Cigarette Brand Preference Among Middle and High School Students Who Are Established Smokers --- United States, 2004 and 2006

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Studies have suggested a link between exposure to tobacco advertising and cigarette brand preference (1,2). Knowing the brand preferences of young established smokers can provide insight into what influences young smokers to start and continue to smoke. A report of 2005 data indicated that the three most heavily advertised brands, Marlboro, Newport, and Camel, were preferred by 81% of U.S. youths aged 12--17 years (3). To assess the cigarette brand preferences among middle school and high school students who were established smokers, CDC analyzed data from the 2004 and 2006 National Youth Tobacco Survey (NYTS). This report summarizes the results of that analysis, which indicated that among established student smokers in middle and high school, Marlboro was the preferred brand (43.3% and 52.3%, respectively), followed by Newport (26.4% and 21.4%, respectively). The use of Newport was significantly higher among blacks in middle school (59.7%) and high school (78.6%) compared with other racial/ethnic groups. Information on brand preferences and tobacco marketing strategies that are attractive to students can be used by tobacco control programs and community initiatives in the design of tobacco countermarketing campaigns. These countermarketing campaigns have been shown to be effective as part of a comprehensive tobacco control program to decrease the initiation of tobacco use among youths and young adults (1).

NYTS is a cross-sectional nationally representative sample of students enrolled in grades 6--12; data are collected approximately every 2 years. Students complete a self-administered survey in a classroom setting. The target population consists of public and private school students in the 50 states and the District of Columbia. Black, Hispanic, and Asian students* are oversampled to ensure enough participants from those racial/ethnic populations to get reliable estimates. Respondents who self-identify as non-Hispanic and select two or more races are classified as multiracial. In 2004, 267 (93%) of 288 eligible schools participated, and of 31,774 students who were sampled, 27,933 (88%) completed the questionnaire, for an overall response rate of 82%. In 2006, 261 (92%) of the 285 eligible schools participated, and of 30,875 students who were sampled, 27,038 (88%) completed the questionnaire, for an overall response rate of 81%. Data for these 2 years were combined to increase sample size and precision of estimates for selected racial/ethnic populations. Data were weighted to provide national estimates, and statistical software was used for all data analyses to account for the complex sample design. T- tests were performed to determine differences between populations in their brand use. The differences were considered statistically significant at p<0.05.

Respondents were asked how many cigarettes they had smoked in their entire life and whether they had smoked in the past 30 days. Established student smokers were defined as having smoked >25 cigarettes in their entire lives and smoked at least one cigarette during the 30 days preceding the survey. To determine the brand of cigarettes most often used in the past 30 days, respondents were asked "During the past 30 days, what brand of cigarette did you usually smoke?" Responses were "I did not smoke cigarettes during the past 30 days; I do not have a usual brand; American Spirit; Camel; GPC, Basic, or Doral; Kool; Lucky Strike; Marlboro; Newport; Parliament; Virginia Slims; some other brand."

For the study period, the percentage of high school students who were current established smokers (14.3%) was more than four times greater than the percentage of middle school students who were established smokers (3.0%) (Table 1). Among middle school students, whites (3.4%) were more likely to be established smokers than blacks (1.8%). Among high school students, significant differences in the prevalence of established smoking occurred among white (17.5%), Hispanic (10.8%), Asian (6.0%), and black (4.3%) students. No differences between male and female students in prevalence of established smoking were observed at either school level.Among middle school students, 43.3% of established cigarette smokers identified Marlboro as the brand they usually smoked during the preceding 30 days, followed by Newport (26.4%), other brands (14.6%), Camel(8.5%), and no usual brand (7.2%) (Table 2). Whites were more likely than blacks, Hispanics, and students of multiple races to smoke Marlboro. Blacks were more likely than whites, Hispanics, and students of multiple races to smoke Newport.

Among high school students, 52.3% of established cigarette smokers identified Marlboro as the brand they usually smoked during the preceding 30 days, followed by Newport, Camel, other brands, and no usual brand (Table 2). Asian, white, Hispanic, and multiracial students were more likely than blacks to smoke Marlboro. Blacks were more likely than Hispanics, multiracial students, Asians, and whites to smoke Newport. Whites and multiracial students were more likely than blacks to smoke Camel, and Hispanics were more likely than Asians to smoke other brands.

Brand preference differed by sex among middle school students: 49.6% of female smokers used Marlboro cigarettes, compared with 37.6% of male smokers, and 12.4% of male smokers used Camel cigarettes, compared with 4.1% of female smokers. Brand preference also differed by sex among high school students: use of Camel and no usual brand was higher for males (15.6% and 4.1%, respectively) than females (9.9% and 2.5%, respectively). The use of Marlborowas significantly higher for females (54.5%) in high school compared with males (50.2%).

Reported by: M O'Hegarty, PhD, S Thorne, MPH, LL Pederson, PhD, K Asman, MSPH, A Malarcher, PhD, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note:

Knowing the brand preferences of student established smokers can provide insights into what influences student smokers to start and continue to smoke. The three most heavily advertised brands, Marlboro, Newport and Camel, continue to be the preferred brands of cigarettes smoked by established student smokers in middle and high school. Among middle school respondents, the preference for these three brands was 78.2%, ranging from 67.7% to 80.5% across racial/ethnic groups and by sex. Among high school respondents, the preference for these three brands was 86.5%, ranging from 79.2% to 90.3% across racial/ethnic groups and by sex. These findings are similar to those reported in earlier surveys. Analyses of the 2002 NYTS indicated that current smokers in middle school identified Marlboro as the brand they usually smoked, followed by Newport, other brands, no usual brand and Camel. Current smokers in high school identified Marlboro as the brand they usually smoked, followed by Newport, other brands, Camel, and no usual brand (4). The current study also showed that Marlborowas the preferred brand among female (54.5%) and male (50.2%) established smokers. Unpublished data confirm that whites comprised a greater percentage of female established smokers than male established smokers in high school and whites are more likely to prefer Marlboro than are other racial/ethnic groups. Most black established student smokers used Newport, a mentholated brand. The tobacco industry has strategically targeted black communities in its advertisements and promotional efforts for menthol cigarettes (5).

In 2005, the cigarette industry spent $13.1 billion in advertising and promotion, down from $14.1 billion in 2004 (6). Since the 1998 Master Settlement Agreement,^† which prohibits tobacco advertising that targets persons aged <18 years, cigarette advertising expenditures in magazines with more than 15% youth readership have decreased (7).^§ However, alternative promotional strategies likely are being used to reach youth, including sample distribution, point-of-sale promotion, specialty item distribution, and sponsorship of public entertainment (7). NYTS data indicate that although self-reported youth exposure to protobacco messages declined during 2000--2004 in all media channels except the Internet, most youth in the United States remain exposed to protobacco messages: in 2004, 81% saw images of smoking on television or in movies, 85% saw tobacco advertisements in stores, 50% saw tobacco advertisements in newspapers and magazines, and 33% saw tobacco advertisements on the Internet (8). The National Cancer Institute and the Institute of Medicine have recommended that stronger and more comprehensive regulations are needed to protect youth from exposure to all forms of advertising and promotional activities by tobacco companies (1,9).

The findings in this report are subject to at least three limitations. First, because the NYTS is limited to youth who are attending middle or high school, the findings might not be generalizable to youth who have dropped out of school. During 2005, nationally, 3% of persons aged 16 years, 4% of persons aged 17 years, and 8% of persons aged 18 years had dropped out of school (10). The dropout rate also varies by race/ethnicity. Second, data were collected by self-report and students might underreport or overreport their tobacco use. Finally, because established student smokers were the focus of this report, sample sizes are small among some racial/ethnic groups; estimates for these groups should be interpreted with caution. The effect of these limitations on estimates of brand use is unknown.

Tobacco advertising and promotional activities are important catalysts that can prompt smoking initiation, especially among youth (1).^¶ Knowing the cigarette brand preferences of middle and high school students who are established smokers and the advertising and marketing used to promote these brands provides information that can be incorporated into targeted mass media campaigns to counter those messages and reduce smoking initiation. Mass media campaigns, combined with other interventions, are one component of comprehensive tobacco control initiatives that have been effective in reducing smoking initiation; other effective components include increasing the unit price of tobacco products, and implementing smoke-free indoor air policies and legislation.** The Institute for Medicine concluded that funding comprehensive tobacco control programs at levels recommended by CDC is needed to decrease initiation among youth and young adults and increase cessation among youth and adults (9).

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