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Smoking in children and adolescents: “Uncool”, but prevalence increases with age
The WHO campaign to mark this year's #WorldNoTobaccoDay drew particular attention to the danger for the younger generation: Even the consumption of a few cigarettes in childhood can have a strong influence on later smoking behaviour1. It is no coincidence that the tobacco industry specifically targets children and teenagers with manipulative marketing strategies. In its campaign, the WHO makes the following striking statement: "If your product killed 8 million people each year, you’d also target a new generation"2. In other words, if a product kills a large proportion of its consumers, the manufacturing company must constantly look for new customers, preferably young ones who can be retained for as long as possible. Of course, this is problematic, because young people have comparatively weak attitudes or knowledge and are therefore particularly receptive to attractive marketing messages3. Especially the age between 10 and 18 years is an important period in which children and adolescents may come in first contact with addictive substances. Environmental influences and first decisions made in this period have a great impact on behavioral development which can last a lifetime.
Picture: WHO campaign on World No Tobacco Day.
Together with partners4 from the "Programm Gesunde Schule Tirol", the CSHI (Center for Social & Health Innovation) has conducted a survey with over 1.000 children and adolescents aged 10 to 18 years. Around 15 percent of the children and adolescents stated that they had smoked a cigarette at least once in the previous week (see Figure 1). However, differences are observable between school types and age cohorts. Participants attending vocational schools showed a significantly higher smoking prevalence than students from other schools. This tendency remains robust when looking at the age cohort between 16 and 18 only (students of the NMS and lower cycle of AHS are naturally excluded). Furthermore, the smoking prevalence increases strongly with age (see fourth graph in Figure 3). Interestingly, young people do not perceive smoking as particularly "cool". This is also the case for older students, who also tend to rate smoking as uncool. However, the perception that smoking is fun and something pleasant is more prevailing and also increased more notably with age.
Figure 1: Smoking prevalence among participating children and adolescents.
One reason for this could be that the tobacco industry is increasingly addressing young people with the "pleasure" aspect of tobacco products, using tailored marketing methods for children and adolescents. For instance, the WHO criticizes the advertisements of sweet and fruity flavors, product placement and product presentation which is particularly attractive to children (e.g. proximity to school, eye level, social media, influencers, coloring of products and product size), as well as the distribution of free samples at places and events frequented by children and adolescents5,6. A major problem is identified by the strong focus on the entertainment industry designed for children and adolescents. This includes glorifying tobacco products in video games, using cartoons to promote electronic nicotine products or financing child-friendly influencers to advertise tobacco products5,7,8.
Figure 2: Smoking prevalence by school type and age: BS = vocational school, NMS = secondary school, AHS/BHS = college-bound high school / college-bound vocational high school. The error bars show the 95% confidence interval.
Although children and adolescents realize that smoking is not necessarily "cool", smoking may become increasingly associated with fun and pleasure. The tobacco industry uses creative marketing strategies to introduce the younger generation to tobacco consumption at an early age. Countermeasures, i.e. government regulations, must be actively taken to reduce the opportunities to promote tobacco products, and educational measures are needed to confront parents, children and adolescents more actively with the health risks of tobacco products.
Figure 3: The relationship between age and attitudes and between age and smoking prevalence. The shaded area shows the 95% confidence interval.
1. Jackson, C., & Dickinson, D. (2004). Cigarette consumption during childhood and persistence of smoking through adolescence. Archives of Pediatrics & Adolescent Medicine, 158(11), 1050-1056.
3. Buijzen, M. (2007). Reducing children's susceptibility to commercials: Mechanisms of factual and evaluative advertising interventions. Media Psychology, 9(2), 411-430.
4. Bildungsdirektion, Versicherungsanstalt öffentlich Bediensteter (BVA), Land Tirol, Pädagogische Hochschule Tirol (PHT), ÖGK - Landesstelle Tirol
5. World Health Organization (2020). Tobacco and related industry tactics to attract younger generations https://www.who.int/news-room/q-a-detail/tobacco-related-industry-tactics-to-attract-generations [Accessed 02.06.2020]
6. Vasiljevic, M., Petrescu, D.C., Marteau, T.M. (2016). Impact of Advertisements Promoting Candy-Like Flavoured E-Cigarettes on Appeal of Tobacco Smoking Among Children: An Experimental Study. Tob Control, 25(2), 107-112.
7. Truth Initiative (2018).Some video games glamorize smoking so much that cigarettes can help players win. https://truthinitiative.org/research-resources/tobacco-pop-culture/some-video-games-glamorize-smoking-so-much-cigarettes-can [Accessed 02.06.2020]
8. Jackler, R.K., Ramamurthi, D. (2017). Unicorns Cartoons: Marketing Sweet and Creamy E-Juice to Youth. Tob Control, 26(4), 471-475.