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Tobacco and YouthTobacco and Youth
Matthew L. Myers, JDCampaign for Tobacco-Free Kids
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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
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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
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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
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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
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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
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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)
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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.
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“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
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The Spread of the Tobacco Epidemic: Targeting Youth
Image source (right): Lung Health Image Library. (2007). Permission granted for educational use.
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Targeting Youth: Japan
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Targeting Youth: Taiwan
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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
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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.
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Malaysian Grand Prix: March, 2004, in Kuala Lumpur
Young boy branded in Marlboro
Image source: Pezzimenti, K. (2004). Permission granted for educational use.
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Targeting Youth: Advertising
Image source: Campaign for Tobacco-Free Kids.
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Targeting Youth: Vietnam
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Targeting Youth: Advertising
Images source: Assunta, M. (1999).
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Targeting Youth: Advertising
A Santiago billboard proclaims: “When women say ‘no,’ they mean ‘maybe.’ When they say ‘maybe,’ watch out.”
Image source: Shellat, L. (2006).
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Spread of the Tobacco Epidemic: Targeting Women
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Targeting Women: Hong Kong
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Targeting Women: Japan
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Reaching New Markets: Romania
Traffic lights in Bucharest, Romania
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Using Western Imagery: Czech Republic
“Give me an Amerika”—Czech slang for a good cigarette
Image source: Essential Action Global Partnership for Tobacco Control.
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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)
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Using Religious Imagery: Philippines
Image source: Mackay, J. (1994).
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Using Religious Imagery: Philippines
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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
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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).
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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
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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
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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
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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
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Warning Labels
Images source: Physicians for a Smoke-free Canada. (2007).
Canada Europe
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Image source: Physicians for a Smoke-free Canada. (2007).
Packaging and Labeling
Smokers are unaware of the true risks and underestimate their own risks
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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).
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The Effect of Price Increases on Cigarette Sales
Source: adapted by CTLT from Chaloupka F. (2006).
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Sources: adapted by CTLT from The World Bank and The United States Department of Agriculture. (2000).
Price Elasticity
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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).
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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
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Bans Reduce Cigarette Consumption
Source: adapted by CTLT from Saffer, H. (2000).
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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
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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
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Counter-Advertising
Source: Adbusters.org. Permission granted for educational use.
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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
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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