Preventive Medicine

Background. The purpose of this study was to evaluate the association between receptivity to cigarette promotions and smoking uptake in a cohort of adolescents. Methods and Measures. This was a prospective cohort study of 480 4thto 11th-grade students conducted in three rural Vermont K–12 schools. Cigarette use was determined by self-report at baseline, 12 months (survey 2), and 21 months (survey 3). Proportional odds models were used to evaluate smoking uptake as a function of baseline measures of cigarette use, receptivity to cigarette promotions, and confounding factors, including grade, parental education, peer smoking, and family smoking. Adolescents were receptive to cigarette promotions if they owned or were willing to use a personal item bearing a cigarette brand logo [cigarette promotional item (CPI)]. Smoking status was measured using a 6-point ordinal index that combined experience and attitudes: 0 5 never smoker/not susceptible to smoking, 1 5 never smoker/susceptible to smoking, 2 5 puffer (1 cigarette or less in lifetime), 3 5 noncurrent experimenter (2–99 cigarettes in lifetime/none in past 30 days), 4 5 current experimenter, and 5 5 smoker ($100 cigarettes in lifetime). Results. The 480 students were equally distributed across grade at baseline. Environmental exposure to smoking was high, and 30% were receptive to cigarette promotions at baseline. Higher levels on the smoking index at baseline were associated with higher grade in school, peer smoking, and receptivity to cigarette promotions. One hundred eighty-five students (38.5%) had moved to a higher category on the smoking index