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Tobacco and Cancer Programme International Union Against Cancer 3, Rue du Conseil-Général, 1205 Geneva, Switzerland Tel: (4122) 809 1830, Fax: (4122) 809 1810 E-mail: tobacco-control@globalink.org | Tobacco and Cancer Programme |
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Importance of Preventing Smoking Onset Among Youth
The overwhelming majority of smokers begin tobacco use before they reach adulthood. Thus one of the keys to a smoke-free society is to prevent youth from ever starting.
An adolescent health issue (1)
While the most serious effects of tobacco use normally occur after decades of smoking, there are also immediate negative health effects for young smokers. Perhaps more importantly, most teenage smokers are already addicted while in adolescence (2). This addiction results in an inability to quit when they later wish to do so.
The younger a person begins to smoke, the greater the risk of eventually contracting smoking-caused diseases such as cancer or heart disease (3). Part of the reason for this is that the level of nicotine dependence in adults is inversely correlated with the age of smoking initiation (4).
Smoking a cigarette increases heart rate and blood pressure (5). For youth, smoking reduces lung function (6) and physical fitness (7), and increases problems for asthmatics (8). Smoking is associated with increased rates of cough, phlegm, wheezing, and shortness of breath in youth (9). For smokeless tobacco use, the short-term effects include leucoplakia (oral soft-tissue lesions) and gum recession (10). Tobacco use is also associated with alcohol and illicit drug use and is generally the first step in a sequence that can include tobacco, alcohol, marijuana, and harder drugs (11).
Smoking by the mother during pregnancy increases: the risk of harm to the foetus, spontaneous abortion, abnormalities of the placenta, stillbirths, low birth weight babies needing special care after birth, and Sudden Infant Death Syndrome (12).
Children exposed to environmental tobacco smoke (ETS) are at greater risk of asthma and asthma attacks, bronchitis and pneumonia (13).
Factors influencing youth smoking
Several factors increase the risk of youth smoking. These include tobacco industry advertising and promotion, easy access to tobacco products, and low prices. Peer pressure plays an important role through peers' and siblings' use and approval of smoking (14). Other risk factors associated with youth smoking include having a lower self-image than peers, and perceiving that tobacco use is normal (15). Many studies show that parental smoking is associated with higher youth smoking (16).
Industry marketing
As the U.S. Surgeon General concluded in 1994, "[y]oung people continue to be a strategically important market for the tobacco industry" (17). Without new young smokers to replace those adult smokers who quit or die, the industry's future is in jeopardy. Here are some excerpts from industry documents which came to light during a Canadian court case:
"Young smokers represent the major opportunity group for the cigarette industry…"
Imperial Tobacco, 1971 Matinée Marketing Plans (18).
"If the last ten years have taught us anything, it is that the industry is dominated by the companies who respond most effectively to the needs of younger smokers. Our efforts on these brands will remain on maintaining their relevance to smokers in these younger groups in spite of the share performance they may develop among older smokers".
Imperial Tobacco, Overall Market Conditions - F88, 1988 (19).
Other industry documents uncovered during the trial indicated that the most important advertising target group for some brands was in the 12-17 age range (20).
In various countries, the industry has marketed to youth by placing advertising in youth-oriented magazines, by sponsoring sports and concerts, by using advertising themes and images attractive to youth (e.g. cartoon characters), by giving out free samples, by promoting a rock concert for which the admission was empty cigarette packages, by placing their trademarks on non-tobacco goods, and by paying movie producers to have brands smoked by actors and actresses in feature films.
Solutions to the youth smoking epidemic: reducing supply and demand
The seriousness of youth smoking requires a comprehensive approach. This includes: 1) reducing supply, that is the amount of tobacco products accessible to youth; and 2) reducing the demand, that is the motivation of youth to consume tobacco by making its use seem appealing, acceptable and affordable.
Reducing supply: preventing the sale of tobacco to young persons
Many countries have laws which make it illegal to sell tobacco products to youth. The age varies, such as from 14 in Colombia (21) to 21 in the U.S. State of Pennsylvania (22). The appropriate minimum age is one which is high enough to prevent smoking onset during the teen years, and normally should be such that the age is higher than the age of almost all secondary students.
While many countries have laws prohibiting tobacco sales to young persons, these laws are normally so poorly enforced that it is common to find that governments collect more in taxes from such illegal sales than they spend on their entire tobacco control strategies.
Jurisdictions which have successfully enforced laws restricting the sale of tobacco to young persons have combined merchant education with designated government agencies sending under-age youths into tobacco retail outlets to conduct unannounced test purchases. If an illegal sale is made, a fine and/or a suspension of the store's ability to sell tobacco will result. The threat of continued enforcement and its consequences means that the vendor has an economic incentive to obey the law. Test purchases need to be repeated and frequent for maximum effectiveness. Increased compliance with the law can dramatically decrease youth smoking (23).
A model comprehensive law preventing tobacco sales to young persons,
A) bans:
B) provides for the following penalties:
C) requires vendors to:
D) designates:
E) provides for effective enforcement:
F) simplifies the administration of the law:
The sale of single cigarettes should be prohibited. Single cigarette purchases are an inexpensive way for youth to start smoking. A ban on packages containing fewer than 20 cigarettes should also be considered.
In some developing countries, laws against selling tobacco to young persons are made even more difficult to enforce because the vendors are often children selling at streetside.
Reducing demand: actions to reduce youth smoking
Taxes. Higher prices brought about by tobacco tax increases have in many places proven to be the most effective way to reduce teen smoking. Youth, who have less disposable income than adults, are particularly price-sensitive to tax increases. Since higher-priced cigarettes become less affordable, some youth quit smoking, others smoke less and are thus less susceptible to addiction, others are motivated to quit, while others never start or postpone when they start. American research found that for every 10% increase in the real (after inflation) price of cigarettes, there was a 14% decrease in consumption among teenagers (24).
Advertising Ban. To prevent industry marketing to youth, there should be a complete ban on tobacco advertising and promotion, including direct or indirect sponsorships of sporting and cultural events, free distribution of tobacco products, and the association of tobacco trademarks with non-tobacco goods (e.g. clothing) or services (e.g. vacations).
Plain Packaging. Laws requiring the plain packaging of tobacco products should be adopted. This measure removes much of the positive imagery tobacco companies associate with their brands. A growing number of studies show that plain packaging would reduce youth smoking (25). See also UICC Tobacco Control Fact Sheet on Generic Packaging.
Industry Price and Profit Controls. In many countries, tobacco companies have levels of profitability far exceeding other industries. To curb this profit, and to reduce the financial incentive to recruit new youth smokers, governments should regulate the non-tax component of manufacturer prices, or should impose special taxes to decrease manufacturer profit.
Package Messages. Prominent health warnings located at the top of the package and in contrasting colours, such as black and white, should warn in plain language of the health consequences of tobacco use through a series of rotated messages. Warnings not only discourage tobacco use, but they help create a situation of "informed consent" for tobacco users. A picture could add to the effectiveness of the warning. A package insert could also provide more detailed information on health consequences and on how to quit. There should also be messages on non-health topics, such as "Quit smoking - Save money."
Smoking Restrictions. Smoking should be banned in day care centres, in elementary and secondary schools (for both staff and students), on school grounds, during school sponsored activities, and in other places frequented by youth. Further, smoke-free workplaces and public places help reduce youth smoking much in the same way that such restrictions reduce adult smoking (26).
Smokeless Tobacco. Smokeless tobacco should be prohibited pre-emptively whenever the product has not yet been introduced in a particular country.
Education. Anti-smoking education campaigns in the mass media and in schools should be part of a comprehensive tobacco control campaign. These education efforts should be carefully designed so that messages are consistent and effective for youth. In some developing countries, the existing school infrastructure may be one of the few affordable ways to promote an anti-smoking message. Before full-scale use, the educational programmes should be carefully evaluated and on-going activities monitored.
Acknowledgement
This fact sheet has been prepared by the National Public Issues Committee of the Canadian Cancer Society under the direction of Mr. Ken Kyle, Mr. Maurice Gingues, and Mr. Rob Cunningham.
Notes/References
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Tobacco and Cancer Programme International Union Against Cancer 3, Rue du Conseil-Général, 1205 Geneva, Switzerland Tel: (4122) 809 1830, Fax: (4122) 809 1810 E-mail: tobacco-control@globalink.org | Tobacco and Cancer Programme |
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