The history of adolescent tobacco prevention and cessation programs and recommendations for moving forward

Abstract

Although tobacco prevention programs have played an important role in the prevention and reduction of adolescent tobacco use, the history of tobacco prevention has been a complex road. In this chapter, we recount this history of tobacco prevention programs as well as how the tobacco industry also developed so-called prevention programs that ultimately instead utilized tactics that actually encouraged more adolescent tobacco use, such as promoting an abstinence only or “forbidden fruit” approach or omitting content related to industry-led marketing. Since then, there has been much that the field of tobacco prevention and cessation has learned in terms of appropriate programming and messaging for adolescents, such as adopting a more “harm-reduction” approach. We walk through the current landscape of adolescent-focused tobacco prevention and cessation programs. We start by highlighting evidence-based theories and frameworks that have been used successfully in tobacco programs, such as Positive Youth Development and Community-based Participatory Research. We then discuss the content needed for successful programs, such as information to counter the appeal of tobacco product flavors, social influences, targeted marketing, and misperceptions of harm. We also recommend approaches for implementation of programs, such as interactive content and educator trainings. It is also important to rigorously and empirically evaluate tobacco programs, with the gold-standard ultimately being the cluster randomized controlled trial method. With the proliferation of new tobacco products constantly entering the market and becoming popular among youth, the practices discussed in this chapter may be used to inform the way forward as public health professionals and educators continue to develop and implement programs for emerging tobacco products. The ongoing development and evaluation of innovative primary prevention, Alternatives-to-Suspension, and cessation programs is critical in order to address the current and continuing issue of adolescent use of all types of tobacco products.