Since this paper was written, several key members of the Florida campaign have resigned or been fired. Former staffers, who achieved unprecedented success in the first year of the campaign, say new restrictions imposed by the legislature may cripple the program's efforts to prevent teens from smoking.Here's an update I wrote in December 1999.
See also: Oregon's Tobacco Tax Campaign
Turning the Rebellion
How Florida is trying to incite teens against tobacco.
Preface“Younger adult smokers have been the critical factor in the growth and decline of every major brand and company over the last 50 years. They will continue to be just as important to brands/companies in the future…”; (emphasis in the original) thus reads an R. J. Reynolds “Strategic Research Report” from 1984. The industry researchers go on to say that grabbing a share of the youth market must be a top priority, because “the brand loyalty of 18-year-old smokers far outweighs any tendency to switch with age.”
OverviewIn August 1997, the state of Florida reached a legal settlement with the tobacco industry that came to be valued at $13 billion. The original agreement called for $200 million to be devoted to a two-year effort to dissuade youth from smoking cigarettes. The Tobacco Pilot Program is now a continuing program that will spend $70 million dollars in an effort to reduce tobacco consumption through aggressive anti-tobacco marketing, coupled with a comprehensive combination of community and school-based efforts. The leaders of the program are now seeking to expand their efforts to include a greater emphasis on adult tobacco cessation.
The goals of the program are to:
The Acting Director of the program, Peter Mitchell, says the marketing and communications component, which gets about a third of the funding, is an essential piece of their overall approach. “You’ve got to have something real that they can feel and touch, that kids can feel and touch that’s out there. You’ve got to have a media campaign. I think it’s a critical thing. I think if you did everything without a media campaign, it’s pretty tough to make it work.” He says health-related instruction or messages, whether being delivered in the school, or out in the community, are important, but they not enough to swing teen attitudes toward smoking. “So much about smoking is about ‘coolness’ and about image; and those aren’t the things that teachers in schools or public health departments, do-gooders, can relate to kids. They don’t have any credibility. I mean, the Department of Health is not known for being cool… We’re a bunch of poorly dressed bureaucrats here. And then you’ve got teachers, you know, they’re not really defining what ‘cool’ is. But you get something on MTV and that gets that whole piece of it.”
Many researchers focus on Stage of Change and other health behavior concepts as organizing principles for anti-smoking campaigns (Pallonen, 1998; Norman, 1998). While the developers of Florida’s program took advice and borrowed ideas from other state programs (the Florida Advisory Board includes members from Massachusetts, California, and Oregon) as well as from the Centers for Disease Control and Prevention, the program takes a direct social marketing approach and relies heavily on “ad-man smarts.”
The media campaign contract was put out to bid. It was awarded to an advertising agency based in Miami: Porter, Crispin & Bogusky. “Our strength is our ability to get below people’s radar.” CPB President Jeff Hicks says there client list includes clothing manufacturers, bicycle makers and other companies that want to reach skeptical and media-savvy young people “who don’t want to be marketed to… Now we’ve got the biggest challenge we’ve ever had, which is to market to teenagers a message which is the absolute last message they want to hear; which is that tobacco can kill you and you shouldn’t use it. Absolutely there is no more heinous message.”
The CPB planning strategy was to start from scratch with what Hicks terms “in situ research;” that is, hanging out with young people to see first hand their interests, attitudes and behaviors. “We go and we follow them around for a day, or we go to their bedrooms and we just kind of look at the posters on their walls and take pictures of the environments in which they live. It’s to get an understanding of, not what they tell you, but what you can glean from just interacting with them.” The agency’s researchers spent time with hundreds of adolescents, both smokers and non-smokers, in communities across Florida. More traditional public health researchers have also identified the need to devote more effort at developing a detailed and nuanced understanding of adolescents (Lichtenstein, 1997).
The MessagesHicks says their research, including statewide surveys, show 100% awareness among teens that smoking is harmful. Indeed he says pushing health-related messages is likely to provoke a rebellious backlash by high-risk teens. Instead of lecturing to these teens about the dangers of smoking, the Florida program opted to use quotes from tobacco executives and others to foment a rebellion by youth against tobacco advertising.
“Evidence is now available to indicate that the 14-to-18 year-old group is an increasing segment of the smoking population. RJR must soon establish a successful new brand in this market if our position in the industry is to be maintained over the long term.” ? source: March 15, 1976 R. J. Reynolds Tobacco Company document stamped “secret.”
This statement and others like it were posted at a Teen Summit held to help launch Florida’s anti-tobacco program. “When you show that to kids, and you say, ‘this is what the tobacco companies are doing,’ it really, really makes them mad,” says Hicks. “We said, what we need to do is we really need to get them, we need to embrace that sense of rebellion; but we need to change it and we need to sort of re-direct it at the tobacco companies.”
One of the tenets of marketing is that it’s easier to sell a “positive” than a “negative” message. So instead of just repeating “Don’t smoke,” the Florida advertising team began promoting a message of liberation from cigarette sales pitches and exposing the techniques tobacco advertisers use to push their addictive product.
When high school student Jared Perez agreed to attend a teen summit on tobacco prevention a couple of years ago, he had no idea he’d wind up a TV star. Some of the ideas he offered resonated with campaign designers. Not long after the summit, Perez and another Florida teen (Josh) were on a speakerphone, making calls to executives at companies that supply or run tobacco advertising. Cameras rolled on every word, as the teens challenged the executives to take responsibility for hooking kids on cigarettes. In Perez’s favorite spot, they put a magazine ad executive on the spot:
Josh: “Do you have any
youth readership at all?”
“This is a good one,” says Perez, “because he says, ‘it’s all about money. And whenever we’ve shown this to people in focus groups, formal focus groups or just informally, that’s the message they come out with, is that they don’t care about you or your health, they just care about the money, which is the message we are trying to get across.” Perez says this sort of message works much better than tired, old health lectures. “So instead of saying smoking’s bad for you, which everybody knows anyways, it’s kinda beating a dead horse, we say, ‘the tobacco industry has lied to you, it’s manipulated you, it’s using you, and now that you know that, do you still want to smoke, do you want to be a pawn, and pay with your life and your pocketbook?”
Perez says many anti-smoking campaign make the mistake of appealing primarily to non-smokers, and even alienating smokers. “You don’t want to say, well, ‘Smoking is stupid, so you smoke, you must be stupid, so don’t smoke.’ You know, well that just makes the people that do smoke go, ‘Forget you, I’m not stupid, you’re the stupid one.’ and what you get is a conflict there, and that helps nobody.” He says an effective campaign has to be “cool, hip and urban,” in order to appeal to those teens mostly likely to fall for the “cool, hip and urban” advertising tactics of the tobacco industry.
Adolescents are not a homogeneous group. Significant differences in smoking behaviors have been documented not only for teens with different levels of educational achievement, but also between boys and girls, whites and minorities, and others sub-groups. Sussman (1998) reported that girls were tempted to smoke in more social situation than were boys. Gender differences were also reported by the Surgeon General (1994) and even a long-term study of adolescent smoking prevention efforts in India (Vartiainen, 1998). A study of prospective social-psychological risk factors for smoking acquisition found only white ethnicity to be statistically significant, although the researchers suggested measuring the factors at closer intervals (Wang, 1999).
A gender analysis of the program (Worden, 1996) found that media messages developed specifically for girls (offering strategies for managing social situations and presenting female role models and testimonials) appeared to produce the intended effect. The researchers say their technique illustrates general methods of reaching clearly defined sub-groups in a population.
The Florida anti-tobacco program recognizes the need to appeal to sub-groups by funding special ethnic activities and appeals, and producing media spots starring girls. One spot features a phone call to an advertising account coordinator for Lucky Strike cigarettes:
Girl: I have a question.
What is the ‘lucky’ part about Lucky
Academic research and evaluations of other state campaigns, particularly California’s effort, support the effectiveness of anti-industry messages (Goldman, 1998; Balbach, 1999).
Along with the television and radio spots, the Florida campaign operates a web site (www.wholetruth.com) and it runs print ads. Perez describes a print ad that slams moviemakers who use cigarettes as a character development short cut. “It looks like a movie rating, and it says “L” for lazy, and it says the makers of this film were too lazy to think of another way to make their character look cool, sexy, or rebellious, instead they’ll just smoke.’”
The Florida campaign also tries to project a positive tone by promoting freedom from tobacco as a “brand.” Program director Mitchell says, “We’ve designed the marketing program to sell a brand, the “Truth” brand; so we are actually selling them something, rather than just telling them not to do something.”
The Florida campaign carefully avoided the types of approach often used by industry-sponsored campaigns that are purported to be aimed at preventing youth from smoking; such as “smoking is not for kids” or “smoking is an adult decision.” Indeed, some internal tobacco marketing documents portray these messages as effective methods for increasing the desirability of smoking among teens:
“…An attempt to reach young smokers, starters, should be based, among others, on the following parameters:
The Philip Morris spots that Hicks refers to are part of a national campaign launched in December 1998. Some of the Philip Morris messages, such as those pointing out that the majority of teens don’t smoke, are in line with the recommendations of leading public health experts. However, while this campaign is too new to have been thoroughly reviewed, critics point out similarities to earlier industry-sponsored campaigns. For example, a Philip Morris statement says, “the ads celebrate adolescents’ decisions not to smoke, to make smart decisions, to think for themselves.” But that approach can have a perverse result, according to an article published in the Journal of Family Practice: “programs with an emphasis on decision making stimulate tobacco use among children,… Children who might never have considered tobacco use to be an option are taught that they must make a decision about using tobacco. Not surprisingly, some decide to try it.” (DiFranza)
In one Philip Morris TV spot an interviewer asks some teens if their friends tried smoking because of peer pressure. The teens agree, replying “Yeah, but that’s dumb though, ya see what I’m sayin’? I mean the reason that it is dumb, not they’re not dumb, but that’s a stupid reason to do anything.” A second teen chimes in, “It’s stupid as far as I’m concerned.”
The message resembles just the sort of approach that Jared Perez warns simply creates a “civil war” between young smokers and non-smokers. A progress report from the Florida campaign blames the Philip Morris ads for sowing confusion among the state’s teens. “Since its commercials, which are preachy and poorly done, run in the same demographic buy as the ‘Truth’ commercials, which have already been established as irreverent and effective, Philip Morris’ efforts have proven problematic. Many teens assume the Philip Morris ads are ‘Truth’ ads and have asked why the campaign has “gone lame.”” (Florida Dept. of Health, 2/4/99)
Because the recognize the power of media messages, the developers of the Florida anti-tobacco campaign worry about counteracting the effect of smoking by characters in movies and on television. It’s a growing concern. A recent study showed that while the amount of smoking in the top movies declined during the 1980’s, it’s now back up to levels seen in the 1960’s. According to researchers, compared to people in real life, lead characters in “reel” life are four times as likely to smoke. (Stockwell, 1997)
Jeff Hicks says the pro-smoking message put out by some moviemakers is just overwhelming. “You look at Leonardo DiCaprio in Titanic, and you think of what that did for making tobacco seem romantic, it’s something we couldn’t undo with any amount of advertising.” So the Florida program aims at the source, organizing efforts by teenagers across the state to mail more than 20,000 postcards to celebrities asking them to portray tobacco use responsibly and accurately.
Among those who have accepted the
Flynn reported (1992, 1996) that mass media campaigns coupled with school-based education produced significant and durable reductions in smoking acquisition in a cohort of students compared to students in control communities. However, when the program results were analyzed for their effects in sample sub-groups, a significant effect was found only among high-risk youth (Flynn, 1997).
University of California-San Francisco professor Stanton Glantz says media campaigns are necessary to get attention, but they must be followed by work, in the community and in legislatures, that brings real change. He and other experts believe that youth will ultimately and finally reject tobacco only when the adults in their lives, and society in general, reject tobacco; so their efforts must go beyond the youth audience. “I think, if you look at when teen smoking started to increase, it was in the early ‘90’s, which is when the public health groups stopped talking about a smoke-free society and started talking about keeping kids from smoking. Now that wasn’t the only thing that happened, but I think that contributed to the upturn in youth smoking.”
Even though Florida’s campaign has a focus on youth, the program is based in part on “a belief in the right of youth to live in a safe, tobacco-free environment.” So the program’s managers are making plans to support smoking cessation for adults.
As Jared Perez prepares to graduate from high school, he’s already contemplating anti-smoking tactics that will work on college campuses, among youth who are now old enough to be the legal targets of tobacco marketing. “And not just being manipulated into buying an expensive shoe,” he notes, “but being manipulated into ruining their health, until they die.”
College students are a market with increasing importance, both for tobacco companies and anti-tobacco activists. While numerous studies document an inverse correlation between education level and smoking (Gfroerer, 1997; Baranowski, 1997), a recent report by Wechsler (1998) that smoking on college campuses had jumped by 27.8% over a 4-year period challenges any simplistic interpretation of the relationship.
Political circumstancesThe Florida Tobacco Pilot Program must maintain a base of political support in order to continue its work. Although Florida will receive billion of dollars for decades to come from its legal settlement with the tobacco industry, the anti-tobacco campaign must seek funding from the state legislature each year. The program was a personal priority of the late Gov. Lawton Chiles. His successor, Gov. Jeb Bush, has been supportive, according to program leaders. Program director Peter Mitchell says the new state Health Secretary has named tobacco control the top prevention priority for the Department of Health. That evidence of support notwithstanding, the program has trimmed its budget request for the coming year from $70 million to $61.5 million.
The original program focus on youth helped make the anti-tobacco campaign acceptable to tobacco industry representatives during legal settlement negotiations. Now the program wants take advantage of a key loophole in its mandate: the goal of creating a tobacco-free environment for youth. The program leaders are asking for specific authorization to expand smoking cessation efforts aimed at adults. Such a tactical shift risks provoking an industry counter-attack. A spokeswoman for Philip Morris, Mary Carnovale, says the demand for a smoke-free society, as a necessary step toward protecting youth, is unacceptable. “I don’t think we agree with that, and I think that adults have the right to make the choice to smoke. It is a free society. We don’t think the rights of adults should be impinged upon, and we will stand up for that very strongly.”
EvaluationIn the Florida Tobacco Pilot Program, “Research and Evaluation” is a program component on equal footing with other components, with a budget for the current year of $4.3 million. The program has established evaluation centers on university campuses around the state, including FAME, The Florida Anti-tobacco Marketing Evaluation at Florida State University. FAME includes baseline and ongoing surveys of youth across the state, as well as national surveys that can offer a comparator for changes in Florida. Other evaluation activities included almost two dozen focus groups in the last three months of 1998 alone (Florida Dept. of Health, 2/4/99).
Although the “Truth” campaign is barely a year old, Jeff Hicks says it is exceeding its goals. “We have almost 93% awareness of our campaign and of “Truth” in the state, which is just unbelievable, to have launched a ‘brand’ and have that kind of awareness in such a short amount of time.” Hicks believes they will soon be able show that the campaign is actually reducing the number of teen smokers.
His agency, Crispin, Porter & Bogusky, as well as all other contractors with the state program have a vested interest in demonstrating their effectiveness. Program director Peter Mitchell points out, “Our major contracts are performance-based. In other words, our vendors only get paid if they perform. In the case of, for instance, our ad agency, we have to see a change in attitudes among youth about tobacco, and then we have to see actually a change in behavior, where they, after two years, have to lower prevalence. That is a very ambitious goal, but one that is now in the contract for the ad agency.”
In addition to almost universal
awareness of the program,
show youth attitudes in Florida shifting in the right direction.
Percentage of teens who agree:“Smoking has nothing to do with whether or not a person is cool.”
Before After 6 mos.
“Tobacco companies try to get young people
to smoke because older
quit smoking or die.”
As these results indicate, the Florida Tobacco Pilot Program is off to an encouraging start. Nevertheless, program director Peter Mitchell predicts a prolonged struggle. “This is really, when you come right down to it, a battle for market share; and I’m trying to take it away from the tobacco companies.” The master marketers of industry are not likely to surrender without a fight.
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