2007 johns hopkins bloomberg school of public health tobacco and youth matthew l. myers, jd campaign...

2007 Johns Hopkins Bloomberg School of Public Health

Tobacco and YouthTobacco and Youth

Matthew L. Myers, JDCampaign for Tobacco-Free Kids

2 2007 Johns Hopkins Bloomberg School of Public Health

Learning Objectives

What we know about youth smoking Statistics How youth tobacco use differs around the world

What we know about what prompts youth to smoke and what leads to the epidemic

What we know about what we can do about youth smoking


Tobacco and Youth

Who wins the battle over youth? The tobacco industry or public health leaders? The key as to how many die from tobacco this

century

The overwhelming majority of all long-term tobacco users start as youth Both in developed and developing nations

Nearly one-fourth of young people who smoke had their first cigarette before the age of ten


Competing Myths

In nations with already high tobacco use rates, youth tobacco use is inevitable, unchangeable, and a natural part of the passage from childhood to adult life

In nations and cultures where children have traditionally not smoked or otherwise used tobacco, there is little need to worry about or focus on youth tobacco use

Youth tobacco use is the same from country to country and culture to culture


There Is No Single Image of Youth Tobacco Use

China, much of India, and Vietnam 7% or less of school-age youth use any form of

tobacco

Chile, Russia, the Czech Republic, Greece, Zambia, and the Kashmir portion of India More than 25% of school-age youth use tobacco

United States, Chile, Greece, Uruguay, and many other countries There is no difference in tobacco use between girls

and boys

Indonesia, Nepal, Thailand, China, much of India, and other countries Far fewer girls use tobacco than do boys


There Is No Single Image of Youth Tobacco Use

Much of India, Nepal, Botswana, Tanzania, Zambia, and Nigeria Far more youth tobacco users use a tobacco

product other than cigarettes—often by a ratio of 2:1 or 3:1

Uruguay, Mexico, the Czech Republic, Romania, Vietnam, the Philippines, Indonesia, Canada, and the United States More youth use cigarettes than other tobacco

products


The Tobacco Epidemic: Industry Promotion

Source: World Health Organization. (2000).

“Tobacco use is unlike other threats to global health. Infectious diseases do not employ multinational public relations firms. There are no front groups to promote the spread of cholera. Mosquitoes have no lobbyists.”

—World Health Organization (2000)


The Tobacco Industry on the Tobacco Epidemic

“We are still in the foothills when it comes to exploring the full opportunities of many of our new markets.”

—Geoff Bible (1996)Former CEO of Phillip

Morris

Source: Philip Morris Internal Documents. (1996); Image source: Lung Health Image Library. (2007).Permission granted for educational use.


“Tobacco is a communicated disease. It is communicated through advertising and sponsorship.”

—Dr. Gro Harlem Brundtland (2000)Former Director-General of the

WHO

The WHO on the Tobacco Epidemic


The Spread of the Tobacco Epidemic: Targeting Youth

Image source (right): Lung Health Image Library. (2007). Permission granted for educational use.


Targeting Youth: Japan


Targeting Youth: Taiwan


Targeting Youth: Malaysia

The Malaysian Grand Prix: March, 2004, in Kuala Lumpur Organizers announced that special emphasis was

to be given to attract school children and college students to attend the race

An entire stand was reserved for young people on the practice days for free

A total crowd of 120,000 was expected, and the organizers said they wanted children to make up 20% of that crowd

The Minister of Youth and Sports called on all parties to support the event


Malaysian Grand Prix: March, 2004, in Kuala Lumpur

Marlboro Girls aplenty, selling limited-edition racing package Marlboros

Image source: Pezzimenti, K. (2004). Permission granted for educational use.


Malaysian Grand Prix: March, 2004, in Kuala Lumpur

Young boy branded in Marlboro

Image source: Pezzimenti, K. (2004). Permission granted for educational use.


Targeting Youth: Advertising

Image source: Campaign for Tobacco-Free Kids.


Targeting Youth: Vietnam



Images source: Assunta, M. (1999).



A Santiago billboard proclaims: “When women say ‘no,’ they mean ‘maybe.’ When they say ‘maybe,’ watch out.”

Image source: Shellat, L. (2006).


Spread of the Tobacco Epidemic: Targeting Women


Targeting Women: Hong Kong


Targeting Women: Japan


Reaching New Markets: Romania

Traffic lights in Bucharest, Romania


Using Western Imagery: Czech Republic

“Give me an Amerika”—Czech slang for a good cigarette

Image source: Essential Action Global Partnership for Tobacco Control.


Image source: Stanclik, K. (2000).

Using Western Imagery: Poland

Polish newspaper ad for new Winchester cigarettes, 2000 “New! Winchester—now 3.70—

the legend of America” (ZL 3.70 ~ 0.82 USD)


Using Religious Imagery: Philippines

Image source: Mackay, J. (1994).


Using Religious Imagery: Philippines


The Tobacco Industry Does Not Have to Succeed

We know how to reduce youth tobacco use and death and disease from tobacco use The challenge is to translate what we know

into sustained action equal to the magnitude of the problem and equal to the tobacco industry’s effort to change and win the minds and hearts of young people


Progress Towards Reducing Tobacco Use

“Our lack of greater progress in tobacco control is more the results of failure to implement proven strategies than the lack of knowledge about what to do.”

— U.S. Surgeon General (2000)

Source: U.S. Department of Health and Human Services. (2000).


Strategies that Reduce Tobacco Use

Having smoke-free laws

Increasing taxes/higher prices

Using strong sustained public education campaigns that include mass media

Using powerful graphic health warnings


Strategies that Reduce Tobacco Use

Curtailing tobacco marketing and countering and exposing the tobacco industry

Expanding access to cessation programs

Involving community organizations and health care professionals


Barriers to Success

A lack of urgency: tobacco kills too slowly

The tobacco industry blaming the victim

The tobacco industry constantly seeks new victims and fights strong action

The tobacco industry has no conscience and no shame: it preys on the vulnerable and acts without regard for the consequences


Barriers to Success

Allowing the tobacco industry to be seen as part of our culture

The tobacco industry never quits—even when it strategically retreats

Assuming that all we had to do was produce the science to solve the problem


Warning Labels

Images source: Physicians for a Smoke-free Canada. (2007).

Canada Europe


Image source: Physicians for a Smoke-free Canada. (2007).

Packaging and Labeling

Smokers are unaware of the true risks and underestimate their own risks


Evidence: Excise Taxes

Raising taxes on tobacco products is the single most effective intervention to reducing tobacco use among young people A 10% increase in price could save ten million

lives worldwide Higher price leads to lower consumption; fewer

youth starting Price elasticity is higher in low- and middle-

income countries A 10% increase in price reduces demand by:

4% in high income countries 8% in low- and middle-income countries Deters youth from taking up smoking

Higher excise taxes lead to more government revenue Higher excise taxes do not lead to smuggling

Source: Jha, P. and Chaloupka, F. (1999).


The Effect of Price Increases on Cigarette Sales

Source: adapted by CTLT from Chaloupka F. (2006).


Sources: adapted by CTLT from The World Bank and The United States Department of Agriculture. (2000).

Price Elasticity


Of 42 developing countries, cigarettes became more affordable in 24 between 1990 and 20011

The tobacco industry was effectively arguing against the government increasing its tobacco taxes

The result: Government received less revenue Tobacco industry gained more smokers

There is a great opportunity to increase tobacco taxes and reduce tobacco use

There is a lack of understanding about the impact of tobacco taxes in low- and middle-income countries—despite the fact that there has been broad consensus among international economists for over a decade in the published literature2

Few Low- and Middle-Income Countries Use Taxes

Sources: 1Blecher, et al. (2004). 2Sunley, et al. (1999).


Sources: Saffer, H. (2000); Chaloupka, F.J. and Warner, K. (2000); Saffer, H. and Chaloupka, F.J. (2000); Wakefield, M., et al. (2000); Pierce, J.P., et al. (1998); Biener, L. and Siegel, M. (2000); Sargent, J.D., et al. (2000); Philip Morris (1990).

Relationship between Advertising and Consumption

Advertising increases tobacco consumption Youth are especially vulnerable

Youth who own promotional items are more likely to become smokers

Comprehensive advertising, sponsorship, and promotion bans decrease consumption (approximately six percent)

Restrictions or partial bans are ineffective: advertising and promotion will increase in permitted forms


Bans Reduce Cigarette Consumption

Source: adapted by CTLT from Saffer, H. (2000).


Countering Industry: School Education Programs

In developed nations, there is no evidence that school education programs by themselves have any long-term impact on consumption

School education programs are always the solution the tobacco industry proposes because it knows it does not work

The only time school education programs have been shown to have an effect is when they are combined with other activities, such as: Increased tobacco taxes Efforts to expand protection against secondhand smoke Community tobacco education programs Sustained, comprehensive counter-advertising

campaigns


Industry Youth Tobacco Prevention Programs

Many major tobacco companies have started their own industry youth tobacco prevention programs

Scientific evidence shows that industry youth tobacco prevention programs: Do not reduce tobacco use Result in youth having more favorable attitudes

about tobacco companies and tobacco products

These are the most devious and subversive forms of tobacco marketing Convincing public health people that they do not

need to counter tobacco industry marketing Making young people more receptive to tobacco

products


Counter-Advertising

Source: Adbusters.org. Permission granted for educational use.


Smoke-Free Air Laws

Vitally important because secondhand smoke is a major cause of premature death and disease

These laws also serve to reduce youth tobacco use Change the norm of what young people see

Do not see adults smoking wherever they go Smoking becomes the unusual behavior and non-

smoking behavior becomes the norm


Summary

In every country that has implemented the tobacco control strategies for which there is a sound science base, we have seen a decline in tobacco use and changed attitudes about tobacco

Where these efforts have succeeded, we have seen changes in disease rates

In countries that acted as if they had solved the tobacco problem and stopped aggressively promoting change, progress has slowed, stopped, or reversed