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Mitigating alternative tobacco-use marketing aimed at the young

A combination of early school interventions and parental behaviour modelling is required to mitigate aggressive alternative tobacco-use marketing aimed at adolescents and younger children, according to two harm reduction experts, writes Chris Bateman for MedicalBrief.

They were speaking at the virtual 3rd Scientific Summit on Tobacco Harm Reduction: Novel products, research & policy, held on 24-25 September 2020 and organised by the University of Thessaly and the University of Patras with the University of West Attica and National and Kapodistrian University of Athens.

Presenting a paper was Dr Lion Shahab, associate professor in psychology at University College London and an expert in addiction, tobacco control and health psychology with a particular interest in novel behavioural and pharmacological smoking cessation interventions.

Shahab said young adults were particularly vulnerable to mass media social marketing – and to becoming addicted. Advertising alternative tobacco products on ubiquitous devices was social, sporty, sexy and conveyed as fun, attractive and harmless.

He said a youngster’s developing brain was more easily affected by exposure to addictive substances, which often made lasting changes in the pre-frontal cortex of the brain where personality development took place.

While existing psychological problems were more associated with the maintenance of smoking, the motivation for continuing was more linked to peers and parents than actual dependence.

Shahab said of globally-accepted study findings: “Very few people started smoking after the age of 21, only about 10%. From about the age of 18 we see a decrease in all-cause mortality compared to people who started smoking before this age.”

Start prevention in kindergarten

Dr Stamatoula Tsikrika, a pulmonologist at the National Centre of Emergency Care in Athens, told summit delegates that changing the overall environment or social context of smoking was vital when turning the all-important spotlight on adolescents.

“They need role models, we must expand local clean indoor air laws, enforce tobacco sales-to-minors bans at supermarkets and corner stores, target developing counties, and enforce school tobacco policies and education programmes.

“I’d recommend starting as early as kindergarten, with programme-specific training for teachers at all levels. We have to make every day a World No-Tobacco Day, not just 31 May,” Tsikrika added.

On the current global smoking prevalence trajectory, there will be an estimated eight million annual deaths attributed to tobacco use by 2030 – 480,320 per annum currently in the United States alone – he said.

In recent years, following the World Health Organization’s Framework Convention on Tobacco Control adopted in 2003, comprehensive tobacco control programmes were launched, often led by the United States Centres for Disease Control’s Best Practice advisories.

This, combined with tobacco control professionals underpinning successful billion-dollar lawsuits against the tobacco industry to recover damages for active and passive smoking, had dramatically swung corporate manufacturing toward harm reduction products.

The anti-tobacco strategy now focused on reducing demand, and if adopted at the highest levels could reduce the incidence of addiction by 30% within a decade.

Tsikrika said prominent and graphic tobacco warning labels did spark more attempts at quitting, but it was as important to address deliberately created misperceptions that some cigarettes were less harmful than others.

He identified ‘heat-not-burn’ products as different from e-cigarettes, saying they used actual tobacco, not the flavoured e-liquid typically found in e-cigarettes.

The concept behind heat-not-burn is that it allows users to experience what looks and feels like smoking a regular cigarette – but without inhaling the combusted tobacco that makes traditional cigarettes so deadly. The modality is less harmful than smoking.

Big tobacco – Adaptive and winning

Tsikrika said the marketing power of tobacco companies had increased in recent years despite legislation attempts and there was not much progress being made in controlling the global smoking epidemic.

He was convinced that prevention was more effective than cessation as an approach to reducing morbidity and mortality. “It will take a combination of political will, inter-sectoral work and scientific evidence to decide whether this is a winnable battle or simple utopia,” he added.

Shahab again stressed the importance of family-based interventions.

“Parental behaviour is a major determinant to adolescent smoking, and we have to take a mitigating approach to affect both child and parental behaviours. We must consult parents and target their psychological well-being and social behaviours to resist child smoking initiation.

“This requires high intervention levels with several face-to-face sessions across the year. That is, if we are to reduce adolescent smoking by the 23% that studies have shown possible,” Shahab said, adding that this worked best with simultaneous school interventions.

It was too early to say whether incentive-based interventions – such as offering prizes for smoke free classes after a certain length of time – worked. This was because no random-controlled studies existed yet.

However, a review in the United Kingdom of school-based intervention programmes focussed on curricula and skills to resist negative influences had shown a 12% reduction in smoking initiation, with lesser short-term successes – but dramatically improved long-term outcomes.


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