Thursday, May 6, 2010


Smoking among youths in the United States has been a significant public health issue for decades. Studies have shown that most adults who smoke began experimenting with cigarettes in middle school and became regular smokers before completing high school.1 Therefore, the continued onset of smoking among adolescents is the primary barrier to long-term reduction in the smoking prevalence in the U.S population.
Each day in the U.S, approximately 3,900 young people between 12 and 17 years of age smoke their first cigarette, and an estimated 1,000 youths become daily cigarette smokers.2 In 2007, 20% of high school students were current cigarette smokers: 18.7% of female and 21.3% of male high school students were known to be smokers.1
Research has revealed that the factors that determine whether a young person starts smoking are complex and interrelated. These factors include peer pressure, family influence, and a perception that smoking is the norm.1This relationship has been explained by social scientists through the Social Learning Theory, which posits that people learn and acquire behavior by observing other people and adopting their behavior. Other factors that determine a smoking habit include low socio-economic status, accessibility, availability and price of tobacco products.2 In addition, it’s been proven that adolescents who have low academic achievements, low self-image or self-esteem, and aggressive behaviors are more likely to adopt a smoking habit.2
In the past years, the tobacco industry began programs worldwide to promote youth smoking education and prevention.3 Companies like Phillip Morris, Lovillards, and R.J Reynolds in the U.S have produced campaigns to discourage youth from smoking. Phillip Morris was known for the slogan “Think, Don’t Smoke” (TDS), a $100million anti-smoking campaign that focused on teens. This campaign was aired nationally between 1998 and 2002.3 The TDS featured role model youths who stated that their minds and bodies were committed to not smoking, and tried to discourage others from smoking.4
During the same period, the industry also distributed book covers in schools around the U.S with slogans “Think, Don’t Smoke” to remind teens to consider the health effects of smoking. In addition to this, the company also sponsored a “Talk, They’ll Listen” (TTL) television ad which admonishes parents to discourage their kids from smoking.4 The industry claimed that it devised its ad campaigns on the advice of experts who deem parental influence extremely important.5
However, these campaigns by Phillip Morris, and many other from the tobacco industry have been met with much criticism since their inception. A school-based study of U.S youths found that exposure to campaigns such as the youth-focused TDS and the parent-focused TTL were actually associated with lower perceived harm of smoking, stronger approval of smoking, and stronger intentions to smoke.6 The tobacco industry failed to understand the dynamics of human behavior, especially among youths.
The Phillip Morris anti-smoking campaigns have been portraying not smoking as a behavior that flaunts rationality, by asking the youths to think, and with the assumption of health as a universal and superseding core value and life goal. The TDS campaign tells teens, in a lecturing manner, to do something no free-spirited emotional teen wants to do – “think”. It cried out for rational thought, but young teenagers have not yet mastered self-analysis.7
Studies showed that programs were less appealing and convincing to youth, and that industry programs subtly promoted smoking.3 Moreover, due to their ulterior motives, it seemed that the tobacco company never wanted the campaigns to be effective.
Despite all the various anti-smoking campaigns sponsored by the tobacco industries, as exemplified by Phillip Morris, the rate of smoking among youths in the U.S continues to rise over the years. The following arguments explain, in detail, why the industry-sponsored campaigns failed to make an impact.
Argument 1
The Campaigns did not consider individual social and environmental factors that influence behavior.
The theory of Social Learning proposes that direct and vicarious experience with rewards and punishments in one’s environment lead to the acquisition of specific beliefs about the consequences of behaviors.8Events in one’s environment affect personality. The TDS campaign did not put into consideration the events in the environment of these youths before asking them to think not to smoke. Human beings make irrational decisions based on social context, economic and environmental factors. Seventy five percent of youth smokers have parents, older siblings, or friends who smoke. Parents’ smoking affects health beliefs such that the more one’s parents smoke, the less one is likely to believe that smoking has health consequences. The TLL campaign reached out to the youth through their parents, but the company forgot to tell the parents, as role models, to stop smoking themselves. Likewise, among their peers, youth believe that smoking gives them enjoyment, makes them popular, and reduces tension.8The more of one’s friends who smoke, the more likely one is to adopt the behavior based on the perceived beliefs.8
In addition, socio-economic status determines one’s behavior. A study showed that, 43% of 17-18 year olds who drop out of school smoke, and other studies have shown that smokers most often come from low socio-economic backgrounds.2These kids might require different and more intensive interventions than just asking them not to smoke.
In general, the TDS and TTL campaign are flawed because they expect youths to “just say no” without considering each person’s cultural, social, economic, and environmental backgrounds that compel them to smoke.
Argument 2
Phillip Morris Campaign Messages are Persuasive and they Challenge Youths’ Autonomy
The Phillip Morris campaigns are authoritative. TDS directly commands teens not to smoke, and TTL indirectly instructs youths not to take up smoking. Campaign creators failed to realize that youths desire to gain control of their lives. Scientists have studied the seemingly infinite number of interdependence variables that affect persuasive messaging.7 According to developmental psychologists, teenagers tend to reject authoritative messages because they believe they are independent,9 hence any message that attempt to challenge their freedom will be rejected.
In addition, the theory of psychological reactance posits that people become motivationally aroused by a threat to or elimination of a behavioral freedom. This motivational state is what is called psychological reactance.10Psychological reactance is an aversive affective reaction in response to regulations or impositions that impinge on freedom and autonomy.11 Phillip Morris TDS campaign, which told American youth- “Don’t Smoke”, was perceived by the recipient to reduce or threaten personal freedom, arouse a motivational state and reactance. The entire process directs the individual towards re-establishing the lost or threatened freedom, hence encouraging them to initiate or continue the habit of smoking.12
Moreover, American society constantly limits the autonomy of its youth: e.g. compulsory education, age limits in many activities, control and monitoring of their sexual and other health-related behaviors.13Some social analysts have proposed that smoking itself is a form of resistance by the youths to authority in general.13Therefore, simply telling the youths not to smoke through TDS campaign, violates their social independence.
Furthermore, some believe that nothing makes tobacco more alluring to adolescents than hysterical grown-ups admonishing them not to smoke.14 The TTL campaign also failed because teens are known to spurn their parents’ advice.
In addition, the TDS television campaign added a slogan that describes the Surgeon General’s warning that smoking is not good for a person’s health. However, the theory of psychological reactance also explains that attributing a message to a highly authoritative source, in an attempt to increase the effect of the warning in the message, could produce reactance in youth, making the message ineffective.12
Considering a young teenager from broken home, socially, economically, and educationally disadvantaged, and who has adopted a smoking habit as a social norm to boost self-esteem, gain control of his/her life, would see such ads like TDS or TTL as a big threat to his/her existence. According to the theory of illusion of control, people feel if they choose a habit or behavior, they own it. Therefore, simply telling youths not to smoke is both useless and ineffective.
Argument 3
Corporate Practices Undermines Effectiveness of Campaigns
Research has revealed that corporate practices play a substantial role in shaping health and health behavior.15 The tobacco company marketing strategy has been described as the most bizarre and extra-ordinary mixed messages in commercial history.12 The same Phillip Morris that encourages adults to continue smoking wants to prevent youths from smoking through TDS and TTL campaigns. This means that they never intended to stop the habit of smoking, but rather delay the onset until adulthood. The campaign, however, failed to realize that youths always want to live for today and prefer not to delay smoking till adulthood.
Corporate practices must be considered as an important social determinant of health. There is clear evidence that the purpose of the industry’s youth smoking prevention program is not to reduce smoking but rather to serve the industry’s political needs by preventing effective tobacco control legislature; preserving the industry’s access to youths; creating allies within policy making and regulatory bodies; defusing opposition from parents and educators; and bolstering industry’s credibility.3
A randomized controlled study was carried out to test whether adolescents’ exposure to anti-smoking ads promotes intentions to smoke, curiosity about smoking, and positive attitude towards the tobacco industry.12 Exposure to Phillip Morris anti-smoking ads was found to have engendered favorable attitudes towards the tobacco company. Ads were noticed to do more to promote corporate image than to prevent youths from smoking.12
Phillip Morris campaigns are considered “warm and fuzzy”, which could actually generate favorable feelings for the tobacco industry, and by extension, its product.5The campaigns were minimally financed, understaffed and run by people with no expertise.5 This reduced the possibility of creating impact in the lives of the youths. Some believe that the big tobacco anti-smoking ads have actually become a new way of getting young people addicted to cigarettes.9
With ulterior motives of tobacco industry at the background, anti-smoking campaigns by tobacco industries like Phillip Morris are ineffective in controlling youth smoking habits, and possibly counterproductive.6
The anti-smoking campaigns to youths in the U.S can still be made effective. Firstly, campaigns must be presented in ways that put individual socio-economic and environmental factors into consideration. In addition, because adults who smoke could influence the kids, public health awareness programs must also focus on reducing smoking habits in adults.
Secondly, instead of just instructing youth not to smoke, campaigns should present a new lifestyle to them as alternatives. Behaviors that interest teens and which they can easily identify with must be created as alternatives for them.
Thirdly, youth anti-smoking campaigns must be taken away from the tobacco industry because they have been proven counterproductive. There is evidence that the tobacco industry purposely promotes and funds ineffective youth anti-smoking campaigns.16In addition, the government should impose heavy tax on the tobacco industry.
1. Campaigns must address soci0-economic, and environmental factors.
Presenting a campaign that considers individual characteristics is an important approach. Public health professionals need to differentiate between “targeting” large groups and “tailoring” to specific individuals. Targeting messages involves segmenting people into homogenous groups and then developing a message that speaks to that group, just like the TDS campaign to the youth. Tailoring, on the other hand requires an assessment of an individual characteristics and then creating a specific message solely suited to that person.7
Public health experts should conduct research to find out what the core values of these youth smokers are individually, the social and environmental factors affecting their existence, and then empower them by giving support to the disadvantaged, creating jobs, sponsoring education, and giving them a sense of ownership. This will appeal more to the youth to prevent them from smoking, rather than sham ads persuading them not to smoke.
In addition, it’s been suggested that tobacco control program should emphasize strategies that encourage cessation among adults. Scientists believe that this approach also impacts on adolescent smoking thus achieving the dual aims of tobacco control programs.17 Campaigns directed at adults, grounded in both health believe model and theories on the process of persuasion, can be aimed to change both attitudes towards smoking and smoking behaviors among adults, who can later influence the young positively.17
Adult campaigns that encourages quitting may influence adolescent smoking by reducing smoking among parents with subsequent reduction in the number of teenagers exposed to a major risk factor for smoking uptake. In addition, making smoking a less desirable adult behavior, can reduce adolescents’ motivation to use tobacco as a signifier of adulthood. Furthermore, as adolescents identify with adults and want to be treated as adults, they are highly likely to attend to the message contained in adult focused anti-smoking campaigns.
Teens want to be like adults, therefore the public health community should realize that the best way to keep kids from smoking is to reduce tobacco consumption among everyone. This sends a strong message to the youths about social norms.18

2. Change message to promote new lifestyle instead of just telling kids what to do
Campaigns aimed at preventing youth from smoking should focus more on giving them options of new lifestyles other than smoking. In Europe, one of the largest public health awareness campaign called “HELP: for a life without tobacco”, has been proven to be effective among youths of the 27 European Union member countries.19 This campaign speaks directly to youth smokers and non-smokers, offering help to quit, not to start, or avoid passive smoking. It provides a comprehensive communication concept that combines television spots (including MTV), e-coaching, YouTube and a website, using state-of-the-art marketing techniques to build a transnational brand that bolsters a positive image of nonsmoking.20 The website is interactive and engages youths in various activities that promote life without tobacco. In addition, they obtain information on various activities that get youth together to promote healthy lifestyles.19 Public health experts in the U.S should adopt this concept and produce anti-smoking campaigns that promote new lifestyles to youths instead of just telling them not to smoke.
An awareness of this approach must be created through multi-media campaigns using youths and high profile artists they can emulate. It can also be introduced to them during various after-school activities in the U.S. Youths can find support through this avenue, and engage in various life promoting activities that take their attention away from bad habits like smoking.
3. Law Enforcement against Tobacco Industry
The tobacco industry must be restricted from getting involved in youth smoking prevention. This is because its ads, such as TDS and TTL by Phillip Morris, and many others have been found to promote corporate image than to prevent youth smoking.12Studies have revealed that one of the ways tobacco industry influences policy and thwarts effective regulations is by promoting and funding ineffective “youth smoking prevention” programs.16 The government must stop this act.
A better way to involve tobacco money in youth smoking prevention would involve taxation. The government should impose a large tax increase on the tobacco industry in order to reduce the sale of its products. Like most goods, the quantity of cigarettes demanded is inversely related to price. So, increasing the price of cigarette with excise taxes will reduce the amount sold. Studies revealed that every 10% increase in the price of a pack of cigarette would produce up to a 7% reduction in the number of children who smoke. This drop would occur because children are far more sensitive to price increase than adults.21 Moreover, W.H.O, in its guidelines on tobacco products revealed that price and tax measures are effective and important means of reducing tobacco consumption particularly in young persons.22
In accordance with the W.H.O Framework Convention on Tobacco Control (FCTC) issued in 2003, the government should act to protect public health policies on smoking from other vested interests of the tobacco industry.22Koop Everett, a former Surgeon General of the United State, once called for a smoke-free society stating that smoking need not be a part of American life.18Studies revealed that this campaign was attacked by tobacco industry and later changed to a less potent and counterproductive one – “We don’t want kids to smoke”. In Massachusetts, the tobacco industry raised a huge fuss when the health department mounted an aggressive and effective media campaign, as well as co-ordinated local programs concentrating on secondhand smoke and de-normalization of tobacco use.18 The U.S government must therefore act in the interest of youths and other citizens by maintain policies that promote health.

Factors contributing to the formation of an enduring health belief or behavior are extremely varied, especially among youths. The theories of human behaviors have been able to prove why the myriads of youth anti-smoking campaigns, especially by the tobacco industry, have failed in curbing the rising prevalence of smoking among youths. The campaigns ignored the effect of smoking parents, friends, and socio-economic factors that prompt youths to smoke. It also did not realize that youths react negatively to authoritative messages that underlie the campaigns. In addition, corporate practices by the tobacco industry have been proven to affect the health of the youths.
In order to make an effective impact, interventions aimed at correcting such enduring habits must put into consideration the social context, psychological needs, and environmental circumstances around which such behavior was formed in each of the teens. The government legislatives must be strict at promoting health of the youths, and public health campaigns aimed at reducing teen smoking should sell to the youths a new lifestyle they can comfortably identify with, and take ownership of.

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16. Zeltner T, Kessler D, Martiny A, Randera F. How tobacco companies fight tobacco control. Available from: Accessed on 04/25/10
17. White V, Tam N, Wakefield M. Do adult focused anti-smoking campaigns have an impact on adolescents? The case of the Australian national tobacco campaign. Available from: Accessed on 04/03/10
18. Editorial: Preventing tobacco use – The youth access trap. Available from: Accessed on 04/10/10
19. The HELP Campaign 2009-2010. Moving towards a smoke-free Europe. Homepage. Available from: Accessed on 04/25/10
20. HELP campaign: tobacco-free lifestyle. World Heart Federation webpage. Available from: Accessed on 04/25/10
21. Barry M. Politics of youth smoking fueled by unproven data: Legislation’s desired effects dress up as facts. The New York Times National. 1998.
22. World Health Organisation. W.H.O Framework Convention on Tobacco Control (FCTC). 2003. Available from: Accessed on 04/25/10.

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