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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