Twenty-two years ago a team of researchers traveled to some 200 U.S. preschools with a game board and a list. That now seminal study, in which 91 percent of the three- and six-year-olds they tested correctly paired mascot Joe Camel with his matching cigarettes, set off a cascade of antismoking legislation aimed at shielding American youth from aggressive tobacco ads. And in 2003 the World Heath Organization followed suit with an international treaty designed to limit the marketing power of tobacco companies in developing countries.

But new findings suggest that tobacco companies have succeeded in moving their campaign overseas regardless of international recommendations. This year a research team in Brazil, China, Russia, Nigeria, Pakistan and India conducted a very similar version of the original Joe Camel study. Among the 2,400 five- and six-year-olds they interviewed, 68 percent could identify at least one tobacco logo.

Experts say the finding is the latest in a series of recent studies to indicate that the same four tobacco companies that U.S. public health advocates kicked out in the 1990s are still targeting the most vulnerable members of society—namely, children, teens and those trying to quit, with a focus on less affluent nations.

Joaquin Barnoya, research assistant professor of public health at Washington University School of Medicine in Saint Louis, says tobacco companies have “learned their lesson from high-income countries” that have restricted their sales by imposing taxes and marketing limitations. Barnoya, who studies tobacco sales and antismoking efforts in Guatemala, says tobacco companies there secure customers by directly violating the law or by finding creative ways around it. For example, although they can’t market their products on television or in magazines, tobacco companies use “nontraditional” advertising, such as paying retailers to place their products in the most visible parts of the store (usually either directly behind or in front of the cash register). Companies also use promotional advertising, such as two-for-one product discounts, to hook smokers who may be trying to quit. These strategies send a message to the consumer that smoking is socially acceptable, Barnoya says: “It’s like a store placing the candy at the front where you’re most likely to see it and buy it.”

Children are highly receptive to marketing, says University of Maryland, College Park, public health research professor Dina Borzekowski, who led this year’s study of five- and six-year-olds. Borzekowski found that the children in Brazil, China, Russia, Pakistan, Nigeria and India who could best identify tobacco brands did not necessarily live with a smoker, further suggesting that kids are picking up knowledge about cigarettes in public rather than at home. “You would think this would only happen with children who lived with smokers or had a family member who smoked, but it didn’t,” Borzekowski says.

In 2005 the countries in which Barnoya and Borzekowski conducted their research joined 168 nations in signing onto an international treaty banning aggressive tobacco advertising—the World Health Organization Framework Convention on Tobacco Control. Despite having agreed to the law in principle, many countries are still failing to execute it. “If you go to these countries, you’ll see signs that say ‘no smoking,’ and right underneath them people are smoking,” Borzekowski says.

Hillel Alpert, a researcher at the Harvard School of Public Health, says tobacco companies are still targeting youth in the U.S. as well. As recently as 2005 R. J. Reynolds was adding flavors—such as orange-mint, chocolate and vanilla—to its Camel cigarettes to increase their appeal to youth and first-time smokers. But after an outpouring of research linked the candy-flavored products with a rise in youth smoking rates, Reynolds was forced to stop selling them. Even so, Alpert says, U.S. tobacco companies continue to add flavors to small cigars, smokeless and other tobacco products. “The industry has found that marketing an addictive product to youth translates into customers who are addicted for life.”

Reynolds spokesperson Richard Smith says the company’s marketing strategy is directed at adults. “Nothing we do is targeting youth,” he says.

Borzekowski’s team is now studying children’s awareness and understanding of warning labels on cigarette packages. In some European countries, where governments have paired the labels with graphic images, consumer demand for the products has decreased, especially among young people. But tobacco companies are fighting efforts to use similar visuals internationally. "We've gotten rid of the giant billboards. We've gotten rid of Joe Camel. But we've sill got work to do, in the U.S. and globally," Borzekowski says.

See also:

>>Do Electronic Cigarettes Really Help Smokers Quit?

>>Smoking Is a Drag at the Box Office

>>Why Some Smokers Get Lung Cancer—and Others Are Spared