anti smoking campaign essay

Are Anti-smoking Adverts Effective?

Background information, arguments against the use of anti-smoking campaigns, counterarguments: the effectiveness of anti-smoking campaigns, recommendations for future practice, reference list.

Smoking is responsible for over 440,000 deaths annually in the United States. A similar number of casualties occur in different parts of the world. Smoking is also “associated with different health problems such cancer, respiratory complications, and lung infections” (Ji, Xiong, Gilpin, & Biener, 2007, p. 34). Every society should create appropriate anti-smoking adverts because they have the potential to deal with the issue of tobacco use.

The loss of individuals due to tobacco use affects the economy of many societies. Many children in the developed world lose their guardians yearly due to smoking (Sachs, 2010). These statistics encourage every society to use the best anti-smoking ads in order to deal with the vice. This persuasive essay explains why anti-smoking adverts are effective towards dealing with smoking.

Studies have proved that “hard-hitting campaigns and adverts can produce positive results” (Ji et al., 2007, p. 29). Sachs (2010) believes strongly that appropriate anti-tobacco adverts can be useful towards addressing this problem. According to Sachs (2010, p. 59), a good advert “stimulates negative emotions thus encouraging more citizens to quit smoking”.

Many scholars “believe that anti-smoking campaigns are incapable of achieving their goals” (Ji et al., 2007, p. 29). This situation explains why our societies have failed to address the problem of smoking. Many people believe that anti-smoking campaigns are usually ineffective. According to Pampel (2009, p. 28), “different youths will ignore every anti-smoking advert”. Some scholars explain why televisions ads do not encourage people to quit smoking.

It is agreeable that “many smokers take a long time before quitting” (Pampel, 2009, p. 54). People will always be imperfect. Human beings will also embrace negative behaviors such as drinking and smoking. That being the case, the decision to illegalize cigarettes cannot produce the best results. Human beings will always make different mistakes.

Pampel (2009) believes that many anti-smoking adverts are ineffective. This fact explains why many people respond negatively to every anti-smoking advert. Peer pressure also encourages more youths to use different drugs. That being the case, anti-smoking ads do not play a major role towards dealing with this problem. Some scholars explain why the decision to illegalize cigarettes can deal with this problem. The above arguments describe why our societies ignore the use of different anti-smoking adverts. Many opponents embrace the use of legal measures (Pampel, 2009).

I strongly believe that effective anti-smoking campaigns can make a huge difference in every society. Our societies should identify the best messages in order to educate more citizens. The Florida Department of Health (FDOH) initiated a new campaign to educate the youth about the dangers of smoking (Sachs, 2010). The campaign embraced the use of aggressive ads. The approach sensitized more people about the dangers of smoking. This successful campaign encouraged hundreds of citizens to quit smoking (Bajde & Vida, 2009).

Adequate media campaigns can also discourage more youths from using hardcore drugs. The practice also “reduces the rate youth tobacco initiation” (Ji et al., 2007, p. 35). The graph below explains how anti-tobacco adverts have produced positive results in the United States.

Graphic images are useful towards education more people about the health implications of cigarettes. For instance, effective ads should explain how our children lose their parents due to smoking. Such “adverts are essential towards reinforcing a person’s desire to stop using cigarettes” (Bajde & Vida, 2009, p. 85). According to a study by Liu and Tan (2009), effective adverts and campaigns have the potential to touch the lives of many people. Such adverts should also analyze how smoking causes different disabilities. This fact explains why powerful anti-smoking advertisements have the potential to address this problem.

Campaigns and adverts showing the implications of smoking can encourage more adults to quit smoking. Such adverts also discourage young people from embracing the vice. According to Liu and Tan (2009, p. 33), “many smokers can quit smoking after seeing several emotional adverts”. This situation explains why “personal testimonies and highly emotional advertisements can encourage more individuals to quit smoking” (Liu & Tan, 2009, p. 34). Strong efficacy messages have the potential to produce good results.

According to Bajde and Vida (2009, p. 81), “teenagers and youths will always establish their unique subcultures”. Such youths also embrace the use of tobacco and other addictive drugs. Every good advert must focus on the best strategies towards sensitizing these youths. The advert presented below has sensitized many people about the dangers of smoking. We must create similar adverts in order to achieve the best goals.

Although “anti-tobacco campaigns can be effective towards dealing with this problem, the biggest concern is why a large number of citizens are still smoking today” (Liu & Tan, 2009, p. 43). Many adverts fail to address the challenges affecting our young people. For example, many youths do not care about their lives. Some adverts “have portrayed old men with wrinkled skins and rotten teeth” (Bajde & Vida, 2009, p. 86). Such adverts encourage the youth to continue smoking because they might not die soon. A good advert must describe how smoking is capable of causing death. This approach will eventually address the health issues associated with tobacco.

The number of smokers is still increasing in different parts of the world. Most of the existing laws have failed to address this challenge. The important thing is for every society to identify the best messages in an attempt to deal with the problem. Our governments should also support different anti-smoking campaigns (Liu & Tan, 2009). Every advert should also deliver the right message to the targeted audience.

Our societies should produce powerful adverts that can communicate to every citizen. The “best approach towards achieving this goal is by using televisions, newspapers, radios, and billboards” (Bajde & Vida, 2009, p. 85). The other challenge is that many adverts are unsustainable. Many anti-tobacco campaigns are usually short-lived. Such ads are ineffective towards informing more people about the consequences of smoking. The government has failed to support different agencies and organizations. This situation has made it impossible for such agencies to deal with the problem of smoking.

The agreeable fact is that anti-smoking ads are effective. Such adverts can produce positive results if our society embraces the best practices. Every advert should target both males and females in order to deal with the issue. Such adverts should also encourage more teenagers to avoid different drugs such as marijuana and heroin (Liu & Tan, 2009). Such addictive drugs encourage the youth to use tobacco and alcohol. In conclusion, different players must come together in order to deal with this problem.

Bajde, D., & Vida, I. (2009). The Impact of Ad Characteristics on Adolescents’ Attitudes towards Antismoking Ads. Managing Global Transitions, 6 (1), 75-93.

Ji, M., Xiong, C., Gilpin, E., & Biener, L. (2007). Assessing the Effectiveness of Anti-smoking Media Campaigns by Recall and Rating Scores: A Pattern-Mixture GEE Model Approach. Journal of Data Science, 5 (1), 23-40.

Liu, H., & Tan, W. (2009). The Effect of Anti-Smoking Media Campaign on Smoking Behavior: The California Experience. Annals of Economics and Finance, 10 (1), 29-47.

Pampel, F. (2009). Tobacco Industry and Smoking . New York, NY: Infobase Publishing.

Sachs, K. (2010). Up in Smoke: How Antismoking Advertisements Have Changed Youth Smoking Habits. The Elon Journal of Undergraduate Research in Communications , 1 (1), 58-69.

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Rhetorical Analysis of Anti-smoking Campaigns

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Social Marketing: The Truth Anti-Smoking Campaign Case Study

Introduction, campaign objectives, marketing mix strategies.

The Truth Initiative is the largest non-profit health organization in the USA the main purpose of this is to eliminate the problem of smoking, which kills more than 480,000 country citizens yearly (“Burden of tobacco,” 2017). The former name of the organization is the American Legacy Foundation; it was established in March 1999. The agreement of November 1998 between 46 states, five territories of the United States, the District of Columbia, and representatives of the tobacco industry (Philip Morris and others) gave start to the introduction of the Truth campaign. It is known that the organization was renamed into the Truth Initiative in September 2015 to be closely connected with a given campaign the primary objective of which was to eliminate the problem of youth smoking. The counter-marketing goals of a given campaign are to reduce the production of tobacco products and to promote a healthy lifestyle among youth through a variety of anti-smoking advertisements. As to the financial aspect, the program is funded by the Truth Initiative itself. The major focus is made on youths aged from 12 to 17 who are at risk of developing an addiction (Farrelly et al., 2002).

Eventually, one of the major objectives of the Truth campaign is to change the established social norms and reduce smoking among adolescents. The Truth Initiative looks forward to seeing a society where all youth and adults reject the use of tobacco products. The campaign objectives are divided into three sets of goals: behavior, knowledge, and belief objectives. As an example of a clearly defined behavior objective, one can bring the fact that the organization resorts to Android and iOS applications to help people develop an effective behavior change model. Regarding a knowledge objective, the Truth Initiative refers to various educational programs to expand people’s competence in the matters of smoking-related diseases. Finally, a belief objective involves changing one’s beliefs through various promotional campaigns that unveil the true statistics of death cases caused by this habit.

Several decades ago branding was defined as a name, slogan, symbol, or a combination of the three to identify the company’s produce. Currently, the interpretation of the term has become changed since the concept appears to be more complex than it used to be previously. Branding is a consumer’s perception of products or services a brand provides. In other words, it is a mental picture that reflects consumer’s attitudes towards the organization that supplies these products or delivers some particular services. Eventually, the concept plays a relevant part in forming one’s desire or reluctance to support a campaign introduced by a brand. This statement makes particular sense when speaking of a health-related campaign.

It is known that the Truth Initiative uses a branding strategy to change both youths’ and adults’ attitudes towards tobacco products and to create a suitable environment for keeping a healthy lifestyle (Moran & Sussman, 2015). This strategy is represented as a serious step forward from a previously used anti-smoking model. It is targeted at controlling risk behaviors among youth and eliminating such a behavioral phenomenon as smoking. The persuasive mechanisms that form the very essence of a given branding strategy were primarily introduced to influence one’s belief system and stimulate behavior change (Harris, Pierce, & Bargh, 2014). It is known that a new model has shown a clear tendency to improve the established situation with the use of tobacco among adolescents. As the organization’s specialists point out, “we’ve helped bring teen cigarette use down from 23 percent in 2000 to 6 percent in 2016” (“Who we are,” 2017, para. 2). Thus, the high brand equity of the campaign among the target audience (youths aged from 12 to 17) has seriously contributed to changing one’s smoking-related beliefs, which proves the overall importance of a branding strategy for behavior intervention practices.

A notable fact about the behavioral intervention is that it considers the same four “Ps” strategy that is used in business and marketing. The strategy involves close consideration of the four factors: product, price, place, and promotion. Regarding the product, any organization engaged in marketing needs to think of an object or a service that can facilitate behavior change. A price factor considers various interventions aimed at reducing the cost of a project. Outside a monetary cost, these interventions may include psychological, emotional, and time costs. As to the place, defining the setting and the time of conducting behavior change turns out to be one of the most important factors to consider. Finally, a promotional aspect presupposes finding communicational channels that would help to reach the target audience (TV, radio, newspapers, etc.).

In the case of the Truth campaign, the website (www.thetruth.com) and the information it contains are viewed as the product of a given strategy (“Who we are,” 2017). The price aspect is represented by the use of a cost-effective method of intervention: “while drawing youths to “truth,” the campaign delivers stark facts about tobacco industry marketing practices, rather than sending directive “just say no” messages” (Farrelly et al., 2002, p. 901). Also, campaign costs become reduced due to annual payments that cigarette manufacturers pay to the states (Xu et al., 2015). Regarding the place, the campaign began in 1998 and covered the entire territory of the United States. As was earlier mentioned, 46 states, the District of Columbia, and five territories of the USA were engaged in signing the Tobacco Master Settlement Agreement (Healton, 2001). Promotion activities involved launching TV and print commercials and using various promotional items, such as stickers, T-shirts, and banners (Farelly et al., 2002).

Each of the mentioned factors carries a huge meaning for overall campaign effectiveness. One cannot draw the audience’s attention without a clearly defined product, which arrives as a synthesis of organizational knowledge and experience. Also, knowledge transferring is impossible without an efficient price strategy used to regulate the campaign costs, for higher program costs may lead to the untimely project termination. Also, one needs to have a clearly outlined setting or a place to monitor the program implementation. However, to make a program work, an organization is supposed to conduct a properly planned promotion campaign since effective intervention is only possible when people get familiar with its principles.

The Truth Initiative used the Legacy Media Tracking Survey (LMTS) for evaluating the results of its anti-smoking campaign (Moran & Sussman, 2015). The first survey was conducted in 1999 before the campaign launch. The LMTS was an ideal measurement instrument since it allowed the evaluators to quickly assess responses and to continue surveying on an ongoing basis. The survey also incorporated measures achieved through the Elaboration Likelihood Model (ELM), which was always used to examine changes in attitude. The combination of evaluation tools was an important decision in the matters of data retrieving: owing to the two combined methods media planners received rapid feedback on how fast campaign messages were delivered to youth. In its turn, it allowed one to take different approaches to information delivery depending on the situation in behavior change practice (Moran & Sussman, 2015). It is known that in 2005 the organization shifted to the Legacy Media Tracking Online (LMTO) data collection tool. The tool performed the same function LMTS did only used more advanced mechanisms of data retrieval.

Litigations arrive as a barrier that takes too much time and effort to overcome. The tobacco industry has shown a clear intent to obstruct the Legacy’s counter-marketing campaigns through numerous court procedures. This long-lasting legal battle creates plenty of challenges for the Truth Initiative to successfully implement a chosen program. Another obstacle is the anti-smoking campaign introduced by the tobacco industry itself (such as Philip Morris’s “Think. Don’t Smoke”). This campaign delivers information in such a way that teenagers start to view smoking as a habit, which is only harmful to teens, not to adults (Farelly et al., 2002). Eventually, such a form of subject interpretation seriously interferes with the Initiative’s plans to reduce smoking among adolescents. Thus, the Truth campaign achievements appear to be less successful

As derived from the outcomes of the research, an anti-smoking campaign launched by the Truth Initiative has proven its effectiveness through the use of a well-structured interventional program and the properly defined counter-marketing goals. Despite the fact, the campaign meets serious barriers, such as litigations and alternative anti-smoking campaigns, it has still the potential to eliminate the problem of tobacco use among adolescents. The statistics demonstrate that smoking among youth has reduced from 20% to 6% over 16 years. As a recommendation to the initiative, one can suggest that an advertising campaign continues to gain speed. Also, the program needs to gain legislators’ support to effectively withstand the attacks of the tobacco industry.

Burden of tobacco use in the U.S. (2017). Web.

Farrelly, M. C., Healton, C. G., Davis, K. C., Messeri, P., Hersey, J. C., & Haviland, M. L. (2002). Getting to the truth: evaluating national tobacco countermarketing campaigns. American Journal of Public Health , 92 (6), 901-907.

Harris, J. L., Pierce, M., & Bargh, J. A. (2014). Priming effect of antismoking PSAs on smoking behaviour: A pilot study. Tobacco Control , 23 (4), 285-290.

Healton, C. (2001). Who’s afraid of the truth? American Journal of Public Health , 91 (4), 554-558.

Moran, M. B., & Sussman, S. (2015). Changing attitudes toward smoking and smoking susceptibility through peer crowd targeting: more evidence from a controlled study. Health Communication , 30 (5), 521-524.

Who we are and what we do. (2017). Web.

Xu, X., Alexander, R. L., Simpson, S. A., Goates, S., Nonnemaker, J. M., Davis, K. C., & McAfee, T. (2015). A cost-effectiveness analysis of the first federally funded antismoking campaign. American Journal of Preventive Medicine , 48 (3), 318-325.

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IvyPanda. (2021, January 10). Social Marketing: The Truth Anti-Smoking Campaign. https://ivypanda.com/essays/social-marketing-the-truth-anti-smoking-campaign/

"Social Marketing: The Truth Anti-Smoking Campaign." IvyPanda , 10 Jan. 2021, ivypanda.com/essays/social-marketing-the-truth-anti-smoking-campaign/.

IvyPanda . (2021) 'Social Marketing: The Truth Anti-Smoking Campaign'. 10 January.

IvyPanda . 2021. "Social Marketing: The Truth Anti-Smoking Campaign." January 10, 2021. https://ivypanda.com/essays/social-marketing-the-truth-anti-smoking-campaign/.

1. IvyPanda . "Social Marketing: The Truth Anti-Smoking Campaign." January 10, 2021. https://ivypanda.com/essays/social-marketing-the-truth-anti-smoking-campaign/.

Bibliography

IvyPanda . "Social Marketing: The Truth Anti-Smoking Campaign." January 10, 2021. https://ivypanda.com/essays/social-marketing-the-truth-anti-smoking-campaign/.

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How to make anti-smoking campaigns more persuasive

Lecturer, Universitas Multimedia Nusantara

Disclosure statement

Juhri Selamet does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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• Bahasa Indonesia

The damaging effects of smoking on our health are well known, and governments are curbing tobacco advertising to reduce the number of smokers. But, in Indonesia, the number of teens and adults who smoke continue to grow at a rate higher than any other country .

A World Health Organisation (WHO) survey of nearly 6,000 respondents found almost 60% of Indonesian teenagers (aged 13-15) are regularly exposed to secondhand smoke at home, and that only 24.5% of adult smokers believed smoking tobacco could cause serious illness.

To increase public awareness of the harmful and deadly effects of tobacco use and secondhand smoke exposure, and to discourage the use of tobacco in any form, the WHO and global partners celebrate World No Tobacco Day (WNTD) every year on 31 May .

Indonesia’s Health Ministry has carried out anti-smoking campaigns to reduce smoking; the latest was launched in 2018. But the campaign messages are not persuasive enough .

I argue that designing anti-smoking campaign messages based on tried and tested health communication theories will make the messages more powerful.

Problem of anti-smoking campaigns

Anti-smoking campaigns in Indonesia are presented as public service announcements on national television and digital media. The Health Ministry launched the latest anti-smoking social media campaign with the hashtag #SuaraTanpaRokok , which translates as voices without cigarettes.

From my observation of #SuaraTanpaRokok , the campaign only focused on attitudes of fear and sadness to indicate disapproval of smoking and perceived risk of smoking.

The campaign tells stories of people who had cancer due to smoking, such as Zainal Arifin Nasution , who underwent surgery for laryngeal cancer, and Ranap Simatupang , who died from lung cancer. The campaign also shows the risk of smoking through images of lung disease.

Persuasive campaign: reasoned action

We need a variety of approaches to designing health messages. Aside from the type of health campaigns the government currently uses, which highlight fear and sadness due to risks of smoking, several social influence theories can be used to develop compelling messages.

Health communication research has demonstrated that health messages that challenge people’s perception of social norms are effective in changing behaviour and in building people’s confidence to stop smoking.

Health campaigns on cancer, anti-smoking and HIV/AIDS awareness often use the theory of reasoned action developed by Fishbein and Ajzen (1975) .

This theory assumes that a person who wants and intends to avoid getting sick will carry out preventive health care. A person’s intention is influenced by their attitude towards behaviours relating to preventive health care as well as by how others view those behaviours.

Based on this theory, persuading someone by targeting their attitudes and social norms can change their behaviours.

Take anti-smoking advertisements in the US, for instance, where campaigns often provide reasoned arguments or messages focusing on what other people think about smoking (social norms) or on individual attitudes toward smoking (personal attitudes).

In “ Addicted Ashtray ”, a girl who is addicted to smoking finds the cigarette vending machine is out of order. She then takes a half-smoked cigarette from an ashtray. This type of health message aims to show that smoking leads to disgusting behaviour.

This approach challenges someone’s attitude towards smoking because they would not want to associate themselves with the appalling behaviour presented in the campaign. This could also make smokers think about how their family and friends view smoking behaviour.

Anti-smoking advertisements can also attempt to influence attitudes by providing information about the toxic content of a cigarette.

Trying to quit

Smoking is addictive, so quitting is difficult for those who are hooked. Designing campaign messages based on social cognitive theory might make people who are struggling to quit feel represented.

Based on this theory, when people see that the message is directed toward their behaviour, the message gains greater representational meaning. So anti-smoking campaigns might provide a story of someone who has quit smoking or is trying to .

Showing benefits of quitting

We can also use the health belief model (HBM) to design anti-smoking campaigns.

HBM posits that an individual will make behaviour changes by assessing not only the risks of their behaviour but also barriers and benefits.

Anti-smoking campaigns can thus also focus on the benefits of not smoking. For example, the US Centers for Disease Control and Prevention give a list of health benefits of being smoke-free: you can enjoy a healthy heart, healthy lungs and lower risks of cancer and erectile dysfunction.

Indonesia’s anti-smoking campaign still focuses on the severe harm that smoking causes. Various communication theories exist and using them to design anti-smoking campaigns can lead to a more effective variety of messages targeting new and young smokers.

• World No Tobacco Day
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• Anti-smoking

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Visual Culture and Health

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• Infectious Disease
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Anti-Smoking Campaigns

• Collection Items

"The proliferation of images through reproduction also means that they can be accompanied by different kinds of text, which can dramatically change the signification of the image. Text can ask us to look at an image differently. Words can direct our eyes to particular aspects of the image, indeed they can tell us what to see in a picture... It could be said that viewers/consumers of images often choose to read particular meanings into them for emotional and psychological reasons, and to ignore those aspects of an image that may work against this response." Marita Sturken and Lisa Cartwright, Practice of Looking: An Introduction to Visual Culture

"The art of visual conversation is aided by a format that encourages speakers seated face-to-face to perform their arguments at length. Such interactive communication calls upon the discernment of an audience that, although absent, is urged to participate as if it were present." Barbara Maria Stafford, Good Looking: Essays on the Virtue of Images

Introduction

This section of the exhibit on anti-smoking campaigns scrutinizes the political, social, and psychological messages utilized by anti-tobacco educators since the 1960s in print advertisements, posters, and billboards, in order to examine how traditional values, cultural conditions, and medical knowledge are conveyed in print media. The exhibit includes images of the cigarette, the smoker, the nonsmoker, smoke-free environments, and celebrities in a variety of campaigns created by voluntary organizations, professional advertising firms, and governmental organizations.

In the first half of the twentieth century, anti-smoking messages emphasized primarily moralistic and hygienic concerns. Anti-tobacco crusaders saw the cigarette as ungodly and unhealthy. Although medical objections to smoking remained implicit in their arguments, activists did not have any medical consensus behind them. In fact, medical opinion was generally noncommittal until the 1964 Surgeon General's Report on Smoking and Health, which consolidated and legitimized 15 years of growing evidence of the dangers of smoking to health.

The 1964 Surgeon General's report marked the beginning of a transformation in attitudes and behaviors related to cigarettes, but smoking norms and habits yielded slowly and incompletely. Despite legislative restrictions on advertising in the late 1960s and early 1970s, the persistent and pervasive marketing of cigarettes continued in different forums. Still, grassroots activists, professional consumer advocates, and the public health bureaucracy remained inspired by scientific and social interest in the hazards of smoking. Their collective anti-smoking campaigns have employed a variety of educational, clinical, regulatory, economic, and counter-advertising strategies.

The Cigarette

In the first half of the twentieth century, cigarette smoking became a widespread habit firmly engrained in American culture. Ennobled by its heroic association with soldiers in each of the World Wars, associated with a new sense of freedom and equality by young women in the 1920s, and generally considered a slightly illicit but forgivable moral transgression, cigarette smoking has remained ubiquitous in popular forms of visual media such as movies, art, and advertising, past and present. As a result, anti-smoking campaigners since the 1960s have been compelled to challenge the perception that the behavior is commonplace and integral to everyday life. Anti-smoking advertisements often use what might be called "deglamorization" and "denormalization" strategies, designed to work against the allure of cigarettes and upset their routine presence in popular culture. By using negative or denunciatory images of the cigarette, for example, they send messages that discourage the aura, appeal, and attractiveness of tobacco use. These messages warn viewers that the cigarette is dangerous, addictive, and deadly. An alternative, moralistic strategy features the cigarette as a threat to traditional social values such as deferred gratification, self-control, and personal responsibility.

Despite the pervasive presence of cigarette smoking in popular culture, and its role as a generational marker, historians have argued that the marketing efforts of tobacco giants never fully legitimized the image of the smoker, with some suspicion that they never intended to. In fact, the seductive quality of smoking cigarettes has often been used as a subtle marketing strategy, emphasizing an association with transgression, defiance, and rebellion. Visual representations of smokers have frequently underscored the guilty pleasure they experience by associating smoking with committing an illicit act. The images of smokers in this section illustrate how anti-smoking campaigns have countered this phenomenon by using three main strategies: 1) appealing to individual and social responsibility; 2) emphasizing evidence from medical research; and 3) deglamorizing the smoker. These images showcase a variety of marketing techniques used to reduce tobacco use by combining information, images, emotional appeals, and psychological tools to influence viewers.

The Non-Smoker and Smoke-free Environments

As the images in this section demonstrate, smoking has long played an important role in popular culture and the shaping of personal identity. This relationship helps explain smoking's persistence, despite widespread anti-smoking campaigns, and also functions as a limit on government intervention in our everyday consumption decisions. Informed by this relationship, anti-smoking advertisers have combined negative representations of smokers with positive portraits of non-smokers as far more appealing or desirable. In some cases this involves emulating the strategies of tobacco advertisers by using the same glamorization and normalization strategies in the depiction of non-smokers as popular or heroic and smoke-free environments as invigorating or therapeutic. These images employ the following techniques: 1) emphasizing the psychological, social, economic, and health benefits of smoking cessation (or regaining non-smoker status); 2) stressing a sense of personal or social responsibility as motivation for choosing to be a non-smoker; 3) using deglamorization strategies to suggest that the non-smoker is more fashionable; and 4) appropriating idealistic or romanticized environmental images as symbolic representations of health and the decision not to smoke.

The Celebrity

The tobacco industry has long capitalized on the ability of the entertainment industry to create, reinforce, and normalize messages. The invaluable marketing advantage this creates for the tobacco companies has allowed them to overcome legislative restrictions on cigarette advertising since the late 1960s. In movies and on television, celebrities facilitate the normalization of cigarette smoking by increasing the perception that the behavior is commonplace and integral to everyday life. Capitalizing on this power, tobacco companies have frequently paid producers and actors to feature their cigarette brands. In Superman II, for instance, Phillip Morris paid 20,000 pounds (about $40,000) for the Marlboro brand name to appear some 40 times in the film. Understanding the power of celebrities as spokespersons for smoking, anti-smoking campaigns have employed counter-marketing strategies to promote smoking cessation and decrease the likelihood of initiation. An integral part of this approach has involved a deglamorization strategy that de-emphasizes and discourages the aura, appeal, and attractiveness of tobacco use through its portrayal of smokers in advertisements.

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National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2012.

Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General.

1 introduction, summary, and conclusions.

• Introduction

Tobacco use is a global epidemic among young people. As with adults, it poses a serious health threat to youth and young adults in the United States and has significant implications for this nation’s public and economic health in the future ( Perry et al. 1994 ; Kessler 1995 ). The impact of cigarette smoking and other tobacco use on chronic disease, which accounts for 75% of American spending on health care ( Anderson 2010 ), is well-documented and undeniable. Although progress has been made since the first Surgeon General’s report on smoking and health in 1964 ( U.S. Department of Health, Education, and Welfare [USDHEW] 1964 ), nearly one in four high school seniors is a current smoker. Most young smokers become adult smokers. One-half of adult smokers die prematurely from tobacco-related diseases ( Fagerström 2002 ; Doll et al. 2004 ). Despite thousands of programs to reduce youth smoking and hundreds of thousands of media stories on the dangers of tobacco use, generation after generation continues to use these deadly products, and family after family continues to suffer the devastating consequences. Yet a robust science base exists on social, biological, and environmental factors that influence young people to use tobacco, the physiology of progression from experimentation to addiction, other health effects of tobacco use, the epidemiology of youth and young adult tobacco use, and evidence-based interventions that have proven effective at reducing both initiation and prevalence of tobacco use among young people. Those are precisely the issues examined in this report, which aims to support the application of this robust science base.

Nearly all tobacco use begins in childhood and adolescence ( U.S. Department of Health and Human Services [USDHHS] 1994 ). In all, 88% of adult smokers who smoke daily report that they started smoking by the age of 18 years (see Chapter 3 , “The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide”). This is a time in life of great vulnerability to social influences ( Steinberg 2004 ), such as those offered through the marketing of tobacco products and the modeling of smoking by attractive role models, as in movies ( Dalton et al. 2009 ), which have especially strong effects on the young. This is also a time in life of heightened sensitivity to normative influences: as tobacco use is less tolerated in public areas and there are fewer social or regular users of tobacco, use decreases among youth ( Alesci et al. 2003 ). And so, as we adults quit, we help protect our children.

Cigarettes are the only legal consumer products in the world that cause one-half of their long-term users to die prematurely ( Fagerström 2002 ; Doll et al. 2004 ). As this epidemic continues to take its toll in the United States, it is also increasing in low- and middle-income countries that are least able to afford the resulting health and economic consequences ( Peto and Lopez 2001 ; Reddy et al. 2006 ). It is past time to end this epidemic. To do so, primary prevention is required, for which our focus must be on youth and young adults. As noted in this report, we now have a set of proven tools and policies that can drastically lower youth initiation and use of tobacco products. Fully committing to using these tools and executing these policies consistently and aggressively is the most straight forward and effective to making future generations tobacco-free.

The 1994 Surgeon General’s Report

This Surgeon General’s report on tobacco is the second to focus solely on young people since these reports began in 1964. Its main purpose is to update the science of smoking among youth since the first comprehensive Surgeon General’s report on tobacco use by youth, Preventing Tobacco Use Among Young People , was published in 1994 ( USDHHS 1994 ). That report concluded that if young people can remain free of tobacco until 18 years of age, most will never start to smoke. The report documented the addiction process for young people and how the symptoms of addiction in youth are similar to those in adults. Tobacco was also presented as a gateway drug among young people, because its use generally precedes and increases the risk of using illicit drugs. Cigarette advertising and promotional activities were seen as a potent way to increase the risk of cigarette smoking among young people, while community-wide efforts were shown to have been successful in reducing tobacco use among youth. All of these conclusions remain important, relevant, and accurate, as documented in the current report, but there has been considerable research since 1994 that greatly expands our knowledge about tobacco use among youth, its prevention, and the dynamics of cessation among young people. Thus, there is a compelling need for the current report.

Tobacco Control Developments

Since 1994, multiple legal and scientific developments have altered the tobacco control environment and thus have affected smoking among youth. The states and the U.S. Department of Justice brought lawsuits against cigarette companies, with the result that many internal documents of the tobacco industry have been made public and have been analyzed and introduced into the science of tobacco control. Also, the 1998 Master Settlement Agreement with the tobacco companies resulted in the elimination of billboard and transit advertising as well as print advertising that directly targeted underage youth and limitations on the use of brand sponsorships ( National Association of Attorneys General [NAAG] 1998 ). This settlement also created the American Legacy Foundation, which implemented a nationwide antismoking campaign targeting youth. In 2009, the U.S. Congress passed a law that gave the U.S. Food and Drug Administration authority to regulate tobacco products in order to promote the public’s health ( Family Smoking Prevention and Tobacco Control Act 2009 ). Certain tobacco companies are now subject to regulations limiting their ability to market to young people. In addition, they have had to reimburse state governments (through agreements made with some states and the Master Settlement Agreement) for some health care costs. Due in part to these changes, there was a decrease in tobacco use among adults and among youth following the Master Settlement Agreement, which is documented in this current report.

Recent Surgeon General Reports Addressing Youth Issues

Other reports of the Surgeon General since 1994 have also included major conclusions that relate to tobacco use among youth ( Office of the Surgeon General 2010 ). In 1998, the report focused on tobacco use among U.S. racial/ethnic minority groups ( USDHHS 1998 ) and noted that cigarette smoking among Black and Hispanic youth increased in the 1990s following declines among all racial/ethnic groups in the 1980s; this was particularly notable among Black youth, and culturally appropriate interventions were suggested. In 2000, the report focused on reducing tobacco use ( USDHHS 2000b ). A major conclusion of that report was that school-based interventions, when implemented with community- and media-based activities, could reduce or postpone the onset of smoking among adolescents by 20–40%. That report also noted that effective regulation of tobacco advertising and promotional activities directed at young people would very likely reduce the prevalence and onset of smoking. In 2001, the Surgeon General’s report focused on women and smoking ( USDHHS 2001 ). Besides reinforcing much of what was discussed in earlier reports, this report documented that girls were more affected than boys by the desire to smoke for the purpose of weight control. Given the ongoing obesity epidemic ( Bonnie et al. 2007 ), the current report includes a more extensive review of research in this area.

The 2004 Surgeon General’s report on the health consequences of smoking ( USDHHS 2004 ) concluded that there is sufficient evidence to infer that a causal relationship exists between active smoking and (a) impaired lung growth during childhood and adolescence; (b) early onset of decline in lung function during late adolescence and early adulthood; (c) respiratory signs and symptoms in children and adolescents, including coughing, phlegm, wheezing, and dyspnea; and (d) asthma-related symptoms (e.g., wheezing) in childhood and adolescence. The 2004 Surgeon General’s report further provided evidence that cigarette smoking in young people is associated with the development of atherosclerosis.

The 2010 Surgeon General’s report on the biology of tobacco focused on the understanding of biological and behavioral mechanisms that might underlie the pathogenicity of tobacco smoke ( USDHHS 2010 ). Although there are no specific conclusions in that report regarding adolescent addiction, it does describe evidence indicating that adolescents can become dependent at even low levels of consumption. Two studies ( Adriani et al. 2003 ; Schochet et al. 2005 ) referenced in that report suggest that because the adolescent brain is still developing, it may be more susceptible and receptive to nicotine than the adult brain.

Scientific Reviews

Since 1994, several scientific reviews related to one or more aspects of tobacco use among youth have been undertaken that also serve as a foundation for the current report. The Institute of Medicine (IOM) ( Lynch and Bonnie 1994 ) released Growing Up Tobacco Free: Preventing Nicotine Addiction in Children and Youths, a report that provided policy recommendations based on research to that date. In 1998, IOM provided a white paper, Taking Action to Reduce Tobacco Use, on strategies to reduce the increasing prevalence (at that time) of smoking among young people and adults. More recently, IOM ( Bonnie et al. 2007 ) released a comprehensive report entitled Ending the Tobacco Problem: A Blueprint for the Nation . Although that report covered multiple potential approaches to tobacco control, not just those focused on youth, it characterized the overarching goal of reducing smoking as involving three distinct steps: “reducing the rate of initiation of smoking among youth (IOM [ Lynch and Bonnie] 1994 ), reducing involuntary tobacco smoke exposure ( National Research Council 1986 ), and helping people quit smoking” (p. 3). Thus, reducing onset was seen as one of the primary goals of tobacco control.

As part of USDHHS continuing efforts to assess the health of the nation, prevent disease, and promote health, the department released, in 2000, Healthy People 2010 and, in 2010, Healthy People 2020 ( USDHHS 2000a , 2011 ). Healthy People provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to encourage collaborations across sectors, guide individuals toward making informed health decisions, and measure the impact of prevention activities. Each iteration of Healthy People serves as the nation’s disease prevention and health promotion roadmap for the decade. Both Healthy People 2010 and Healthy People 2020 highlight “Tobacco Use” as one of the nation’s “Leading Health Indicators,” feature “Tobacco Use” as one of its topic areas, and identify specific measurable tobacco-related objectives and targets for the nation to strive for. Healthy People 2010 and Healthy People 2020 provide tobacco objectives based on the most current science and detailed population-based data to drive action, assess tobacco use among young people, and identify racial and ethnic disparities. Additionally, many of the Healthy People 2010 and 2020 tobacco objectives address reductions of tobacco use among youth and target decreases in tobacco advertising in venues most often influencing young people. A complete list of the healthy people 2020 objectives can be found on their Web site ( USDHHS 2011 ).

In addition, the National Cancer Institute (NCI) of the National Institutes of Health has published monographs pertinent to the topic of tobacco use among youth. In 2001, NCI published Monograph 14, Changing Adolescent Smoking Prevalence , which reviewed data on smoking among youth in the 1990s, highlighted important statewide intervention programs, presented data on the influence of marketing by the tobacco industry and the pricing of cigarettes, and examined differences in smoking by racial/ethnic subgroup ( NCI 2001 ). In 2008, NCI published Monograph 19, The Role of the Media in Promoting and Reducing Tobacco Use ( NCI 2008 ). Although young people were not the sole focus of this Monograph, the causal relationship between tobacco advertising and promotion and increased tobacco use, the impact on youth of depictions of smoking in movies, and the success of media campaigns in reducing youth tobacco use were highlighted as major conclusions of the report.

The Community Preventive Services Task Force (2011) provides evidence-based recommendations about community preventive services, programs, and policies on a range of topics including tobacco use prevention and cessation ( Task Force on Community Preventive Services 2001 , 2005 ). Evidence reviews addressing interventions to reduce tobacco use initiation and restricting minors’ access to tobacco products were cited and used to inform the reviews in the current report. The Cochrane Collaboration (2010) has also substantially contributed to the review literature on youth and tobacco use by producing relevant systematic assessments of health-related programs and interventions. Relevant to this Surgeon General’s report are Cochrane reviews on interventions using mass media ( Sowden 1998 ), community interventions to prevent smoking ( Sowden and Stead 2003 ), the effects of advertising and promotional activities on smoking among youth ( Lovato et al. 2003 , 2011 ), preventing tobacco sales to minors ( Stead and Lancaster 2005 ), school-based programs ( Thomas and Perara 2006 ), programs for young people to quit using tobacco ( Grimshaw and Stanton 2006 ), and family programs for preventing smoking by youth ( Thomas et al. 2007 ). These reviews have been cited throughout the current report when appropriate.

In summary, substantial new research has added to our knowledge and understanding of tobacco use and control as it relates to youth since the 1994 Surgeon General’s report, including updates and new data in subsequent Surgeon General’s reports, in IOM reports, in NCI Monographs, and in Cochrane Collaboration reviews, in addition to hundreds of peer-reviewed publications, book chapters, policy reports, and systematic reviews. Although this report is a follow-up to the 1994 report, other important reviews have been undertaken in the past 18 years and have served to fill the gap during an especially active and important time in research on tobacco control among youth.

• Focus of the Report

Young People

This report focuses on “young people.” In general, work was reviewed on the health consequences, epidemiology, etiology, reduction, and prevention of tobacco use for those in the young adolescent (11–14 years of age), adolescent (15–17 years of age), and young adult (18–25 years of age) age groups. When possible, an effort was made to be specific about the age group to which a particular analysis, study, or conclusion applies. Because hundreds of articles, books, and reports were reviewed, however, there are, unavoidably, inconsistencies in the terminology used. “Adolescents,” “children,” and “youth” are used mostly interchangeably throughout this report. In general, this group encompasses those 11–17 years of age, although “children” is a more general term that will include those younger than 11 years of age. Generally, those who are 18–25 years old are considered young adults (even though, developmentally, the period between 18–20 years of age is often labeled late adolescence), and those 26 years of age or older are considered adults.

In addition, it is important to note that the report is concerned with active smoking or use of smokeless tobacco on the part of the young person. The report does not consider young people’s exposure to secondhand smoke, also referred to as involuntary or passive smoking, which was discussed in the 2006 report of the Surgeon General ( USDHHS 2006 ). Additionally, the report does not discuss research on children younger than 11 years old; there is very little evidence of tobacco use in the United States by children younger than 11 years of age, and although there may be some predictors of later tobacco use in those younger years, the research on active tobacco use among youth has been focused on those 11 years of age and older.

Tobacco Use

Although cigarette smoking is the most common form of tobacco use in the United States, this report focuses on other forms as well, such as using smokeless tobacco (including chew and snuff) and smoking a product other than a cigarette, such as a pipe, cigar, or bidi (tobacco wrapped in tendu leaves). Because for young people the use of one form of tobacco has been associated with use of other tobacco products, it is particularly important to monitor all forms of tobacco use in this age group. The term “tobacco use” in this report indicates use of any tobacco product. When the word “smoking” is used alone, it refers to cigarette smoking.

• Organization of the Report

This chapter begins by providing a short synopsis of other reports that have addressed smoking among youth and, after listing the major conclusions of this report, will end by presenting conclusions specific to each chapter. Chapter 2 of this report (“The Health Consequences of Tobacco Use Among Young People”) focuses on the diseases caused by early tobacco use, the addiction process, the relation of body weight to smoking, respiratory and pulmonary problems associated with tobacco use, and cardiovascular effects. Chapter 3 (“The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide”) provides recent and long-term cross-sectional and longitudinal data on cigarette smoking, use of smokeless tobacco, and the use of other tobacco products by young people, by racial/ethnic group and gender, primarily in the United States, but including some worldwide data as well. Chapter 4 (“Social, Environmental, Cognitive, and Genetic Influences on the Use of Tobacco Among Youth”) identifies the primary risk factors associated with tobacco use among youth at four levels, including the larger social and physical environments, smaller social groups, cognitive factors, and genetics and neurobiology. Chapter 5 (“The Tobacco Industry’s Influences on the Use of Tobacco Among Youth”) includes data on marketing expenditures for the tobacco industry over time and by category, the effects of cigarette advertising and promotional activities on young people’s smoking, the effects of price and packaging on use, the use of the Internet and movies to market tobacco products, and an evaluation of efforts by the tobacco industry to prevent tobacco use among young people. Chapter 6 (“Efforts to Prevent and Reduce Tobacco Use Among Young People”) provides evidence on the effectiveness of family-based, clinic-based, and school-based programs, mass media campaigns, regulatory and legislative approaches, increased cigarette prices, and community and statewide efforts in the fight against tobacco use among youth. Chapter 7 (“A Vision for Ending the Tobacco Epidemic”) points to next steps in preventing and reducing tobacco use among young people.

• Preparation of the Report

This report of the Surgeon General was prepared by the Office on Smoking and Health (OSH), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), USDHHS. In 2008, 18 external independent scientists reviewed the 1994 report and suggested areas to be added and updated. These scientists also suggested chapter editors and a senior scientific editor, who were contacted by OSH. Each chapter editor named external scientists who could contribute, and 33 content experts prepared draft sections. The draft sections were consolidated into chapters by the chapter editors and then reviewed by the senior scientific editor, with technical editing performed by CDC. The chapters were sent individually to 34 peer reviewers who are experts in the areas covered and who reviewed the chapters for scientific accuracy and comprehensiveness. The entire manuscript was then sent to more than 25 external senior scientists who reviewed the science of the entire document. After each review cycle, the drafts were revised by the chapter and senior scientific editor on the basis of the experts’ comments. Subsequently, the report was reviewed by various agencies within USDHHS. Publication lags prevent up-to-the-minute inclusion of all recently published articles and data, and so some more recent publications may not be cited in this report.

• Evaluation of the Evidence

Since the first Surgeon General’s report in 1964 on smoking and health ( USDHEW 1964 ), major conclusions concerning the conditions and diseases caused by cigarette smoking and the use of smokeless tobacco have been based on explicit criteria for causal inference ( USDHHS 2004 ). Although a number of different criteria have been proposed for causal inference since the 1960s, this report focuses on the five commonly accepted criteria that were used in the original 1964 report and that are discussed in greater detail in the 2004 report on the health consequences of smoking ( USDHHS 2004 ). The five criteria refer to the examination of the association between two variables, such as a risk factor (e.g., smoking) and an outcome (e.g., lung cancer). Causal inference between these variables is based on (1) the consistency of the association across multiple studies; this is the persistent finding of an association in different persons, places, circumstances, and times; (2) the degree of the strength of association, that is, the magnitude and statistical significance of the association in multiple studies; (3) the specificity of the association to clearly demonstrate that tobacco use is robustly associated with the condition, even if tobacco use has multiple effects and multiple causes exist for the condition; (4) the temporal relationship of the association so that tobacco use precedes disease onset; and (5) the coherence of the association, that is, the argument that the association makes scientific sense, given data from other sources and understanding of biological and psychosocial mechanisms ( USDHHS 2004 ). Since the 2004 Surgeon General’s report, The Health Consequences of Smoking , a four-level hierarchy ( Table 1.1 ) has been used to assess the research data on associations discussed in these reports ( USDHHS 2004 ). In general, this assessment was done by the chapter editors and then reviewed as appropriate by peer reviewers, senior scientists, and the scientific editors. For a relationship to be considered sufficient to be characterized as causal, multiple studies over time provided evidence in support of each criteria.

Four-level hierarchy for classifying the strength of causal inferences based on available evidence.

When a causal association is presented in the chapter conclusions in this report, these four levels are used to describe the strength of the evidence of the association, from causal (1) to not causal (4). Within the report, other terms are used to discuss the evidence to date (i.e., mixed, limited, and equivocal evidence), which generally represent an inadequacy of data to inform a conclusion.

However, an assessment of a casual relationship is not utilized in presenting all of the report’s conclusions. The major conclusions are written to be important summary statements that are easily understood by those reading the report. Some conclusions, particularly those found in Chapter 3 (epidemiology), provide observations and data related to tobacco use among young people, and are generally not examinations of causal relationships. For those conclusions that are written using the hierarchy above, a careful and extensive review of the literature has been undertaken for this report, based on the accepted causal criteria ( USDHHS 2004 ). Evidence that was characterized as Level 1 or Level 2 was prioritized for inclusion as chapter conclusions.

In additional to causal inferences, statistical estimation and hypothesis testing of associations are presented. For example, confidence intervals have been added to the tables in the chapter on the epidemiology of youth tobacco use (see Chapter 3 ), and statistical testing has been conducted for that chapter when appropriate. The chapter on efforts to prevent tobacco use discusses the relative improvement in tobacco use rates when implementing one type of program (or policy) versus a control program. Statistical methods, including meta-analytic methods and longitudinal trajectory analyses, are also presented to ensure that the methods of evaluating data are up to date with the current cutting-edge research that has been reviewed. Regardless of the methods used to assess significance, the five causal criteria discussed above were applied in developing the conclusions of each chapter and the report.

• Major Conclusions
• Cigarette smoking by youth and young adults has immediate adverse health consequences, including addiction, and accelerates the development of chronic diseases across the full life course.
• Prevention efforts must focus on both adolescents and young adults because among adults who become daily smokers, nearly all first use of cigarettes occurs by 18 years of age (88%), with 99% of first use by 26 years of age.
• Advertising and promotional activities by tobacco companies have been shown to cause the onset and continuation of smoking among adolescents and young adults.
• After years of steady progress, declines in the use of tobacco by youth and young adults have slowed for cigarette smoking and stalled for smokeless tobacco use.
• Coordinated, multicomponent interventions that combine mass media campaigns, price increases including those that result from tax increases, school-based policies and programs, and statewide or community-wide changes in smoke-free policies and norms are effective in reducing the initiation, prevalence, and intensity of smoking among youth and young adults.
• Chapter Conclusions

The following are the conclusions presented in the substantive chapters of this report.

Chapter 2. The Health Consequences of Tobacco Use Among Young People

• The evidence is sufficient to conclude that there is a causal relationship between smoking and addiction to nicotine, beginning in adolescence and young adulthood.
• The evidence is suggestive but not sufficient to conclude that smoking contributes to future use of marijuana and other illicit drugs.
• The evidence is suggestive but not sufficient to conclude that smoking by adolescents and young adults is not associated with significant weight loss, contrary to young people’s beliefs.
• The evidence is sufficient to conclude that there is a causal relationship between active smoking and both reduced lung function and impaired lung growth during childhood and adolescence.
• The evidence is sufficient to conclude that there is a causal relationship between active smoking and wheezing severe enough to be diagnosed as asthma in susceptible child and adolescent populations.
• The evidence is sufficient to conclude that there is a causal relationship between smoking in adolescence and young adulthood and early abdominal aortic atherosclerosis in young adults.
• The evidence is suggestive but not sufficient to conclude that there is a causal relationship between smoking in adolescence and young adulthood and coronary artery atherosclerosis in adulthood.

Chapter 3. The Epidemiology of Tobacco Use Among Young People in the United States and Worldwide

• Among adults who become daily smokers, nearly all first use of cigarettes occurs by 18 years of age (88%), with 99% of first use by 26 years of age.
• Almost one in four high school seniors is a current (in the past 30 days) cigarette smoker, compared with one in three young adults and one in five adults. About 1 in 10 high school senior males is a current smokeless tobacco user, and about 1 in 5 high school senior males is a current cigar smoker.
• Among adolescents and young adults, cigarette smoking declined from the late 1990s, particularly after the Master Settlement Agreement in 1998. This decline has slowed in recent years, however.
• Significant disparities in tobacco use remain among young people nationwide. The prevalence of cigarette smoking is highest among American Indians and Alaska Natives, followed by Whites and Hispanics, and then Asians and Blacks. The prevalence of cigarette smoking is also highest among lower socioeconomic status youth.
• Use of smokeless tobacco and cigars declined in the late 1990s, but the declines appear to have stalled in the last 5 years. The latest data show the use of smokeless tobacco is increasing among White high school males, and cigar smoking may be increasing among Black high school females.
• Concurrent use of multiple tobacco products is prevalent among youth. Among those who use tobacco, nearly one-third of high school females and more than one-half of high school males report using more than one tobacco product in the last 30 days.
• Rates of tobacco use remain low among girls relative to boys in many developing countries, however, the gender gap between adolescent females and males is narrow in many countries around the globe.

Chapter 4. Social, Environmental, Cognitive, and Genetic Influences on the Use of Tobacco Among Youth

• Given their developmental stage, adolescents and young adults are uniquely susceptible to social and environmental influences to use tobacco.
• Socioeconomic factors and educational attainment influence the development of youth smoking behavior. The adolescents most likely to begin to use tobacco and progress to regular use are those who have lower academic achievement.
• The evidence is sufficient to conclude that there is a causal relationship between peer group social influences and the initiation and maintenance of smoking behaviors during adolescence.
• Affective processes play an important role in youth smoking behavior, with a strong association between youth smoking and negative affect.
• The evidence is suggestive that tobacco use is a heritable trait, more so for regular use than for onset. The expression of genetic risk for smoking among young people may be moderated by small-group and larger social-environmental factors.

Chapter 5. The Tobacco Industry’s Influences on the Use of Tobacco Among Youth

• In 2008, tobacco companies spent $9.94 billion on the marketing of cigarettes and $547 million on the marketing of smokeless tobacco. Spending on cigarette marketing is 48% higher than in 1998, the year of the Master Settlement Agreement. Expenditures for marketing smokeless tobacco are 277% higher than in 1998.
• Tobacco company expenditures have become increasingly concentrated on marketing efforts that reduce the prices of targeted tobacco products. Such expenditures accounted for approximately 84% of cigarette marketing and more than 77% of the marketing of smokeless tobacco products in 2008.
• The evidence is sufficient to conclude that there is a causal relationship between advertising and promotional efforts of the tobacco companies and the initiation and progression of tobacco use among young people.
• The evidence is suggestive but not sufficient to conclude that tobacco companies have changed the packaging and design of their products in ways that have increased these products’ appeal to adolescents and young adults.
• The tobacco companies’ activities and programs for the prevention of youth smoking have not demonstrated an impact on the initiation or prevalence of smoking among young people.
• The evidence is sufficient to conclude that there is a causal relationship between depictions of smoking in the movies and the initiation of smoking among young people.

Chapter 6. Efforts to Prevent and Reduce Tobacco Use Among Young People

• The evidence is sufficient to conclude that mass media campaigns, comprehensive community programs, and comprehensive statewide tobacco control programs can prevent the initiation of tobacco use and reduce its prevalence among youth.
• The evidence is sufficient to conclude that increases in cigarette prices reduce the initiation, prevalence, and intensity of smoking among youth and young adults.
• The evidence is sufficient to conclude that school-based programs with evidence of effectiveness, containing specific components, can produce at least short-term effects and reduce the prevalence of tobacco use among school-aged youth.
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• Cite this Page National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2012. 1, Introduction, Summary, and Conclusions.
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The New York Times

The learning network | are antismoking ads effective.

Are Antismoking Ads Effective?

Questions about issues in the news for students 13 and older.

• See all Student Opinion »

The federal government is behind a new series of advertisements intended to deter people from smoking or to spur them to quit. Have you seen any antismoking ads? Do you think they are effective? Why do you think people continue to smoke despite knowing the dangers associated with the habit?

As The Times’s Gardiner Harris reports , the government is paying for the first-ever nationwide antismoking ad campaign, according to Dr. Thomas R. Frieden, the director of the Centers for Disease Control and Prevention:

“We estimate that this campaign will help about 50,000 smokers to quit smoking,” Dr. Frieden said Wednesday in an interview. “And that will translate not only into thousands who will not die from smoking but it will pay for itself in a few years in reduced health costs.” The advertisements, which will appear on television and in newspapers starting Monday, show former smokers discussing the terrible health consequences of their habits. In one TV ad, Terrie, 51, of North Carolina, who has a hole in her neck and barely any hair on her head after suffering head and neck cancer, tells the camera, “I want to give you some tips about getting ready in the morning.” She then pops in a set of false teeth, dons a blond wig and inserts a small speaker into the tracheotomy in her neck. She ties on a scarf to hide the device and says, “And now you’re ready for the day.” An announcer says: “You can quit. For free help, call 1-800-QUIT-NOW.” Studies have shown that such graphic advertisements are effective in persuading smokers to quit, but they have also often led to opposition from smokers, who call them alarming and demeaning, and to efforts by the industry to end financing for the ads.

Students: Tell us what you think about antismoking ad campaigns like this one. Do you think they might persuade teenagers either not to take up smoking or to quit? Do you know anyone who smokes? Why do you think millions of people — including approximately 3.4 million teenagers — continue to smoke even though the health risks are well known?

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i believe that these ads are very helpful in getting people to not start smoking, but if they have already become addicted they won’t have much effect.

I think teenagers start smoking for attention, and because they are stupid.

I think it would work because a lot of teenagers watch t.v. and sometimes they could get scared and quit so they don’t look like what the people do in the t.v.

Quieting is harder then anyone thinks. It is also different for every person. I think if people have something to quiet for it might be easier. If they do put up a ton ads i think it might help quite a few people. However in London on their cigerettes it has a yellow strip that says “smoking causes cancer” yet people still buy them and still smoke them.

I believe that this add will most only effect those who have just started smoking or have not fully become addicted. People who have been smoking for years will most likely not be effected by this campaign. Being a teenager myself, I can say that adds like these have little to no effect on the majority of teenagers. This is due to the fact that they are more concerned with popularity. Or that they have had hundreds if not thousands of advertisements and projects like D.A.R.E shoved down there throats, and they have lost there effectiveness. Yes, I know several people who smoke. I believe 3.4 million teenagers smoke because because it can relax the individual, and temporally raise self-esteem.

People across America smoke because of one major reason. Peer pressure. People at young ages are told its cool and that its not that bad and then they get addicted to them. Once you are addicted you cant drop the habit or it is very difficult.

I think that these campaigns are good at reaching out to smokers. The only thing that I do not like though is that they are spending thousands of dollars on changing other’s minds. Smoking is a personal choice and people should not try to stop it.

I think that anti smoking ads are effective, cause even if one person doesn’t smoke or stops smoking, they are effective.

I think that they should keep having antismoking ads and compaigns because it helps push the fact that its bad for you and can hurt your insides alot. I dont know anyone that smokes and I think campaigns will help persuade students not to smoke and to stop once they see how it hurts you.I think they still smoke because theyre confused and they dont know what to do and no one wants to help them stop.

I honestly think most teenagers pay no mind to the anti-smoking ads. I know a lot of people who smoke and know it’s bad for them so they try to stop but it’s so addictive they can’t just like any other cigarette smoker.

People continue to smoke because they are ignorant and obviously don’t care about life. The campaign should continue

I believe these antismoking ads as long as they are informative to show all the bad side affects that come with smoking.

If someone had shown an ad when I was a teenager depicting, say, someone walking around with their smoker’s lungs on the outside of their body, I would have never started smoking. 25 years later I finally quit. It wasn’t easy but the agony of withdrawal pales in comparison to the endless agony of addiction. I thank God for giving me the strength to quit before experiencing serious health consequences.

I don’t think I agree with the government spending that much money on anti-smoking ads. I wouldn’t have a problem with it normally, but since the economy is in such a bad place, I think the government should be using their money more effectively. I think these ads would be fine if it was some kind of health organization sponsoring them. But for the money to be provided by our struggling government to tell people something they already know, seems ineffective.

I think that campaigns like this are helpful in some ways. Maybe if certain companies advertized instead of the government it would be more effective. Regardless of who is doing this campaign I think that it is a good idea.

I think that anti-smoking ads are somewhat effective. If people want to smoke, they will smoke. The only thing they do is show the risks in smoking, wich is good.

Smoking is gnasty and it probably really hard to quit once you start because you can get addicted to it. It tells you on the pack that you can die. The ads are probably somewhat effective

I believe antismoking ad campaigns like this would persuade teenagers to either quit or not take up smoking. I know numerous teenagers who have smoked and wouldn’t want to end up like the lady with a hole in their necks. The ad would shock potential cigarette users into not taking up the detrimental habit and/or convince current smokers to quit. Millions of people continue to smoke even though the health risks are well known because of the addictive nicotine inside of the cigarettes. If we are able to reveal the hazards to teenagers early on and convince them not to smoke, then they won’t have to deal with the hazardous side effects of cigarettes later on in their lives.

Anti-Smoking campaigns can go both ways. I think that it does encourage people to not smoke or quit smoking, but at the same time it is still putting it out there, almost like advertising cigarettes. In this generation, it seems as though no matter what teenagers see on TV or hear from their parents etc., they will do what they want. You can’t stop them no matter how hard you try. And most teenagers won’t quit smoking with the thought that they still have time to quit since they’re young, but after a while it becomes too hard and you’re stuck with it. I know many people who smoke. I guarantee that everybody who smokes knows the risks and health dangers associated with it, but they do not stop because half of them probably do not care and want to continue, having no willpower to stop, and half of them care but it is too hard to stop. What you need most to quit is willpower and definitely someone to do it with you.

These campaigns are good in showing that smoking is very harmful. Most smokers know of the consequences of smoking and its their choice to contintue to do it.

I think the companions and anti smoking ads do help in some ways. Some of the “smart” people might look at an ad, and see what will happen if he/she continues smoking, so they might stop. Most teenagers smoke to get attention or look cool, so they probably won’t stop. At my school, I really don’t know the names of students, but several students smoke including some 6th graders. Like I said most people want to look boss and cool, so they start smoking, when smoking is totally not cool.

I feel that anti-smoking ads that are graphic like this will be effective in helping people decide to not smoke or even to quit smoking if they already do. The long term consequences for smoking are traumatic and if ads are shown on national television they will reach millions of people and deter them from an awful habit to get into. The only thing I don’t agree with here is the fact that the government is funding these advertisements. There are many other issues that our country is facing right now, national debt being one of them, and putting money into TV advertisements is not helping that situation at all.

I believe anti smoking ads are half affective. Some people actually take the ads and don’t smoke. Some people might just literally say, “screw not smoking.” I personally don’t smoke and take those ads and actually take the advice of not smoking.

I agree with Kelsey. Campaigns to stop smoking are hlepful is many ways. Since the goverment is funding these ad campaigns, I think more citizens will realize how horrible this cigarettes problem is. This ad will definetly show teenagers the lifetime effect of nicotine which will cause them to quit smoking. I do not know anyone who smokes. I think millions of teenagers continue to smoke for the look.

I think they should post up the adds and see what it does. I mean i dont think more people will start smoking because of these adds so what do they have to lose? It can only make things better. and i think people still smoke because its hard to quit and they just dont care about their health.

I feel that the ads do not effect smokers at all. Maybe people who watch TV will just become anti smokers and not smoke but it is hard to stop smoking and so they are not usually interested in hearing about it unless they REALLY want to quit.

What's Next

CDC’s Tips From Former Smokers® Launches New Ads to Encourage People to Quit Smoking

For Immediate Release: Monday, February 5, 2024 Contact: Media Relations (404) 639-3286

The Centers for Disease Control and Prevention’s (CDC)  Tips From Former Smokers ® ( Tips ®) campaign returns today with new ads to encourage people to quit smoking. This year, seven new people are featured in the ads sharing their stories about how cigarette smoking and smoking-related diseases have negatively impacted their lives.

Many of this year’s new ads include messaging about the harms of menthol cigarettes , which can contribute to tobacco-related health disparities. Menthol in cigarettes can make it easier to start smoking and harder to quit. The Tips campaign promotes messages and free resources to help adults quit smoking. Year after year, the campaign has proven its effectiveness and has saved lives and money by helping more than one million U.S. adults to quit smoking and inspiring millions more to try to quit.

Real people, real stories inspire people to quit smoking

Tips tells the stories of more than 45 brave people from different backgrounds who have been impacted by the serious long-term health effects from smoking and secondhand smoke exposure. New 2024 ads feature the following people:

• Angie P. smoked menthol cigarettes because she thought it would help her cope with the fear that people around her would not accept that she is gay. She smoked for 26 years. She wants to encourage other LGBTQ+ people who smoke to love themselves and protect their health by quitting smoking.
• Elizabeth B. and Stephen B. Elizabeth smoked menthol cigarettes for 35 years. She has smoking-related peripheral artery disease, which makes walking difficult and sometimes painful. She also developed kidney cancer. Her husband, Stephen, helps take care of her.
• Ethan B. smoked menthol cigarettes for 39 years. He grew up seeing ads that convinced him smoking menthol cigarettes was “cool.” As an adult, he had multiple smoking-related strokes.
• John B. smoked for 22 years. He tried several different ways to quit smoking, but nothing seemed to work. He kept trying until he found the methods that worked best for him. Those methods included counseling and two quit-smoking medicines.
• Noel S. smoked menthol cigarettes for more than 20 years. He suffered a smoking-related heart attack at age 36. Noel quit smoking so he could be around to watch his younger family members grow up.
• Tammy W. ate healthy, exercised regularly, and ran marathons. She also smoked menthol cigarettes for 23 years. She told herself that menthol cigarettes were less harmful than non-menthol cigarettes. At age 44, she had severe heart disease and needed open heart surgery.

“While cigarette smoking among adults has declined, it remains the leading cause of preventable disease, disability and death in the United States, and some groups continue to be affected more than others,” said Deirdre Lawrence Kittner, PhD, MPH, Director of CDC’s Office on Smoking and Health. “The Tips campaign reaches adults with compelling messages and information to motivate them to quit smoking. It also promotes free resources that can help them quit – no matter who they are or where they live.”

Tips is the first federally-funded national tobacco education campaign. It uses multi-media platforms to increase the reach of quit smoking messages. Tips ads will run nationally on broadcast and cable TV, and on digital and social media channels. Additional ads will be placed to reach specific audiences including people who are African American, American Indian, Alaska Native, Hispanic/Latino, Asian, Native Hawaiian and other Pacific Islanders, LGBTQ+, and deaf or hard-of-hearing.

Menthol cigarettes contribute to tobacco-related health disparities in the United States

Though fewer people in the U.S. smoke cigarettes now than in recent decades, the use of menthol cigarettes among people who smoke has increased. This includes groups that already have higher percentages of tobacco use and tobacco-related health problems.

Tobacco companies add menthol to make their products seem less harsh and more appealing to people who have never used cigarettes. Menthol enhances the effects of nicotine on the brain and can make cigarettes even more addictive. People who smoke menthol cigarettes can be less likely to successfully quit than people who smoke non-menthol cigarettes.

Young people, racial and ethnic minority groups, LGBTQ+ people, women, people with a low income, and people with mental health conditions are more likely to smoke menthol cigarettes than other groups. Tobacco companies aggressively market menthol-flavored tobacco products to different groups of people, especially people who are African American. This marketing contributes to certain groups being more likely to smoke menthol cigarettes than other groups.

Quitting is possible and free resources are available

The Tips campaign promotes free resources to help adults quit smoking . Quitting smoking is beneficial at any age and is one of the most important steps people can take to improve their health. For free quit smoking resources and more information about the  Tips  campaign, including links to the ads, visit  www.cdc.gov/Tips .

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CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.

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