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Tobacco advertising should be banned in all media and limitations placed on alcohol advertising to prevent exposure of substance-related content to children and adolescents, according to the American Academy of Pediatrics (AAP).

In a policy statement published in the October issue of Pediatrics, the AAP pointed out that while parents and schools are trying to convince children to "just say no" to drugs, the $25 billion spent on advertising for cigarettes, tobacco, and prescription drugs is urging them to "just say yes."

And in fact, research has suggested that advertising may be linked to almost one-third of adolescent tobacco and alcohol use, the AAP noted.

An estimated $15 billion is spent each year on tobacco advertising in an attempt to spread the message that smokers are glamorous, adventurous, and independent, with the result that in a 2009 study nearly half of teenagers said they had tried smoking.

The most heavily advertised brands are the most popular, according to the policy statement. The campaign that featured Joe Camel led to an increase in Camel's market share among teen smokers from 0.5% to 32%.

Similarly, alcohol advertising that depicts users as successful and fun-loving is widely seen on adolescent-oriented and sports programs.

Magazines for teens actually contain almost 50% more advertisements for beer than magazines aimed at adults, along with more than 90% more advertisements for sweet alcoholic drinks, the academy noted.

The pervasiveness of alcohol advertising was demonstrated in research among nine- and ten-year-olds, when almost as many children recognized the Budweiser frogs as recognized Bugs Bunny.

Entertainment media also is rife with references and depictions of tobacco and alcohol use, with nearly 20% of prime time television shows portraying the use of tobacco, according to the policy statement.

And despite the fact that in 2009 for the first time, half of all popular movies didn't depict smoking, during that year more than half of movies rated PG-13 still contained tobacco use.

"A number of correlational and longitudinal studies have confirmed that exposure to television and movie smoking is now one of the key factors that prompt teenagers to smoke," the AAP statement said.

One meta-analysis found that such exposure accounted for nearly half of smoking initiation among adolescents.

"The case is strong for the argument that smoking shown in entertainment media plays a causal role in smoking onset. Certainly, it is time to eliminate all tobacco advertising and to decrease the depiction of smoking in mainstream media," the AAP stated.

Exposure to adult-themed movies also can lead to increases in smoking and drinking. In a study that included more than 700 young adolescents, being permitted to watch R-rated films or having a television in the bedroom greatly increased the initiation of smoking.

Furthermore, another study found that teenagers who watched more than three R-rated movies a month were five times more likely to drink than their nondrinking peers, the statement said.

New media also share the blame, with Web sites selling tobacco, alcohol, and prescription drugs, and social networking sites featuring profiles referring to substance abuse.

The policy statement concluded with a number of specific recommendations for pediatricians:

• Pediatricians should encourage parents to supervise media exposure, particularly by emphasizing the importance of removing television sets from bedrooms.
• They should encourage parents to limit young viewers' exposure to PG-13 and R-rated movies.
• They also should remind parents to turn off the television during dinner.
• Pediatricians should encourage Congress to ban all tobacco advertising in media accessible to children, and should encourage lawmakers to restrict alcohol advertising.
• In addition, they should ask the White House Office on Drug Control Policy to conduct antismoking and antidrinking campaigns among young people.
• Finally, they should request greater cooperation from the advertising and entertainment industries, as well as heightened sensitivity to the susceptibility of children and adolescents to unhealthy behaviors.

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