Youth Smoking Prevention Programs Research Articles

Tobacco Industry Promotional Strategies Targeting American Indians/Alaska Natives and Exploiting Tribal Sovereignty.

American Indians/Alaska Natives have the highest commercial tobacco use in the United States, resulting in higher tobacco-caused deaths and diseases than the general population. Some American Indians/Alaska Natives use commercial tobacco for ceremonial as well as recreational uses. Because federally recognized Tribal lands are sovereign, they are not subject to state cigarette taxes and smoke-free laws. This study analyzes tobacco industry promotional efforts specifically targeting American Indians/Alaska Natives and exploiting Tribal lands to understand appropriate policy responses in light of American Indians'/Alaska Natives' unique sovereign status and culture. We analyzed previously secret tobacco industry documents available at the Truth Tobacco Documents Library (https://industrydocuments.library.ucsf.edu/tobacco/). Tobacco companies used promotional strategies targeting American Indians/Alaska Natives and exploiting Tribal lands that leveraged the federally recognized Tribes' unique sovereign status exempting them from state cigarette taxes and smoke-free laws, and exploited some Tribes' existing traditional uses of ceremonial tobacco and poverty. Tactics included price reductions, coupons, giveaways, gaming promotions, charitable contributions, and sponsorships. In addition, tobacco companies built alliances with Tribal leaders to help improve their corporate image, advance ineffective Youth Smoking Prevention programs, and defeat tobacco control policies. The industry's promotional tactics likely contribute to disparities in smoking prevalence and smoking-related diseases among American Indians//Alaska Natives. Proven policy interventions to address these disparities including tobacco price increases, cigarette taxes, comprehensive smoke-free laws, and industry denormalization campaigns to reduce smoking prevalence and smoking-related disease could be considered by Tribal communities. The sovereign status of federally recognized Tribes does not prevent them from adopting these measures. American Indians/Alaska Natives suffer disparities in smoking prevalence and smoking-related diseases as compared with other groups. The tobacco industry has used promotional tactics including price reductions, coupons and giveaways, casino and bingo promotions, charitable contributions and sponsorships, and so-called Youth Smoking Prevention (YSP) programs to specifically target American Indians/Alaska Natives and exploit Tribal sovereignty, which likely contribute to disparities in tobacco use and related diseases and deaths among this population. Tribal and public health policy makers should consider rejecting ineffective YSP programs and instead consider adopting proven policy interventions including tobacco price increases, cigarette and casino taxes, comprehensive smokefree laws, and anti-industry denormalization campaigns to reduce smoking and smoking-related disease.

Long-Term Health and Medical Cost Impact of Smoking Prevention in Adolescence

PurposeTo estimate smoking progression probabilities from adolescence to young adulthood and to estimate long-term health and medical cost impacts of preventing smoking in today's adolescents. MethodsUsing data from the National Longitudinal Study of Adolescent Health (Add Health), we first estimated smoking progression probabilities from adolescence to young adulthood. Then, using the predicted probabilities, we estimated the number of adolescents who were prevented from becoming adult daily smokers as a result of a hypothetical 1 percentage point reduction in the prevalence of ever smoking in today's adolescents. We further estimated lifetime medical costs saved and quality-adjusted life years (QALYs) gained as a result of preventing adolescents from becoming adult daily smokers. All costs were in 2010 dollars. ResultsCompared with never smokers, those who had tried smoking at baseline had higher probabilities of becoming current or former daily smokers at follow-up regardless of baseline grade or sex. A hypothetical 1 percentage point reduction in the prevalence of ever smoking in 24.5 million students in 7th–12th grades today could prevent 35,962 individuals from becoming a former daily smoker and 44,318 individuals from becoming a current daily smoker at ages 24–32 years. As a result, lifetime medical care costs are estimated to decrease by $1.2 billion and lifetime QALYs is estimated to increase by 98,590. ConclusionsEffective smoking prevention programs for adolescents go beyond reducing smoking prevalence in adolescence; they also reduce daily smokers in young adulthood, increase QALYs, and reduce medical costs substantially in later life. This finding indicates the importance of continued investment in effective youth smoking prevention programs.

Abstract 2157: Causal effects of delaying smoking initiation on subsequent lung cancer risk

Abstract Background: Methods that report relative risks when describing the association between age at smoking initiation and lung cancer adjust for variables unknown or unpredictable at the time of initiation (smoking duration, pack-years etc.). Such methods do not provide valid estimates of the causal effect of smoking initiation. Also, relative risks are not informative for assessing the effects of youth smoking prevention programs or describing the impact of individuals' decisions to start smoking. Applying a causal modelling framework, we estimate absolute lung cancer risk - a metric more relevant to public health than relative risk - given variables fixed at the age of smoking initiation and averaging over subsequent smoking behaviors. Methods: We used the Environment And Genetics in Lung cancer Etiology (EAGLE) study (1942 lung cancer cases, 2116 controls), a population-based case-control study in Lombardy, Italy. We classified risk factors as fixed at smoking initiation (gender, childhood exposure to tobacco smoke [CETS], lung cancer family history [FH], birth cohort) and as causally related to the initiation age (pack-years, cigarettes per day, quitting, nicotine dependency). Using the sampling fractions for controls selection, we reconstructed the original study cohort and estimated absolute lung cancer risks overall and conditionally on fixed factors. We predicted lung cancer rates for different ages at smoking initiation as number of cases per 100,000 person-years (PY) using a binomial linear model and estimated corresponding risk differences (RD) and 95% confidence intervals (CI). Instead of adjusting for the effects of smoking behaviors that happen after initiation, we averaged over them. We show how assumptions about factors unknown at smoking initiation affect the estimates. Results: Delaying smoking initiation from age 16 to age 20 reduces estimated lung cancer rate in men from 149 to 78 cases per 100,000 PY with a RD=71 (95% CI 25 to 120), but there is apparently no corresponding effect in women (RD= -1 [95% CI -50 to 48] from 26 to 27 cases per 100,000 PY). The effect of delaying initiation is larger for those without CETS (RD=113 [95% CI 52 to 174] cases per 100,000 PY from 156 to 43) than those with CETS (RD=45 [95% CI -2 to 92] cases per 100,000 PY from 92 to 47). For those with FH RD was 214 (95% CI -106 to 534) cases per 100,000 PY from 282 to 68, and for those without FH it was 44 (95% CI 3 to 85) cases per 100,000 PY from 85 to 41). RDs were greater for early birth cohorts. There was heterogeneity among individuals with same initiation age but different subsequent smoking behaviors. Conclusion: We estimated absolute lung cancer risk from a case-control study using information fixed at the initiation age and averaging over subsequent smoking behaviors. Our estimates show substantial impact of delaying initiation in men, even if the person eventually smokes. Extrapolation to current youths and young adults requires integration of data on contemporary smoking patterns. Citation Format: Orestis A. Panagiotou, Fangyi Gu, Carolyn Reyes-Guzman, Maria-Teresa Landi, Michele Bloch, Neil E. Caporaso, Sholom Wacholder. Causal effects of delaying smoking initiation on subsequent lung cancer risk. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 2157. doi:10.1158/1538-7445.AM2014-2157

Social normative beliefs regarding cigarette smoking in Hungarian adolescents

Hungary will continue to experience a high burden of disease and death from lung cancer and other tobacco-induced disease unless there is a significant reduction in youth smoking. Social factors have been found to be among the most important determinants of adolescent smoking, yet few studies have investigated social normative beliefs in Hungarian youth. The purpose of the current study was to investigate three measures of smoking normative beliefs thought to influence adolescent smoking: perceived prevalence of smoking; perceived popularity of smoking among successful/elite elements of society; and perceived disapproval by friends and family. A cross-sectional school-based survey of eighth grade (n = 258) and 12th grade (n = 288) students in Mako, Hungary was conducted to assess social normative beliefs about smoking, current smoking, ever smoking, and susceptibility to smoking. The association of the normative beliefs with the smoking behavior variables was examined through logistic regression analysis, and the underlying factor structure of the normative belief items in the current sample was determined through factor analysis. The percent of boys reporting current smoking was 40.5% in 12th grade and 27.0% in eighth grade. Among girls, the percent was 44.0% of 12th graders and 29.1% of eighth graders. Parent/peer disapproval was the most consistently associated normative belief with smoking behavior and susceptibility to smoking across both samples. Youth smoking prevention programs should consider assessing and taking into account normative beliefs and develop strategies that provide accurate information about the actual prevalence of smoking, the types of individuals who smoke, and approval/disapproval of smoking by parents and peers.

Tobacco retailer density surrounding schools and youth smoking behaviour: a multi-level analysis

BackgroundYouth smoking prevention should be a public health priority. It is not only vital to prevent youth from smoking but also to prevent non-smoking youth from becoming susceptible to smoking. Past research has examined factors associated with youth's susceptibility to become a future smoker, but research has yet to examine tobacco retailer density and susceptibility to smoking among never smokers. The objectives of this study are to examine how tobacco retailer density surrounding schools and social smoking influences are associated with smoking susceptibility among youth of never smokers, and occasional and daily smoking among youth of current smokers.MethodsData were collected in 2005-2006 from grade 9 to 12 students attending 76 secondary schools in Ontario, Canada, as part of the SHAPES-On study. A series of multi-level logistic regression analyses were performed to understand how student- and school-level factors are associated with three smoking behaviour outcomes: smoking susceptibility among never smokers, occasional smoking, and daily smoking.ResultsThe number of tobacco retailers surrounding a school was found to be associated with the likelihood of a never smoker being susceptible to future smoking (OR 1.03, 95CI% 1.01, 1.05). We also identified that being surrounded by smoking social influences, specifically family and close friends, can substantially increase the likelihood that never smokers are at risk for future smoking or that youth are already occasional or daily smokers.ConclusionsWe identified that the number of tobacco retailers surrounding a school was associated with an increased odds of being susceptible to future smoking among male never smokers. Smoking social models surrounding youth also appears to have an important impact on their smoking behaviour regardless of their smoking status. It is important for youth smoking prevention programs to begin early, interrupt youths' susceptibility to future smoking, and focus on subgroups that are at higher risk of smoking. The government should consider the impact of tobacco retailer density on youth smoking behaviour, and be cautious when granting licenses for establishments to sell tobacco products.

Social Normative Beliefs About Smoking Among Vietnamese Adolescents

Tobacco-related deaths in Vietnam are forecast to climb from 40 000 annually to 70 000 by 2030. Previous research in Western nations has found social factors to be important determinants of adolescent smoking. Because these factors remain unexplored in Vietnamese youth, the purpose of this study was to examine social normative beliefs regarding smoking in a school-based sample of North Vietnamese adolescents and the association of these factors with smoking behavior and susceptibility to smoking. Three measures of normative beliefs regarding smoking were evaluated in cross-sectional surveys of secondary students. Of the 3 measures, parent/peer disapproval was the most consistent normative belief associated with smoking behavior and susceptibility to smoking. Youth smoking prevention programs should consider assessing and taking into account normative beliefs and develop strategies that provide accurate information about the actual prevalence of smoking, the types of individuals who smoke, and approval/disapproval of smoking by parents and peers.

Tobacco Industry Use of Corporate Social Responsibility Tactics as a Sword and a Shield on Secondhand Smoke Issues

The tobacco industry has used corporate social responsibility tactics to improve its corporate image with the public, press, and regulators who increasingly have grown to view it as a merchant of death. There is, however, an intractable problem that corporate social responsibility efforts can mask but not resolve: the tobacco industry's products are lethal when used as directed, and no amount of corporate social responsibility activity can reconcile that fundamental contradiction with ethical corporate citizenship. This study's focus is to better understand the tobacco industry's corporate social responsibility efforts and to assess whether there has been any substantive change in the way it does business with regard to the issue of exposure to secondhand smoke. The results show that the industry has made no substantial changes and in fact has continued with business as usual. Although many of the tobacco companies' tactics traditionally had been defensive, they strove for a way to change to a more offensive strategy. Almost without exception, however, their desire to appear to be good corporate citizens clashed with their aversion to further regulation and jeopardizing their legal position, perhaps an irreconcilable conflict. Despite the switch to offense, in 2006 a federal judge found the companies guilty of racketeering.

Avoiding “Truth”: Tobacco Industry Promotion of Life Skills Training

Purpose To understand why and how two tobacco companies have been promoting the Life Skills Training program (LST), a school-based drug prevention program recommended by the Centers for Disease Control and Prevention to reduce youth smoking. Methods We analyzed internal tobacco industry documents available online as of October 2005. Initial searches were conducted using the keywords “life skills training,” “LST,” and “positive youth development.” Results Tobacco industry documents reveal that since 1999, Philip Morris (PM) and Brown and Williamson (B&W) have worked to promote LST and to disseminate the LST program into schools across the country. As part of their effort, the companies hired a public relations firm to promote LST and a separate firm to evaluate the program. The evaluation conducted for the two companies did not show that LST was effective at reducing smoking after the first or second year of implementing the program. Even so, the tobacco companies continued to award grants to schools for the program. PM and B&W’s role in promoting LST is part of a public relations strategy to shift the “youth smoking paradigm” away from programs that highlight the tobacco industry’s behavior and toward programs in which the industry can be a partner. Conclusions Individuals and organizations responsible for developing and implementing tobacco control and youth smoking prevention programs should be aware of PM and B&W’s role and motivations to encourage the wide-spread adoption of LST in schools.

Relationship between high school student smoking and recognition of cigarette advertisements

We report the results of a study examining the level of advertisement recognition and tobacco experimentation in a group of U.S. high school students. Students who smoked as few as one cigarette per week were found to identify a preferred cigarette brand. One brand of cigarettes accounted for 76% of all preferred brands. A dose-response relationship was found between smoking level and cigarette advertisement recognition, with regular smokers recognizing 61.6% of advertisements, compared with only 33.2% for nonsmokers. These data have potential implications for youth smoking prevention programs. Future research is needed to explain this association and to establish whether cigarette advertising and adolescent smoking are causally related.