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    I agree. Virtually every smoker, at least in the First World, was a teenager who wanted to look cool or defiant. Most of the anti smoking campaigns that I have seen seem to be aimed at adults who have seen the light and want to stop. We need these campaigns, but we also need to open another front to dissuade teenagers from starting in the first place.

    The decision to take up decades or a lifetime of smoking is nearly always made by children. Tobacco companies know this and have been intentionally marketing addictive poison to minors for decades.

    Telling a 15 year old that something bad might happen to them when they are very old (35 or 50 perhaps) probably won’t cut it. We need to make smoking appear as unappealing as acne, something that will be bad for them now – a sort of mirror opposite of the old tobacco advertising. While they weren’t allowed to show anyone under 25 in the ads, no one looked older than 25.

    Perhaps talk about bad breath, nicotine stains and smoker’s cough, emphasising how unappealing these are to the opposite s_x. Perhaps we could emphasis the cost ($100 a week for a pack a day smoker – what else could you do with the money). Perhaps we could emphasise impotence – albeit a longer term impact but we could help form a mental connection between this very unappealing consequence and smoking in young men’s minds. I also remember some graphic ads some years back showing fish hooks springing out of filter tips (emphasising how quickly they would be hooked).

    And finally, has anyone heard of a non-smoker who felt like they missed out on one of life’s great pleasures by never taking up the habit?

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    Yes, the most effective advertising taps into, and even appropriates, personal values and ‘felt experience’. Coca-Cola sells ‘happiness’ (and who doesn’t want that?), and feel-good ads for oil companies don’t talk about oil, but about parents’ aspirations for their children and the kind of world they will live in. Public health social marketing needs to be much more like commercial marketing in terms of its research base and its sophistication. Adolescents may be a tricky market, but they are not an impossible one.

    There have been promising efforts, but these are largely isolated, uncoordinated and short-term. Twenty years ago, the ACT Division of the Heart Foundation used a few thousand dollars of left-over funding to run a series of PSAs targeting youth smoking. Based on the theme of, ‘Smoking – it can take you right out of the picture’, and with the support of both the Heart Foundation and the Cancer Council, the ads were written and acted by members of Canberra Youth Theatre and filmed ‘on location’ around Canberra. The ads featured practical issues which mattered to high school students, such as smoking and weight control and a boy’s response to an otherwise attractive girl who smokes. (As usual, no money for an evaluation.) In the 1980s, ASH UK worked with a financial institution to give young people a simple, face-saving way to say ‘no’ when offered a cigarette: they developed an endowment savings product which allowed a teen to truthfully assert that, ‘My parents are giving me £1000 when I’m 21 if I don’t smoke, and I really need that money!’

    Health promotion (including Australian health promotion) provides numerous examples of earnest but failed attempts at persuasion and behaviour change. Unfortunately, the analyses of these failures frequently confuse two quite distinct aspects of an initiative: the ‘what’ and the ‘how’. Blaming the wrong aspect means that we might stop doing something when it was the right thing to do but just the wrong approach (usually because it’s not based on good research), and that we continue to do things for which there is no effective approach.

    Anti-smoking social marketing aimed at young people is a case in point. There are varied opinions about this, and public health advocates who wanted to see a top-quality ‘campaign that speaks to young people’ lost that battle long ago to those who argued that such marketing doesn’t work, and given that teens want to be like adults, messages aimed at adults will have a dual impact on teens by changing adult behaviour and changing the image of what it means to be an adult. However, it could be argued that good qualitative research tells us, first, that the problem isn’t that social marketing to teens doesn’t work – it’s just that we don’t tend to do it very well; and, second, that teens don’t want to be like adults, they want to be like the next age group up (eg, 16 yr olds want to be like 18-22 year olds). Failures such as the 1995 cinema campaign which sought to convey the message to teens that smoking was ‘boring’ have served to warn governments and health advocates away from trying to talk directly to teens. But was it the wrong thing to do, or just the right thing done badly? (See for a history of Australian tobacco control campaigns.)

    It’s not easy, and there are certainly complications. These include limited resources, which result in advocates having to argue with Ministers’ offices and health departments about what constitutes the biggest bang for the buck; as a consequence, we often get ads that are widely, rather than specifically, targeted. There are also cultural differences between Australian teens and those in other countries which will influence what works. For example, an effective US anti-smoking youth campaign which highlights the tobacco industry’s manipulation of young people and encourages young people to lobby their elected representatives won’t be as effective where the industry hasn’t been demonised, where teens are more cynical about corporate manipulation, and where there is less of a tradition of direct political action by young people.

    Finally, there is the strong argument that you change behaviour and social norms by changing the environment, such as through smoke-free public places and workplaces and the elimination of tobacco advertising. Certainly I don’t think anyone would argue against the importance of social venues becoming non-smoking, even if this presents opportunities for some sort of ‘solidarity’ among smokers. Smoking in films remains a divisive issue, with some leading tobacco control advocates resistant to tackling the issue head-on, while others argue that failing to address this significant influence on young people’s attitudes and perceptions constitutes a major gap in efforts to discourage youth smoking.

    Turner has raised a number of important questions, but the basic one is still this: should we be trying to directly address youth smoking through campaigns that target youth and, if so, will we have the resources to do it well? There was excellent qualitative research done in the 1990s by researchers such as Tom Carroll and Bev Carroll, and the team which produced Finding the strength to kill your best friend – smokers talk about smoking and quitting (Carter S, Borland R, Chapman S.. Australian Smoking Cessation Consortium and GlaxoSmithKline Consumer Healthcare; Sydney: 2001). We know even more now about psycho-social influences on health-related behaviour, as well as the ‘behavioural economics’ of decision-making. If Turner’s point is that we need to be smart, be savvy, and think like commercial marketers rather than like health professionals in order to successfully market our ‘product’ to young people, then I couldn’t agree more.

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    The other possibility of course is to adopt Professor Jon Berricks proposal and prohibit the sale of tobacco products to anyone born this century. This would phase out smoking in about 60 years. these children are now aged twelve but would never be able to buy cigarettes. As most research shows that children get cigarettes from their peers, then it would not take many years before each age cohort could not buy cigarettes. They would not be penalised, this is not prohibition. We could save an entire generation of people from tobacco smoke.


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