Responses to tobacco control policies among youth

OBJECTIVE: Explore adolescents' response to current and potential tobacco control policy issues. DESIGN: The 13 site Tobacco Control Network (TCN), sponsored by the Centers for Disease Control and Prevention, conducted 129 sex and ethnic homogeneous focus groups. PARTICIPANTS: 785 white, African American, Asian American/Pacific Islander, American Indian, and Hispanic adolescents who were primarily smokers from rural, urban, and suburban locations across the USA. MAIN OUTCOME MEASURES: Awareness, knowledge, opinions, and behaviour regarding laws and rules, prices, cigarette ingredients, and warning labels. RESULTS: Teenagers were generally familiar with laws and rules about access and possession for minors, but believed them ineffective. They were knowledgeable about prices, and reported that a sharp and sudden increase could lead them to adjust their smoking patterns but could also have negative consequences. They found a list of chemical names of cigarette ingredients largely meaningless, but believed that disclosing and publicising their common uses could be an effective deterrent, especially for those who were not yet smoking. They were aware of current warning labels, but considered them uninformative and irrelevant. CONCLUSIONS: Understanding teenagers' attitudes and behaviours before implementing policies that will affect them will likely increase their effectiveness. Disclosing and publicising the chemical contents of cigarettes, and increasing prices quickly and sharply, are potentially effective areas for policy change to impact adolescent tobacco use.     

Investing in youth tobacco control: a review of smoking prevention and control strategies

OBJECTIVE: To provide a comprehensive review of interventions and policies aimed at reducing youth cigarette smoking in the United States, including strategies that have undergone evaluation and emerging innovations that have not yet been assessed for efficacy. DATA SOURCES: Medline literature searches, books, reports, electronic list servers, and interviews with tobacco control advocates. DATA SYNTHESIS: Interventions and policy approaches that have been assessed or evaluated were categorised using a typology with seven categories (school based, community interventions, mass media/public education, advertising restrictions, youth access restrictions, tobacco excise taxes, and direct restrictions on smoking). Novel and largely untested interventions were described using nine categories. CONCLUSIONS: Youth smoking prevention and control efforts have had mixed results. However, this review suggests a number of prevention strategies that are promising, especially if conducted in a coordinated way to take advantage of potential synergies across interventions. Several types of strategies warrant additional attention and evaluation, including aggressive media campaigns, teen smoking cessation programmes, social environment changes, community interventions, and increasing cigarette prices. A significant proportion of the resources obtained from the recent settlement between 46 US states and the tobacco industry should be devoted to expanding, improving and evaluating "youth centred" tobacco prevention and control activities.     

Regulatory strategies to reduce tobacco addiction in youth

Preventing tobacco addiction and achieving cessation in established users are the cornerstones of efforts to reduce tobacco use and disease. It has been increasingly recognised that reducing tobacco toxin exposure has theoretical potential to reduce disease in continuing tobacco users. This has been controversial because such approaches also carry the potential to undermine prevention and cessation. As complicated as harm reduction issues are for adults, they are still more complicated for youth. Harm reduction is not a singular approach, but rather a concept that encompasses an extremely diverse array of potential approaches. These carry equally diverse potential risks and benefits. The regulatory framework (for example, whether or not the Food and Drug Administration regulates the approach) is also predicted to be a major factor in determining the consequences of harm reduction approaches. This paper examines the various issues and potential approaches concerning the application of harm reduction to youth. We conclude that although some carry great risk, others may actually support broader tobacco control efforts to prevent tobacco use and foster cessation in youth and adults.     

Minors' tobacco possession law violations and intentions to smoke: implications for tobacco control

Objectives: To test: (1) whether citation under the Minors in Possession (MIP) law, vicarious citation (knowing someone who was cited), and threat of driving licence suspension are associated with decreased intentions to smoke next year; and (2) whether the policy is differentially enforced.     

Characteristics associated with rapid transition to tobacco dependence in youth.

Epidemiologic data suggests the smoking trajectory for some adolescents escalates rapidly and that tobacco dependence can develop quickly after initiation. In this study, we examine variation in cigarette consumption and individual characteristics associated with the rapid development of tobacco dependence, focusing particularly on the 24-month interval after tobacco initiation. The analysis is based on public use data files of the National Household Survey on Drug Abuse conducted in 1994-1996. Representative samples of adolescents aged 12-17 years old, totaling 13,831, completed a standardized interview assessing demographic characteristics, tobacco involvement and past year dependence, and psychological functioning over the preceding 6-month period as assessed by the Youth Self-Report. Analyses were restricted to the 1,734 youth who had started smoking within 0-24 months prior to being assessed, of which the onset for 70% of them was between 11-24 months. Logistic regression models took into account sample weights and used a variance estimation procedure appropriate for the complex multistage sampling design. Overall, 210 recent initiators met dependence criteria (13.5%, 95% CI = 12.0-15.2). Dependent smokers had greater cigarette involvement than youth who had not transitioned to being tobacco dependent by the time of assessment. Variation in mental health and sociodemographic characteristics were also detected. Disruptive behavior (p = .05) and being female (p = .02) were associated with being tobacco dependent. The rapid transition to dependence in youth depends not only on cigarette consumption features, but may also be associated with individual characteristics.     

Targeting youth and concerned smokers: evidence from Canadian tobacco industry documents

OBJECTIVE: To provide an understanding of the targeting strategies of cigarette marketing, and the functions and importance of the advertising images chosen. METHODS: Analysis of historical corporate documents produced by affiliates of British American Tobacco (BAT) and RJ Reynolds (RJR) in Canadian litigation challenging tobacco advertising regulation, the Tobacco Products Control Act (1987): Imperial Tobacco Limitee & RJR-Macdonald Inc c. Le Procurer General du Canada. RESULTS: Careful and extensive research has been employed in all stages of the process of conceiving, developing, refining, and deploying cigarette advertising. Two segments commanding much management attention are "starters" and "concerned smokers". To recruit starters, brand images communicate independence, freedom and (sometimes) peer acceptance. These advertising images portray smokers as attractive and autonomous, accepted and admired, athletic and at home in nature. For "lighter" brands reassuring health concerned smokers, lest they quit, advertisements provide imagery conveying a sense of well being, harmony with nature, and a consumer's self image as intelligent. CONCLUSIONS: The industry's steadfast assertions that its advertising influences only brand loyalty and switching in both its intent and effect is directly contradicted by their internal documents and proven false. So too is the justification of cigarette advertising as a medium creating better informed consumers, since visual imagery, not information, is the means of advertising influence.     

Human rights-based approach to tobacco control

The Framework Convention for Tobacco Control (FCTC) is currently the most potent tool for implementation of tobacco control laws across the globe. The FCTC is derivative from previously constructed international human rights conventions. These previous conventions have enforcement mechanisms, unlike the FCTC. However, the FCTC relies on state parties to report periodically on its implementation rather than on a continuous monitoring system. The Human Rights and Tobacco Control Network proposes that abiding by the principles of human rights delineated by international treaties, citizens across the globe can demand effective action for tobacco control. This paper explains the link between fundamental human rights and the right to tobacco control. Mechanisms are described to link the FCTC and its principles with human rights-based monitoring reports, which are provided to oversight committees for the other human rights conventions. The initial work of the Human Rights and Tobacco Control Network is summarised and considers the future directions for the human rights-based approach to tobacco control.