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NEW YORK (Reuters Life!) - Teenagers who frequently encounter the Marlboro man, or other familiar icons of the tobacco and cigarette industry, may be more likely to be lured into lighting up, according to a study.
Nearly a quarter of all high school students in the United States smoke cigarettes, according to the U.S. Centers for Disease Control and Prevention (CDC). Of these, nearly a third will continue smoking and die early from a smoking-related disease.
Though cigarette advertisements have been tied to teen smoking before, the study -- which appeared in Pediatrics -- showed that tobacco ads have an impact even when other advertising doesn't.
There had been speculation that previous studies had simply identified teenagers who were receptive to all kinds of behavioral prompts, such as advertising in general, said James Sargent of Dartmouth Medical School in Hanover, New Hampshire, who took part in the study along with German researchers.
"This study shows that it is the specific images from tobacco ads that predict smoking and not such a character trait," he told Reuters Health in an email.
Sargent and his colleagues surveyed 2,100 teens aged 10 to 17 who had never smoked, showing them billboard advertisements for six different cigarettes and eight other commercial products, with all brand information removed.
Each teen was then asked how often they had seen each image and if they could identify the represented brand.
During the following nine months, about 13 percent of the teens began smoking.
The top third of teens in terms of exposure to advertisements and brand recognition had nearly a 50 percent greater risk of lighting up, on average, compared to teens in the bottom third.
This was true even after accounting for other possible risk factors, such as age, sex, family's economic situation, school performance, and having a friend or family member who smoked.
Sargent said young teens were particularly vulnerable because that was the time at which they were eager to develop identities independent of parents.
"They do this by 'trying on' things they see others doing, much like trying on clothes in a store. They try smoking, in part because of the way they view other smokers and also in part because of what they think smoking might do for them," he said.
"For example, a young male might adopt smoking to appear more manly -- like the Marlboro man."
Tobacco advertisements may directly or subtly hint that smoking is tied to sex appeal, independence or, for girls, thinness. Cigarette advertisements are banned from U.S. billboards, televisions and radios, and they have become rare in print magazines. Still, both the U.S. and Germany lag behind nations such as Italy and New Zealand, which have implemented total bans on cigarette advertising.
The researchers said that when teens abstain from smoking, they may be unlikely to pick up the habit later in life. But roughly 30 percent of teen smokers will continue to smoke and die early of a smoking-related disease, according to the CDC.
"In this way, smoking causes more death than alcohol, obesity and illicit drug use combined," said Sargent.
"Tobacco image advertising is one cause of smoking onset, this is why regulatory limits on such (ads) are necessary."
Reporting by Lynne Peeples at Reuters Health; editing by Elaine Lies