0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

The Tobacco Industry and Underage Youth Smoking:  Tobacco Industry Documents From the Minnesota Litigation FREE

Cheryl L. Perry, PhD
[+] Author Affiliations

From the Division of Epidemiology, University of Minnesota, Minneapolis.


Arch Pediatr Adolesc Med. 1999;153(9):935-941. doi:10.1001/archpedi.153.9.935.
Text Size: A A A
Published online

Objective  To learn how underage youth have been regarded by the major tobacco companies, as revealed in industry documents during the Minnesota litigation.

Data Sources  Documents from Brown & Williamson Tobacco Corp, Lorillard Tobacco Co, Philip Morris Inc, and R. J. Reynolds Tobacco Co.

Study Selection  Documents available from the State of Minnesota and Blue Cross and Blue Shield of Minnesota v Philip Morris Inc et al during the discovery process of the trial. Hundreds of industry documents related to youth, teenagers, and young adults were examined. A sample of documents are referenced as illustrations of key points.

Conclusions  Underage youths are viewed by the tobacco industry as critical to its future. Underage youth smoking patterns were examined for decades. Reductions in youth smoking rates were seen by tobacco companies as a negative trend for the companies. Specific marketing campaigns were directed at underage youth and were successful with this age group. Tobacco industry practices should continue to be carefully scrutinized.

THE GROUNDBREAKING 1998 tobacco trial in Minnesota provided access to millions of pages of internal tobacco industry documents. As an expert witness for the State of Minnesota, I examined hundreds of industry documents related to youth smoking. These documents, along with the published literature, formed the basis of my testimony on youths and smoking.1 The major opinion of this testimony was that the actions of tobacco companies were a substantial factor in causing underage youths (<18 years old) to smoke. This article presents examples from tobacco industry documents that contributed to this opinion. Copies of those documents can be obtained from the Minnesota depository or from various Web sites that have been created since the settlement agreement in May 1998.2

Youths are critical to the tobacco companies. Most people begin to smoke as underage teens, with only about 18% beginning to smoke at 18 years and older and only 5% beginning at 21 years and older.3 Thus, early through middle adolescence is the developmental stage during which smoking onset occurs. This is important for several reasons. First, younger adolescents cannot fully comprehend the consequences of smoking cigarettes; cognitively, they have not yet attained true abstract reasoning capabilities.4,5 Therefore, messages concerning the long-term consequences of smoking are mostly remote and irrelevant to adolescents. Second, adolescence is probably the only developmental stage during which smoking could be viewed as "functional." Smoking can be seen by adolescents as serving key developmental tasks, such as establishing autonomy, independence, intimacy, and identity, particularly when role models portray these attributes as being associated with smoking.3,6,7 Third, adolescents become addicted to cigarettes and find it difficult to quit, even when they are motivated to do so.3 For example, nearly half of high school seniors who smoke reported that they would like to quit; nearly 40% had tried to quit and had been unsuccessful.3 Of those seniors who were smoking at least 1 cigarette a day, nearly 80% were still smoking 5 to 6 years later.3 In other words, adolescent smokers become adult smokers. Finally, most people smoke only 1 to 3 cigarette brands in their lifetimes, such as Marlboro or Camel cigarettes, making cigarettes the most "brand loyal" consumer product in the United States.8 Attracting young people to smoke a particular brand is critical to the future of cigarette companies because young people tend to smoke the same brand as they grow older. Adolescents, then, are a vulnerable population that can be exploited, given their inability to fully comprehend the long-term consequences of their actions, particularly if a product or behavior can be shown to meet the developmental tasks of adolescence. This is clearly problematic with cigarettes because they are addictive and the primary cause of premature death in the United States.3 In fact, 1 of 3 teen smokers will die prematurely as a result of smoking.9

Tobacco industry documents reveal that the industry has a long history of studying the smoking patterns of underage youth. Companies responded to decreases among teens who smoked their brands as a negative trend, explicitly recognizing the importance of underage youth to the future of their business. Documents also reveal that underage youths were a target group for the marketing campaigns of cigarette companies, some of which were successful in attracting youths.

Tobacco companies have recognized the importance of underage teens for decades. A Philip Morris (PM) document, written by Myron Johnston of the PM Research Department in 1981, summarizes the importance of teens to their business:

It is important to know as much as possible about teenage smoking patterns and attitudes. Today's teenager is tomorrow's potential regular customer, and the overwhelming majority of smokers first begin to smoke while still in their teens. In addition, the 10 years following the teenage years is the period during which average daily consumption per smoker increases to the average adult level. The smoking patterns of teenagers are particularly important to Philip Morris . . .

Furthermore it is during the teenage years that the initial brand choice is made: At least a part of the success of Marlboro Red during its most rapid growth period was because it became the brand of choice among teenagers who then stuck with it as they grew older—this combined with the rapid growth in the absolute number of teenagers [emphasis in original].10(p808)

Thus, in this document, the importance of understanding and studying underage youths was quite evident because teenagers were seen as primarily responsible for the success of Marlboro cigarettes—the brand that became the No. 1 cigarette on the market and whose sales have made PM the dominant cigarette company for the past 2 decades.

The critical importance of young smokers was also stressed in the documents of R. J. Reynolds Tobacco Co (RJR). In a 1984 RJR Marketing Department report, Diane Burrows discussed the relative importance of new smokers:

Younger adult smokers have been the critical factor in the growth and decline of every major brand and company over the last 50 years. They will continue to be just as important to brands/companies in the future for two simple reasons:

• The renewal of the market stems almost entirely from 18-year-old smokers. No more than 5% of smokers start after age 24.

• The brand loyalty of 18-year-old smokers far outweighs any tendency to switch [brands] with age.

Thus the annual influx of 18-year-old smokers provides an effortless momentum to successful "first brands"* (*ie those which appeal to 18-year-old smokers rather than to switchers ages 19-24). Marlboro grows by about .8 share points per year due to 18-year-old smokers alone [emphasis in original].11(p8465)

This document clearly states that the success of a cigarette company, the "renewal of the market," depends on which cigarette brand is selected as a young person's first brand because young people are "loyal" to their first brand. Although the document refers to 18-year-old smokers, most smokers begin smoking daily and select their first brand of cigarettes before age 18 years.3,8 As a 1974 RJR memo from D. W. Tredennick, RJR's director of consumer research, from the Marketing Research Department points out: ". . . most smokers begin smoking regularly and select a usual brand at or before the age of 18."12(p1308)

In addition, RJR's data on 18-year-olds were obtained by examining trends in the 16- to 17-year-old and 18- to 20-year-old age groups and therefore represent a range of ages, including underage teens.13 Being the initial brand of choice among young people, then, is a crucial objective for cigarette companies, according to these documents, because more revenue can be gained in the long-term by attracting young smokers in the first place than by trying to persuade them later to switch to a new brand.

From the cigarette industry's perspective, then, underage youth are crucial to the future of its business because it is during this time that youth begin to smoke, smoke their first brand of cigarettes, and "stick with it" as they grow older. A 1982 RJR Marketing Department report from Diane Burrows summarizes what a decline in young smokers means to the cigarette companies: ". . . the loss of younger adult males and teenagers is more important in the long term, drying up the supply of new smokers to replace the old . . . . This is not a fixed loss to the industry: its importance increases with time."14(p1371)

Tobacco companies have engaged in a broad spectrum of research studies of underage teens. This research is in addition to the large body of literature on adolescents, the cause of smoking, and smoking behavior that has been available from academic and government scientists.

Research on Youth Smoking Prevalence and Brand Preferences

Studies of smoking prevalence and brand preference of underage youths were done by all major tobacco companies. As early as 1958, RJR, through the William Esty Co, New York, NY, conducted nationwide surveys of high school students that examined smoking prevalence by age, sex, and grade level and which brands students smoked.15,16 In addition, household surveys were conducted for RJR by National Family Opinion Inc, Toledo, Ohio, until at least the early 1980s, with annual reports of prevalence and brand preferences of 14- to 17-year-olds.1723

Philip Morris also surveyed underage teens as early as 1968, with graphs showing that the largest percentage of Marlboro smokers by age group were underaged teens (15-17 years).24 Thus, as early as 1969, PM recognized that Marlboro cigarettes were more appealing to underage youth than to adults. In 1975, Myron Johnston of the PM Research Department wrote in a memo the reasons for the "Decline in the Rate of Growth of Marlboro Red":

In my opinion, the decline in Marlboro's growth rate is due to four factors:

1. Slower growth in the number of 15-19 year olds

2. The recession

3. Price increases in 1974

4. Changing brand preferences among younger smokers.

. . . Most of these studies have been restricted to people age 18 and over, but my own data, which includes younger teenagers, shows even higher Marlboro market penetration among 15-17 year olds [emphasis added].25(5497)

Thus, PM was able to ascertain, by their "own data," that the slowing down of the phenomenal growth of Marlboro cigarettes in the middle 1970s was caused, in part, by there being fewer teens, which caused even greater competition among cigarette companies to attract more younger smokers to maintain their revenue into the future. The same 1975 memo25 summarizes the importance of 15- to 19-year-olds to PM's revenues from Marlboro cigarettes: "The correlation between Marlboro sales and the number of 15-19 year olds is .996 [emphases in original]."25(p5498)

Because Marlboro had captured such a large percentage of the underage teen market by the middle 1970s, sales of Marlboro were nearly completely dependent on the number of teens in the population.

Lorillard (LD) monitored the smoking behavior of 13- to 17-year-olds using government data,26 and Brown & Williamson (B&W) collected data on 16- to 25-year-olds in their Brand Switching Studies2732 from the late 1960s to 1980s. Thus, all the major cigarette companies had access to current data on teenage smoking patterns and brand preferences and were aware of which competing brands were increasing in popularity among the young.

Research on Smoking Trends Among Youth

Cigarette companies claim that they do not want underage youth to begin to smoke.3335 Yet, a decrease in underage youth smoking was viewed as a negative trend for the industry, contrary to their public statements. For example, in an RJR Marketing Development Department memo in 1980 written by G. H. Long, the future chief executive officer of RJR and then executive vice president of marketing, to E. A. Horrigan, the chairman of the company, it was noted that, whereas the percentage of 14- to 17-year-old smokers who smoked PM's brands had increased, RJR's percentage had decreased among this age group. The conclusion to the memo stated: "Hopefully, our various planned activities that will be implemented this fall will aide in some way in reducing or correcting these trends."36(p3894)

In other words, "correcting" the decrease in underage smokers became an objective of RJR's marketing activities at the highest levels of the company.

A second RJR document analyzed the effects of the Fairness Doctrine on underage teens (12 to 17 years old).14 The Fairness Doctrine was a national policy in effect from 1967 to 1971.3 During this time, cigarette advertisements were allowed on television, but antismoking ads were also required, at the rate of about 1 antismoking advertisement for each 12 cigarette advertisements.37 Analyses of this period show that youth smoking began to significantly decline after the introduction of regular antismoking advertisements. The RJR document, written by Diane Burrows in 1982, stated:

The Fairness Doctrine was also found to have an important negative effect during its first year (accounting for a 3 percent point drop in 12-17 incidence) . . . Thus, the absence of TV advertising after 1970 was implicitly a negative effect, but the absence of the Fairness Doctrine was a larger implicit positive."14(p1377)

In other words, the introduction of antismoking commercials due to the Fairness Doctrine had a "negative effect," in that the percentage of youths aged 12 to 17 years who smoked significantly declined. R. J. Reynolds recognized that not being allowed to advertise on television had a negative impact but that antismoking advertisements had an even greater perceived negative impact.

Not only antismoking advertisements but also the price of cigarettes can influence teens. Youths seem to be at least as price sensitive to the cost of cigarettes as adults.3 Thus, an increase in price causes a decrease in consumption among youths. A PM document in 1987 commented on the effects of price increases for cigarettes caused by increased excise taxes:

. . . the 1982-83 round of price increases caused two million adults to quit smoking and prevented 600,000 teenagers from starting to smoke. . . . this means that 700,000 of those adult quitters had been PM smokers and 420,000 of the non-starters would have been PM smokers. . . . we were hit disproportionately hard. We don't need that to happen again [emphases in original]."38(p6179)

Philip Morris was clearly aware of the effects of price increases on underage smokers—420,000 teenagers would have been PM smokers, but had, by their calculations, decided not to start. The response from PM was they did not "need that to happen again." That is, they did not need additional state or national taxes on cigarettes that might prevent young people from starting to smoke.

Research Relevant to Marketing

Tobacco companies also engaged in research with or about underage teens that would be directly relevant to marketing to this age group. One of the most explicit documents was a report by the Roper Organization Inc, New York, NY, who conducted a study in 1974 on behalf of PM entitled "A Study of Smoking Habits Among Young Smokers." This study involved direct interviews with 1050 smokers younger than 24 years. The survey for the study is included in the document and indicates that the Roper Organization would survey young people aged "14 or younger."39(p6185) There were 620 interviews conducted with young people 18 years or younger. The purpose of the interviews was "to gain insights as to what is happening with regard to brand preferences and images of cigarette brands in that segment of the population."39(p6152) Interviewers went to 35 locations around the country, to popular "hangouts" of young people. They concluded that "Marlboro is the starting brand for young whites, and Kool is the starting brand for young blacks"39(p6155) and that "certainly Philip Morris should continue efforts for Marlboro in the youth market . . . ."39(p6157) Thus, the Roper Organization identified for PM that Kool cigarettes were competing with Marlboro, but primarily with young black adolescents. Marlboro was still the brand of choice for young whites, and therefore, "continued efforts," such as advertising and promotional activities, were recommended to attract these youths.

In 1973, an RJR document written by Claude Teague, a researcher in RJR's Research Planning Department, analyzed what might be appropriate for a new brand to be "particularly attractive to the young smoker."40(p7358) The document, entitled "Some Thoughts About New Brands of Cigarettes for the Youth Market," states:

At the outset it should be said that we are presently, and I believe unfairly, constrained from directly promoting cigarettes to the youth market; that is, to those in the approximately twenty-one year old and under group.

. . . Realistically, if our company is to survive and prosper, over the long term, we must get our share of the youth market.

. . . Perhaps these questions may be approached by consideration of factors influencing pre-smokers to try smoking, learn to smoke and become confirmed smokers [emphasis added].40(p7358)

He goes on to address these factors:

For the pre-smoker and ‘learner' the physical effects of smoking are largely unknown, unneeded, or actually quite unpleasant or awkward. The expected or derived psychological effects are responsible for influencing the pre-smoker to try smoking and provide sufficient motivation during the ‘learning' period to keep the ‘learner' going . . . .40(p7359)

He also recommends:

A careful study of the current youth jargon, together with a review of currently used high school American history books and like sources for valued things might be a good start at finding a good brand name and image theme.40(p7367)

This document reiterates the need for RJR to get their "share of the youth market" to "survive and prosper." It then analyzes why a "pre-smoker" would be motivated to begin and continue to smoke—psychological benefits, rather than anything inherent to cigarettes. Finally, the document includes a recommendation to review youth jargon and high school books for sources for a new brand name and image—that is, to intentionally seek symbols that would be relevant and appealing to underage youths.

The Canadian affiliate of RJR, RJR Macdonald Inc, also studied adolescents, such as in the Youth Target 1987 study,41 which involved interviews with 15- to 24-year-olds on psychosocial factors related to smoking and smokers. This was not presented during the Minnesota trial, but the findings from studies of Canadian youths would clearly be relevant to youths in the United States.

Underage teens were also included in marketing reports. One of the most important was the 1975 Marketing Plans Presentation to the RJR Board of Directors at Hilton Head, SC, in 1974 by C. A. Tucker, the company's vice president of marketing. The presentation outlines marketing accomplishments and plans for 1975. The first marketing "opportunity area" for 1975 was to "increase our young adult franchise."42(p1311) The document defines young adult to include underage teens and provides a rationale for their importance as the No. 1 targeted group for 1975:

First, let's look at the growing importance of the young adult in the cigarette market. In 1960, this young adult market, the 14-24 age group, represented 21% of the population.

As seen by this chart, they will represent 27% of the population in 1975. They represent tomorrow's cigarette business. As this 14-24 age group matures, they will account for a key share of the total cigarette volume—for at least the next 25 years [emphasis added].42(p1311)

Young adults, then, were defined as 14- to 24-year-olds to the RJR Board of Directors, consistent with the breakdown used in their studies of smoking prevalence discussed previously.1723 Again, young adults were seen as critical to RJR because they "represent tomorrow's cigarette business." The marketing plans for 1975 are also outlined in some detail in this document. Among them, multicomponent advertising and promotional campaigns to reach young adults, 14- to 24-year-olds, are described:

We have increased our media efforts toward young adults for our brands. These include:

• Increased advertising insertions in traditional young adult magazines like Sports Illustrated, Playboy and Ms.

• . . . Expanded outdoor with selective locations for maximum young adult exposure. . . .

Each of our major special events is directed against young adults.42(pp1316-1317)

. . . Our special merchandising division is in its second year with its successful wholesale operation of premiums at beaches and special events through a separate sales force and a mobile store. We anticipate selling over a million items in 1975—a million ‘walking billboards' for our brands.

We will continue our special sampling programs . . . Where there are large congregations of young adults.42(p1320)

Thus, these marketing plans included many specific activities that would attract young adults, with young adults explicitly defined in the document as 14- to 24-year-olds—clearly including underage youths. These plans are consistent with a recent report that magazines with higher youth readership are more likely to advertise youth brands of cigarettes.43 R. J. Reynolds—including the RJR Board of Directors—was made aware that young people would be "walking billboards" for their cigarettes.

A second RJR memo, written in 1975 by J. F. Hind to C. A. Tucker, confirms that the objectives outlined by Tucker in the Hilton Head presentation were being implemented, and that these efforts included underage youths:

Our attached recommendation to expand nationally the successfully tested ‘Meet the Turk' ad campaign and new Marlboro-type blend is another step to meet our marketing objective: To increase our young adult franchise. To ensure increased and longer-term growth for CAMEL FILTER, the brand must increase its share penetration among the 14-24 age group which have a new set of more liberal values and which represent tomorrow's cigarette business.44(p5557)

Thus, RJR's marketing efforts explicitly involved underage youths, and these included new advertising campaigns for Camel Filter cigarettes.

The Joe Camel campaign had its origins at about this same time in the late 1960s and early 1970s. A cartoon camel character was first used in France to promote Camel cigarettes and was referred to as the "French Camel." A 1974 RJR memo stated: "I think the French advertisement for Camel Filters is a smash. . . . It's about as young as you can get, and aims right at the young adult smoker Camel needs to attract [emphasis added]."45(p3940)

Thus, RJR acknowledged that the cartoon camel "aims right at the young adult smoker" at a time when the young adult market was defined to be 14 to 24 years old. The French Camel was reconsidered in the middle 1980s46 and evolved into the infamous Joe Camel campaign beginning in 1988.

Brown & Williamson also specifically targeted youths. Kool cigarettes were particularly popular among youths in the early 1970s. In 1973, noting the success of Kool with the younger age groups, R. L. Johnson wrote28:

KOOL's stake in the 16-25 year old population segment is such that the value of this audience should be accurately weighted and reflected in current media programs. As a result, all magazines will be reviewed to see how efficiently they reach this group and other groups as well (emphasis added)."28(p2240)

Thus, B&W recognized its success with underage youths and their importance to its company, and were clear in its intentions to "reach this group."

Finally, PM notes in a summary document on Marlboro in 1979, which addresses its success with younger smokers:

Marlboro dominates in the 17 and younger category, capturing over 50% of this market. In the 18-24 age group, Marlboro dominates with 30.7% share. Marlboro Red is smoked by the younger group; Lights by the older group.

. . . We now have a single minded advertising campaign which is a source of strength for the brand, and successfully conveys flavor and quality at the same time [emphasis added].47(p8174)

Philip Morris recognized the strength of their Marlboro advertising campaign in that it had "captured" more than half of underage smokers. The Marlboro Man continued to be successful in attracting young people, and PM continued to market to that group, years after recognizing in 1969 that underage youths was the group most responsive to the campaign.

Specific advertising and promotional campaigns have been successful in reaching underage youths and have increased individual companies' shares of the youth market. Some campaigns, such as the introduction of "female brands" in the late 1960s, resulted in an overall increase in underage youth smoking,37,48 in part because youths seem to be more sensitive or "amenable" to advertising than are adults.4952

Tobacco companies also noted their success with underage youths. A 1978 LD memo on sales of Newport cigarettes in the northeast states:

The success of NEWPORT has been fantastic during the past few years. Our profile taken locally shows this brand being purchased by black people (all ages), young adults (usually college age), but the base of our business is the high school student [emphasis added]."53(p7131)

Newport is currently 1 of the top 3 brands of cigarettes smoked by underage youths.49

Philip Morris also reported on the indisputable success of the Marlboro campaign with underage youths. As part of a PM Product Testing Short Course in the Research and Development Division, the success of Marlboro is explained: "Marlboro floundered for eight years and then hit a responsive chord among post-war baby boom teenages with the theme from the Magnificent Seven and an image uncalculatedly right for the wave of teenages coming of age."54(p7504)

The image, of course, was the Marlboro Man cowboy. Thus, the Marlboro Man, the image of independence and autonomy, found a "responsive chord" among teenagers in the late 1960s and 1970s. Because of the large number of baby boom teenagers, Marlboro captured the market and become the most popular cigarette brand among youths. Subsequently, because the baby boomers aged, Marlboro became the most popular brand among adults.49

Similarly, B&W reported on its success with Kool cigarettes in 1973: "KOOL has shown little or no growth in share of users in the 26+ age group. Growth is from 16-25 year olds."28(p2238)

In other words, Kool only appealed to younger people, including underage teens. In a 1979 document discussing the "History and Key Trends of the U.S. Cigarette Market," B&W attributes the success of Kool to the following: "An increase in KOOLs' advertising and promotion to blacks and youth in the late 60's speeded up these developments [emphasis added]."55(p5009)

Thus, B&W acknowledges in this document that blacks and youths were target groups for its advertising and promotional activities and that these resulted in more rapid growth for Kool.

Finally, RJR reported on the success of Salem in 1975: "SALEM King shows encouraging growth by posting a four point gain in the 14-17 market. There were no changes in the older markets [emphasis added]."19(p2726)

Again, increases among 14- to 17-year-olds who smoked Salem cigarettes were seen as positive and "encouraging," and Salem was increasing in popularity only among underage youths, not among those 18 years and older. More recently, in a review of the 1990 "Joe in Action" Camel advertising campaign, an RJR document notes: "Specifically, the 1990 work . . . firmly established CAMEL as a SUBOC [second usual brand of cigarettes] among competitive adult smokers, and helped realize tangible increases as a FUBOC [first usual brand of cigarettes] . . . ."56(p346)

Thus, the Joe Camel campaign resulted in more young people smoking Camel cigarettes as their first usual brand. But, as discussed previously, and as an RJR document points out,12 most smokers begin smoking regularly and select a usual brand at 18 years or younger.

Each of the major cigarette companies—PM, RJR, B&W, and LD—had a successful youth brand during the past 25 years: Marlboro, Camel, Kool, and Newport, respectively. Marlboro, however, continues to dominate the youth market, with "an image uncalculatedly right" for autonomy-seeking adolescents worldwide.

This article provided a summary and examples of the hundreds of documents on youth and smoking that are available from the depository in Minneapolis, Minn, as a result of the May 1998 settlement of the Minnesota lawsuit. The tobacco industry was, and is, well aware of the critical role of underage youths to the future of their industry. Most who reach age 21 years as nonsmokers will remain so.3 The tobacco companies were explicit in their interest in the underage youth market up to about 1980, when social pressures to not market to teens increased. Still, in the 1980s, we saw dramatically increased spending on cigarette advertising and promotional activities,3 a greater percentage of the marketing budget being spent on promotional activities that are particularly potent with underage youths,3,57 continuation of the Marlboro Man campaign so that 69% of underage smokers smoked Marlboro cigarettes in 1989,49 and the introduction of Joe Camel in 1988 to rival the Marlboro Man for an increased share of the youth market for RJR. In the 1990s, the percentage of underage smokers increased significantly for the first time in nearly 25 years. The tobacco industry has promised to do whatever is necessary to reduce youth smoking. Given the evidence collected in this lawsuit, tobacco industry promises and actions concerning youth smoking should be closely scrutinized and monitored because the industry's survival depends on underage youths to be "replacement smokers" for those smokers who quit or die. Their actions, including their advertising and promotional activities in this country and overseas, may likely continue to contradict their promises.

Accepted for publication January 14, 1999.

I served as an expert witness for the State of Minnesota and Blue Cross and Blue Shield of Minnesota, who provided support for this research in preparation for testimony.

I acknowledge and thank Carolyn Williams, PhD, Harry Lando, PhD, Kelli Komro, PhD, Sara Veblen-Mortenson, MSW, MPH, and Bonnie Manning from the Division of Epidemiology, University of Minnesota, and Roberta Walburn, JD, and Gary Wilson, JD, from the Robins, Kaplan, Miller & Ciresi law firm, Minneapolis, for their review and insightful comments on the manuscript.

Editor's Note: Wouldn't it be wonderful if the entire tobacco industry went up in smoke?—Catherine D. DAngelis, MD

Reprints: Cheryl L. Perry, PhD, Division of Epidemiology, University of Minnesota, 1300 S Second St, Suite 300, Minneapolis, MN 55403 (e-mai (e-mail: perry@epivax.epi.umn.edu).

The Putnam Pit Online, Transcript of testimony for the State of Minnesota et al v Philip Morris Inc et al. Available at: http://www.putnampit.com/march9transcript.html. Accessed March 9, 1998.
Not Available, The Tobacco Resolution. Document archive by company. Available at: http://www.tobaccoresolution.com. Accessed June 14, 1998.
US Department of Health and Human Services, Preventing Tobacco Use Among Young People: A Report of the Surgeon General.  Atlanta, Ga US Dept of Health and Human Services, Office on Smoking and Health1994;
Blum  RWStark  T Cognitive development in adolescence. Semin Adolesc Med. 1985;125- 32
Leventhal  HGlynn  KFleming  R Is the smoking decision an "informed choice"? JAMA. 1987;2573373- 3376
Link to Article
Hill  JPHolmbeck  GN Attachment and autonomy during adolescence. Ann Child Dev. 1986;3145- 189
Bandura  A Social Learning Theory.  Englewood Cliffs, NJ Prentice-Hall International Inc1977;
RJ Reynolds (RJR) Bates No 50779 8137, U.S. Cigarette Market in the 1990's  June21 1990;
US Department of Health and Human Services, Projected smoking-related deaths among youth—United States. MMWR Morb Mortal Wkly Rep. 1996;45971- 974
Philip Morris (PM) Bates No 1000390803,Johnston  ME Young Smokers Prevalence, Trends, Implications and Related Demographic Trends  March31 1981;
RJR Bates No. 50192 8462,Burrows  DS Young Adult Smokers: Strategies and Opportunities RJR Marketing Development Department report February29 1984;
RJR Bates No. 50122 1308,Tredennick  DW What Causes Smokers to Select Their First Brand of Cigarette? memo to FB Christopher, Jr, RJR Marketing Research Department July3 1974;
RJR Bates No. 50068 6301,Duffy  K Younger Adult Smokers memo to LW Hall, Jr October23 1980;
RJR Bates No. 50301 1370,Burrows  DS NBER Models of Price Sensitivity by Age/Sex memo to JR Moore September27 1982;
RJR Bates No. 50111 3724. William Esty Co, The Youth Research Institute Study Regarding Cigarette Smoking Among 7,521 High School and College Students in 80 Cities Throughout the United States, October-November 1959: Summary of Findings, December 1959. Not Available
RJR Bates No. 50111 3743. William Esty Co, The Youth Research Institute Study Regarding Cigarette Smoking Among 8,112 High School and College Students in 82 Cities Throughout the United States, October-November 1958: Summary of Findings, 1958. Not Available
RJR Bates No. 50034 7108, Summary of Decisions Made in the MRD-Esty Meeting, Concerning Spring 1971 NFO Tobacco Products Survey, April 7, 1971. Not Available
RJR Bates No. 50235 3747,Sherrill  JH Share of Smokers by Age—Top Ten Brands memo to WS Smith, Jr, RJR Marketing Research Department September26 1972;
RJR Bates No. 50354 2726,Wallace  JM Share of Smokers by Age Group product research report to TL Ogburn, Jr October30 1975;
RJR Bates No. 50023 4050,Key  T Share of Smokers by Age Group memo to TL Ogburn, RJR Marketing Research Department August12 1976;
RJR Bates No. 50138 0878,Durgee  JF Share of Smokers by Age Group memo to TL Ogburn October31 1977;
RJR Bates No. 50079 4841,Duffy  K Addendum for report "Teenage smokers (14-17) and new adult smokers and quitters," memo to JB Stuart July31 1980;
RJR Bates No. 50845 3890,Barnes  M Aging 18 Year Old Smokers into NFO Panel Data memo to EN Monahan December8 1981;
PM Bates No. 1000306237,Johnston  ME Marlboro Market Penetration by Age and Sex memo to RB Seligman May23 1969;
PM Bates No. 1003285497,Johnston  M The Decline in the Rate of Growth of Marlboro Red memo to RB Seligman May21 1975;
Lorillard (LD) Bates No. 03926040,Moroz  LR Smoker Incidence by Age Groups memo to JR Ave November25 1981;
Brown & Williamson (BW) Bates No. 670186789, New Product Concepts. Not Available
BW Bates No. 170052238,Johnson  RL Conclusions based on Wave XIII and the Latest Black Study memo to RA Pittman February21 1973;
BW Bates No. 665076813,Marshall  LM KOOL: Analysis of Brand Switching Study-Wave #18 report to MC Wilson Ted Bates Advertising Co September10 1975;
BW Bates No. 680116947, Viceroy Agency Orientation Outline. Not Available
BW Bates No. 660005261, Viceroy Switching Study Analyses-Wave 28  February4 1981;
BW Bates No. 670579884, Information Center. Switching Study Report  October26 1983;
BW Bates No. 690149518, Growing Up in Smoke [telecast]. "20/20." October 20, 1983.
Tobacco Institute (TIMN) Bates No. 0032424, Draft Statement  August1 1979;
TIMN Bates No. 0041988, Transcript. "Good Morning America."  December12 1990;
RJR Bates No. 50845 3894,Long  GH MDD Report on Teenage Smokers (14-17) memo to EA Horrigan July22 1980;
Pierce  JPGilpin  EA A historical analysis of tobacco marketing and the uptake of smoking by youth in the United States: 1890-1977. Health Psychol. 1995;14500- 508
Link to Article
PM Bates No. 2022216179,Johnston  M Handling an Excise Tax Increase memo to J Zoler September3 1987;
PM Bates No. 1002646151 Roper Organization Inc., A Study of Smoking Habits Among Young Smokers prepared for Philip Morris Inc July1974;
RJR Bates No. 50298 7357,Teague  CE Some Thoughts About New Brands of Cigarettes for the Youth Market research planning memo February2 1973;
RJR Bates No. 51267 9728 Creative Research Group., Youth Target 1987 prepared for RJR Macdonald.
RJR Bates No. 50142 1310,Tucker  CA 1975 Marketing Plans Presentation to RJR Board of Directors Hilton Head, SC September30 1974;
King  CSiegel  MCelebucki  CConnolly  GN Adolescent exposure to cigarette advertising in magazines. JAMA. 1998;279516- 520
Link to Article
RJR Bates No. 50577 5557,Hind  JF Memo to CA Tucker  January23 1975;
RJR Bates No. 50230 3940,Blackmar  D French Camel Filter Ad memo to R McReynolds February7 1974;
RJR Bates No. 50458 5737,Mitchell  AN Camel Younger Adult Smoker Focus Groups RJR marketing research report February1 1985;
PM Bates No. 2043828174, Marlboro, summary on Philip Morris letterhead  March29 1979;
Pierce  JPLee  LGilpin  EA Smoking initiation by adolescent girls: an association with targeted advertising. JAMA. 1994;271608- 611
Link to Article
Centers for Disease Control and Prevention, Changes in the cigarette brand preferences of adolescent smokers—United States, 1989-1993. MMWR Morb Mortal Wkly Rep. 1994;43577- 581
Perry  C The relationship between "share of voice" and "share of market" and implications for youth health promotion. J Health Educ. 1998;29206- 212
Link to Article
Pollay  RWSiddarth  SSiegel  M  et al.  The last straw? cigarette advertising and realized market shares among youths and adults. J Marketing. 1996;601- 16
Link to Article
PM Bates No. 2500002189, The Cigarette Consumer  March20 1984;
LD Bates No. 03537131,Achey  TL Product Information memo to C. Judge August30 1978;
PM Bates No. 2028817401,Ennis  DMTindall  JEEby  LC Product Testing Short Course  R&D Department Philip Morris USA January23-24 1984;
BW Bates No. 670624932,Parrack  ET History and Key Trends in the U.S. Cigarette Market Brand Management October1979;
RJR Bates No. 50749 0339 Young & Rubicam, Camel Advertising Overview  December4 1990;
Pierce  JPChoi  WSGilpin  EAFarkas  AJBerry  CC Tobacco industry promotion of cigarettes and adolescent smoking. JAMA. 1998;279511- 515
Link to Article

Figures

Tables

References

The Putnam Pit Online, Transcript of testimony for the State of Minnesota et al v Philip Morris Inc et al. Available at: http://www.putnampit.com/march9transcript.html. Accessed March 9, 1998.
Not Available, The Tobacco Resolution. Document archive by company. Available at: http://www.tobaccoresolution.com. Accessed June 14, 1998.
US Department of Health and Human Services, Preventing Tobacco Use Among Young People: A Report of the Surgeon General.  Atlanta, Ga US Dept of Health and Human Services, Office on Smoking and Health1994;
Blum  RWStark  T Cognitive development in adolescence. Semin Adolesc Med. 1985;125- 32
Leventhal  HGlynn  KFleming  R Is the smoking decision an "informed choice"? JAMA. 1987;2573373- 3376
Link to Article
Hill  JPHolmbeck  GN Attachment and autonomy during adolescence. Ann Child Dev. 1986;3145- 189
Bandura  A Social Learning Theory.  Englewood Cliffs, NJ Prentice-Hall International Inc1977;
RJ Reynolds (RJR) Bates No 50779 8137, U.S. Cigarette Market in the 1990's  June21 1990;
US Department of Health and Human Services, Projected smoking-related deaths among youth—United States. MMWR Morb Mortal Wkly Rep. 1996;45971- 974
Philip Morris (PM) Bates No 1000390803,Johnston  ME Young Smokers Prevalence, Trends, Implications and Related Demographic Trends  March31 1981;
RJR Bates No. 50192 8462,Burrows  DS Young Adult Smokers: Strategies and Opportunities RJR Marketing Development Department report February29 1984;
RJR Bates No. 50122 1308,Tredennick  DW What Causes Smokers to Select Their First Brand of Cigarette? memo to FB Christopher, Jr, RJR Marketing Research Department July3 1974;
RJR Bates No. 50068 6301,Duffy  K Younger Adult Smokers memo to LW Hall, Jr October23 1980;
RJR Bates No. 50301 1370,Burrows  DS NBER Models of Price Sensitivity by Age/Sex memo to JR Moore September27 1982;
RJR Bates No. 50111 3724. William Esty Co, The Youth Research Institute Study Regarding Cigarette Smoking Among 7,521 High School and College Students in 80 Cities Throughout the United States, October-November 1959: Summary of Findings, December 1959. Not Available
RJR Bates No. 50111 3743. William Esty Co, The Youth Research Institute Study Regarding Cigarette Smoking Among 8,112 High School and College Students in 82 Cities Throughout the United States, October-November 1958: Summary of Findings, 1958. Not Available
RJR Bates No. 50034 7108, Summary of Decisions Made in the MRD-Esty Meeting, Concerning Spring 1971 NFO Tobacco Products Survey, April 7, 1971. Not Available
RJR Bates No. 50235 3747,Sherrill  JH Share of Smokers by Age—Top Ten Brands memo to WS Smith, Jr, RJR Marketing Research Department September26 1972;
RJR Bates No. 50354 2726,Wallace  JM Share of Smokers by Age Group product research report to TL Ogburn, Jr October30 1975;
RJR Bates No. 50023 4050,Key  T Share of Smokers by Age Group memo to TL Ogburn, RJR Marketing Research Department August12 1976;
RJR Bates No. 50138 0878,Durgee  JF Share of Smokers by Age Group memo to TL Ogburn October31 1977;
RJR Bates No. 50079 4841,Duffy  K Addendum for report "Teenage smokers (14-17) and new adult smokers and quitters," memo to JB Stuart July31 1980;
RJR Bates No. 50845 3890,Barnes  M Aging 18 Year Old Smokers into NFO Panel Data memo to EN Monahan December8 1981;
PM Bates No. 1000306237,Johnston  ME Marlboro Market Penetration by Age and Sex memo to RB Seligman May23 1969;
PM Bates No. 1003285497,Johnston  M The Decline in the Rate of Growth of Marlboro Red memo to RB Seligman May21 1975;
Lorillard (LD) Bates No. 03926040,Moroz  LR Smoker Incidence by Age Groups memo to JR Ave November25 1981;
Brown & Williamson (BW) Bates No. 670186789, New Product Concepts. Not Available
BW Bates No. 170052238,Johnson  RL Conclusions based on Wave XIII and the Latest Black Study memo to RA Pittman February21 1973;
BW Bates No. 665076813,Marshall  LM KOOL: Analysis of Brand Switching Study-Wave #18 report to MC Wilson Ted Bates Advertising Co September10 1975;
BW Bates No. 680116947, Viceroy Agency Orientation Outline. Not Available
BW Bates No. 660005261, Viceroy Switching Study Analyses-Wave 28  February4 1981;
BW Bates No. 670579884, Information Center. Switching Study Report  October26 1983;
BW Bates No. 690149518, Growing Up in Smoke [telecast]. "20/20." October 20, 1983.
Tobacco Institute (TIMN) Bates No. 0032424, Draft Statement  August1 1979;
TIMN Bates No. 0041988, Transcript. "Good Morning America."  December12 1990;
RJR Bates No. 50845 3894,Long  GH MDD Report on Teenage Smokers (14-17) memo to EA Horrigan July22 1980;
Pierce  JPGilpin  EA A historical analysis of tobacco marketing and the uptake of smoking by youth in the United States: 1890-1977. Health Psychol. 1995;14500- 508
Link to Article
PM Bates No. 2022216179,Johnston  M Handling an Excise Tax Increase memo to J Zoler September3 1987;
PM Bates No. 1002646151 Roper Organization Inc., A Study of Smoking Habits Among Young Smokers prepared for Philip Morris Inc July1974;
RJR Bates No. 50298 7357,Teague  CE Some Thoughts About New Brands of Cigarettes for the Youth Market research planning memo February2 1973;
RJR Bates No. 51267 9728 Creative Research Group., Youth Target 1987 prepared for RJR Macdonald.
RJR Bates No. 50142 1310,Tucker  CA 1975 Marketing Plans Presentation to RJR Board of Directors Hilton Head, SC September30 1974;
King  CSiegel  MCelebucki  CConnolly  GN Adolescent exposure to cigarette advertising in magazines. JAMA. 1998;279516- 520
Link to Article
RJR Bates No. 50577 5557,Hind  JF Memo to CA Tucker  January23 1975;
RJR Bates No. 50230 3940,Blackmar  D French Camel Filter Ad memo to R McReynolds February7 1974;
RJR Bates No. 50458 5737,Mitchell  AN Camel Younger Adult Smoker Focus Groups RJR marketing research report February1 1985;
PM Bates No. 2043828174, Marlboro, summary on Philip Morris letterhead  March29 1979;
Pierce  JPLee  LGilpin  EA Smoking initiation by adolescent girls: an association with targeted advertising. JAMA. 1994;271608- 611
Link to Article
Centers for Disease Control and Prevention, Changes in the cigarette brand preferences of adolescent smokers—United States, 1989-1993. MMWR Morb Mortal Wkly Rep. 1994;43577- 581
Perry  C The relationship between "share of voice" and "share of market" and implications for youth health promotion. J Health Educ. 1998;29206- 212
Link to Article
Pollay  RWSiddarth  SSiegel  M  et al.  The last straw? cigarette advertising and realized market shares among youths and adults. J Marketing. 1996;601- 16
Link to Article
PM Bates No. 2500002189, The Cigarette Consumer  March20 1984;
LD Bates No. 03537131,Achey  TL Product Information memo to C. Judge August30 1978;
PM Bates No. 2028817401,Ennis  DMTindall  JEEby  LC Product Testing Short Course  R&D Department Philip Morris USA January23-24 1984;
BW Bates No. 670624932,Parrack  ET History and Key Trends in the U.S. Cigarette Market Brand Management October1979;
RJR Bates No. 50749 0339 Young & Rubicam, Camel Advertising Overview  December4 1990;
Pierce  JPChoi  WSGilpin  EAFarkas  AJBerry  CC Tobacco industry promotion of cigarettes and adolescent smoking. JAMA. 1998;279511- 515
Link to Article

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 51

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
JAMAevidence.com