NEW YORK, Mar 01 (Reuters Health) -- Adolescents who are attracted to tobacco ads or who own free lighters, sports bags or other promotional items are nearly three times as likely to become regular smokers than those who do neither, study findings suggest

``The important thing about our study was that we first looked at involvement in tobacco marketing among youth who had no experience with smoking,'' said lead author Dr. Lois Biener of the Center for Survey Research at the University of Massachusetts in Boston. It was not clear if adolescents started smoking because the advertisements caught their attention or if already established smokers were simply more likely to recognize and identify them, she said in an interview with Reuters Health. In the new study, Biener and colleague Dr. Michael Siegel interviewed 529 nonsmoking Massachusetts youths in 1993 and again in 1997. The children, who were 12 to 15 at the first interview, were asked if they owned tobacco paraphernalia and if they could identify cigarette advertisements. Four years later, 21% of the adolescents had become regular smokers (defined as having smoked 100 or more cigarettes). However, 46% of adolescents who owned promotional items or could name a tobacco brand had become established smokers. Among those who had never taken a puff of a cigarette but either owned promotional items or could name a brand, the progression-to-smoking rate was 29%, according to the study. White adolescents were more likely than nonwhites to become established smokers, as were those who lived with a smoker, were friends with a smoker, began smoking early or had a rebellious personality. Adolescents who are looking for an identity may find cigarette items and advertising particularly appealing, because it allows them to ``try on the image of a smoker,'' according to the researchers. In light of the new study findings, it is not clear if current regulations on tobacco advertising are enough to protect the public health and the authors suggest a more comprehensive ban on cigarette-promoting products. ``Promotional items are still able to be created for special events that tobacco companies sponsor,'' said Biener. ``I would like to carefully monitor any new marketing strategies that the tobacco companies may be developing.''

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