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Matthew C. Farrelly, Ph.D.

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 Many evidence-based interventions available


± Smoke-free air laws and ordinances
± Increasing the price of tobacco
± Multi-component quitlines
± Reducing client out-of-pocket costs for effective cessation
therapies
± Provider reminder systems, w/ and w/out provider education
± Mass media campaigns
 Studies show that increases in funding for state TCPs
± Decrease the prevalence of smoking among youth and
adults
± Decrease per capita cigarette sales
± Promote cessation (not yet published)

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 Media campaigns
± Truth campaign
± Correcting misperceptions
 Price/tax increases
± Experimentation
± Progression to regular/established smoking
 School-based tobacco prevention
± Short-term vs. long-term effects
± Coordinated with other interventions (e.g., media)
 Community mobilization
± Community Education
± Policy change
 Changing adult norms

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 £CI monograph makes it clear that media can work


 What¶s more elusive is understanding ³active
ingredients´ in successful campaigns
 Comprehensive evidence that the truth® campaign
has been successful. Demonstrated impact on
± Awareness
± Attitudes, beliefs, intentions and perceptions of use
‡ Particularly salient for 18-24 ³straight-to-work´ subgroup
± Prevalence and initiation
 Little evidence (in my opinion) of true synergies with
other interventions despite push for ³comprehensive´
approaches

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‡ Launched in 2000
‡ Modeled after Florida
campaign
‡ Current campaign ³Do
you have what it
takes?´
‡ Mock interviews in a
Stephen Colbert style
‡ Points out how tobacco
is like no other industry

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 In 2000, 46% of middle school students thought that
55% or more of high school students smoke
 By 2008 this dropped to 16%.

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 Vraphic and emotional


testimonial style that
available evidence
suggests may be the
most effective strategy
for adult cessation.
 Awareness high among
youth (71% in 2007)
 Vood receptivity

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 Vive a voice to youth in making
informed decisions
 Embody a social movement
against tobacco
 Promising to make a difference in
the lives of important people
around you
 Inoculating youth from tobacco
 Offering an alternative to smoking:
a nonsmoking teen lifestyle.
 Awareness reached over 50%
 Influenced attitudes. 8

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 Aimed at youth 12-14


 Short-term health effects
± Yellow teeth
± Bad smelling clothes
± Wrinkles
± Hairy tongue
 Research has shown that
younger children relate to
these messages
 £o evidence that it
reduces smoking
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 Tobacco, drug, and


alcohol messages
under one umbrella
campaign
 High production value
 £ovel messages
± Positive, but not
hokey
± Humorous
± Clever
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 ]nderstand your audience well


± Target at-risk youth
 Ensure that a meaningful percentage of the target
audience is consistently exposed to your message
 £ot clear if there is any one theme or strategy that
works best with youth
 Strong support for truth approach from Florida and
the ].S.

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 Higher prices prevent progression to regular use, but


do little to prevent experimentation
± Many youth obtain cigarettes from social sources (initially)
 Reasonably large effects for young adults
± Effects significantly larger than for other adults
± Effects may be decreasing over time in the ]S
 £eed to have a comprehensive tax policy that
includes all forms of tobacco to encourage
unintended effects (e.g., roll your own,
compensation)


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 Systematic reviews have generally concluded that


these programs do not produce long-term effects
 Long-term Hutchinson study viewed by many in
tobacco control as definitive evidence that these
programs are not effective
 I agreed until I read Brian Flay¶s recent review of
reviews (in ‘   
 , 2009)
 Flay re-examined the recent systematic reviews and
concluded they suffered from methodological
problems

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 He concludes that school-based smoking prevention programs can


have long-term effects if they are:
± Interactive social influences or social skills programs
± Involve 15 or more sessions up to at least 9th grade
± Produce substantial short-term effects
± Include the use of peer leaders rather than adults exclusively
± Include community components
 Implementing an effective program is challenging
± Many lists of ³evidence-based´ programs include programs that do
not meet rigorous standards of evidence
± Programs need to be implemented with fidelity
± Teachers need training
± Demanding accountability is often challenging

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 Peer-led approach, with careful selection of influential
peers (e.g., good leaders, looked up to) (Campbell et
al, 2008, ‘  )
 Engage in informal conversations with peers about
the effects of smoking and benefits of not smoking
 10-week intervention period in schools in west of
England and southeast Wales
 Randomised (it was in the ] ) trial with 29 control
and 30 intervention schools
 Results: reasonably consistent effects on youth
smoking 15

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 ]S Centers for Disease Control and Prevention recommends


focusing on promoting ³durable changes in social norms´
through policy change.
± This strategy is favored over ³individually focused educational and
clinical approaches with a smaller span of impact.´
 Implement policies that have the greatest population impact on
tobacco use (e.g., smoke-free air laws, excise taxes)
 Community coalition efforts are needed to effect policy change
in all settings, including ³homes, work sites, schools, places of
worship, places of entertainment, health care settings, civic
organizations, and other public places.´

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 Many states have programs


± American Legacy Foundation funded several states in the
early 2000s, several continue with state support
± Mixture of policy advocacy and community education
± Some focus on youth empowerment as a goal and less on
achieving concrete tobacco control outcomes
 Anti-industry focus still common
 Smoking in movies appears to be an emerging topic
of interest

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 Website description of youth activism program:


± Express your individuality
± Voice your opinion
± Communicate with your peers and others
± Make a difference
± Vet FREE gear
 Media Campaign by same message

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 Reminding p  p not


to sell cigarettes to kids.
 Organizing   to
educate youth and
adults.
 Promoting  



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Maine Indiana

ansas

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 Often focus too much on community education rather


than policy change
 Youth-oriented interventions preach to the converted
± ³Voody goody´ kids are not credible messengers for at-risk
youth
 Florida¶s SWAT
± £ews media coverage of SWAT associated with the passage
of tobacco product placement ordinances (£iederdeppe,
Farrelly, Wenter, 2007)
± £ewspaper coverage of youth advocacy efforts in FL
contributed to observed declines in current smoking
(£iederdeppe et al, 2007)

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 Focus on policy change likely to be the most


productive use of resources
± Product placement/point-of-sale ordinances
± Tobacco-free schools (focus on smoke-free grounds)
± Tobacco advertisement-free magazines
± Integrate with adult coalitions to focus on other advocacy
issues

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 Some states have focused efforts on adults (18+ or


25+), betting on a trickle down effect
± Some evidence to support this
± Perception that prevention is challenging with fluid youth
trends and preferences
± May lead to slower change among youth and young adults

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