10.13 Encouraging young people not to smoke

For decades, the tobacco manufacturing industry has publicly stated that it does not wish young people to start smoking. The health establishment has long regarded these claims with scepticism on the grounds that it is self evident that if an industry that kills half of its regular, persistent consumers wishes to stay in business, then it needs to find a steady stream of new recruits. Despite industry protestations to the contrary, there is ample evidence that its promotional activities in Australia1 and internationally2 have in the past targeted, and continue to target, new usersi (see also Chapter 11). Initiatives adopted by the tobacco industry with the stated intention of reducing the appeal of its products to young people have been designed to forestall government intervention and to give the impression that the industry is cooperative and responsible. In the words of a British American Tobacco official in 1973, describing a voluntary agreement for the industry in Hong Kong to withdraw tobacco advertising during children's television viewing hours: '...this is one of the proposals that we shall initiate to show that we as an industry are doing something about discouraging young people to smoke. This of course is a phony way of showing sincerity as we all well know'.4 ii

As part of the industry strategy to embrace corporate responsibility, youth smoking prevention programs have been developed worldwide. These have typically taken the form of programs aimed at retailers, advertising aimed at young people and their parents, and sponsorship of 'life skills' educational programs.5 These activities have been widely criticised by tobacco control experts for their demonstrated ineffectiveness, as well as the benefits they may bring the tobacco industry, including:5–7

  • the appearance of being proactive and responsible, while participating in activities which they recognise are unlikely to affect uptake of smoking among young people
  • forestalling more effective tobacco control measures that will damage the industry's interests, such as advertising bans or taxation increases
  • shifting responsibility for prevention from the industry and placing the onus on retailers, parents and social groups
  • fostering partnerships with government and non-government health and education interests, which may give the industry political clout as well as credibility
  • strengthening communications with retailers and shoring up support for future lobbying activities
  • making opponents look like extremists
  • giving the industry an opportunity to communicate directly with young people
  • reinforcing smoking as an 'adult choice' (hence enhancing its cachet among teenagers)
  • providing 'proof' if required in a legal setting that the industry has taken action to discourage youth smoking.

Interestingly, despite opposing real tax increases and denying the effect that higher prices have on reducing tobacco consumption, British American Tobacco Australia CEO David Crowe appeared to acknowledge the importance of price in youth smoking prevention during a media interview on his opposition to plain packaging reforms. David Crowe stated that a direct consequence of plain packaging will be that, 'we no doubt will modulate our price down, more people will smoke. We all know, things get cheaper people buy more and more kids will smoke. And that is obviously completely opposite to what the Government intends'.7

10.13.1 Youth access programs

Access programs address how young people purchase tobacco, and generally focus on the retail environment. In Australia it is illegal in every state and territory for anyone aged younger than 18 to purchase tobacco products. Laws regarding sales to minors have long been a component of a comprehensive tobacco control program and their role in Australian tobacco control policy remains important as a deterrent to under-age sales.8

However there is debate over how effective access laws are in reducing prevalence in young people, since it is well known that younger smokers obtain their cigarettes from a variety of sources, particularly friends and family.9 This means that although strictly policed laws might indeed reduce sales to minors, they do not stop young people from getting cigarettes via their social networks.10 Investigation of tobacco industry documents in Australia and overseas has shown that the industry has co-opted youth access issues as a low-risk opportunity for gaining important public relations benefits.5,1,11

Since the early 1980s, the Australian tobacco industry has actively supported access programs by providing information and signage to tobacco retailers.1 The three Australian companies currently co-sponsor a program called '18+—it's the law', which provides in-store materials and advice to retailers.iii For the launch of the 2002 version of the program, the tobacco industry advertised in both the trade and mainstream press. In an environment in which discourse between the tobacco industry and the public is greatly curtailed, this advertising provided a rare opportunity for the industry to portray itself as a socially responsible corporate citizen.

10.13.2 'Life skills' programs

Another component of the industry's activities in youth smoking prevention is sponsorship of life skills education programs. These programs typically touch on licit and illicit drug use, and include themes such as personal responsibility, self-determination, self-esteem, peer influences and media influences. There is strong evidence that in the US, the tobacco industry has actively supported programs known to be ineffective and that in doing so it has managed to keep at bay the introduction of other, more hard-hitting life skills programs.iv 12 Analysis of these programs has found them to be fundamentally deficient from a public health perspective.13 These programs have also provided the tobacco industry with leverage against the introduction of stronger tobacco control measures intended to protect young people.12,14

Efforts by the Australian tobacco industry to distribute material in schools failed during the 1980s.15,16 In the late 1990s Philip Morris funded the development of a program for Australian teachers to help schoolchildren 'say no' to smoking, illicit drugs, drinking and bullying. Philip Morris wished to conceal its association with the program, 'I've got the power', due to fears that if the connection were exposed, the program would meet with hostility.1 Their fears proved well founded and the program has not gained acceptance in Australia.17 However, despite criticism, Philip Morris has had involvement with funding educational materials about substance abuse intended for young Aboriginal people, in collaboration with the NSW Aboriginal Education Consultative Group and the Victorian Aboriginal Education Association Incorporated.18

The World Health Organization has recommended against the use of tobacco industry-endorsed youth smoking prevention programs, in recognition that they are intended to serve industry purposes rather than reduce the uptake of smoking.14

10.13.3 Anti-smoking advertising

In the US and other countries tobacco companies have launched extensive television and magazine advertising campaigns with the stated intention of discouraging smoking among young people.5 These programs have proliferated, Philip Morris taking its offensive to more than 70 countries in 2001.5 In the US, the volume of tobacco-sponsored anti-smoking advertising has equalled or exceeded that of health interests.19, 20

In 1998, Philip Morris commenced the 'Think. Don't Smoke' campaign in the US. This was soon followed by another campaign by US-based company, Lorillard, with the slogan 'Tobacco is whacko if you're a teen'.20 The common message of these advertisements is that smoking is an adult choice and that young people don't need to smoke to fit in socially. The Philip Morris advertisements do not explain exactly why young people should not smoke, instead repeating the theme that you do not have smoke to 'be cool'.20, 21 Philip Morris has also produced advertisements aimed at parents ('Talk. They'll Listen').

Several studies from the US show that industry-funded programs have not been effective20–24 and may even have fostered a more positive attitude towards the tobacco companies.20, 24 A large study conducted over a four-year period found that tobacco industry campaigns neither reduced smoking nor intention to smoke among the target audience, and that advertisements advising parents to talk to their children about smoking might have influenced teenagers in their senior high school years to smoke.22 The tobacco companies do not support campaigns that could affect profitability or undermine industry operations.5, 12

i Experimentation with smoking overwhelmingly occurs during the teenage years. Data from the 2010 National Drug Strategy Household Survey shows that the mean age for initiation of smoking in Australia is 16.0 years3

ii See Knight and Chapman4 for detailed discussion of tobacco industry activities in Hong Kong. This excerpt from minutes of a meeting between representatives of tobacco manufacturers in Hong Kong may be viewed at: http://legacy.library.ucsf.edu/tid/owq24e00/pdf;jsessionid=07C0248832774571CB38B8ED892AB35A

iv Such as programs that expose industry tactics, deal graphically with health effects and denormalise smoking. See Chapter 5.

Recent news and research

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References

1. Carter S. From legitimate consumers to public relations pawns: the tobacco industry and young Australians. Tobacco Control 2003;12(suppl. 3):iii71-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14645951

2. US Department of Health and Human Services. Reducing tobacco use: a report of the Surgeon General. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/2000/complete_report/index.htm

3. Australian Institute of Health and Welfare. 2010 National Drug Strategy Household Survey report. Drug statistics series no. 25, AIHW cat. no. PHR 145. Canberra: Australian Institute of Health and Welfare, 2011. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737419578&libID=10737419577

4. Knight J and Chapman S. 'A phony way to show sincerity, as we all well know': tobacco industry lobbying against tobacco control in Hong Kong. Tobacco Control 2004;13(suppl. 2):ii13-21. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/13/suppl_2/ii13.pdf

5. Landman A, Ling PM and Glantz SA. Tobacco industry youth smoking prevention programs: protecting the industry and hurting tobacco control. American Journal of Public Health 2002;92(6):917-30. Available from: http://www.ajph.org/cgi/reprint/92/6/917

6. Wakefield M, McLeod K and Perry CL. 'Stay away from them until you're old enough to make a decision': tobacco company testimony about youth smoking initiation. Tobacco Control 2006;15(suppl. 4):iv44-53. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/15/suppl_4/iv44

7. Miller B. Tobacco industry ups plain pack campaign. Radio National, Australian Broadcasting Corporation, (Sydney) 2011:17 May. Available from: http://www.abc.net.au/worldtoday/content/2011/s3218995.htm

8. Ministerial Council on Drug Strategy and Department of Health and Ageing. National Tobacco Strategy 2004-2009. Canberra: Commonwealth of Australia, 2005. Available from: http://www.health.gov.au/internet/wcms/publishing.nsf/Content/phd-pub-tobacco-tobccstrat2-cnt.htm

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10. Fichtenberg CM and Glantz SA. Youth access interventions do not affect youth smoking. Pediatrics 2002;109(6):1088-92. Available from: http://pediatrics.aappublications.org/cgi/reprint/109/6/1088

11. Ling PM, Landman A and Glantz SA. It is time to abandon youth access tobacco programmes [Editorial] . Tobacco Control 2002;11(1):3-6. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/11/1/3.pdf

12. Mandel L, Bialous S and Glantz S. Avoiding 'truth': tobacco industry promotion of life skills training. Journal of Adolescent Health 2006;39(6):868-79. Available from: http://repositories.cdlib.org/postprints/1559/

13. Sussman S. Tobacco industry youth tobacco prevention programming: a review. Preventive Science 2002;3(1):57-67. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12002559

14. World Health Organization. Building blocks for tobacco control: a handbook. World Health Organisation Tobacco Free Initiative. Geneva: WHO, 2004. Available from: http://www.who.int/tobacco/resources/publications/general/HANDBOOK%20Lowres%20with%20cover.pdf

15. Tobacco request rejected. The West Australian, (Perth) 1988:3 Jun. 31

16. ABC Television. Young people and smoking [transcript]. Pressure Point, Australian Broadcasting Corporation, (Sydney) 1985:25 April.

17. Chapman S. Tobacco giant's antismoking course flops. British Medical Journal 2001;323(7323):1206. Available from: http://www.bmj.com/cgi/content/full/323/7323/1206/a

18. Metherell M. Smoke giant offers lesson for schools. Sydney Morning Herald, (Sydney) 21 September 2002: Available from: http://www.smh.com.au/articles/2002/09/20/1032054962835.html

19. Wakefield M, Szczypka G, Terry-McElrath Y, Emery S, Flay B, Chaloupka F, et al. Mixed messages on tobacco: comparative exposure to public health, tobacco company- and pharmaceutical company-sponsored tobacco-related television campaigns in the United States, 1999-2003. Addiction 2005;100(12):1875-83. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16367989

20. Henriksen L, Dauphinee AL, Wang Y and Fortmann SP. Industry sponsored anti-smoking ads and adolescent reactance: test of a boomerang effect. Tobacco Control 2006;15(1):13–8. Available from: http://tc.bmjjournals.com/cgi/content/abstract/15/1/13

21. Biener L. Anti-tobacco advertisements by Massachusetts and Philip Morris: what teenagers think. Tobacco Control 2002;11(suppl. 2):ii43-6. Available from: http://tobaccocontrol.bmj.com/cgi/reprint/11/suppl_2/ii43.pdf

22. Wakefield M, Terry-McElrath Y, Emery S, Saffer H, Chaloupka FJ, Szczypka G, et al. Effect of televised, tobacco company-funded smoking prevention advertising on youth smoking-related beliefs, intentions, and behavior. American Journal of Public Health 2006;96(12):2154-60. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17077405

23. Wakefield M, Flay B, Nichter M and Giovino G. Effects of anti-smoking advertising on youth smoking: a review. Journal of Health Communication 2003;8(3):229-47. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12857653

24. Farrelly MC, Healton CG, Davis KC, Messeri P, Hersey JC and Haviland ML. Getting to the truth: evaluating national tobacco countermarketing campaigns. American Journal of Public Health 2002;92(6):901-7. Available from: http://www.ajph.org/cgi/reprint/92/6/901

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