detergents~ Other parts of this report suggest that such cigarette brand awareness is picked up from family, friends and other people, in countries where cigarette advertising is not allowed. However, the fact that cigarette brand awareness is high even in countries with no tobacco advertising is related to the industry's argument that the purpose of cigarette advertising is to induce brand switching, not just brand awareness which constitutes only the initial step, and can be generated through means other than advertising. *Substituted for "beer'. I0 C~ ....a 0 r~ t.e4 BatCo document for PFSFC 1 March 1999

8. STARTING TO SMOKE: KEY FACTORS What are the influences which seem to be at work when children start to smoke? As CRU's research experience with children has shown them to be highly aware of brands and advertising in different markets, regardless of product usage, this international study set out to consider children's own views of the ways in which they came to smoke in the first place. The impact of advertising as an initiating factor was included in this framework. The conclusions which emerge from this international survey will cause little surprise, at least in the central theme. On the one hand, there are the, curiosity and the daredevil approaches to the first puff; on the other, there is the influence of friends, schoolmates and family. They are largely common=sensical, and corroborate several national studies (see Appendix G), although in a comparative and comparable manner, and in the context of varying degre~ of tobacco=advertising control In this research project, questions were asked on the circumstances of the fhst smoke. Results of ~vhy" and ~vith whom" are given in Tables 3 and 4. Unfortunately, there are no UK data on "why", but a generally comparable question was asked in all countries outside the United Kingdom. For this purpose, a list of possible reasons was shown to all respondents in CRU's surveys; and a further list was provided concerning ~where the f'trst cigarette was smoked." Several statements presented to respondents aspossible reasons for starting to smoke occupy almost a traditional status, having been identified by researchers at various intervals during the most recent decades (d. McKennell ct al., 19673. In all countries, hardly surprisingly, among reasons given, "to see what it was like'came in i'trst place, followed by variations on the theme of conformity (19% in Australia and 16% in Turkey said that all their friends smoked; 20% in Sweden and 19% in Spain said that someone gave them one), or of daredevilry (38% gave this answer in Hong Kong and 16% in Argentina). Looking ~tough", or "grown up~, "showing off" and "being bullied", however, did not emerg~ as significant masons for starting to smoke in the countries surveyed, with the exception of Norway, wh=re I I% started smoking "to look tough." On the other hand, advertising was hardly mentioned as a potential reason for starting to smoke by children who had tried a cigarette. In relation to personal, familial and socio-cultural factors, advertising was found to be insignificantly related to smoking initiation. Greater interest probably lies in Table 4, which presents answers to the question "With whom?" Certain socio=cultural differences were apparent, although detailed examination of these was not possible within the scope of the studies conducted. However, a couple of the most obvious differences can be explained by the fact that, in Spain, it is the local custom for children to be given a quick puff of a cigaxette at weddings, to indicate "coming of age."This would account for the very different pattern in Spain-- not merely the high proportion of given cigar~es (referred to above )) but also the far higher percentage 01%) who' referred to a special occasion (see Table 3). This was a category added for Spain alone, and not enquired about elsewhere. Twenty-seven percent of children in Hong Kong, 24% in Turkey, and 21% in Argentina claimed that they were alone at the time of their rust cigarette. In the case of Hong Kong, being =alone" usually meant during the brief period between arriving home from school, and parents arriving home from work. Similarly, less parental supervision in Turkey during holidays led to children trying their lust cigax~tte ~alone." Similar variations spilled into answers given on the environments and locations. Clearly, we would expect that the most common environment for the first puff would be with a fricnd, family or peer group. The exception, once again, is Spain where ~others in the family,""fathcr," and"mother" scored more heavily, again stressing the special wedding occasion already mentioned. Table 4 has much more to tell us. While 27% of children in Hong Kong, 21% in Argentina, and 24% in Turkey first practised smoking on their own, afar higher proportion started smoking in the company of sorneone in their 11 :7x C:3 C:) CY~ BatCo document for PFSFC 1 March 1999

family. Indeed, an additional question asking where the child was at the time of first trial, shows that the proportion saying that they started within their own home was as follows: FIRST CIGARETTE TRIAL TOOK PLACE AT HOME ll-15-year-olds England 15% Scotland 12% Wales 12% 7-15-ytmr-olds Argentina 53% Australia (7-16 years) 38% Canada 39% Hong Kong 55% Norway 29% Spain 26% Sweden 37% Switzerland 26% Turkey 33% Perhaps because of question wording or question positioning in the surveys (although reasons are not clear), United Kingdom figures are far lower than elsewhere, but remain substantial. Still the above numbers dearly highlight the importance of parental habits and attitudes. Children are exposed to many different influences, such as the authority of parents, the comradeship and rivalry of siblings and/or peers. For instance, in the United Kingdom, it is very clear that the habits of brothers and sisters are of more importance than those of parents, the latter inevitably playing a larger role in one-child households (and, in consequence, presumably playing that role in every household, as far as the fL,'stbom is concerned). A note is relevant here on Hong Kong. Among all those interviewed (that is, the total sample of 1003 respond- ents), 44% said that their father smoked -- an identical proportion to those in England -- and 55% said that they came from a family where somebody smoked, compared with 65% in England. However, whereas in England 37% reported that their mother smoked, only 4% gave this answer in Hong Kong. In other words, it would appear from the very small number of children and mothers smoking in Hong Koag, that the maternal role is critical in juvenile smoking initiation in that eotmtry. Conversely, in Turkey the influence of mothers (in the ease of boys) appears to be far less relevant compared with the influence of friends and fathers with respect to smoking initiation. Mothers were present on only I% of occasions when boys had their first cigarette, eompaxed with 11% of occasions when fathers were present. Furthermore, as it is not socially acceptable in Turkey for women to smoke on the street, significantly more girls than boys had their ftrst cigarette at home. 12 0 0 O~ .g:a. BatCo document for PFSFC 1 March 1999

9. CONCLUSIONS Smoking initiation is a complex process involving a combination of personal, f~al and socio-cultural factors. The prment research programme has identified these factors on a national basis, but has also revealed a striking similarity of crkical factors on a cross-cultural basis. The start of juvenile smoking was found to depend very much on the influence of family and friends, combined with personal curiosity -- "to see what it was like." Broader cultural factors were also found to be relevant, especially in '..he case of Hong Kong and Turkey. It is quite apparent that becoming a smoker involves a complex developmental process that is built up not from one single factor, but from a combination of factors over a considerable period of time. Advertising has bccn postulated as having a positive bearing on the smoking initiation process, but CRU's survey Irmdings show clearly that advertising plays an insignificant role in th~ respect. Altogether, the factors accounting for smoking initiation are highly consistent internationally, and were found to be largely unrelated to the presence or absence of advertising, as affected by a.variety of government controls. i: I° 13 .z~ CY~ BatCo document for PFSFC 1 March 1999

O TABLE I OVERALL SMOKING BEHAVIOUR International Data- Percentages Giving This Answer From Full Sample Aged 7-15 Years Australia (*) Norway Spain Hong Canada Argcntina Sweden Switzerland Turkey Kong Total in Numbers 998 998 1016 1003 1012 1008 1021 1093 1000 Never 56% 54% 5 I% 90% 67% 85% 64% 63% 79% Once 23% 24% 34% 7% 17% 1 I% 23% 23% 6% Used to 9% 5% 6% !% 5% I% 3% 8% 10% Occasional 6% 5% 3% -- 3% 2% 4% 4% 2% .... ,J Regular (**) 5% 10% 4% 1% 8% I% 6% 3% 3% No Answer I% 2% 2% I% -- -- -- i% I% -I "U "11 "I'1 _..x [g ._.x ¢D tD ¢.O (*) 7-16 year olds were interviewed in Australia. (**) "Regular smoker" refers to children who smoke at least one cigarette every week. ZI 9 [0109

O o i _.x ¢.D ¢D tO TABLE 2 Total in Number5 Never Onc~ Used to Occasional Regular No Answer OVERALL SMOKING BEHAVIOUR Percentages Giving This Answer Among Respondents Aged I1-15 Years United Kingdom England 3658 5O% 19% 13% 5% 13% Wales Scotland 2778 2798 58% 44% 17% 19% !o% 15% 4% 5% 11% 16% Australia Norway Spain llong Canada Argentina 11-16 yrs Kong 608 553 558 559 576 417 44% 43% 41% 85% 53% 81% 25% 29% 41% I1% 2O% 12% 13% 8% 6% I% 8% I% 9% 6% ~% -- 5% 3% 9% 13% 7% 3% 15% 3% -- I% .... Sweden 611 5O% 29% 4% 6% 10% Switzerland 638 5O% 29% IO% 6% 4% Turkey 560 68% 8% 14% 4% 6% g 91;'[0[09

O g =- =.. "'1 "O "1rl (n "rl C) __x ~g -.ql t') _.x tO t,O ¢O TABLE 3 STARTING TO SMOKE Answers Given To Prompted Reasons For Starting ToSmoke- First Mentions United Kingdom Total in Numbers of those who have ever smoked No Comparable Question 483 Hong 1 Norway (*) Spain (*) Kong (*) Canada (*) Argentina (*) Sweden (*) Switzerland (*) rurkey (*} FIRST MOST IMPORTANT REASON I 491 94 360 163 To see what it was like All my friends smoked Someone gave me one For a dare I jUSt found one I was bullied i had seen advertising Because parents smoked Tried to look tough Tried to show off l- Tried to look grown up Special occasion Because brother/sister smoked 78% 19% 18% 7% 5% 4% 42O 64% 6% 9% 4% 4% 35% 5% 19% O% O% I% 40% 5% 14% 38% 2% 0% 48% 14% 9% 5% 4% 3% 43% 7% 13% 16% 3% 2% I% 371 46% 4% 2O% 9% 6% 2% I% O% o% I% 2% I% I% N/A I% 09Io 0% I% N/A NIA NIA N/A N/A 6% 2% I% 2% N/A I% N/A I% 2% 3% 31% N/A 7% 2% I% I% N/A I% Australia (*) All N/A N/A !!% 2% 1% N/A N/A N/A 3% 4% I% 3% N/A N/A Mentions 4O0 208 54% 34% 12% 16% 13% 10% 8% 7% 4% 3% I% 6% 2% 1% 2% I% !% I% {% 6% 2% 4% N/A N/A I% I% (*) Question Wordings: Australia: "Can you remember when you tried your first cigarette? Was it for any of these reasons7" Norway, Spain, llong Kong, Switzerland, Sweden, Turkey, Argentina, Canada: "These are some (other) reasons that people have given us as to why they smoked their first cigarette, i would like you to look through them and decide if any of them had any part in your trying a cigarette. Tell me which was the most important reason?" 6t,9PI0[09

== O o=. O O ¢D (D ¢O TABLE 4 STARTING TO SMOKE Others Present At Time Of First Smoke (*) United Kingdom Australia Norway Spain Hong Canada Argentina Sweden Switzerland Turkey England[ Wales J Scotland 7-16yrs Kong Total in Numbers of Those Who llave Ever Smoked 2025 1328 1697 583 420 491 94 360 163 371 400 208 Friends 65% 71% 7~ 54% 69% 29% 38% 53% 27% 58% 48% 47% Brother 7% 7% 4% 7% 4% 16% ! I% 6% !1% 5% 8% 4% Sister 6% 5% 5% 8% 5% 14% 6% 6% 6% 4% 5% 2% Mother 3% 2% 3% 15% 14% 34% 9% 14% 17% 17% 17% 4% Father 4% 2% 2% 16% 12% 32% 18% I1% 17% I1% 15% 12% Others 6% 4% 5% 10% -- 33% 10% 9% 25% 2% 7% 7% Alone 9% 8% 8% 7% 8% I% 27% 10% 21% 1 I% 16% 24% Can't Remember 9% 7% 8% -- I% -- w 1% -- -- I% -- Percentage of Mentions (**) 109% 106% 105% 117% 113% 159% 119% 110% 124% 109% 116% 100% Questions wording in United Kingdom: "Who were you with, the first time you tried smoking a cigarette?" Almost identical wordings were used elsewhere, except that precoding allowed for"one friend" against "more than one friend". (*) United Kingdom figures concern children aged ! I upwards; all others concern children from 7 years upwards. Technically, we arc dr.scribing an event which took place at a specific age, and therefore this difference between the two age groups is irrelevant, altllough it seems very likely that the higher percentage mentioning father and mother outside the United Kingdom reflects more recent recall by younger smokers. (**) Totals add up to morc than 100% because several answers wen: allowed. .............. _ ...... - .......~-~_.~ ~. .... ~=_.--. _~/:~

APPENDIX A THE CHILDREN'S RESEARCH UNIT (CRU) The Children's Research Unit is a London-based market research company specialisingin research with children and young people in the United Kingdom and internationally. It was set up in 1972 by Glen Smith, a child psychologist, who is a full member of the British Market Research Society. CRU has played a leading role in developing the field of children's research in the United Kingdom and abroad, by applying modifications of established clinical procedures for obtaining information from children and young people. Studies have been conducted by CRU in a wide variety of areas such as town planning (play facilities), road safety, career guidance, drug abuse, toys and games, computers and software, magazines and comics, food and drink, TV programmes, and advertising in all media. CRU regularly disseminates information concerning its research findings about a wide variety of markets, via the international conference circuit and professional publications. In addition, CRU is frequently consulted by the media (television, press and radio) regarding children's reactions to advertising, their consumer behaviour patterns, interests/lifestyles, and other issues. Channel 4 Television (London) recently fdmed a session at CRU's headquar- ters where children were being interviewed about television advertising. CRU's clients include major manufaz'mams, advertisers, professional and trade associations, media groups, government units (the UK Central Office of Information regarding road safety, and the European Parliament regarding anti-drug campaigns), banks, film companies, television groups and publishing houses. In addition to carrying out field research on a national and international scale, the company also conducts research at its Observation Studio, with a two-way mirror facility, and at its Electronic Research Laboratory. CRU also runs a regular children~ panel 18 Ox O r.~ BatCo document for PFSFC 1 March 1999

APPENDIX B INTERVIEWING CHILDREN: GENERAL COMMENTS In children's research, CRU is frequently asked the question: "At what age can children be considered 'reliable' research respondents?" Since a wide range of individual differences can be found whenever children are grouped in chronological-age levels, answers to such questions can only be couched in general terms. Overall, CRU's policy (dictated by past experience) is to interview children from a minimum age of 5 years. Clearly, due to the 5-year-otd's lack ofconeeptual development, interview exchanges have to be short, to the point and carefully structured, in order to allow the child freedom of response. Children under the age of 5 yeats are more productively assessed using direct observation methods, as applied in the company's two-way mirror Observation Studio. It is of fundamental importance to any research programme involving children to utilise rapporbbuilding techniques which aim to estabtish rapport between the interviewer and the child as early as possible in the interview situation. Unless the child is particularly sophisticated, there is a strong tendency in aduk/child interview set6ags for the child to behave in approval-seeking terms, when confronted by an un/amfliar adult. This can induce the child to respond in a manner which he/she considers the interviewer wants to see/hear. If this attitude prevails, the interview becomes wortld~. In order to prevent thB happening" CRU interviewers convey to the child at an early point in the interview that it is primarily what he/she thinks/feels about the subject under discussion which is important, and, as such, there are no "right" or "wrong" answers when evaluative questions are posed. The interviewer communicates this also at selected intervals during the interview, to serve as reinforcement and/or as a confidence-building technique. We have found that this usually produces honest responses from children who, in many cases, are often unaccustomed to the experience of meeting an unfamiliar adult who is interbred in their views. Location The choice of interview setting can also enhance rapport. For an investigation of this nature and complexity, CRU has found that school settings are not conducive to investigating complex or controversial areas, given the authoritarian overtones and lack of privacy for the individual respondent. Therefore, CRU usually interviews children in private at their home. In this conmxt, a basic flaw is pr~ent in a number of studies relating to cigarettes and smoking behaviour, that is, the interviews are conducted in the classroom/school setting, with all the attendant overtone of authoritarian attitudes which can bias the respondents'willing~ess to provide honest answers. This is particularly true in the case of controversial issues, such as juvenile smoking, where the expected attitude of the school towards under-age smokers is one of disapproval. Some overclaiming of smoking incidence can also occur amongst the more *rebellious" pupils. Lessening the Interview Task" from the Child's Viewpoint CRU usually interviews children at home after being at school all day. Rather than becoming an extension of the school day, the interview experience provides a refreshing contrast -- not only in terms of subject matter but also by having a shared experience between interviewer and child, with no distractions. Confrontational interrogative interviewing is avoided at all costs, and usually the child sits next to the interviewer in order to enhance the"sha.,'mg" climate throughout the interview. Additionally, i£ fatigue becomes apparent, rest periods take place when the child discusses subjects which are considered important to him or her. Self-Completion Methods Are Inadequate In view of the complexity of the issues surrounding smoking and non-smoking decision-making processes, and the influences impinging on such processes, attempts to investigate this area among children by using se/f- completion questionnaires are clearly inadequate. Such questionnaires offer a very poor substitute for the individual personal interview in which full explanatory reassurances and clarifications can be given to the child. The classroom setting works against the individual in need of reassurance or clarification, and it may be subject to pcer-group influences. Administrator Bias Previous studies have drawn atremion to the variable effects of using an adult reference figure well-known to the respondents (a teacher, in the case of the Ledwith study, 8) as the questionnaire administrator. Results have been 19 I i .i Ox O'x L.rl r',o BatCo document for PFSFC 1 March 1999

found to vary according to the orientation of the teachers involved, that is, as a smoker or a non-smoker. Ledwith does not attempt to describe the orientation of the teachers concerned in his study, but this factor may have affected the answers he obtained. CRU's strategy is to use interviewers unknown to respondents, so that their smoking behaviour is similarly unknown. Planning of Questions Given children's tendency to respond to question cues in socially approval-seeking terms, it is imperative that all questions are factually and clearly stared, and contain balanced response options. For example, k is inst~cient to merely ask a child whether he/she agrees with a particular statement. The child must always be given the option to agree or disagree, within the structure of the question. If we assume that children are more likely to agree than to disagree with an unfamiliar adult interviewer, care must be taken to allow the child more freedom ofchoiee than the approach commonly taken when interviewing adults. This is the approach used by CRU. 20 0"~ C:) Cyx ~r~ BatCo document for PFSFC 1 March 1999

APPENDIX C CRU~ RESEARCH METHODS USED IN THIS STUDY In the Fast instance, exploratory qualitative research was conducted in each country, in order to identify the key attitudes of respondents to smoking issues. A Master Qucstionnair~ was then drawn up, for quantiiicafion purposes. The main topics covered in the questionnai~ ar~ noted in Appendix E. Approximately I000 respondents between the ages of 7 and 15/16 years were personally interviewed in each of +,he nine countries dimcdy surveyed by CRU. Children and young people were rccntitcd via a quozaaample (where selection requirements such as age and sex were pre-determincd), and individual interviews were conducted in home. (The exception to this was Canada, where respondents were interviewed in shopping-mall locations.) All interviews were conducted with the permission of a parer and the willing participation of the child, although in strict confidence and in the absence of either parent. Since identical interviewing procedures were adopted in each country, the samples interviewed were broadly comparable. Leading research agendes conducted the interviews in their country of origin under dose supervision from CRU's directors. The Research Rationale I. Market Selection In addition to tobacco, CRU selected two extra markets, alcohol and confectionery (interpreted as "beer" and "chocolate'*) in order to provide product comparisons in the nine countries surveyed. However, to re.strict quantitative interviews to manageable lengths, comparable questions about these three products (tobacco, alcohol and confectionery) were only asked about brand and advertising awareness, including the sources of awareness. The bulk/remainder of the questionnaire coneentratcd on investigating dgarettc/tobacco issues sxclusively. 2. Application of Distancing Techniques CRU used a distancing technique for obtaining each child's attitudes and behaviour patterns in relation to smoking/non-smoking as follows. The interview fn~ focu.ssed onparemalbehavfoue, then aibiing~ and friends, and finally on the respondem him/herself. In this way, by talking lastly about other people's bchaviour in a non-judgemental manner, rapport was built up between interviewer and respondent, and the child became appropriately more relaxed and confident when reporting on his/her own bchaviour. QUESTION EXAMPLES I would like to ask you about your own family, whether they smoke or don't smoke nowadays. (IN'I'ERVIEW~R: ENTER ALL ANSWERS IN GRID BELOW). FOR EACH FAMILY MEMBER, ASK THE SAME SUB-QUESTIONS: i) Does he/she live at home with you? ii) Does he/she smoke or not smoke? iii) What does he/she smoke -- dgarettc, cigar, pipe? iv) For each item smoked, does he/she smoke: A lot Sometimes Hardly ever v) And, do you know did he/she ever smoke? • What abom your Father?. ASK QUESTIONS i)-v) ABOVE • What about your Mother?. ASK QUESTIONS i)-v) ABOVE • Have you any brothers? IF YES, FOR EACH BROTHER, STARTING WITH THE OLDEST, ASK: • Is he older or younger than you? THEN ASK i)-v) ABOVE IF NO, ASK: • Have you any sisters? IF YES, FOR EACH SISTER, STARTING WITH THE OLDEST, ASK: • Is she older or younger than you? THEN ASK i)-v) ABOVE • And what about yourself, have you tried a cigarette, even just a puff, to see what it was Like? (CIRCLE CODE) 21 Ox ./::= (7x BatCo document for PFSFC 1 March 1999

3. The Fi~ Smoking Experience Many assumptions have been made by the critics of advertising, who claim that advertising is of p~ary importance to smoking initiation (see Appendix G). In order to explore such an assumption, CRU concentrated on investigating the first dg'at~e experience. It is usually the case that first product experiences in most markets cannot be recalled by children, due to their very young age at the time, given that trial occurs during pre-schoo! years. This applies to confectionery, cereals, milk, soft drinks, etc. Tobacco represents an exception, and children have lltfle difficulty in recalling their f'wst experience with this product. The main reason for this situation is that fwst cigarette trials are usually unpleasant or even traumatic, and these negatives fuel children's memories. Furthermore., children are older when trying their fLrSt dgarette or their first alcoholic drink than is normally the case with respect to trials of other products. Consequent- ly, the first smoking experience can be more readily evoked and recounted. QUESTION EXAMPLES • How oM were you when you tried that first cigarette? (CIRCLE APPROPRIATE CODE) 5 YEARS OR UNDER 6 YEARS 7 YEARS 8 YEARS 9 ARS ~!0 YEARS =11 YEARS 12 YEARS 13 YEARS .14 YEARS I5 YEARS • Where were you when you tried it? I 2 3 4 5 6 7 8 9 V X • And where did you get that f~t eigarett~ from? (PROBE FULLY) • These are some other reasons that people have given us as to why they tried their first dgarette. I would like you to look through them, and decide if any of them had any part in your trying a dgar~te. Tell me, which was the most important reason? (SHOW PROMPT CARD) (PROBE: ANY OTHER REASONS?) 22 I TRIED IT FOR A DARE BECAUSE ALL MY FRIENDS SMOKED SOMEONE GAVE ME ONE I WAS BULLIED I'D SEEN ADVERTISING FORCIGARETI'ES I JUST FOUND ONE I WANTED TO SEE WHAT IT WAS LIKE I TRIED IT TO LOOK TOUGH I TRIED IT TO LOOK GROWN-UP I TRIED 1T TO SHOW OFF Cx CD ¢D OX t.rl (.rl BatCo document for PFSFC 1 March 1999

APPENDIX D SMOKING FREQUENCY In the i 982 and 1984 United Kingdom Government Surveys condumed by Dobbs and Marsh (I, 2), a preliminary question asked all. children to check the alternative, from those listed below, which they felt best described their position:* Statements I have never smoked I have only tried smoking once I used to smoke sometimes, but I never smoke a cigarette now I sometimes smoke cigarettes now, but I don't smoke as many as one a week I usually smoke between one and six dgaxcaes a week I usually smoke more than six cigareRes a week, but less than forty I usually smoke forty or more cigarettes a week Abbreviations for ~ca~on "Never smoked" "Tried once" "Used to smoke" "Smokes occasionally" "Smokes regularly" "Smokes regularly" -smokes regularly" To consider =Less than 6 cigarettes a week" as amounting to "Smokes regularly" may seem strange. It must be considered, however, that obtaining cigarettes and smoking them is much more difficult for juveniles than for adults, so that a small number of cigex~ttcs smoked amounts to "regularly" as far as children are concerned. In later parts of the interview, further questions were asked which could, at the analysis stage, bc cross-checked against the original statements. For example, some of those who originally said that they never smoked, subsequently admitted tO having tried once or twice. In the final data, the adjusted figures were used. It is important to stress the care which was taken by the UK Government study to ensure that the statements measured the real level of incidence. However, the effects of these adjustments were small, as can bc illustrated from the IrK study from 1984: ADJUSTMENT BEFORE AFTER Has never smoked 50% 45% Tried once 19% 24% Used to smoke 13% 13% Smokes occasionally 5% 6% Smokes regularly 13% 13% Note: The official report refers to this part of the survey as England and Wales since certain Welsh schools were included to provide comparability with the 1982 study. For ease of reading throughout this report, it is referred to as "England." The OPCS's application of Bewley's Smoking Prevalence Indicator became a central part of CRU's planning of surveys in other countries. It was therefore repeated exactly in the children-and-smoking surveys reported here. * These dmsifications can be found in: Bewley B.R. and Bland J.M. "Academic and Social Factors Retat~l to Ciga~:tte Smoking by Schoolchildren'. British Journal of Preventive and Social Medicine, 1977.31 : 18-24 (54). 23 cr,, c3 c:) r,,.. o',, BatCo document for PFSFC 1 March 1999

O o O ~r __x tO tO tO I,o APPENDIX E DESCRIPTION OF THE REPORTED SURVEYS Date Argentina 1986 Australia 1984 Canada 1986 Hong Kong 1986 Norway 1985 Agency CRU CRU CRU CRU Method Personal lntcrvicws: at home Personal Interviews: at home Personal Interviews: in Shopping Mall 1.oratlons Personal Interviews: at home Size i008 998 1012 1003 Age Range (*) 7-15 yrs 7-16 yrs 7-15 yrs 7-15 yrs CRU Personal Interviews: at home 998 %!5 yrs Spain 1986 CRU Personal Interviews: at home 1016 %15 yrs Sweden 1987 CRU Personal Interviews: at home 1021 7-15 yrs Switzerland 1987 CRU Personal Interviews: at home 1093 7-15 yrs Turkey 1987 CRU Personal Interviews: at home 1000 7-15 yrs United Kingdom England Scotland Wales 1984 1984 1984 Office of Population Censuses and Surveys Note: (*) In all surveys both boys and girls participated, Writlcn Questions: at school Z 91z[O[09 3658 2778 2798 I 1-15 yrs 11-15 yrs 11-15 yrs

O ¢,D ¢.D ¢D MAIN TOPICS COVERED IN SURVEYS Smoking Patterns Factors Affecting the Start Advertising Awareness of Smoking Argentina X X X (*) Australia X X X (*) Canada X X X (*) Hong Kong X X X (~') Norway X X X (*) Spain X X X (*) Swt~icn X X X Switzerland X X X Turkey X X X United Kingdom X X (*) Brand awareness questions wcr© asked in lhcs¢ countries. 9c]91710109

O o =o to APPENDIX F COMPARISON OF RESTRICTIONS ON TOBACCO ADVERTISING IN COUNTRIES COVERED IN THIS REPORT POINT-OF-SALE COUNTRY TELEVISION RADIO CINEMA PRESS SPONSORSIIIP POSTERS ADVERTISING "'I ...x O ...x ¢D ¢D ¢D ARGENTINA AUSTRALIA CANADA IIONG KONG Commercial advertis- ing available. Restric- tions include no ci- RareSt© commercials during intermissiom or immediately before or afterprogrammes aimed at persona under 21, No tobacco commercials before 10 p.m. Cigarette and roll- your-own advertising prohibited since 1976. Commercial advertis- ing available. Cigarctte and roll-yourq)wn ad- vertising disallowed by vohmlary agreement since January I, 1972. No tobacco ads 4.30- 6.30 p.m. or in pro- grammes directed at young peopk. Commercial advertis- ing available. Restric- lions include no ci- garetle commercials during intermissions or immediatcly before or ~ter programmes mined at persons under 2 I. No tobacco commercials before 10 p.m. Cigarelle and roll- your.own advertising prohibited since 1976. Commercial advertis- ing available. Cigarette and roll-your-own ad- vertising disallowed by voluntary agreement since January I0 197Z Restriction as for "IN, except no 4.30-6.30 ~m. broadcasting ban. egulated by TV au- thority. Cmnmercial advcrtis- Commercial advcrtis- No specific restrictions Commercial advcrtis- No specific rcslricthms ing available. Restric- in.~ available. No spe- for tobacco, ing availablc. No Ape- for tobacco. lions include no tobac- cil,c restrictions for cific restrictions for co advertising in cigarettes, cigarettes. seances accessible to pe~ns under 18, No ads in children's programmes and general programmes during school holidays. Commercial advertis- ing only available its some ouldoor cinemas. No specific rcstrictions for tObaCco, No specific restrictions for tobacco. No specific restrictions No specific restrictions No specific restrictions No specific restrictions for tobacco, for tobacco, for tobacco, for tobacco. Commercial advertis. in8 available. No spe- CilIC r~[licliol~ Inr tobacco. No specific restrictions for Iobacco. Advertising for the ~?mOnSored event to be ited to non-clcc- Ironic media. Sponsor- ship in amateur sports to be phased out. No specific restrictions for tobacco. Commercial advertis- ing available. Specific restrictions for lob:teen iaJclmJc no advertising for cigarettes and roll* your-own in immc- diatc vicinity of prim- a~t and secondary schools. Ouldoor pos- tea advertising for to- bacco prohibited in British Columbia by provin~al legislation. Tobacco advertising prohibited on build- rags owned by munici- palities of Toronto and Hamillon since May 1980. No specific restricfiom for tobacco. No specific restrictions for Iobacco. No specific restrictions for tobacco. NORWAY 6(j917 [ 01 09 Commercial adverlising not available. No tobacco advertising permitted. Commercial advertising not available. No tobacco advertising permitted. No tobacco advertising permitted. No tobacco advertising perrailted. No sponsorship per- mitted, No tobacco advertising permitted. No tobacco advertising permitted.

O0 e-I, C) O o_ 0 0 e,, 3 II) ,-h 0 -I "10 "YI O~ "11 0 ml 0 _=~ CD ~D ~D SPAIN SWEDEN SWI'ITI~RI.ANII Unrestricted except for Catalonia, Reslriclions include no ads for high-tar brands. No ads before 9.30 p.m, Commcrdal advertis- ing not available. Commcrd~l advcrlis- ng available. Tobacco advcrtisinJ~ prohibited siu~ April 24, 1964. Tobacco advertlsiug ou fi~rcign slalions luo:.leasliug pr.- graum)~ m,,inly aimed al Swiss audiclw¢ dis- allowed "4J*c¢ Augusl 19, 1982 by volunta~J agreement. R~lricled as for TV. Exception for new Iow-lar brands for 2 yeanl al'lar inlroduc- lion. Commercial advcrtis- ing no! available. Commcrclal adverlis- ing available. Tobacco advertifing on foreign stalions broadcasthlg programmcs mainly aimed al Swiss flu- dim~¢ disallowed since August |9, 1982 by vollul| ;iry a~[ccUlClil. Tobacco advertising prohibited since July I, 1979. Commercial advcrtls- lug available. Serf- impos~l restrictions by movie dislributors: when p rogrammcs arC access,bit for Dcopic younger IIlan 16 years, only parl of movie coluulcrcials or slitlc cOJZlll~rciaI~ arc shown dunng allot- noon programme sop sions. No specific rea- Iriclior~ for Iobacco. I"IIRK EY Conlmer¢ialadvertising Commercial ~ver~ising No mtrictions. available. Tobacco available. Tobacco advertising prohibited, advertising prohibkcd, UNI'fED Commercialadvcrlising Commercial advcrtL~ing Volunea[y conlrols. No K IN(iDOM available. No cigarette available. No cigarcllc cinema advcrdsing (*). o¢ roll-your-own o[ roll-your-own advertising pcrmilled, advertising pcrmilted. (*) Up 1o I April 1986, advertising was pcrmiUcd in programmes for those aged 18 years and over. No specific restrictions for tobacco. • Reslrictjons on tobac- co advc~li~ing. Commcrcif,I advcrlis- ing available. Specific restrictions for Iobacco by voluntary agree- mcnL I.imilations oil ad space in. newspapers altd ,uagaztucs. Tobacco advertising allowed. Volunlary agreements on Iobacco advcrtisi,~g since 1975. No specific restrictions for tobacco. Prohiblrcd since July I, 1979. SF.ciGc rnuictions. By lc[~islatiou, no ad- vertising on whick:s used for span or on sports CCloipment. By v(dmttary agrccmcul, no advcrlifing al ,-vents intended for cbikh'cn aml urouml ski lilts ~t up primari- ly for use by children. Allowed cxccpl for football. Volunlary restrictions since 1977 on expendi- tures, messages, health warnings, ctc. ReSlrictions for tobac- co. No postcrs in Cata- lonia. Tob~co advertising prohibited sin,'," July I, 1979. Commcrclal advcrtis- ins available. Spccific rcstriclions for tobacco by local aulhotilies in some towns and by vo- lunlary agrecmcol. In some 300 lawns, hw.al aulhorilies prohibi! ndwrtising oa pt~:- raises owned by Ih¢ Iowa. No reslrictions. Voluntary re,slriclions on expcvKlilures and sites ~¢ar schools. Advcrlisintl only al- lowed for domcsdc brands, Rc..-ldClions on tobac- co advertising. No spccil'~; rcslriclions for tobacco. No reslriclions. No specific reslrictions for tobacco. 099171O109

APPENDIX G REVIEW OF THE LITERATURE Many single factors have been postulated as to why children and young people start to smoke. However, a review of the international literature indicates that it is not any one factor but a combination of factors which contribute to the decision of whether to smoke or not. Social factors, for instance, have been increasingly recognised internationally as worthy of more detailed examination, and a large number of studies have focussed on the association between social-network variables and the smoking habits of children and young people (9, I0). Most of the scientific literature in this field consistently agrees that social factors represent by far the most dominant influence as regards starting to smoke (l I); and this was also the conclusion of studies from the late 1950s when Horn et al. (12) rated parental and peer group factors as the two most important ones for predicting smoking among high-school students. An early Norwegian study (13) concluded that parental attitudes and peer group pressure were of major importance. In their comprehensive review of research and theory on the modification of smoking behaviour, Leventhal & Clearly 04) state that social pressure is a prime initiator of experiments with cigarettes. On the other hand, personality factors are not considered important in predicting the start of smoking. Williams (I 5) maintains that the relationships between smoking and personality variables have often been tenuous, and occasionally contradictory. Personality factors appear to influence the amount and type of smoking, rather than the actual adoption of the habit, which is determined more by the social and familial environments of the person. Regarding parental behaviour, a large number of studies confirm that the probability that children and young people smoke increases when their parents smoke (16, 17, 18, 19, 20, 2 l, 22, 23, 24, 25, 26, 27, 28, 29, 30, 3 I, 32, 33, 34, 35, 36, 37, 38). Some studies conclude that the mother's example is of greater importance than the father's (39, 40, 41), whilst two studies claim the opposite (42, 43). A few studies did not fred any association between parental smoking behaviour and the children's habits (44, 45, 46). Bynner (47), in his well-known study of smoking amongst schoolboys, maintains that the association between the parent's and the children's smoking habits is moderate, a conclusion conforming with many of the studies mentioned above. Palmer (48) found that girls more than boys are influenced by their parents' habits. Some researchers report that the relation between parental and child smoking habits is stronger between father and son than between mother and daughter (49, 50, 5 I, 52, 53, 54, 55, 56). That mothers' and daughters' habits are particularly closely related, is reported from two studies (57, 58). Horn's study from 1968 (59) showed that children reduce their use of tobacco when their parents stop smoking. Attention has also been given toparentalattimdes. Several researchers have demonstrated that families who are permissive as regards smoking generate an increased probability that the children will start smoking (60, 61, 62, 63, 64, 65, 66, 67). Williams (68) finds that girls more than boys are influenced by parental attitudes. Significant association has also been reported between parents' permissiveness and children's smoking behaviour (69, 70, 71). The effect of living outside theparentalhome, or with only one of the parents, has also been studied. Wake et aL (72) found that young people living with their parents smoked less than those living outside the family home. Another study concludes that boys leaving their parents at a young age are more likely to smoke (73). A high percentage of smokers has been found amongst children in homes where the parents are divorced (74, 75). Several surveys have focussed on the role of siblings. The conclusions are consistent: when sisters or brothers are smokers, the probability that a child will start smoking is increased (76, 77, 78, 79, 80, 8 l, 82, 83, 84, 85, 86, 87). One study has also concluded that sisters' influence is greater than brothers' influence (88). Another researcher has maintained that the smoking habits of boys are particularly influenced by their brothers (89), whilst one study has confirmed that the association between girls and their sisters' smoking habits is particularly high (90). A near-perfect consistency is found in studies where the smoking habits of young people and children have been compared with the smoking habits of best friend or closest friends. When best friend or friends are smoking, the probability of being asmoker is strongly increased (91, 92, 93, 94, 95, 96, 97, 98, 99, 100, 101,102, 103, 104, 105, 106, 107). Overall, the findings of these studies indicate that children and young people are most likely to smoke when their father, mother, siblings or best friend(s) smoke, and when the parents are permissive towards children's smoking. Within the family, the association seems to be strongest between persons of the same sex. An additional finding from an early study also deserves mention: children smoke less when their parents have stopped smoking (108). Advertising has been postulated as having a positive bearing on the decision of the child or young person to start smoking; and several studies have attempted to identify advertising as a major influence in this respect. Fisher & Magnus (109) claim that their survey leaves "little doubt" that advertising leads children to take up smoking. However, certain methodological deficiencies and a sample containing children from "disadvantaged" schools (45%) raise serious questions as to the dam's validity. 08 O', O r.,. O'~ BatCo document for PFSFC 1 March 1999

Research among children and adolescents has indicated that they are often able to name cigarette brands. Chapman & Fitzgerald (I I0, I I l) surveyed secondary schools to ascertain juvenile brand preference and adverds- ing recall, bu~ they did not address themselves to the problems of conducting complex and controversial research within schools (refer to Appendix B's sections on "Location" and "Administrator Bias"), and a limited self- completion questionnaire was utilised. Notwithstanding, the authors claim that their data show that'adolescents are well aware of advertisements," but also point out that "the role played by advertising in the decision to smoke needs ref'ming conceptually, so that appropriate questions may be asked in research." Similar problems occurred in a more recent UK study of children aged 9 to 13 years (112). Charlton claims that children as young as 9 are attracted by certain cigarette advertisements and enjoy looking at them. She speculates that children may see "positive images" as generic to smoking and the positive impressions they gain from advertisements could be one of the important influences in their decision to smoke. Sixity-sevcn per cent of 9- to 10-year-olds and 84 per cent of 12-to 13-ycar-.olds could name at least one cigarette brand. Seventeen per cent of the younger group and 23 per cent of the older group named a favourite cigarette advertisement. Those children who named a favourite advertisemem showed significantly g~ater support for the claimed*positive values" of smoking such as looking tough, looking grown-up, calming nerves, giving confidence and controlling wright. These impressions applied equally to smokers and nonsmokers. Comparatively few children -- 20 per cem of smokers in the younger group and 12 per cent in the older group -- smoked the brand they named as their favourite advertisement. And three out of four smokers expressed no brand loyalty. Of those who did, taste of the cigarette was the main reason given for choosing it. Research on the effect of exposure to cigarette advertising on smoking behavour consists principally of studies in which teenage smokers have been asked in they feel that their behaviour has been in any way shaped by advertising, and investigations in which independent measures of exposure to advertising messages have been statistically related to the dependent measure of smoking. Statistical relationships between self-reported exposure to, and attitudes towards, cigarette advertising and smoking behaviour have not emerged. Lcmin (l [3) reported no link between television advertising and children's smoking habits. Levitt & Edwards (114) likewise failed to f'md any significant connection between attitudes towards television cigarette advertisements and teenage smoking behaviour. Ledwith (115) claims that televised sports sponsorship by tobacco manufacturers acts as cigarette advertising to children. Lcdwith carried out a survey with 880 secondary schoolchildren aged 11 to i 6 years. It was found that the children were most aware of cigarette brands which had been most frequently associated with sponsored sporting events on television. Children's TV viewing of a recent snooker championship sponsored by one cigarette manu- facturer was positively correlated with the proportion of children associating that brand and other brands used in TV sponsorship, with sport. FoUowing a snooker championship sponsored by another cigarette manufacturer, a second survey was carded out on a new sample showing that awareness of this brand, and the proportion of children associating it with the sport, has increased from the first survey. Lcdwith claims that this demonstrates that the TV sports sponsorship by tobacco manufacturers acts as dgarette advertising to children and therefore circtanvents current advertising guidelines. These findings are neither unequivocal nor conclusive, however. The author himself acknowledges that his study makes no attempt to establish causal Links between sponsorship and children's smoking behaviour. The sample, though described as representative, was drawn from just four schools in one education authority. The question- naires were structured and may not have allowed sufficient freedom for children to respond accurately and in full to questions about their smoking behaviour. These forms were completed in school and administered by teachers. Doubts have been raised about the validity of children's responses to questions about their smoking habits -- a behaviour usually frowned upon by schools -- under these circumstances. Nor were pupils given a free choice to participate in the study, the decision to take part being taken by the headmaster of the school. K insey's (116) discussion of the impact of advertising on smoking among children is overly simplistic and once again fails to take into account the growing body of research and the shortcomings of many surveys on the prevalence and antecedents of young smoking behaviour. Smoking among children and adolescents is influenced by a plethora of personal (Mitic, McGuire & Neumann ([ 17), Livson & Leino (118)) and social factors (International Advertising Association (119)). A great deal of the research on children's and adolescent's smoking behaviour, however, has suffered from methodological limitations. Bold and sweeping statements about young people's smoking have often derived from research with small non-representative samples and inadequate self-report measures of behaviour. Limited or absent theoretical models have meant that researchers have considered only a few of the relevant influence or have failed to investigate effectively how different factors (personal, social, cultural and developmental) interact with each to affect smoking initiation and prevalence among young people. 09 Crx O O Ox BatCo document for PFSFC 1 March 1999

APPENDIX H REFERENCES I. Dobbs J. & Marsh A., Smoking Among Secon- dary Schoolchildren. An enquiry, carried out for the Department of Health & Social Security, The Welsh Office & the Scottish Home and Health Department London: Office of Population Censuses & Surveys, Social Survey Division, 1983. 2. Dobbs J. & Marsh A., Smoking Among Secon- dary Schoolchildren in 1984. An Enquiry Carded out for the Department of Health & Social Security, The Welsh Office & the Scottish Home and Health De- partment London: Office of Population Censuses & Surveys, Social Survey Division, 1985. 3. Smith G. & Sweeney A.E. *Children & Television Advertising -- An Overview," London: Children's Research Unit, 1984. 4. Esserman J. "A Study of Children's Defences Against Television Commercial Appeals." Tel~dsion Advertising & Childrtm, New York: Child Research Service, 1981: 43-55. 5. Gaines L. & Esserman J. "A Quantitative Study of Young Children's Comprehension of TV Program- rues & Commercials." Television Advertising & Child- tin, New York: Child Research Service, 1981: 95-I07. 6. Donahue T.R., Hcnke L.L. & Donahue W.A. *Do Kids Know What TV Commercials Intend?" Jour- nal of Advertising Research 20: (Y), 1980: 51-57. 7. Smith G. & Swecney A.E., 1984, ibid. 8. Ledwith F. *Does Tobacco Sports Sponsorship on Television Act as Advertising to Children?" Health Education Journal, 1984: 43: 85-88. 9. Bewiey B.R., Day I. & Idle L. "Smoking by Children in Great Britain -- A Review of the Litera- tort." London: Social Science Research Council & Medical Research Council, 1976. 10. Williams T.M. "Summary and Implications of Review of Literam~ Related to Adolescent Smoking" Washington: US Department of Health, Education & Welfare. Public Health Service, Centre for Disease Control 1971 II. Royal College of Physicians. "Smoking or Health: A Report of the Royal College of Physicians. London: Pitman Medical 1977. 12. Horn D., Courts F.A., Taylor R.M. & Solomon E.S. "Cigarette Smoking among High School Sin- dents." American Journal of PubLic Health, 1959, 49, 1497-1511. 13. Norwegian Cancer Society. "Rovldng lant barn og unge. En kartiegging av roykevanm" blant skoleelev- er" (Smoking among Children and Youth. A registra- tion of smoking behaviour among schoolchildren). Oslo: The Norwegian Cancer Society, 1957. 30 14. Leventhal H. & Cleary P.D. ~The Smoking Problem: A review of the research and theory in bchav- ioural risk modification." Psychological Bulletin, 1980, 88: 370-405. 15. Williams, 1972, ibid. 16. Horn et al., 1959, ibid. 17. Lundberg A. "Cigarett-rokning bland skokffick- or" (Cigarette smoking among Schoolgirls), Svenska lakartidningen, 1960, 57:1568-1579 18. Morison J.B. & Medovy H.'Smoking Habits of Winnipeg Schoolchildren." Canadian Medical Associa- tion Journal, 1961, 84: 1006-I012. 19. Salber EJ. & MacMahon B. "Cigaretm Smok- ing among High School Students related to Social Class and Parental Smoking Habits." American Journal of PubLic Health, I961, 51: 1780-1789. 20. Salber E.J., Welsh B. & Taylor S.V. "Reasons for Smoking given by Secondary Schoolchildren." Journal of Health & Human Bchaviour, 1963, 4:118- 129. 21. Morison J.B. "Health Education and Cigarette Smoking -- A Report on a Three-year Programme in the Winnipeg School Division, 1960-1963." Canadian Medical Association Journal 1964, 91: 49-56. 22. DHEW Publication. "Teenage Smoking:. Na- tional Patterns of Cigarctm Smoking, Ages 12 through 18, in 1968 and 1970." Washington: DHEW Publica- tion No. (HSIVD 72-7508 US Department of Health, Education & Welfare, Public Health Service, 1972. 23. Vilstrop K. "Skolebom og Tobak. En underso- gelse af vaner og holdinger blant 8-16 drige" (School- children and Tobacco. A Study of Habits and Attitudes among 8-16 year olds). Copenhagen: Ejnar og Meta Thorscm Fond, 1973. 24. Davidson R.L. & Fletcher S.M. "Education about Smoking among Young Adults: A Study in a College of Further Education". Geneva: UICC Techni- cal Report Series l I, 1974, 24-29, 25. Fcscr H. Psychologische Beitrage zu Rauchver- haltcn, Raucherentwohnung und Nichtrauchertraining" (Psychological Contributions to Smoking Behaviour, Smoking Cessation, and Non-Smoker Training). Re- habilitation, Sozialmedizin, Physikallsche Mcdizin, Fr~- ventivmedi2Jn, 1975, 28: (3-4), 47-52. 26. Higgins M. & KcUcr J. "Familial Occurrence of Chronic Respiratory Disease in Familial Resemblance in Ventilatory Capacity." Journal of Chronic Diseases, 1975, 28: 239-231. 27. Baric L.IC, McArthur C. & Fisher C. "Norms, Attitudes and Smoking Behaviour amongst Manches- ter students." Health Education Journal, 1976, 35: 142-150. G", C~ G', C~ ¢...e4 BatCo document for PFSFC 1 March 1999

III I I II i i i i ,ill I • I iii I 2g. Bernard J.G. & Boyer G. "Epidemiological Study of Tobacco Smoking among Young Men in France." Bulletin of the World Health Organisation, 1976, 53: 75-81. 29. Hanley J.A. & Robinson J.C. ~igarette Smok- ing and the Young:. A National Survey." Canadian Medical Association Journal, 1976, 114:511-517. 30. Schwm'z W. & Paun D. "Psychologische As- pekte des Rauchers" (Psychological Aspects of Smok- Lag). In Gibe! W. (Ed.): Gesundheitsschaden dutch Rauchen - M6glichkeiten eLaer Prophylaxe. Berlin: Akademi¢ Verlag, 1976, 93-I05. 31. Wilde J. & Taubert E. "Der ELafluss der Ekem auf die Rauchgcwohnheiten ffugcndlicher" (Parental Influence over the Smoking Habits of Young People). Zcitschrift ffir Erkrankungen der Atmungsorgane mit Folia Bronchologia, 1976, 144: 5-I I. 32. Green P.E. "Teenage Cigarette Smoking in the United States 1968, 1970, 1972 & 1974." In Stdnfeld J., Griffiths W., Ball IC & Taylor R.M. (Eds.): Health Consequences, Education Cessation Activities and Go- vernmental Action, Vo|. II. Proceedings of the Third World Conference on Smoking & Health, New York, June 2-5, 1975, DHEW Publication No. ('NIH) 77-1413, 1977. 33. Rimpela M., Eskola Ahlstrom-Laasko S. & Karmas L. "Nuroten Tupakointitatavat Suomessa sky- oylla 1973" (Smoking Habits of Finnish Youth, 1973). University of Tampere, Department of Public Health Sciences, Research & Reports, Series, 1977, No. 23, 1-40. 34. Allegrante J.P., O'Rourke T.W. & Tuncalp S.A. "Multivariate Analysis of Selected Psychosocial Varia- bles on the Development of Subsequent Smoking Be- haviour," Journal of Drug Education. 197g, 7: 237-248. 35. Beaglehold R., Eyles E. & Harding W. "Ci- garette Smoking Habits, Attitudes and Associated Fac- tors in Adolescents." New Zealand Medical Journal, 1978, 87: 239-242. 36. Bewley B.R. "Smoking in Cklldhood." Post- graduate Medical Journal, 1978, 54: 19%199. 37. Pearson R. & Richardson K. ~'he Smoking Habits of 16-Year-Olds in the National a'dld Devel- opmem Study." Public Health, 1978, 92: 136-144. 38. Rawbone R.G., KeeLing C.A., Jenkins A. & Guz A. "Cigarette Smoking among Secondary School Chil- dren 1975: Its Prevalence and Some of the Factors that Promote Smoking" Health Education Journal, 1979, 38: 92-99. 39. Galli N.A. "A Comparative Analysis of the Atti- tudes and Behaviours of School Children (Selected Grades 4-12) and their Parents Towards Drugs." DIS- sertation Abstracts International B, 1973, 34: 730-731. 40. DHEW Publication'Teenage Smoking:. Nation- al Patterns of Cigarette Smoking Ages [2 through 18, in 1968 and 1970." Washington: DHEW Publication No. (HSM) 72-7508, US Department of Health, Education & Welfare, Public Health Service, 1972. 41. Baric et al., ibid. 42. Nilsen E. "Sosiale normcr og opplysnLagsar- beid" (Social Norms and Educational Activities). Oslo: The Norwe#an Cancer Society, 1967 (unpublished). #3. Wilde & Tauber, 1976, ibid. 44. Jensen L.M. & Thompson J.C. "Report of 1965 Smoking Survey, Lincoln Public Schools -- Senior High Schools."The Journal of School Health, 1965, 36.- 366-373. 45. Bergen B.J. & Olcscn E. "Some Evidence for a Peer Group Hypothesis about Adolescent Smoking." Health Education Journal, 1963, 21: 113. 46. Revill j."Teenage Pressure." Health Education Journal, 1978, 37: 171-178. 47. Bynner J.M. "The Young Smoker. A Study of Smoking among Schoolboys, Carried out for the Min- istry of Health." London: HMSO, Government Social Survey, 1969. 48. Palmer A.B. "Some Variables Contributing to the Onset of Cigarette Smoking among Junior High School Students." Social Science & Medicine, 1970, 4: 359-366. 49. Horn et al., 1959, ibid. 50. Barren E.A. "High School Students' Smoking Patterns. ~ Canadian Journal of Public Health, 1962, 53, 500-506. 51. Bonell-Lewis W.H.B. "The Smoking Habits of Women Students in a Teachers' Training College." Health Education ffoumal, 1963. 52. Wohlford P. "Initiation of Cigarette Smoking: Is it Related to Parental Smoking Behaviour?"J'ournal of Comulting and Clinical Psycholotv, 1970, 34: 148-151. 53. HiggLas & Keller, 1975, ibid. 54. Bcwley B.R. & Bland ff.M. "Academic Perfor- mance and Social Factors Related to Cigarette Smok- Lag by Schoolchildren." British Journal of Preventive and Social Medicine, 1977, 31: 18-24. 55. Banks M.H., Bewley B.R., Bland J.M., Dean J'.R. & Pollard V. "Long-Term Study of Smoking by Secondary Schoolchildren.~ Archives of Disease in Childhood, 197g, 53: 12-19. ,¢6. Bcwiey, 1978, ibid. 57. Batarda Granate M.C. "Tobacco habits of Fe- male Adolescents: Journal da Socicdadc das Ciencias Medic, as de Lisboa, 1973, 137: (8), 523-550. ,¢8. Rawbone et. al., 1979, ibid. 59. Horn D. "Current Smoking among Teenagers." Public Health Repom, 1968, 83: 4,¢8-460. 60. Nilsen E. "Smoking Habits among Schoolchild- ren in Norway." British Journal of Preventive and Social Medicine, 1959, 13: 5-13. O', r-.. BatCo document for PFSFC 1 March 1999

61. Byrmer, 1969, ibid. 62. Palmer, 1979, ibid. 63. V~Lrup, 1973, ibid. 64. Davidson & Fletcher, 1974, ibid. 65. Wake F.R., Thomas F. & O'Farrell. "The Smoking Behaviour of Grade Seven Schoolchildren in an Eastern Canadian City." UICC Technical Reports Series ii, 1974, 15-23. 66. Hanley & Robinson, 1976, ibid. 67. Allagrante et al., 1978, ibid. 68. Williams A.F. ~Personality and other Character- istics Associated with Cigarette Smoking Among Young Teenagers" Journal of Health and Social Behaviour, 1973, 14: 374-380. 69. Bergen & Olesen, 1963, ibid. 70. Batarda, 1973, ibid. • 71. Bafic et aL, 1976, ibid. 72. Wake et aL, 1974, ibid. 73. Battegay IL, Muehlemann R., HeU D., Zehnder R., Hocch P. & Diillnger A. "Alkohol Tobak und Drogen ira Leben des jungen Mannes. Untersuchuag an 4,082 Schweiz~ R.ekrmen betreffend Suchtmittel- konsum im Zivilleben and wghrend der gekruten- schule" (Alcohol Tobacco and Drugs in the Lives of Young Meg Study on 4,082 Swiss Recruits on the Consumption of Addictive Products in Civilian Life, and During Training School). Sozialmedizinische und Padagogische Jugendkundem, 1977, 14. 74. Green, 1977, ibid. 75. DHEW Publication, 1976, ibid. 76. Salber & Taylor, 1973, ibid. 77. Horn, 1968, ibid. 78. Byuner, 1969, ibid. 79. DHEW Publication, 1972, ibid. 80. Wake et al., 1974, ibid. 81. Erne H. & Bruppacher R. "Familiare Faktoren uad Zigaretten Konsum bei Adoleszenten" (Familial Factors and Cigarette Consumption by Adolescents). Sozial und Prgventivmedizin, 1975, 20:. 236-237. 82. Higgins & Keller, 1975, ibid. 83. Stanhope J'.M. & Prior I.A.M. "Smoking Be- haviour and Respiratory Health in a Teenage Sample: The Rotoma Lakes Study." New Zealand Medical Journal, 1975, 82: 71-76. 84. Green, 1977, ibid. 85. Banks et al., 1978, ibid. 86. Beaglehold et al., 1978, ibid. 87. Bewlcy, 1978, ibid. 88. DHEW Publication, 1976, ibid. 32 89. Bewley B.R., Bland J.M. & Harris R. "Factors Associated with the Starting of Cigarette Smoking by Primary Schoolchildren." British Journal of Preventive and Social Medicine, 1970, 28: 37-.44. 90. Bergen & Olesen, 1963, ibid. 91. Nilsen, 1959, ibid. 92. Bergen & Olesen, 1963, ibid. 93. Bynner, 1969, ibid. 94. Palmer, 1970, ibid. 95. Bewley et aL, 1970, ibid. 96. Levitt E.E. & Edwards .]'.A. ~A Multivariate Study of Correlative Factors in Youthful Cigarette Smoking." Developmental Psychology, 1970, 2: 5-11. 97. Hill D. *Peer Group Conformity in Adolescent Smoking and Its Relationship to AfftUation and Auto- nomy Needs." Australian Journal of Psychology, 1971, 23: 189-199. 98. Batarde Granatc, 1973, ibid. 99. Foss R. "Personality, Social Influence and Ci- garette Smoking."Journal of Hcakli and Social Behav- lout, 1973, 14: 279-286. I00. Vilstrup, 1973, ibid. I01. Wake ctal., 1974, ibid. 102. Bewlcy & Bland, 1977, ibid. 103. Green, 1977, ibid. 104. Allegrante et aL, 1978, ibid. 105. Beaglehold ctaL, 1978, ibid. 106. Bewlcy, 1978, ibid. 107. Revill, 1978, ibid. I08. Horn ctal., 1959, ibid. I09. Fisher Deborah A. & Magnus Paul. "Out of the Mouths of Babes. The Opinions of 10 and l I Year Old Children Regarding the Advertising of Cigarettes." Community Health Studies 1981, 5: (I), 22-26. • I I0. Chapman S. & Fitzgerald B. =Brand Prefer- ence and Advertising Recall in Adolescent Smokers: Some Implications for Health Promotion" American Journal of Public Health 1982, 72: (5), 491-494. I II. Chapman S. =Understanding Cigarette Adver- rising -- A New Approach to Anti-Smoking Educa- tion." Canberra, Australian Commonwealth Depart- ment of Health, Health Services and Teaching Paper No. 6, September 1981. I12. Charlton A. "A Children's Advertisement- awareness Related to Tack Views on Smoking." Health Educational Journal, 1986 45: (2) 75-79. 113. Lernin B. "A Study of the Smoking Habits of 14-year old Pupils in Six SchooLs in Aberdeen." Medi- cal Officer, 1966 (August 5), 116: 82-85. O~ (ZD cZ~ (P, BatCo document for PFSFC 1 March 1999

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