Role of the Mass Media in Sales of Tobacco Products to Adolescents

activity฀apart฀from฀sleeping฀ [93] .฀The฀TV฀is฀therefore฀be฀a฀useful฀means฀of฀inluencing฀ children฀and฀adolescents฀with฀regard฀to฀acceptable฀social฀behaviour,฀cultural฀norms,฀issues฀ of฀daily฀living฀and฀health-related฀matters฀ [94] .฀In฀fact,฀several฀mass฀media฀campaigns฀have฀ been฀run฀in฀the฀past฀in฀attempts฀to฀inluence฀smoking฀behaviour฀among฀young฀people฀ [95] .฀ Speciic฀programmes฀have฀been฀used฀for฀some฀schools฀ [34,฀79,฀96,฀97] .฀Information฀pro- grammes฀prepared฀speciically฀for฀the฀mass฀media฀have฀been฀very฀much฀less฀common฀ [98,฀99] ,฀although฀such฀campaigns฀can฀actually฀lead฀to฀a฀transient฀reduction฀in฀smoking฀ prevalence฀see฀also฀Fig.฀ 12.7 ฀ [98] . An฀analysis฀recently฀published฀by฀the฀Cochrane฀Group฀ [100] ฀warns฀that฀the฀results฀of฀ different฀campaigns฀cannot฀be฀evaluated฀from฀a฀single฀viewpoint฀because฀the฀baseline฀situ- ation฀in฀one฀study฀is฀not฀necessarily฀comparable฀with฀that฀in฀another฀study฀or฀campaign.฀ Generalisation฀of฀the฀information฀obtained฀is฀complicated฀by฀a฀wide฀range฀of฀individual฀ factors฀arising฀out฀of฀the฀characteristics฀of฀a฀community฀and฀the฀location฀of฀the฀particular฀ school฀ [101] .฀ Similarly,฀ according฀ to฀ a฀ meta-analysis฀ of฀ other฀ school-based฀ prevention฀ programmes฀only฀16฀21฀out฀of฀131฀studies฀analysed฀their฀data฀on฀a฀statistically฀sound฀ basis฀ [102] ,฀the฀common฀failing฀being฀that฀changes฀in฀the฀control฀group฀were฀not฀consis- tently฀included฀in฀the฀analysis.฀Furthermore,฀the฀level฀of฀impartiality฀of฀the฀media฀agencies฀ or฀periodicals฀was฀not฀always฀clearly฀deined. According฀to฀one฀analysis฀from฀the฀USA฀of฀the฀impact฀of฀magazine฀articles฀on฀health฀ education฀topics฀over฀the฀period฀from฀1950฀to฀1983,฀it฀is฀clear฀that฀print฀media฀may฀in฀fact฀ inluence฀ the฀ initiation฀ rate฀ in฀ the฀ general฀ population฀ [25] .฀ The฀ number฀ of฀ educational฀ articles฀on฀the฀harmful฀effects฀of฀smoking฀correlated฀with฀smoking฀cessation฀in฀adults฀but฀ not฀with฀smoking฀initiation฀in฀adolescents฀because฀this฀latter฀group฀was฀not฀the฀target฀read- ership฀for฀these฀magazines,฀and฀greater฀emphasis฀on฀this฀aspect฀needs฀to฀be฀made฀in฀future฀ [25] .฀Without฀doubt,฀broad-based฀PR฀campaigns฀of฀this฀type฀are฀appropriate฀instruments฀ for฀educational฀purposes฀in฀those฀countries฀with฀a฀high฀smoking฀prevalence,฀e.g.฀Southern฀ and฀Southeastern฀Europe. According฀to฀the฀analysis฀published฀by฀the฀Cochrane฀Group฀ [100] ฀on฀the฀inluence฀of฀ mass฀media฀interventions฀on฀smoking฀behaviour฀among฀young฀people,฀six฀mass฀media฀cam- paigns฀were฀suitable฀for฀preventing฀smoking฀initiation฀in฀this฀target฀population,฀and฀two฀of฀ these฀six฀media฀interventions฀also฀caused฀a฀reduction฀in฀smoking฀prevalence฀among฀adoles- cents฀ [103–105] .฀Overall,฀eficacy฀has฀been฀assessed฀as฀only฀moderately฀positive฀to฀date. Fig. 12.6 ฀฀฀Effect฀of฀initiation฀ policies฀on฀the฀number฀of฀ smokers฀in฀the฀United฀States฀ within฀50฀years.฀a฀Status฀ quo;฀b฀50฀reduction;฀฀ c฀100฀reduction;฀d฀ 100฀reduction฀plus฀25฀ delayed฀initiation฀ [90] 60 50 40 30 20 10 1993 2003 2013 2023 2033 2043 Smokers [Millions] a b c d In฀summary,฀media฀campaigns฀to฀encourage฀smoking฀cessation฀and฀discourage฀smoking฀ initiation฀can฀be฀useful฀and฀effective฀provided฀that฀they฀are฀not฀inluenced฀by฀the฀tobacco฀ industry.฀However,฀the฀campaigns฀must฀utilise฀previously฀validated฀material฀and฀the฀pro- grammes฀themselves฀must฀be฀designed฀speciically฀to฀include฀children฀as฀the฀target฀audience.฀ Wherever฀possible,฀programmes฀should฀be฀screened฀on฀children’s฀TV฀channels฀at฀the฀right฀ time฀of฀day฀and฀they฀should฀be฀of฀an฀appropriate฀duration฀to฀ensure฀acceptance฀by฀children.

12.11 Role of Government and Community in Primary Prevention

Central฀government฀is฀hardly฀involved฀in฀the฀regulation฀of฀cigarette฀sales฀in฀the฀various฀ countries฀within฀and฀outside฀Europe,฀not฀even฀when฀the฀issue฀at฀stake฀is฀the฀protection฀of฀ young฀people฀from฀the฀hazards฀of฀smoking.฀One฀exception฀is฀the฀UK฀government฀with฀its฀ “Smoking฀kills”฀campaign฀that฀has฀been฀running฀now฀for฀10฀years฀ [106] :฀£100฀million฀has฀ been฀allocated฀to฀achieve฀three฀main฀goals฀within฀the฀next฀3฀years.฀One฀of฀these฀goals฀is฀to฀ reduce฀smoking฀among฀adolescents฀16-years฀old฀from฀13฀to฀9฀or฀less฀by฀the฀year฀ 2010,฀with฀a฀fall฀to฀11฀by฀the฀year฀2005.฀This฀is฀linked฀to฀a฀bundle฀of฀measures,฀such฀as฀ minimal฀tobacco฀advertising฀in฀shops,฀tough฀enforcement฀on฀under-age฀sales,฀proof-of-age฀ 100 90 80 70 60 50 40 30 20 10 1950 1953 1956 1959 1962 1965 1968 1971 1974 1977 1980 1983 Year Percentage of population lines 80 70 60 50 40 30 20 10 Magazine articles bars Smoking causes lung cancer Smoking is hazardous to nonsmokers health Fig. 12.7 ฀฀฀Population฀ beliefs฀ on฀ the฀ harmfulness฀ of฀ smoking฀ left฀ axis,฀ and฀ annual฀ number฀ of฀ articles฀on฀smoking฀and฀health฀indexed฀in฀The฀Reader’s฀Guide฀to฀periodica฀l฀Literature฀right฀axis฀ [25] .฀In฀the฀early฀1950s,฀there฀were฀less฀than฀20฀magazine฀articles฀on฀smoking฀and฀health฀each฀year.฀ The฀highest฀peak฀in฀magazine฀coverage฀was฀75฀articles,฀which฀occurred฀surrounding฀the฀release฀of฀ the฀1964฀Surgeon฀General’s฀report.฀The฀percentage฀of฀the฀population฀believing฀that฀smoking฀is฀ hazardous฀to฀non-smoker’s฀health฀was฀below฀50฀in฀1974,฀but฀had฀approached฀70฀by฀the฀early฀ 1980s cards,฀and฀strong฀rules฀on฀the฀siting฀of฀cigarette฀vending฀machines.฀“We฀want฀children฀to฀ be฀able฀go฀into฀shops฀without฀being฀faced฀with฀tobacco฀adverts฀or฀promotional฀materials”฀ [106] .฀To฀ensure฀the฀achievement฀of฀these฀goals,฀the฀White฀Paper฀describes฀detailed฀mea- sures฀that฀are฀to฀be฀implemented฀by฀central฀and฀local฀governments. Since฀tobacco฀consumption฀is฀a฀socially฀determined฀phenomenon,฀changes฀in฀the฀social฀ environment฀and฀social฀norms฀could฀become฀important฀ [107] .฀It฀is฀entirely฀conceivable฀ that฀ a฀ change฀ in฀ norms,฀ values฀ and฀ behavioural฀ patterns฀ would฀ increasingly฀ discredit฀ tobacco฀consumption,฀and฀that฀this฀would฀then฀be฀further฀mirrored฀in฀the฀social฀environ- ment.฀This฀objective฀can฀be฀assisted฀by฀charitable฀organisations฀in฀many฀countries฀dedi- cated฀to฀the฀struggle฀for฀a฀smoke-free฀environment฀–฀a฀goal฀that฀would฀also฀include฀schools.฀ School฀฀curriculum-based฀smoking฀prevention฀programmes฀might฀well฀prove฀highly฀effec- tive฀ [108] ฀and฀local฀communities฀should฀help฀to฀create฀a฀positive฀non-smoker฀image฀ [109] .฀ A฀combined฀school-฀and฀community-based฀tobacco-use฀prevention฀programme฀clearly฀has฀ the฀potential฀to฀reduce฀smoking฀initiation฀rates,฀as฀demonstrated฀by฀studies฀in฀28-year-old฀ non-smokers฀ [72] .฀Analysis฀of฀the฀data฀by฀the฀Cochrane฀Group฀also฀indicates฀a฀positive฀ result฀ [110] . A฀restriction฀on฀the฀sale฀of฀tobacco฀products฀to฀minors฀is฀an฀important฀aspect฀of฀preven- tion.฀Sales฀to฀minors฀must฀be฀reduced฀in฀accordance฀with฀the฀following฀stipulated฀recom- mendations฀ of฀ the฀ WHO:฀ a฀ minimum฀ age฀ 18฀ years,฀ b฀ licence฀ system฀ for฀ tobacco฀ retailers,฀c฀threat฀of฀penalties฀for฀illegal฀sale฀of฀tobacco฀goods,฀through฀to฀revocation฀of฀ licence,฀d฀statutory฀prohibition฀on฀sales฀to฀minors,฀e฀no฀sales฀in฀health฀service฀buildings,฀ schools฀or฀sports฀facilities฀and฀f฀no฀sales฀from฀cigarette฀vending฀machines฀or฀self-service฀ stores฀ [34,฀111] .

12.12 Concluding Remarks

The฀issues฀surrounding฀primary฀tobacco-use฀prevention฀programmes฀designed฀to฀deter฀ •฀ students฀from฀smoking฀in฀their฀youth฀need฀to฀be฀revisited.฀Children฀try฀tobacco฀just฀as฀ they฀try฀alcohol฀or฀illicit฀drugs.฀Even฀though฀it฀may฀sound฀surprising,฀these฀facts฀cannot฀ be฀altered฀overnight฀because฀adolescents฀typically฀want฀to฀discover฀what฀the฀world฀has฀ to฀offer.฀Consequently,฀this฀experimentation฀phase฀can฀only฀be฀suppressed. Attempts฀to฀limit฀tobacco฀consumption฀by฀using฀school-based฀programmes,฀mass฀media฀ •฀ campaigns฀or฀restrictions฀on฀tobacco฀sales฀to฀minors฀have฀been฀effective฀principally฀in฀ the฀context฀of฀research฀studies.฀However,฀some฀of฀the฀studies฀conducted฀to฀date฀are฀ highly฀complex฀and฀would฀be฀impractical฀in฀a฀real-life฀setting.฀The฀ease฀with฀which฀ minors฀can฀obtain฀illicit฀drugs฀demonstrates฀the฀futility฀of฀seeking฀to฀prevent฀the฀supply฀ of฀these฀substances.฀The฀only฀possible฀guarantee฀of฀success฀might฀be฀through฀the฀world- wide฀coordination฀of฀such฀efforts฀ [97] . Advertising฀ encourages฀ smoking฀ initiation฀ and฀ sustains฀ smoking฀ see฀ •฀ Chap.฀ 13 ,฀ whereas฀advertising฀bans฀reduce฀the฀number฀of฀smokers,฀although฀the฀factors฀involved฀ in฀smoking฀behaviour฀are฀very฀dificult฀to฀identify฀individually.฀The฀burden฀of฀proof฀for฀ the฀effectiveness฀of฀advertising฀bans,฀however,฀lies฀with฀public฀health฀authorities.