All Fired Up : Critics Call Tobacco Industry’s Anti-Cigarette Messages for Teens Inappropriate, Misleading

How do you convince kids not to smoke?

That’s the question of the moment for educators, health activists--and the tobacco industry.

While educators struggle to reduce smoking rates among youth--the only segment of U.S. society in which smoking has not declined in the past decade--the tobacco industry is promoting its own anti-smoking program this summer in a 30-city tour punctuated with public service announcements on radio, television and billboards.

As one industry official puts it: “We all agree kids shouldn’t smoke.”

But the industry’s involvement in delivering this message has many anti-smoking activists enraged. They claim its method of educating youth about tobacco is inappropriate and misleading.

The material in question includes a free brochure produced by the Tobacco Institute, an industry group, entitled, “Tobacco: Helping Youth Say No,” and public service announcements carrying the message, “Smoking should not be a part of growing up.”

Also challenged is another youth-oriented program, called “Right Decisions, Right Now,” produced by R.J. Reynolds Tobacco Co.

Both programs emphasize that only adults should choose whether to smoke--an approach many health educators say fails.

The campaigns do little more than give the industry an appearance of public responsibility in order to gain favor with legislators who could further restrict cigarette advertising and marketing techniques, industry foes say.

“We don’t feel the effort on behalf of the tobacco industry is sincere,” says Michael Eriksen, director of the U.S. Office on Smoking and Health. “(The material) falls short of what we feel is important in getting kids not to use tobacco.”

But, says industry spokesman Peter G. Sparber: “There are people who are simply offended that the tobacco industry is even funding this.”

The war of words became particularly heated this summer when a harsh critique of the industry material was published in the June issue of the Journal of Family Practice.

“ ‘Tobacco: Helping Youth Say No’ will turn teachers and parents into unwitting accomplices in addicting another generation of children to nicotine,” say physicians Joseph R. DiFranza and Tim McAfee, anti-smoking activists who wrote the article.

DiFranza and McAfee object to the advice to parents that “your children should be involved in the decision not to smoke.” The booklet suggests parents tell their children: “Some adults may choose to smoke but there are many activities in which young people shouldn’t participate.”

But, say DiFranza and McAfee, children who might never have considered smoking are taught that they must make a decision about it: “Not surprisingly, some decide to try it.”

“With things that are important we don’t give kids the choice,” DiFranza said in an interview. “We don’t ask them whether or not they want to have a tetanus shot or whether or not they want to attend school.”

The booklet does not contain information about the health risks of smoking for either children or adults. Instead, smoking is portrayed as an adult activity, DiFranza charges.

“What could make smoking more appealing to a teen-ager than to portray it as a rite of passage into adulthood?” the authors ask.

Another public service message, “Smoking should not be a part of growing up,” and the tobacco industry’s “It’s the law” poster and billboard campaign--meant to remind retailers that tobacco products cannot be sold to minors--also backfire, says Julia Carol, co-director of the Berkeley-based Americans for Nonsmokers Rights.

The “It’s the Law” campaign at best has no effect and at worst is bad, she says: “Being told you’re not allowed to do something and that it’s an adult activity, well, they might as well be saying to kids, ‘I dare you.’ ”

But, according to Sparber, the “Tobacco: Helping Youth Say No” brochures fill an important void in the youth tobacco-control field. The material is designed to help parents talk openly with their children about any sensitive topic, he says. About 290,000 brochures have already been distributed.

Besides the current media tour, promotions for the brochures have run in Parade Magazine, TV Guide, People and other publications, and include a toll-free number to obtain the material.

“How can you say that improving parenting skills cannot be effective?” asks Sparber, director of Family COURSE Consortium, which produced the brochures.

The material is meant to supplement existing tobacco-control materials, he says, because few programs address how parents can talk to their kids about smoking.

“There is not much out there (for parents),” Sparber says. “We think that our piece is a very large missing piece.”

The Family COURSE (which stands for Communication Through Understanding, Respect and Self-Esteem) Consortium is a separate organization and operates independently from the Tobacco Institute, Sparber says. However, it is funded by and housed at the Institute.

At the heart of the issue is a debate about which methods convince kids not to smoke, use drugs or practice any risky behavior.

According to DiFranza and McAfee, preventive programs are traditionally based on one of two approaches.

The “affective approach” suggests that internal factors--such as a youth’s self-esteem, decision-making capabilities and motivation to feel better--play a big part in whether he or she succumbs to influences to smoke or use drugs.

Another tactic--the “social influences” approach--suggests that outside factors--such as advertising and whether parents smoke--are most influential.

DiFranza and McAfee contend that “Tobacco: Helping Youth Say No” is an affective approach, which numerous studies suggest doesn’t work.

A ground-breaking study of Los Angeles students in the mid-1980s was the first of many to debunk the affective approach, says Dr. C. Anderson Johnson, director of the Institute for Health Promotion and Disease Prevention at the University of Southern California.

Johnson tested both methods on seventh-grade students after doubts about affective approaches surfaced.

He found the social influences program successful in delaying tobacco, alcohol and marijuana use. The affective education initially had no impact.

And by the time final observations were made, some classrooms that had received the affective program had significantly more drug use than control groups.

“I certainly didn’t expect it to have a negative impact,” Johnson says, “or I wouldn’t have done it.”

He has not seen “Tobacco: Helping Youth Say No,” but adds that the message that smoking is an adult choice “is not the message I would want to convey. Kids often do consider themselves adults.”

Tobacco industry spokesman Sparber says ordering kids not to smoke or trying to scare them doesn’t work:

“If you look at the incidence of kids heeding this advice, it isn’t much of a record. Educators are constantly looking for new ways, better ways of teaching. I think educators have come to realize that the family structure needs to be employed if kids are to be steered in an appropriate direction.

“You have to deal with a child’s decision-making abilities. There is plenty of information out there about what you shouldn’t do and why you shouldn’t do it. Kids are inundated with information. The question is how can a parent participate actively in showing a child how to make a good decision.”

While the Tobacco Institute program is directed at parents, the R.J. Reynolds Tobacco Co.’s program is for youths, parents or teachers and addresses peer influence, says Maura Payne, an R.J. Reynolds spokeswoman.

The campaign, which has reached 175 cities, consists of free brochures, posters and table tent cards. Advertisements are placed in education and parenting publications and include a toll-free number to request materials. Billboards have also been strategically placed near schools.

“At ages 12 to 15, which is when kids tend to experiment with smoking, they get wary of preachy messages,” Payne says. “Our whole theme throughout the effort is ‘you don’t have to smoke to be cool’ to undermine the pressures they get out there. The health messages are already out there. But kids don’t get a lot of the undermining of peer pressure. That’s the No. 1 reason kids say they experiment with cigarettes; they want to look cool with their friends.”

According to several studies, a major reason kids say they start smoking is because their parents do. Other reasons include peer influence, tobacco product advertising and promotion, and illegal sales of tobacco to youths.

Many educators say a health message should be a component of all programs. A national survey of almost 50,000 students published early this year showed nearly half of all eighth-graders didn’t think there was a great risk to smoking one or more packs of cigarettes a day, said Lloyd D. Johnston, survey director and a psychologist at the Institute for Social Research at the University of Michigan.

Anti-smoking forces also criticize the Reynolds program for the message that “smoking should not be a part of growing up,” instead of taking a broader view that smoking harms people of all ages.

Moreover, R.J. Reynolds’ brochure for parents who smoke--”How to Talk to Your Kids About Not Smoking Even If You Do”--irks tobacco-control advocates because it advises parents to explain to children that “you smoke because you enjoy smoking.”

The brochures say nothing about nicotine addiction, a major reason why many adults smokers continue to smoke, according to Eriksen of the Office on Smoking and Health. Almost three-quarters of adults would like to quit smoking if they could, and half consider themselves addicted, he says.

“With those types of statistics it’s terribly misleading to say adults smoke because they enjoy it,” he says. “The tobacco industry fails to acknowledge that tobacco use results in disease and death.”

This is not the first time tobacco industry educational materials have generated controversy.

The first Tobacco Institute youth booklet, “Helping Youth Decide,” was published in 1984 in conjunction with the National Assn. of State Boards of Education. The NASBE’s involvement with the industry led to scalding denunciations from then-U.S. Surgeon General C. Everett Koop and the American Lung Assn.

The NASBE withdrew its name from the material in 1988 because of the criticism, but remains supportive of the effort.

But the tobacco industry campaign that kicked off early this year has again put anti-smoking leaders on edge. They particularly worry that financially strapped schools might accept any free anti-smoking program or material.

Earlier this year, R.J. Reynolds approached the San Diego Unified School District, offering the material for “field testing.” School officials took the request before the county’s Tobacco Control Coalition, which represents 56 agencies.

“We felt the program was not comprehensive and was sending mixed messages,” says Dianne Williams, a public health educator with the San Diego Department of Health Services and Tobacco Control Resource Center.

“If you look at the material, on the surface it’s glossy, nice, very beautiful. A lot of schools don’t have the money to buy material like that. It’s free. But if you analyze the message content, it’s an inappropriate message.”

The San Diego County Office of Education recommended that schools refuse the material.

Most schools rely on anti-smoking curricula published by the American Cancer Society and American Lung Assn. that “are very well-founded,” Williams says.

The controversy symbolizes how the anti-smoking battle has shifted dramatically to youth in recent years, experts say.

According to the Office on Smoking and Health, three-fourths of adults who smoke report trying their first cigarette before age 18 and half say they were regular smokers by that time.

Moreover, while smoking rates among adults continue to decline, rates have remained stable among youths. In 1989, the most recent year for a federal survey, 16% of males and 15.3% of females ages 12-18 admitted smoking in the past month. Among 18-year-olds, 29.1% of boys and 21.3% of girls smoked weekly. More white youths smoke than blacks or Latinos.

In the past year, anti-smoking advocates have lobbied to halt vending-machine sales of cigarettes and to enforce penalties for selling cigarettes to minors. Health activists have also accused the tobacco industry of devising advertising and marketing strategies aimed at youth, such as R.J. Reynolds’ Joe Camel cartoon character. A study published earlier this year in the Journal of the American Medical Assn. found Joe Camel is very effective in reaching children.

Tobacco industry officials vigorously deny they advertise to youth and say they support measures aimed at stopping youths from smoking.

“We continue to hear that a lot of cigarette advertising goes out to kids, but I don’t see support for that,” Sparber says. “If the tobacco industry wanted to simply put on a show they wouldn’t be doing this (educational campaign).”

But, says Michelle Bloch, a Washington health policy consultant and ardent tobacco industry foe, “the tobacco industry’s posture has been that we don’t want kids to smoke. We know that is a bald-faced lie.

“They lose 2.5 million customers every year; those who quit and those who die. You have to replace those people every year just to stay in business.”