5.22 Interactive technology and multimedia

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5.1 Introduction

5.2 Stages in the uptake of smoking

5.3 Factors influencing uptake by young people—overview

5.4 Physiological aspects

5.5 Individual personality traits and psychiatric influences

5.6 Intentions, attitudes and beliefs

5.7 The home environment

5.8 The smoking behaviour of peers, and peer attitudes and norms

5.9 The educational environment: achievements, aspirations and 'school connectedness'

5.10 Other drug use

5.11 Accessibility of tobacco products to young smokers

5.12 Affordability of tobacco products

5.13 Opportunity to smoke

5.14 Cultural background

5.15 Tobacco advertising and promotion targeted at young people

5.16 Products and packaging created to appeal to new users

5.17 Factors influencing uptake of smoking later in life

5.18 Uptake—a concluding note

5.19 What is meant by prevention?

5.20 Approaches to youth smoking prevention

5.21 Mass media strategies/campaigns

5.22 Interactive technology and multimedia

5.23 School-based interventions

5.24 Peer influence and education

5.25 Parent/family/home targeted interventions

5.26 Reducing tobacco access and supply

5.27 Reducing product appeal

5.28 Promotion and visibility of tobacco

5.29 Denormalising smoking

5.30 Taxation and pricing of tobacco products

5.31 Harnessing predictors of uptake to prevent smoking

5.32 Preventing smoking in more 'at risk' groups

Acknowledgments

References

In marketing parlance, 'new' or emerging technologies include media such as the internet and web-based programs, mobile phone communications and electronic games. Terms such as 'e-health,' 'e-marketing 'and 'm-marketing'246 (the sending of marketing messages to mobile phones) have now entered our lexicon and teenagers are at the forefront of an increasingly wired world.247 Interactive or emerging technologies present a potential opportunity for new and innovative ways to engage young people in health promotion.248 Although there is limited literature concerning the use of interactive technologies in youth smoking prevention to date, the potential benefits identified in Table 5.4 still apply.

5.22.1 Mobile phones

A Western Australian survey from 2007 has reported that 87% of school students aged 12-16 have their own mobile phone.115 A review of the social impact of mobile phones in Australia denotes them as 'must haves' for teenagers wanting to keep up and achieve social acceptance.255 For young people, mobile phones are much more than a technological gadget: they are aspirational and symbolise freedom, growing up, and having fun, and have spawned a new mode of interaction among friends.

Mobile phones are of potential interest to youth smoking prevention for two quite different reasons: firstly, as a potential channel of communication for smoking prevention strategies, and secondly, as a type of smoking 'substitute'.

5.22.1.1 Mobile phones as a prevention strategy

Text messaging interventions have been used with teenagers on a number of specific health issues, such as diabetes management,256 as well as more broadly, as in the UK program that enabled teenagers to text a community nurse with questions or health concerns (regarding issues such as sexual health or puberty).257

Mobile phone based interventions specifically targeting adolescents or children are sparse in the published tobacco control literature. A randomised control trial in New Zealand explored the use of mobile phones as a delivery medium for smoking cessation programs for young adults (36% of the sample aged 16-19 years). Cessation rates among those receiving the text message intervention were about double those of the control group at six week follow up, and reported quit rates at six months remained high.258 In WA, Smarter than Smoking piloted messaging 10,000 young people, inviting them to participate in a quiz-based competition. At 34 cents per delivery, evaluation of the pilot study concluded that it was both a cost effective and an acceptable means of communicating with young people.259

5.22.1.2 Relationship between mobile phones and smoking

There has been some interesting debate in the literature around the relationship between mobile phones and smoking among young people. In a letter to the British Medical Journal in 2000, it was hypothesised that observed declines in teen smoking in the UK might be attributable in part to the rising uptake of the mobile phone. The authors contended that mobile phones are an effective competitor in the teen market for products that offer 'grown up' style, individuality, rebellion, bonding with peers, sociability, and adult aspiration.260 Researchers in Japan concurred that smoking prevalence had declined as mobile phone ownership and usage increased.261 However, more recent studies have failed to find evidence to support the hypothesised protective effect of mobile phone ownership on smoking uptake.262, 263 In fact, Steggles concludes that:

'We found a positive association between the extent of smoking experience and the likelihood of owning a mobile... Rather than competing, mobile phone ownership appears to be a complementary behaviour to smoking, possibly reinforcing a young person's image of himself or herself as an aspiring adult.'263

5.22.2 Internet and web-based strategies

As noted in a review by Ribisl,136 the internet can, and is, being used both to encourage (overtly or covertly) and discourage youth smoking. At the 'enticing' end of the spectrum, the internet provides opportunities for young people to access and purchase tobacco products without scrutiny of age,136 and has spawned pro-smoking genre in the 'home-movie' type offerings on websites such as YouTube.[20] There are also websites abounding with content or chatrooms that glamorise smoking lifestyle and culture.136, 264 While not based in Australia, the cyber world is global, and there are websites in the US, for example, which feature pictures of celebrity smokers, provide information about smoking in movies, and provide smoking advice to teen smokers.136 The tobacco industry has also harnessed the internet to communicate with young customers135, 137 (see also Section 5.15.4 and Chapter 11, Section 11.6.5).

At the other end of the spectrum, the internet is used by those in tobacco control to try and engage young people, with websites exposing tobacco industry tactics and encouraging grassroots advocacy136 and working as a delivery vehicle for youth cessation programs.265 Other elements of youth smoking prevention websites include embedding information and messages on tobacco in games, quizzes, simulations, fact sheets and self assessments, and in personalised feedback and peer discussion groups.266

In Australia, a youth website, OxyGen[21], was developed in 1999 by Smarter than Smoking (WA), Quit South Australia and Quit Victoria. The OxyGen website provides information on industry tactics, facts and figures about smoking and tobacco products, interactive educational activities, and updates on tobacco issues and events around Australia. The site averages approximately 12,000 visits per month.

One of the challenges for health related websites is that they are 'competing' with other fascinating high-tech websites that appeal to youth, including sites providing pure entertainment and fun as opposed to an underlying health agenda. OxyGen also has to avoid becoming dated and disengaging for young people, but without the marketing budgets of corporate websites. To this end, OxyGen was relaunched in 2004, with current plans to make it even more interactive.