Is state's teen anti-smoking group on target?
John Zhang posed the basic problem while brainstorming with other teenagers last week about putting more punch behind their anti-smoking message: Nothing seems to penetrate the psyche of certain kids.
Target Market members met last week.(Jerry Holt - Star Tribune)Tell them that tobacco companies are manipulating them or that smoking will kill them, Zhang said, and all too often the response is "nicotine is awesome."
Zhang, 17, and the other teenagers at the session are front-line warriors in the state's latest battle to reach those stubborn holdouts and to discourage teenagers from experimenting with tobacco. Organized through a $6.4 million campaign called Target Market, they were meeting at TMHQ, the program's funky storefront office on University Avenue in St. Paul.
A couple of miles away, at the State Capitol, legislators are debating the same question with a different twist: Is the two-year-old campaign working, and is it worth the price?
Even some tough-minded tobacco critics -- Rep. Phyllis Kahn, DFL-Minneapolis, for example -- have misgivings.
Well-done anti-smoking campaigns are necessary to counteract the tobacco industry's efforts to lure new customers, experts say. But such counter-marketing is a young science without a consensus about which of its many tactics work best. Minnesota health officials may have spoken too soon, experts said, by declaring success in advance of rigorous studies that could support the claims.
State Health Commissioner Jan Malcolm insists that the program is discouraging kids from using tobacco. There hasn't been time, she said, to back that claim with solid research, though those evaluations are underway. She acknowledged that there have been mistakes. But she and other defenders of the program say the slip-ups haven't been serious enough to justify slashing Target Market, which is one component of a larger state anti-smoking effort.
"It is extraordinarily hard to tease out the effects of all of the components," she said. "What we know from other states and the Centers for Disease Control is that the magic is in the comprehensive approach."
What's working, why?
There is no debate that any effort to tackle tobacco addiction should begin with youth. Ninety percent of those who smoke start before age 18.
Surveys by Target Market and other groups find that teen smoking has declined in Minnesota in the past two years. Target Market surveyed one random sample of about 1,000 Minnesota 12-to 17-year-olds in January 2000 and another in June 2001. In the second survey, 12 percent of the teens said they had used tobacco during the past three weeks, down from 16 percent in the earlier survey.
But many factors contributed to the decline, experts say.
â€¢ First, the culture of tobacco use has changed after years of reductions in adult smoking and restrictions on lighting up in public places. One of the strongest influences on kids' smoking is whether they see adults doing it at home. And kids today are less likely than they have been in several decades to see adults smoking anywhere.
â€¢ Second, cigarettes are harder for kids to buy because laws have restricted tobacco sales and displays.
â€¢ A third strong deterrent is price. The state Health Department estimates that for each 10 percent increase in cigarette prices, youth consumption falls by 13 percent. In Minnesota, the average price of a pack of cigarettes has jumped more than 50 percent since 1999, to $3.48 a pack, according to industry-supported studies by Orzechowski and Walker, an economic consulting firm in Arlington, Va.
And, in budget-balancing negotiations, Senate Democrats have proposed a 60-cent-a-pack increase in the cigarette tax.
State health officials assert that Minnesota teens are showing a reduction beyond those other influences. When compared with teens elsewhere, who also saw culture changes and price increases, some younger Minnesota teens had a greater decline in smoking rates, said Randahl Kirkendall, manager of the Health Department's tobacco prevention and control.
Gov. Jesse Ventura defended Target Market last week, but many influential legislators aren't convinced. The controversy flared recently when Rep. Kevin Goodno, R-Moorhead, circulated lyrics from songs performed by a punk band that Target Market hired for an event last fall. The band, Alkaline Trio of Chicago, typically performs songs laced with obscenities and references to binge drinking.
The message may have been mixed, Malcolm said, but she pleaded for critics to understand the difficulty of reaching members of the nicotine-is-awesome crowd, many of whom love bands like Alkaline Trio.
Alana Petersen, Target Market's executive director, has vowed to do a better job of screening entertainers.
Some of the program's defenders say that legislators' true motive is a short-sighted effort to balance the budget. The campaign uses about one-third of $21 million generated in interest from a tobacco-prevention endowment. House Republicans want to use more than $300 million of the endowment -- the portion that funds Target Market and other tobacco prevention efforts -- to reduce the state's deficit.
Now, even Kahn, a long-time fighter for restricting tobacco, is calling for the state to "back away" from the campaign. Instead, the Legislature should raise cigarette taxes, let the impact take effect and then rigorously assess the options for further steps, she said.
What those options might be is part of the evolving social science around teenagers and counter-marketing.
Message with an edge
Target Market is patterned after a similar campaign that began in Florida in 1998. It had two elements that were viewed as shockingly avant-garde: It recruited teenagers for community-level efforts. And it supplemented their message with aggressive, statewide marketing to make the point that tobacco companies try to addict youths to a deadly product in order to make a profit.
Like Minnesota's campaign, it used rock concerts and similar events. Like Minnesota's campaign, it featured real teens confronting tobacco executives, and edgy advertisements that adults didn't always like.
And it seemed to be effective.
A year ago, the Journal of the American Medical Association (JAMA) reported that over two years in Florida, cigarette use declined 40 percent among middle school students, and 18 percent among high schoolers. The declines, the researchers said, were greater than national averages.
Such programs "may have shifted youth norms about tobacco use," concluded the authors, public health researchers at the Florida Department of Health.
Said Malcolm: "We were heavily influenced by the success that Florida had."
Other states have adopted similar campaigns, and so has the American Legacy Foundation, a national anti-tobacco organization funded by tobacco settlement money. Its TV advertisements feature kids piling up body bags around tobacco company headquarters.
While there is ample evidence that anti-tobacco advertising is vital to mute the effects of tobacco advertising, some recent studies question whether kids are moved by the realization that tobacco companies are trying to manipulate them.
The National Cancer Institute has reported study results that found such ads do reach kids and make them more savvy, but have "no impact" on smoking intentions.
What matters to kids "is whether their friends like the product or not," said Cornelia Pechmann, an expert on anti-tobacco advertising at the University of California, Irvine, who helped write the cancer institute's report.
Her research shows that kids like the anti-industry message, she said. But the ads that seem to nudge them away from smoking are the ones that show that smoking is not cool and that people who smoke are losers. "That has been shown to be very powerful across 30 years," she said.
Not surprisingly, it's the flip side of tobacco advertising that for five decades has implied that smoking is cool, she said.
"The cigarette ads are so alluring and so subtle in how they are enticing kids," she said. The success and pervasiveness of tobacco advertising is why the Centers for Disease Control and Prevention recommends that states spend at least a third of what tobacco companies spend in countermarketing, she said.
The question remains open, however, on how the money could make a real difference.
The teen experts who perched on second-hand sofas at TMHQ last week had plenty of ideas for connecting with their peers: another booth at the State Fair this year, more TM gear -- T-shirts, CDs and concert tickets for giving away -- more music, music, music.
But they, too, struggled with the challenge of driving the connection to a no-smoking conclusion. No preaching, said Dominique Sanders, 15, of St. Paul. "I don't like to have people preaching at me," he said.
And the message has got to be cool, said Rodriguez Barnett, 17, St. Paul. Mocking adult-speak, he said, "Theoretically, my hypothesis is that we're a grass-roots organization that targets teens."