Young children recognize cigarette brands in countries with most smokers Sep. 30, 2013 - Nearly two-thirds of young children in low- and middle-income countries can identify cigarette brand logos, according to a study from researchers at the University of Maryland School of Public Health (UMD SPH) and the Johns Hopkins Bloomberg School of Public Health (JHSPH). The study, published in the journal Pediatrics, examined the reach of tobacco and cigarette marketing among some of the world's most vulnerable populations, sampling five and six year-old children from Brazil, China, India, Nigeria, Pakistan and Russia. These countries were selected because they have the highest number of adult smokers among low- and middle-income countries. "Previous studies show that children and adolescents who are highly exposed to pro-smoking messages are more likely to smoke," said Dr. Dina Borzekowski, lead author of the Pediatrics study and research professor in the UMD SPH Department of Behavioral and Community Health. It should be of great concern that the majority of very young children in our study were familiar with at least one cigarette brand. Even in households without smokers, children could identify tobacco logos. The United States created stronger regulations for tobacco advertising in the 1990s after similar research found that six year olds were as familiar with Camel tobacco's "Joe Camel" mascot as with the Disney Channel's Mickey Mouse. "Regulations created by the World Health Organization to restrict tobacco advertising exist outside of the United States, but beyond our country's borders these regulations may not be as effective," Borzekowski explains, referring to the WHO Framework Convention on Tobacco Control. Multi-national tobacco companies appear to have moved their promotional efforts from high-income, industrialized countries to low- and middle-income countries where there are often weak tobacco control policies and poor enforcement. While smoking is stabilizing or decreasing in wealthy countries, people in low and middle-income countries are taking up the habit at alarming rates. In China, for example, nearly one third of adults are cigarette smokers (about 53 percent of men), according to WHO data. With five and six year-old children aware of domestic and international tobacco brands, there is a need to enforce stronger regulations in countries where tobacco companies have increased efforts to attract new users. When children are aware of logos, they are more likely to like and want those products. This is concerning when the products -- such as tobacco -- should not be used by children. Borzekowski and colleagues suggest changes including requiring larger graphic warning labels on cigarette packages. Additionally, they urge changes to limit children's exposure to the point of sale of tobacco products, including establishing minimum distances between these retailers and places frequented by young children. "This study reiterates that more needs to be done to reduce the ability of tobacco companies to market their products to children," said co-author Dr. Joanna Cohen, director of the Johns Hopkins Institute for Global Tobacco Control. Countries can implement and enforce bans on tobacco advertising, promotion and sponsorship, including putting large picture warnings on the front and back of cigarette packs. Plain and standardized packaging, now required in Australia, also helps to reduce the attractiveness of cigarette packs among young children. For this study, researchers worked one-on-one with the participating children, asking them to match pictures of different products with their corresponding logos. In China, where roughly 71 percent of households with participating children had a tobacco user, 86 percent of children could identify at least one cigarette brand logo. Pakistan had the second highest percentage, with 84 percent of children capable of identifying at least one cigarette brand logo. Russia ranked last on the list with half of the participants able to identify any of the cigarette brand logos. In addition to examining a child's familiarity with tobacco logos, the study also looked at the child's intentions to smoke and his or her level of media exposure.