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Special ReportA Closer Look

Countering Tobacco Use Among Young Adults: New Approaches Needed

For the tobacco industry, a 22-year-old who isn't a smoker represents a challenge but also an opportunity.

The reason: While most - but by no means all - smokers start as teenagers, only about one-third are fully addicted smokers by age 18. Young adulthood, typically defined as ages 18 to 25, is when many transition from light smokers to heavy smokers - or quit. If smoking hasn't taken root by age 25, studies show, chances are good it's not going to.

This young adult period, tobacco control researchers point out, is one of transitions in roles, responsibilities, and behaviors. Many of the barriers to smoking are gone: High school is done, many people leave home for college or go to work and, for the first time, have an income and are able to purchase tobacco products legally.

image of Smoke-free event sponsored by Urban Fuel in Las Vegas These facts haven't escaped the tobacco industry, which in 2005 spent more than $13 billion to market tobacco products. Their efforts have not been in vain: At slightly below 25 percent, 18- to 25-year-olds have the highest smoking rate of any adult age group.

Tobacco control researchers have concluded that new approaches are urgently needed to reach young adults with smoking prevention and cessation messages and interventions. The importance of this task is magnified because, as numerous studies show, the best way for a smoker to avoid the enormous health risks of smoking, including cancer, is to quit at a young age.

Fortunately, results from a number of recent studies have provided a more complete dossier of young adult smokers, with new data that suggest some potentially promising avenues for influencing young adults' tobacco use behavior.

A Clearer Picture
Socioeconomics are critical to smoking behavior. It's now well established, for example, that young adults with less education and, often, lower incomes, are far more likely to smoke. In one recent study, 48 percent of survey respondents with only a high school education or less smoked - nearly twice the rate of respondents with at least a college education.

Several studies also have reported that less educated young adults try to quit as frequently as their more highly educated counterparts. However, physicians are less likely to advise young adult smokers to quit, compared with older smokers.

Several things are abundantly clear, says Dr. C. Tracy Orleans, a Distinguished Fellow at the Robert Wood Johnson Foundation. First, programs aimed at young adults with lower levels of education and income have to become a high priority.

"That represents one of the most important challenges for tobacco control," Dr. Orleans says, particularly because socioeconomic disparities have expanded over the past several decades.

And second, to better reach young adults - and all smokers, in truth - the packaging and delivery of antismoking messages and cessation interventions has to improve.

To do so, explains Dr. Orleans, a member of the public-private Youth Tobacco Cessation Collaborative, tobacco control and public health officials might want to take cues from an unlikely source, the tobacco companies.

"We have to use the same viral marketing strategies [as the tobacco industry], get online, develop connected communities, use the same approaches tailored to psychographics," she says.

Psychographics, explains Dr. Stanton Glantz, director of the Center for Tobacco Control Research and Education at the University of California, San Francisco, underlie much of tobacco industry marketing.

"They do these extensive surveys that ask many different questions," says Dr. Glantz, who, along with his colleague Dr. Pamela Ling, has studied thousands of pages of tobacco industry documents made available to the public as a result of litigation against the tobacco industry. "They would be viewed as unscientific questions: What kind of music do you like? What's your favorite movie? Do you fix your own car?"

Using statistical techniques, Dr. Glantz continues, the tobacco companies sift through the data "looking for clouds of people, who they are and what their smoking behavior is, and their marketing and messages are built around that."

And just as the tobacco industry uses psychographics to deliver its messages directly to targeted populations - via magazines, sporting events, the Internet, and bars and clubs - the tobacco control community needs to do the same, says Dr. Orleans.

New Approaches
Some small but encouraging changes are already happening. Researchers in New Zealand and the United Kingdom, for instance, have reported some success with smoking cessation programs for young adults that incorporate one of their new favorite pastimes, cell phone text messaging.

On the other end of the spectrum, in Las Vegas, a program sponsored by the Clark County Health Department called Urban Fuel sponsors regular "Smokefree and Sexy" events at some of the most popular clubs on the Vegas strip. And, says Malcolm Ahlo, Urban Fuel's 26-year-old program director, its largest event, called "Nasty Habits," has become so popular that tickets have to be purchased well in advance through a major ticketing firm.

Surveys at Urban Fuel's smaller, weekly events show that most attendees prefer the smoke-free environments. "Even the smokers," says Mr. Ahlo.

And the companies that manufacture smoking cessation medications also are catching on. GlaxoSmithKline (GSK), for example, now sponsors NASCAR events and has counseling booths at races where it also promotes its products. GSK also recently introduced Cinnamon Surge, a new flavor of its Nicorette nicotine gum. Cinnamon Surge has bright red, flashy packaging, a catchy tag line ("Fight Fire with Fire"), and a Web site with pictures of young adults that, when clicked on, lead to tips for how to best use the product and quit smoking.

—Carmen Phillips