Frequency of contact with cigarette advertising and smoking experience among young women in Japan.

Cigarette advertising plays a crucial role in adolescent smoking. A survey with a self-administered questionnaire was conducted to 198 female nursing students in Kitakyushu City in 1996 to provide primary data on the young women's contact with cigarette advertising in various media in Japan. The proportions of respondents who had seen cigarette advertising on TV and that on billboards were both over 95% of the effective respondents, the highest among all the media, followed by magazines, newspapers and the radio. The proportion of respondents who "frequently" had contacts was the highest by TV, followed by billboards, newspapers, magazines and radio. Over 50% of students who had past/current smoking experience felt that they were "frequently" exposed to cigarette advertising, and, on other hand, approximately 50% of those who had never smoked felt that they "occasionally" saw cigarette advertising, on both TV and billboards. In Japan, young women seem to be heavily exposed to cigarette advertising through various media. This study implies that TV and billboards are the most frequently contacted media of cigarette advertising and perhaps the most influential to smoking among young people.

A survey with a selfadministered questionnaire was conducted to 198 female nursing students in Kitakyushu City in 1996 to provide primary data on the young women's contact with cigarette advertising in various media in Japan.
The proportions of respondents who had seen cigarette advertising on TV and that on billboards were both over 95% of the effective respondents, the highest among all the media, followed by magazines, newspapers and the radio. The proportion of respondents who "frequently" had contacts was the highest by TV , followed by billboards, newspapers, magazines and radio.
Over 50% of students who had past/current smoking experience felt that they were "frequently" exposed to cigarette advertising , and, on the other hand, approximately 50% of those who had never smoked felt that they "occasionally" saw cigarette advertising, on both TV and billboards.
In Japan, young women seem to be heavily exposed to cigarette advertising through various media.
This study implies that TV and billboards are the most frequently contacted media of cigarette advertising and perhaps the most influential to smoking among young people. J Epidemiol, 1997 ; 7 : 43-47.
youth smoking, cigarette advertising, media, smoking prevention Cigarette smoking by adolescents is a big concern in Japan as well as in many other countries in the world. For instance, the proportion of senior students in Japanese high schools who smoked within the past month is reported to be 27% to 37% in males and 5% to 15% in females

SUBJECTS AND METHODS
This study was conducted as part of a survey on nursing students' attitude and behavior regarding smoking. A self-administered questionnaire was distributed to female students of three nursing schools in Kitakyushu City, Japan, in 1996. All the students were in the first year of their course, and this survey was carried out about one month after their enrollment in school. Among these three schools, one was a four-year college and the other two were three-year professional schools. One of the professional schools included a course for the assistant-nurse certificate.
The number of the subjects was 198, and that of the respondents was 197. The non-respondent was an absentee on the day of the survey. The effective response rate, thus, was 99.5%. The respondents were mainly 18 to 24 years of age though nine students were over twenty-five years old.
Questionnaire sheets were distributed by the author in each classroom. Each sheet was anonymously filled out and then put into an envelope. The author collected the completed questionnaires a few days later. There was no opportunity for the faculty of the schools to intervene in the survey process.
The following points were covered in this study; 1) Awareness of cigarette advertising in various media, that is, TV, radio, newspapers, magazines and billboards, 2) Perceived frequency of exposure to cigarette advertising in each medium, and 3) The current and past smoking status.
Measuring the exact frequency of exposure to cigarette advertising in the media has a lot of difficulties, especially in the case of objective measurement such as counting students' viewing of cigarette TV advertisements. The author, thus, used a subjective measure in the questionnaire, that is, the perceived frequency of contact with cigarette advertising that was asked by using three categories, "frequently," "occasionally" and "rarely."  Over 50% of the students who had past/current smoking experience felt that they were "frequently" exposed to cigarette advertising, and, on the other hand, approximately 50% of those who had never smoked felt that they "occasionally" saw cigarette advertising on these two media.

RESULTS
In the other three media, that is, newspapers, magazines and radio, there was no significant difference observed in the distribution of perceived frequency of contact with cigarette adver-tising between people who had smoking experience and who did not.

DISCUSSION
In terms of the awareness of cigarette advertising, TV and billboards were the two most remarkable media in this survey.
In addition, perceived frequency of the contact with cigarette advertising on both TV and billboards was the highest among all the media. In Japan, self-regulation of cigarette advertising on TV is implemented by the tobacco industry; Cigarette advertising on TV is broadcast only from 10:54 P.M. to 5:00 A.M. Due to this self-regulation, cigarette advertising on TV is in fact concentrated in only a few hours around midnight.
TV is unlike radio or print in many ways, the most important of which is that it is a medium of moving images ~. TV advertising uses motion and action to create impact, uses stories to entertain, and touches feelings ~. The survey results suggest that respondents receive more memorable impacts from cigarette advertising on TV than from that of other media.
Concentrated broadcasting of cigarette advertising during a few hours on TV possibly enhances this tendency.
No regulation in size, number and location by either the government or the tobacco industry is implemented in cigarette advertising on billboards. Billboard advertising can deliver messages with quick impact while viewers are passing by",. if billboards are located on the way to school or home, students can repeatedly receive a prosmoking message from them.
Both tables show that cigarette advertising in newspapers and magazines, or the print media, get medium awareness and perceived contact from the respondents. In Japan, both nationwide and local papers often contain cigarette advertisements. Newspapers, however, have a relatively limited readership among young people in Japan. In addition, the visual quality of newspaper advertisements seems to be too poor to convey the preferable image of the tobacco products to young readers. Regarding magazine advertisements, self-restriction by the tobacco industry prohibits cigarette advertising in women's and minors' magazines. Therefore, I think that the print media could get only medium awareness and perceived contact from the young females of this survey.
In this study, both awareness and perceived frequency of contact was low regarding cigarette advertising on the radio. Radio is a, so-called, background medium; Most people who are listening to the radio are doing something else at the same time ~. The impact of advertisements on the radio seems to be weak. Also, the proportion of respondents who have no contact with the radio itself was approximately 20% in this study. A smaller number of people listen to messages of lesser impact on the radio.
As shown in Table 1, there was a positive relationship between smoking experience and advertising awareness on the radio and in magazines. A careful interpretation should be applied to this result. The other three media did not have a detectable relationship due to the extremely high proportion of advertising awareness. This, so-called, ceiling effect is supposed to be caused by the dichotomous questions about the awareness of cigarette advertising, which provide inadequate information about the exposure of the subjects to the advertising. Table 2 shows that, on TV and billboard advertising, perceived frequency of exposure to cigarette advertising is positively related to the smoking experience. There are two possible explanations for this result. One is that high exposure to cigarette advertising on these two media promotes the initiation of smoking among young people. The other explanation is that smokers are more intend on being exposed to, or look at cigarette advertising on these two media. This type of crosssectional study cannot distinguish these two explanations from one another. In both cases, however, TV and billboards are possibly the most influential media on adolescents regarding smoking.
There are several studies concerning the relationship between cigarette advertising and smoking. Botvin et al 8).
reported that exposure to cigarette advertising in periodicals and newspapers was predictive of current smoking status through a survey on junior high school students in the United States. In their study, young people with high exposure to cigarette advertising were significantly more likely to be smokers than were those with low exposure to cigarette advertising. In addition, a study in the United States s) demonstrated that the three most commonly purchased brands among youth smokers were the three most heavily advertised brands. As mentioned, Japan is one of the few countries that permits cigarette advertising on TV. I presume, therefore, that the relationship between cigarette advertising and youth smoking in Japan would be somewhat stronger than that in countries where no cigarette advertising on TV is permitted. Further research will be needed to examine this hypothesis. Rimpela et al10). cited in a review that the task of tobacco sales promotion information is not limited to persuading young people to start smoking but also aims at neutralizing the impact of health education, and that the effects of cigarette advertising consist of complicated social and individual processes. Future research on cigarette advertising and adolescent smoking in Japan should overcome the complexity of the issue, by using some behavioral theories, such as the Social Learning Theory11), to get a clear picture.
The study population of this survey was female nursing students. A few studies have shown that the smoking prevalence of female nurses was higher than that of the general female population in Japan). Among the nursing students of this survey, the current smoking rate was 17.8%, which was almost the same level with that of females in their twenties previously reported in Japan). The current results of this female nursing students' survey are probably not so different from those of the general young Japanese female population. The number of smokers among the nursing students could increase during either their study years or their professional lives. A longitudinal study of these subjects will be required to investigate the characteristics of nurses' smoking.
There are several limitations in this study, such as convenience sampling and small sample size. In terms of sampling, I used a convenience sampling in selecting schools, that is, a sampling without a specific randomizing measure. Though specific biases are probably not introduced into this sampling, a better-designed sampling should be applied to further research.
In many countries, various legislative restrictions on tobacco advertising are implemented by the government. Studies in some developed countries suggest that properly implemented total advertising bans could reduce tobacco consumption and smoking prevalence e. For instance, Norway introduced a strict total tobacco advertising ban in 1975. Smoking prevalence in Norway has declined since the late 1970s among minors as well as among adults12). Further research on the influence of tobacco advertising on smoking behavior and social norms of people, particularly of young people, is required to develop appropriate measures for tobacco advertising control in Japan .