Tobacco and Public Health - TCSC Indonesia

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ADOLESCENT SMOKING
Public health approaches to reduce smoking initiation
In the United States and in many other countries, there is strong public support for
using the public sector to discourage adolescents from starting to smoke. Four of the
major approaches used are: the conduct of counter-advertising campaigns, increases in
cigarette price through increases in state excise taxes on cigarettes, and increasing
enforcement of regulations and laws forbidding merchants to sell cigarettes to minors
and school programs.
Can a mass media campaign lead to a reduction in
initiation rates?
The first population-based antismoking mass media campaign occurred in the late
1960s and was associated with a marked decline in the per capita consumption of cigarettes
(Warner 1977). During the 1980s the Office on Smoking and Health in the
United States ran a sporadic national mass media program through public service
announcements (Pierce et al. 1992) and many of these productions targeted adolescent
smoking. The first statewide antismoking mass media campaigns started in Australia
in 1983 using health consequences messages in paid media. These were demonstrated
to effectively reduce adult-smoking prevalence (Dwyer et al. 1986; Pierce et al. 1990).
While adolescents were a target of some of the early campaigns, effective changes in
adolescent smoking behavior were not demonstrated.
Clear evidence that mass media antismoking campaigns could affect youth smoking
was demonstrated with the Florida Tobacco Control Program (Bauer et al. 2000). The
Florida ‘Truth’ campaign sought to engage youth in a movement that included questioning
tobacco industry public messages. This program achieved extremely high
awareness among 12–17 year olds (92%). More than 10 000 youth signed up for an
action program. Over 2 years, this program achieved dramatic changes in youth smoking
across all levels of the smoking uptake continuum in both middle and high schools.
The level of committed never smokers increased from 67 to 76 per cent in middle
schools. The level of experimentation decreased by 25 per cent and the prevalence of
current smokers dropped by more than one-third in middle school and by 18 per cent
in high school. These changes are unprecedented, and this program is the model for
the American Legacy National antismoking program that began in the United States in
1999 with money supplied by the tobacco industry in their legal settlement agreement
with the Attorneys General of the various states.
What is the effect of price on initiation?
Econometric studies abound demonstrating that smoking behavior is heavily influenced
by cigarette price, as predicted by standard economic theory. The price elasticity
of demand is the phrase used to describe the estimated impact of a change in price on