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Exposure to Tobacco Advertisements or Promotions and Susceptibility to Smoking Among Adolescents in China from 2013-14 to 2021: Findings from the China National Youth Tobacco Survey
29 Pages Posted: 21 Dec 2023
More...Abstract
Background: Tobacco advertisements or promotions (TAPs) can significantly promote tobacco consumption and compared to adults, adolescents are more likely to notice and be influenced by TAPs.
Methods: Samples of middle school (MS) and high school (HS) students with national and provincial representativeness were examined during 2013-14 and 2021. Exposure to different TAPs and non-smokers’ susceptibility to smoking were determined. Multilevel logistic regression were used to assess the effect of exposure to TAPs on susceptibility to smoking in different age groups, and whether this exposure moderated the effect of anti-tobacco messages on susceptibility.
Findings: In 2021, MS and HS students had high exposure to TAPs on TV/movies (64.1% and 69.4%) and at points-of-sale (POS; 41.9% and 38.9%), but MS students had slightly lower percentages than in 2013–14. In 2021, 8.9% of MS students and 12.8% of HS students who were non-smokers were susceptible to smoking, a 6.0% decrease compared to 2013–14 among MS students. Exposure to TAPs had significant and positive associations with susceptibility after adjusting for covariates in all age groups (all P < 0.05). Anti-tobacco messages decreased susceptibility to smoking, but TAPs moderated this effect.
Interpretations: Students had decreasing exposure to TAPs over time, but exposures remained high, especially at POS and TV/movies. Non-smokers had low susceptibility to smoking, and this decreased over time. Exposure to TAPs was positively associated with susceptibility to smoking, especially in younger students. Exposure to TAPs also reduced the benefits of anti-tobacco messages.
Funding: Tobacco epidemic surveillance and tobacco control integrate intervention program.
Declaration of Interest: We declare no competing interests.
Ethical Approval: The study protocols were approved by the Institutional Review Board of the China CDC. School officials and respondents provided verbal consent before the interview.
Keywords: Chinese adolescents, Tobacco advertisements or promotions, Susceptibility to smoking, Anti-tobacco messages
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