Transcript Youth & Tobacco

An Overview Of Issues, Objectives and Measurement
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Waxman/Kennedy
Product
Industry
“TOBACCO CONTROL”
PRODUCT
FDA Primary Regulator of Manufacture, Marketing and
Distribution of Tobacco Products
Set National Manufacturing Standards (Control of Ingredients)
Oversight and Control all aspects of harm reduction products
Public Disclosure of Research (Past, Present)
INDUSTRY
“TOBACCO CONTROL”
PRODUCT
INDUSTRY
Impose Appropriate Regulatory Controls
Promote Cessation
Strengthen Legislation Against Illicit Trade
Youth
Adults
YOUTH
to ensure that the Food and Drug Administration has
the authority to address issues of particular concern to
public health officials, especially the use of tobacco by
young people and dependence on tobacco”
to continue to permit the sale of tobacco products to
adults in conjunction with measures to ensure that they
are not sold or accessible to underage purchasers”
ADULTS
“FAMILY SMOKING PREVENTION”
“FAMILY SMOKING PREVENTION”
The use of tobacco products by the Nation’s children is a pediatric disease of considerable
proportions that results in new generations of tobacco-dependent children and adults.
Virtually all new users of tobacco products are under the minimum legal age to purchase
such products.
Reducing the use of tobacco by minors by 50 percent would prevent well over 10,000,000
of today’s children from becoming regular, daily smokers, saving over 3,000,000 of them
from premature death due to tobacco-induced disease. Such a reduction in youth smoking
would also result in approximately $75,000,000,000 in savings attributable to reduced
health care costs.
Tobacco company documents indicate that young people are an important and often
crucial segment of the tobacco market. Children, who tend to be more price sensitive than
adults, are influenced by advertising and promotion practices that result in drastically
reduced cigarette prices.
Tobacco product advertising is regularly seen by persons under the age of 18, and persons
under the age of 18 are regularly exposed to tobacco product promotional efforts.
Tobacco product advertising often misleadingly portrays the use of tobacco as socially
acceptable and healthful to minors.
Children are exposed to substantial and unavoidable tobacco advertising that leads to
favorable beliefs about tobacco use, plays a role in leading young people to overestimate
the prevalence of tobacco use, and increases the number of young people who begin to use
tobacco.
Advertising, marketing, and promotion of tobacco products have been especially directed to
attract young persons to use tobacco products and these efforts have resulted in increased
use of such products by youth. Past efforts to oversee these activities have not been
successful in adequately preventing such increased use.
Children are more influenced by tobacco marketing than adults: more than 80 percent of
youth smoke three heavily marketed brands, while only 54 percent of adults, 26 and older,
smoke these same brands.
Tobacco advertising and marketing contribute significantly to the use of nicotine-containing
tobacco products by adolescents.
Tobacco advertising expands the size of the tobacco market by increasing consumption of
tobacco products including tobacco use by young people.
The use of tobacco products in motion pictures and other mass media glamorizes its use for
young people and encourages them to use tobacco products.
Text only requirements, although not as stringent as a ban, will help reduce underage use of
tobacco products while preserving the informational function of advertising.
Comprehensive advertising restrictions will have a positive effect on the smoking rates of
young people.
Restrictions on advertising are necessary to prevent unrestricted tobacco advertising from
undermining legislation prohibiting access to young people and providing for education
about tobacco use.
Because past efforts to restrict advertising and marketing of tobacco products have failed
adequately to curb tobacco use by adolescents, comprehensive restrictions on the sale,
promotion, and distribution of such products are needed.
FACTS/BELIEFS
<=>
=>
ACTIONS
Youth Impact(s)
Solution(s)
Marketing
(Ad/Promotion)
Favorable Beliefs about Tobacco
RESTRICTIONS
Seen Regularly
Portrays Use as Socially Acceptable
Portrays Use as Healthful
Overestimate Peer Prevalence
Increase Initiation
Increase Consumption
Impact Brand Choice
Undermines Legislation (Access)
Stimulus
Establishing the Facts
Developing Programs
Setting Goals
Measuring Progress
“FAMILY SMOKING PREVENTION”
Awareness/Influence/Perception
Product Design (i.e., Flavors)
Initiation/Experimentation/Trial
Regular/Frequent Use
Dependence
Retail Access
Cessation
Recidivism
Youth tobacco involvement has been a central theme in
supporting tax increases, smoke-free legislation, advertising
and promotion restrictions and retail licensing
Sources
Asian Pacific Journal of Cancer
Prevention
American Journal of Health
Promotion
Tobacco Control
Tobacco Industry Advertising,
Promotion and Youth Influence
(Published Studies)




Nicotine & Tobacco Research
Cochrane Database Systematic
Review
Journal of the National Cancer
Institute
American Journal of Preventive
Medicine




American Journal of Public
Health
Preventive Medicine

Archives of Pediatric &
Adolescent Medicine

Reported exposure to pro-tobacco messages in the media:
trends among youth in the United States, 2000-2004
The relationship between tobacco advertisements and
smoking status of youth in India
Tobacco industry targeting youth in Argentina
The impact of tobacco promotion at the point of sale: A
systematic review
Impact of tobacco advertising and promotion on increasing
adolescent smoking behaviors
Influence of tobacco marketing and exposure to smokers on
adolescent susceptibility to smoking
Progression to established smoking: the influence of
tobacco marketing
Receptivity to tobacco advertising and promotions among
young adolescents as a predictor of established smoking in
young adulthood
Effect of cigarette promotions on smoking uptake among
adolescents
Cigarette promotional items in public schools
On December 11,1991, the Journal of the American Medical Association (JAMA)
published three articles on R.J. Reynolds' "Joe Camel" campaign. One article described a
study done with preschoolers in the state of Georgia that concluded that Joe Camel was
almost as recognizable to 6 year olds as Mickey Mouse. Another article stated that said
the ad campaign had successfully grown Camel's share of the market among underage
smokers from 0 .5%to 32 .8%.
The advertisements and packaging employ stylish designs and
bright colors that further emphasize the flavor.11 In fact, nearly
every aspect of the marketing for these flavored tobacco products,
except the health warnings, is strikingly similar to the marketing
used for similarly flavored candies and sweetened beverages.
(Pick Your Poison: Responses to the Marketing and Sale of
Flavored Tobacco Products, A Law Synopsis by the Tobacco
Control Legal Consortium, February 2009)
Mint, Wintergreen, Spearmint, Cherry,
Berry Blend, Vanilla, Apple, Peach, Citrus
Virginia Slims Superslims Lights, which come in a lipstick-size
pack of 20 cigarettes, are "clearly designed to appeal to teen
girls," says Cheryl Healton of the American Legacy Foundation, an
anti-smoking group. Source: USA Today, online, 11/2008

Billions of dollars and a variety resources have/are
used to address youth tobacco issues:
oMedia programs to address adolescent prevention and
cessation
oSchool and Community based prevention programs
oPeer-group activities and programs
oEmphasis on the role of Parents
Is smokeless tobacco a good substitute for cigarettes? In 1986, the Surgeon General
concluded that the use of smokeless tobacco "is not a safe substitute for smoking
cigarettes. It can cause cancer and a number of noncancerous conditions and can lead to
nicotine addiction and dependence." Since 1991, the National Cancer Institute (NCI), a part
of the National Institutes of Health, has officially recommended that the public avoid and
discontinue the use of all tobacco products, including smokeless tobacco. NCI also
recognizes that nitrosamines, found in tobacco products, are not safe at any level. The
accumulated scientific evidence does not support changing this position.
What about using smokeless tobacco to quit cigarettes? Because all tobacco use causes
disease and addiction, NCI recommends that tobacco use be avoided and discontinued.
Several nontobacco methods have been shown to be effective for quitting cigarettes. These
methods include pharmacotherapies such as nicotine replacement therapy and bupropion,
individual and group counseling, and telephone quitlines.
Christy Turlington Poster
Produced in 2001
(Celebrities Against
Smoking).
This poster features
baseball star Torii Hunter,
outfielder for the Los
Angeles Angels of Anaheim
and a five-time Gold Glove
winner, promoting an antispit tobacco message. Torii
is a superb role model for
young people, encouraging
them to be tobacco free and
use physical activity as a
healthy alternative
This tobacco-free sports
poster featuring Olympic
gold medalists Picabo
Street (Alpine skiing) and
Dominique Dawes
(gymnastics), Oregon State
University football star Ken
Simonton, Brazilian soccer
star Sisi, and World Cup
champion mountain biker
Alison Dunlap emphasizes
that you cannot excel in
sports by using tobacco.
Pro-skateboarder Tony Hawk,
who started the extreme
sports movement, has turned
away big-money offers from
tobacco companies.
This poster, featuring Hawk in
action, clearly demonstrates
that this mega-sports star
would rather use his celebrity
status to teach kids about the
dangers of using tobacco
Intersection with FDA Tobacco Legislation Programs?
Adolescent use of tobacco products in past month
Adolescent use of cigarettes in past month
Adolescent use of spit tobacco in past month
Adolescent use of cigars in past month
Children/Adolescent initiation of cigarette use
Average age at first tobacco use
Smoking cessation attempts by adolescents
Children’s exposure to tobacco smoke at home
Nonsmoker’s exposure to environmental tobacco smoke
Adolescent exposure to tobacco advertising and promotions
Change in the 12-17 Year-Old Population
Number of 12-17 Year-Olds
12-17 Year-Old Fraction of 12+ Pop
12.0
36,000,000
34,000,000
11.0
10.5
30,000,000
10.0
28,000,000
9.5
26,000,000
9.0
24,000,000
8.5
22,000,000
8.0
The change in the 12-17 year-old population goes from
24,233,207 in 2000 to 34,045,685 in 2050
2050
2048
2046
2044
2042
2040
2038
2036
2034
2032
2030
2028
2026
2024
2022
2020
2018
20,000,000
2016
2014
2012
2010
2008
2006
2004
2002
Source: U.S. Census Bureau
7.5
Number of 12-17 Year Olds
32,000,000
2000
Fraction of the 12-17 Year-Old Population (%)
11.5
"Trying a cigarette is not equivalent to
being a smoker, and it is unfair to
adolescents to treat them as if it were.
Further, it does not lead to good public
policy and it makes careful monitoring
of the effect of the policy impossible.
Policy should be based on good data,"
Kovar says.
(Copyright 1998 PR Newswire, Inc., August 10,
1998)
Looking at HP 2010, adolescent tobacco use goals are
based on current prevalence of any use during the past
30 days
Groups
12-17 Year-Olds
Pop (000’s)
% Age 12-17
Notes
2007 NSDUH estimate
25,241
Ever Smoked in Lifetime
5,971
23.8
Even one cigarette
Smoked in Past Month
2,482
9.9
Smoked on 1+ of past 30 days
Smoked 100 in Lifetime
1,442
5.7
Part of Adult Definition
Smoked 20 of Past 30 Days
985
3.9
“Frequent smoker”
Smoked 100 in Lifetime and
20 of Past 30 Days
869
3.4
Consistent with adult definition
68.5% of adolescents who smoked in the past 30 days smoked on average one or less
cigarettes/day. Approximately, 78% smoked five or less cigarettes/day.
Dependence
12-17 Year-Olds Who Smoked in the Past 30 Days. Meet the
NDSS Criteria?
No
Yes
Total
(% of Total)
(% of Total)
(% of Total)
1-20 Days
60.0
5.1
65.1
21-30 Days
17.1
17.8
34.9
Total
77.1
22.9
100.0
~568K 12-17 Year-Olds
An ongoing study of the behaviors, attitudes,
and values of American secondary school
students, college students, and young adults
~50,000
8th, 10th and
12th Grades
Annual
The primary source of statistical information
on the use of illegal drugs by the U.S.
population
~68,000
Age 12+
Annual
Youth Risk
Behavior Survey
Sponsor: CDC
Focus on behaviors among youth causing the
most important health problems
~14,000
9th – 12th
Grades
Biannual
National Youth
Tobacco Survey
Sponsor: CDC /
Legacy
The NYTS was designed to provide a baseline
for comparing progress toward meeting the
Healthy People 2010 goals for reducing
tobacco use among youth
~27,000
6th – 12th
Grades
Biannual
Monitoring the
Future
Sponsor: NIDA
National Survey on
Drug Use and
Health
Sponsor: SAMHSA
Global Youth Tobacco Survey (GYTS)
Initiated in 1999 the World Health Organization (WHO) and Centers for Disease Control and
Prevention’s (CDC's) Office on Smoking and Health developed the Global Youth Tobacco Survey
(GYTS) to track tobacco use among young people across countries using a common
methodology and core questionnaire. The GYTS surveillance system is intended to enhance the
capacity of countries to design, implement, and evaluate tobacco control and prevention
programs.
Sample Composition – School –based (public/private) survey of students age 13-15
Methodology – Collected in the classroom, anonymous, self-administered questionnaire
Categories
Advertising Receptivity
Beliefs and Expectancies
Smoking Susceptibility
Dependence
Friends/Family Smoking
Mood
Problems
Smoking Behavior
Stressors
Temptations to Smoke
Self-Efficacy
Validity of Self-Report
Beliefs and Expectancies
Tobacco Motives Inventory
Thomas A. Wills, Ph.D.
Adolescent Smoking Consequences
Questionnaire
Johanna M. Lewis-Esquerre,
Ph.D.
Fishbein-Azjen-Hanson Questionnaire Mary Jane S. Hanson, Ph.D.,
C.R.N.P.
Postive Negative Outcome
Expectancies
Madeline Dalton, Ph.D.
Smoking Decisional Balance
Wayne F. Velicer
Short form- Smoking Consequences
Questionnaire
Mark G. Myers, Ph.D.
45
NOTE: Weighted by State Population, data f rom all states and D.C. included
40.1
40
35
30
Average RVR (%)
Since FFY 2003, all
States and U.S.
Jurisdictions have been
required to meet the
federally established
RVR target of 20.0
percent. FFY 2007 is the
second year that all
States and DC were
found in compliance with
all Synar regulatory
requirements.. (Source:
SAMHSA Website)
25.4
25
20.5
20.0
Goal
20
17.5
16.3
14.1
15
12.8
11.6
10.8
10.5
2006
2007
10
5
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
Adolescents purchased less than one percent of the cigarette volume sold in retail
outlets in 2007 (Youth Risk Behavior Survey, Tax Burden on Tobacco)
A Person 18 or Older, 10.4
Store, 16.1
Some Other Way, 11.7
Vending Machine, 1.0
Stole Them, 6.3
Someone Else Bought
Them, 26.5
2007 YRBS
Borrowed Them, 28.0
Source: Youth Risk Behavior Survey (Adolescents LE 17 Years-Old)
Over 95% of youth got their first cigarette from social sources (2002 California Youth
Tobacco Survey)
Store
Vending Machine
Someone else bought them
Borrowed them
Stole them
Some other way
A person 18 or older
TOTAL
How Usually Got Own
Cigarettes During Past
30 Days
1997
2007
(%)
(%)
29.8
16.1
1.7
1.0
22.9
26.5
33.0
28.0
3.6
6.3
9.0
11.7
*
10.4
100.0
% Point
Change
-13.7
-0.7
3.6
-5.0
2.7
2.7
10.4
%
Change
-45.9
-40.4
15.6
-15.2
73.1
30.2
NA
100.0
Note: Adolescents 17<= years-old
Source: Youth Risk Behavior Survey, Public Use Data
* Category not included in 1997 survey
There was a 40%+ decline in adolescents indicating
a retail outlet as their usual source of cigarettes!
Retail Access
MTF 8th Grade
MTF 10th Grade
MTF 12th Grade
85
75
Prevalence (%)
65
55
EVER USED (1999-2008)
45
MTF
35
25
YRBS
NSDUH
15
% Chg
% Pt Chg
Cigarettes
8th Grade
10th Grade
12th Grade
-53.5
-45.0
-30.8
-23.6
-25.9
-19.9
Grades 9-12
-28.6
-20.1
Age 12-17
-36.1
-13.4
YRBS 9-12 Grades
NSDUH Age 12-17
45
MTF 12th Grade
10th Grade
8th Grade
YRBS 9-12 Grades
In the past
year,
among
12-17
year-olds.
(2007
National Survey
NSDUH Age 12-17
NYTS Grades 9-12
NYTS Grades 6-8
on Drug Use and Health) - 3.96 million used a cigarette / 1.2
million used a cigarette for the first time (~3,300/day)
40
35
Prevalence (%)
30
25
CURRENT USED (1999-2008)
MTF
Cigarettes
8th Grade
10th Grade
12th Grade
% Chg
-61.1
-52.1
-41.0
% Pt Chg
-10.7
-13.4
-14.2
YRBS
Grades 9-12
-42.5
-14.8
Age 12-17
-34.2
-5.1
NYTS*
Grades 6-8
NYTS*
Grades 9-12
*2000-2006
-42.7
-29.6
-4.7
-8.3
20
15
10
5
0
NSDUH
MTF 8th Graders
MTF 10th Graders
MTF 12th Graders
NSDUH Age 12-17
35
30
Prevalence (%)
25
20
15
EVER USED (1999-2008)
10
MTF
5
NSDUH
% Chg
% Pt Chg
Smokeless
8th Grade
10th Grade
12th Grade
-31.9
-40.2
-33.3
-4.6
-8.2
-7.8
Age 12-17
-21.4
-2.1
0
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
MTF 8th Graders
MTF 10th Graders
MTF 12th Graders
YRBS Grades 9-12
NSDUH Age 12-17
In 14the past
year, among
12-17 year-olds.
(2007
National Survey
on
Drug Use and Health) - 1.30 million used smokeless tobacco / 0.6
million used smokeless tobacco for the first time
12
Prevalence (%)
10
8
CURRENT USED (1999-2008)
6
MTF
Smokeless
8th Grade
10th Grade
12th Grade
% Chg
-22.2
-23.1
-22.6
% Pt Chg
-1.0
-1.5
-1.9
YRBS
Grades 9-12
1.3
0.1
Age 12-17
4.3
0.1
-27.8
-7.6
-1.0
-0.5
4
NSDUH
2
NYTS*
Grades 6-8
NYTS*
Grades 9-12
* 2000-2006
0
1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
YRBS Grades 9-12
NSDUH Age 12-17
NYTS Grades 9-12
NYTS Grades 6-8
In the
past year, among 12-17 year-olds. (2007 National Survey on
25
Drug Use and Health) - 2.37 million used a cigar / 1.1 million used a
cigar for the first time.
20
Prevalence (%)
15
CURRENT USED (1999-2008)
Cigars
Grades 9-12
% Chg
-23.2
% Pt Chg
-4.1
Age 12-17
-22.2
-1.2
NYTS*
Grades 6-8
NYTS*
Grades 9-12
* 2000-2006
-43.7
-20.3
-3.1
-3.0
YRBS
10
NSDUH
5
0
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
See Ads in Retail Outlets
1999
70
2004
Source: National Youth Tobacco Survey
65.6
66.5
60
% of 12-17 Year-Olds
50
When you go to a convenience store, supermarket
or gas station how often do you see ads for
cigarettes and other tobacco products or items that
have tobacco company names or pictures on
them?
40
30
20.9
20
17.8
10
5.7
3.3
6.8
3.0
4.5
6.0
0
Never Go to Store
All/Most of the Time
Some of the Time
Hardly Ever
Never
Smoking on TV/in Movies
1999
50
2004
Source: National Youth Tobacco Survey
45.0
44.7
45
43.6
40
35.9
% of 12-17 Year-Olds
35
30
When you watch TV or go to the
movies, how often do you see
actors smoking?
25
20
15
12.6
10
7.0
4.0
5
2.3
2.5
2.4
0
Don't Go
Movies/Watch TV
Most of the Time
Some of the Time
Hardly Ever
Never
See Tobacco Ads on the Internet
1999
45
2004
Source: National Youth Tobacco Survey
40
35
% of 12-17 Year-Olds
30
38.5
When you are searching the Internet on a
computer how often do you see ads for
tobacco products?
38.2
32.7
25.8
24.2
25
20.0
20
15
11.4
10
9.1
5
0
Most of the Time
Some of the Time
Hardly Ever
Never
Youth appear to be having a more difficult time
getting tobacco (SAMHSA, WE CARD)
 The prevalence of “ever” and “current” youth
smoking has been falling (since the MSA)
 Experimentation with cigarettes by youth appears to
have also declined (convergence of “ever” and
“current” cigarette use)

Waxman/Kennedy
Establishing the Facts
Developing Programs
Setting Goals
Measuring Progress
FDA Regulation Means Setting Measurable Goals

Emphasis on Prevention, Cessation and Nonsmoker
Protection
Continued Focus on Youth Issues
Exposure to Secondhand Smoke
Denormalization (PR and Consumer Contact)
Tax Increases
Evolving Interaction with Other Groups
Increasing Emphasis on State-Level Programs and
Information
 Marginalizing Federal Preemption
 Ratification of FCTC


Emphasis on Prevention, Cessation and Nonsmoker
Protection
 Evolving Interaction with Other Groups

Reaching out to Federal Agencies, Advocacy Groups, Health
Organizations (IOM)
Joint Projects
Linking Databases
Sharing Goals
Increasing Emphasis on State-Level Programs and
Information
 Marginalizing Federal Preemption
 Ratification of FCTC

Emphasis on Prevention, Cessation and Nonsmoker
Protection
 Evolving Interaction with Other Groups

Increasing Emphasis on State-Level Programs and
Information
 Marginalizing Federal Preemption
 Ratification of FCTC
