“Sell when you can, you are not for all markets.” Wm Shakespeare TABLE OF CONTENTS Welcome Waiting for the ink to dry Priority focus - Young women Smoking among 18-24 year old college students Beyond the campus - Smoking among non-collegiate 18-24 year olds Market appeal The unwritten pages - Blue collar workers, unions, and the tobacco industry From the field - Vermont program aims to reach non-college young adults Resource spotlight A helping hand Resources and links Let’s talk. . . Special thanks

Ah, to be 18 again . . . taking the bull by the horns, living life to its fullest, feeling indestructible . . . making the transition to independence, adopting life changing behaviors, being targeted by the tobacco industry as one of the smokers of the future . . . the life of the young adult.

As the tobacco industry seeks to “renew the market,” attention has concentrated on 18–24 year olds, a group that is as diverse as it is vulnerable. And the tobacco industry has been effective: 18–24 year olds are the only age group that smokes more now than ten years ago.

In this issue of ttac exchange, we bring you information on this complicated age group. Clearly this is a key challenge for tobacco control advocates, and it is complicated by the diversity of this age group. Gender, education level, income level, membership in a union—research is beginning to shed light on how all of these factors influence smoking behavior, and how tobacco control interventions might target specific sub-groups among 18–24 year olds.

Let’s make the most of what we do know, and strive to fill in what we don’t know.

Dearell Niemeyer, MPH
Director, Tobacco Technical Assistance Consortium

“Being reckless and carefree, it’s like we’re drawn to things that make us cool, that we are not trying to conform to what makes us good people, that we are not really respected as adults yet anyway and we are not children anymore.” (CDC Focus Group with 18–24 year olds*)

“This is not a homogenous group. It has pronounced disparities,
which emphasizes the need for interventions to be designed accordingly.”
–Reba Griffith, CDC Office on Smoking and Health.

Tobacco control advocates face some unique challenges with young adults.

• Smoking rates differ by educational level, income level and gender.
• Attitudes and behaviors towards smoking vary significantly within this group.
• The tobacco industry can legally market to this group, and does so.
• Interventions are relatively easy to implement at the college venue, but outside that organized environment no other obvious central location exists.

And the importance of this age group can’t be overstated.

• It is the only age group with a rise in smoking prevalence in the past decade.
• These are key years in young adult lives, when many are in transition and embarking on new experiences.
• It is a time when young adults are vulnerable and open to influence, and, openness, and one when lifetime habits are solidifying.
  

The majority of tobacco control programs focus efforts on preventing the onset of smoking for children and teens, and cessation for older adults—issues which serve as the first and last chapters of tobacco control. Young adults, also known as the 18–24 year olds, are the blank pages in between . . . waiting to be completed.

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“Frankly, we don’t have a clue how to reach young women who aren’t in college.
So many of them are part of our communities’ work forces, but they are not unionized—
I’m talking about technicians, beauticians, etc. So far, the best we have come up with is to use mass media.
We need to identify what these young women are reading and watching.”
–Victoria Almquist, Manager-Outreach, Campaign for Tobacco-Free Kids

So how do we reach 18-24 year old women? Most young women in the workforce are not part of one definable group, such as a union, that can be reached with a single intervention. Instead, research is focusing on the subtle differences between groups of young women and the tactics that work for each sub-group.

TARGETING YOUNG WOMEN& COUNTERING ADVERTISING EXAMPLES

Project Virile Female
In 1990, the Women vs. Smoking Network, a women’s tobacco control organization, uncovered an RJ Reynolds plan to begin marketing its new brand, Dakota, to women. The brand, which was code-named Project Virile Female in marketing documents, was to target young women aged 18-20 years old. The documents detailed several proposed strategies for attracting young women to the new cigarette. Using the documents it had uncovered, the Women vs. Smoking Network went on a media blitz, bringing negative media attention to the tobacco company. In the face of that criticism, RJR continued to test market Dakota, but the brand was withdrawn after two years because of low sales. Source: SGR, 2001, See full case study p512-51

Women Thing Music
In 1997, Women Thing Music, a new record company owned by Philip Morris Tobacco Company, offered unsigned female music artists lucrative recording contracts and an opportunity to be featured on a new CD. This CD, targeted toward young women, was available only with the purchase of two packs of Virginia Slims cigarettes. Outraged by this promotion, celebrity artists organized a counter-music campaign, Virginia SLA. Source: SGR 2000 Reducing Tobacco Use; SLAM website; Press release

Find Your Voice
In December 1999, Philip Morris launched a new $40 million campaign targeting women, particularly minority women, with the slogan "Find Your Voice." The ads have been featured in a variety of publications such as Glamour, Ladies’ Home Journal, People, and Essence. In response to this ad campaign, several women’s groups, led by the American Medical Women’s Association and the National Coalition FOR Women AGAINST Tobacco, joined together on a campaign to counter the tobacco industry’s targeting of women. Source: SGR, 2001 p. 502; Press release from campaign; Philip Morris Removes Slogan From Ads In Second Attempt Responding to Critics

CESSATION

One Quarter of Young Women Smoke—They Want to Quit But Only Three Percent Succeed
New data from the American Legacy Foundation surveys shows that, despite recent declines in tobacco use nationwide, a quarter of young women (16-24 years old) are smokers. Perhaps more alarming, although 83% said they believe they can quit smoking, and 60% tried to quit at least once in 2002, less than 3% succeeded in quitting smoking for at least a year.
Additional statistics available on quit attempts & wanting to quit: Fact Sheet on Young Women and Smoking (American Legacy Foundation)

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“I think smoking is also a very social thing and college is the time like when you have the most
socialization going on. I don’t think that’s an avoidable fact. Like if you’re in front of the library,
if anywhere, you can sit and hang and have a cigarette and it’s fun . . .”
(CDC Focus Group with 18–24 year olds)

According to a national study, 26.7% of college students smoke cigarettes, 28% of college students who smoke begin to smoke regularly at or after the age of 19, when most were already in college. Source: 1997 Harvard Alcohol Survey Many who start to smoke want to stop, but can’t. Approximately 70% of smokers report wanting to kick the habit Source and 50% of college students surveyed tried to quit in the previous year.

There are many reasons for the increased cigarette use among this population, including an inaccurate perception of the smoking norm, more freedom to make personal decisions, stress, increased visibility of smoking on campus, increased peer pressure, and heavy targeting by the tobacco industry.

Programmatic gaps do exist. Few intervention studies have been conducted on college prevention programs—so there is little information on effectiveness. In addition, few cessation programs are available on college campuses, and the ones that are available have not been evaluated to measure effectiveness.

For more detailed information and resources on smoking among 18–24 year old college students, click here: Get the facts from ttac!

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“I’m really tired of people telling me not to smoke . . . I mean, you’re just not in the mood to hear it . . .
You know smoking is bad for you—I have the facts . . . I know—it’s not like I don’t know what I’m doing.
I just don’t constantly need someone telling me what to do. I can make my own decisions.”
(CDC Focus Group with 18–24 year olds)

There are striking differences in the smoking prevalence rates between non-college educated 18–24 year olds and colleges students of the same age. The 2002 Monitoring the Future Survey reports that the differences in smoking between these two groups are seen prior to high school graduation, with marked differences in the prevalence rates of the college bound high school senior versus the non-college bound high school senior.

There have been multiple explanations for the differences between the non-college 18-24 year olds and the college students of the same age. These include MSA restrictions, marketing trends of tobacco companies, and the lack of a central venue for non-college 18–24 year olds.

For more detailed information and resources on smoking among 18–24 year old non-college students, click here: Get the facts from ttac!

“There is evidence of a cohort-effect among smokers. If a class or birth cohort establishes a high rate
of smoking at an early age, then the smoking rate is likely to remain high through the life period,
simply because of addictive nature of tobacco.”

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According to CDC, 28.7% of young adults ages 18–24 are smokers.

This age group is appealing to the tobacco industry
“The tobacco industry is well aware of the market potential of this age group. They recognize that many young adults are still in the early stages of smoking initiation, and it is their goal to solidify smoking habits and increase cigarette consumption. The tobacco industry is particularly interested in the non-college young adult, as this group is more likely to become established smokers than their college counterpart. Another key reason is that advertising and marketing is not restricted by the Master Settlement Agreement (MSA), as the MSA only restricts marketing to youth 17 and under.”
–Deborah McLellan, Executive Director, with the Organized Labor and Tobacco Control Network

The Campaign for Tobacco-Free Kids provides an excellent summary of the facts.
Click here to view: Tobacco Company Marketing to College Students since the Multistate Settlement Agreement Was Signed

The tobacco industry is interested in blue collar workers
“Blue collar workers are the tobacco industry’s best and most loyal customers. Analysis of smoking prevalence data have shown that occupational class matters – it has a significant independent effect on smoking and prevalence in and of itself. Blue collar workers are 71% more likely to smoke than white collar workers. As compared to white collar workers, blue collar workers are heavier smokers, start to smoke earlier, and are less successful in quitting smoking. The tobacco industry sees this group as key to their growth.”
–Deborah McLellan, Executive Director, with the Organized Labor and Tobacco Control Network

The tobacco industry targets young women
“Most people are familiar with the “Find your voice” campaign that Virginia Slims ran for a long time that featured women of different ethnicities with slightly different messages. Given what we know about smoking and damage to the throat and lungs, this proclamation was a slap in the face. There are countless other examples of offensive advertisements that target and feature women. It’s been nearly 2 years since any brand has run print ads—the tobacco companies are focusing their promotional dollars on couponing and point-of-sale tactics, instead.”
–Victoria Almquist, Manager-Outreach, Campaign for Tobacco-Free Kids

Tobacco Control article, From Social Taboo to "Torch of Freedom": The Marketing of Cigarettes to Women,
available at: http://tc.bmjjournals.com/cgi/content/full/9/1/3.
This article explores the history of tobacco marketing to women. An accompanying PowerPoint presentation,
“Marketing Tobacco to Women,” includes samples of advertising from around the world:
http://tc.bmjjournals.com/misc/powerpoint.shtml

The industry documents provide evidence
“There is considerable evidence in industry documents revealing Big Tobacco’s strategies. Consider the following two examples . . .” –Deborah McLellan, Executive Director, with the Organized Labor and Tobacco Control Network

To learn more about what the tobacco company internal documents say about marketing to this group,
see the article by Pam Ling ad Stan Glantz:
Why and How the Tobacco Industry Sells Cigarettes to Young Adults: Evidence from Industry Documents

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Exchange visits with Deborah McLellan, Executive Director, with the Organized Labor and Tobacco Control Network to explore further unions and the tobacco industry.

“In a world filled with stress, you’ve got to smoke.”
(CDC Focus Group with 18–24 year olds*)

Efforts focusing on the non-college population are pages yet to be written in the tobacco control and prevention handbook. Young adults not in college are more difficult to reach, and they face different life issues than the college crowd. But it is precisely this group that needs to be reached the most, as they are more likely to become and remain smokers. As we’ll see, unions and trade associations are just one way to make some inroads.

What strategies are effective in decreasing smoking rates among blue collar workers?
“First, I think it is important to realize that many strategies are not working simply by looking at prevalence rates. However, research has shown that a key component to reduce smoking among this population group is by relating smoking to broader occupational health issues, such as reducing exposure to all hazards, at the worksite, including smoking and exposure to secondhand smoke. It is important to take a holistic approach to blue collar workers.”

Are there gaps in research for this group?
“Yes, there are many gaps that need to be addressed. One notable issue is that a specific objective to reduce smoking among blue collar workers was included in Healthy People 2000, but dropped in Healthy People 2010. It is critical that this group not be overlooked and that it continues to be monitored.”

Talk to us about cutting-edge efforts to reduce smoking among blue collar workers.
“Here are some examples of a few innovative approaches:”

• The Organized Labor and Tobacco Control Network is a project which seeks to reduce class-based health disparities due to high levels of tobacco use and exposure to secondhand smoke among working people and their families. With seed funding from the American Legacy Foundation, it seeks to conduct research to find the most effective methods of reducing smoking among blue collar workers and to build capacity by providing training and technical assistance to, and forging collaborations between the labor and tobacco control movements. Although it is a national project, the Network currently provides training and technical assistance to labor unions and tobacco control organizations in five states: California, Massachusetts, Michigan, Minnesota, and New York.
  For more information about the Network, check out the Project web site.
   
• In California, Project BUILT – State Building and Construction Trades Council of California, is working with the tobacco control community and the building trades to reduce exposure to secondhand smoke in union halls and members’ homes, to include smoking hazards in health and safety training of union apprenticeship programs, and to implement and enforce voluntary workplace smoking bans. Project BUILT also aims to increase smoking cessation among members and to educate building trade members about how the tobacco industry targets blue collar workers.
  To learn more about Project BUILT, go to the Project web site.
   
• In Massachusetts, the Massachusetts AFL-CIO, and in particular the iron workers, are working with the Dana-Farber Cancer Institute on research projects to develop methods to reduce smoking among their members. Iron workers traditionally have a very high prevalence of tobacco use.
  For more information contact: Deborah McLellan at Deborah_McLellan@dfci.harvard.edu

Tell us about the historical relationship between unions and the tobacco industry?
“By reviewing industry documents we are trying to better understand the tobacco industry attempts to persuade labor leaders to support the industry’s efforts around tobacco control policy issues such as worksite smoking bans and excise taxes. Some unions, such as the Bakery, Confectionery and Tobacco Worker’s Union, have been more open to industry influence than others, as some of their members are employees of tobacco companies. However, since the EPA made second-hand smoke a Class A carcinogen, unions have become increasingly interested and involved in this issue What was once thought of as a moral issue, outside the purview of unions, has now become a health and safety issue for which unions fight.

It is important to understand that if a union appears to be siding with the tobacco industry the union may in fact be taking a stand against management. For example, a smoking ban instituted by management without labor input in a unionized work setting may be opposed by labor. This does not necessarily mean that the union is pro-smoking—most are not. It means that the union is protecting the voice of its membership by protesting the unilateral action by management.”

How about the historical relationship between tobacco control advocates and unions?
“Unions are not a homogeneous group, so the relationship between tobacco control advocates and unions has varied. The National Education Association, for example, has passed a number of tobacco control policies and has developed a comprehensive school-based program on tobacco prevention, media literacy, and advocacy. The Association of Flight Attendants, AFL-CIO, was influential in garnering support for landmark legislation that banned smoking on domestic flights of six hours or less. Other unions have been less interested in working with tobacco control.”

What advice can you give tobacco control advocates wanting to partner with unions?
“Four things come to mind when partnering with a union.

1. Do your homework prior to the initial contact. Know what specific labor issues are important to the union and if someone within the union has a personal interest in smoking. Look to see where interests overlap. It does not make sense, for example, to approach a union about a worksite smoking ban if its membership works primarily outdoors.
    
2. Remember that unions are political organizations whose “bread and butter” issues are wages, hours, and working conditions. “Health” may not be a priority. Many unions today are fighting for their survival. When approaching a union, be aware that they will ask and expect something in return for their support, such as cessation resources for their smokers.
    
3. Involve them from the beginning. As with any effort to build a strong partnership, it is important that labor unions be involved in coalition efforts from the beginning of a campaign, and not brought in at the end simply to rubber-stamp decisions already made.
    
4. Acknowledge that a class bias may exist when working with this group. While this class bias will never be completely eliminated, it is important to acknowledge that it exists.”

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ttac exchange spoke with Barbara Moeykens, Social Marketing Specialist, with the Tobacco Control Program, in the Vermont Department of Health about a new program designed to reach the non-college young adult population.

What can you tell us about young adult smokers in Vermont?
“Young adult smokers are the fastest growing group of smokers in Vermont. We know that this group is being targeted aggressively by the tobacco industry, yet the tobacco control community lacks the research and strategies needed for successful interventions. Virtually all of the published literature focuses on college populations, and we have reason to believe that non-college young adults have even higher smoking rates than those attending college.”

What did you find out about the behavior of non-college young adults?
“From a review of the published literature, inquiries to other states, and our own focus group findings with non-college young adults, the target population can be characterized as follows: They are a group in transition. Some live independently, but many are still living with their families. They’re likely to be working low wage jobs. Many are feeling as though they have more responsibilities and feel more anxiety than at earlier points in their lives. Some also expressed feeling lost, and even have a sense of failure. Young adults find future health concerns all too easy to dismiss because they assume they’ll quit long before it’s an issue. But proof of immediate health concerns is shocking and has an impact; it destroys their assumption that this is not something they’ll need to worry about.”

Tell us about your program
“First let me emphasize that we are just beginning to implement our program. Given our findings, we developed four key strategies to specifically reach the non-college young adult population:

Strategy 1: Use friend networks to promote quitting.
We know that social networks are very important to young adults, so one key strategy is to encourage them to quit in teams. They would form their own support network by quitting as a team, and they would use the Vermont Quit Line to register their team, find out about available local resources, and to obtain self-help materials.

Strategy 2: Reach young adults where they are smoking.
Another strategy is to reach young adults where they are smoking, such as bars, colleges, and work settings. Events in these settings would provide information about the contest, a sign up sheet to register teams, and other promotional materials.

Strategy 3: Promote use of the Quit Line as a central resource; giving them a unique reason to call.
Strategies aimed at this group need to move beyond traditional means of communication. We know that this age group is not inclined to use traditional quit line services, and so we need to offer something that has particular appeal to this age group through the Vermont Quit Line. We will create radio advertising that will direct them to the Vermont Quit Line to register their team in the Quit to Win contest.

Strategy 4: Break through the tendency to dismiss health concerns by providing young adults with a real-life story of someone experiencing health effects at an early age.
Specifically, we want to use TV to air segments of Pam Laffin’s story – the young woman and mother of two who died from emphysema at the age of 31. More information on the ads can be found at http://www.cdc.gov/tobacco/mcrc/mass.htm.
For an interview with Pam Laffin: http://www.pbs.org/healthweek/featurep5_335.htm

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exchange has chosen to spotlight two key resources this issue—one already available and another in development.
Read on for more details . . .

Tobacco Free U—Tobacco control on college campuses
In recent years, tobacco control professionals have been making headway to address smoking among college students. BACCHUS and GAMMA has been on the forefront in developing resources for this population. Last year, they launched a web site for college students and those working with college students: Tobacco Free U. This site provides a wealth of background and programmatic information.

If you’re looking for information about tobacco use and its consequences, the site provides facts and figures about:

• tobacco use among college students
• consequences of smoking
• secondhand smoke, and
• tobacco industry marketing.

The site features a range of programming ideas to help create a “tobacco-free campus” and get students involved in tobacco control on campus, like:

• Clean Indoor Air Policies: Students can learn about recent successes in campus policies, how to build a campus task force, and see a sample policy.
• Cessation: The site includes specifics on cessation from how to help smokers quit to how to build a campus wide cessation program.
• Comprehensive campus program ideas, including information about social norms approach, curriculum infusion, and the Great American Smokeout.
• Evaluation: How to take steps to evaluate a program’s success.

Visit Tobacco Free U to get started on creating a tobacco-free campus.

An Upcoming Resource for Young Adults
The College Tobacco Prevention Resource (CTPR) provides practical information, ideas, and guidance to college leaders involved with tobacco prevention. The CTPR favors a comprehensive approach to prevention that combines traditional education and cessation programs with efforts to create a physical, social, and policy environment that supports tobacco-free campuses. As colleges emerge as the new front line in tobacco prevention, CTPR aims to provide resources to assist with the planning, implementation, and evaluation of effective campus tobacco policies and programs.

The new CTPR web site, which is slated to launch in November, contains:

• Facts on college tobacco use
• Strategies for comprehensive college tobacco prevention
• Recommended steps for taking action on your campus
• Case Studies
• Glossary and Links
• Frequently Asked Questions

The Case Studies section is particularly important. Here, visitors to the site can access information about program or policy descriptions, the history leading up to proposed changes, the processes by which the changes took place, the results of the changes, plans for future program or policy implementation, and lessons learned.

CTPR was developed by the National Center for College Health and Safety’s College Tobacco Prevention Initiative.

For more information: ttac@sph.emory.edu

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Let ttac help you prioritize how to fill in the pages of 18-24 year olds in your community.

Consider the following services available through ttac specific to young adults:

• Connect advocates who are interested in focusing on young adults.
• Work together to develop creative ways to counter tobacco industry point of sale flexibility.
• Identify effective prevention and cessation tools and strategies specific to young women and other young adult priority groups.
• Assist in developing strategies for surveillance among blue collar workers.
• Disseminate information to states on blue collar workers and unions.

Get the facts from ttac!

• Click here to view information on Smoking among non-collegiate 18-24 year olds
• Click here to view information on the Smoking among 18-24 year old college students

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• Trends among 18-24 year olds
• Tobacco industry marketing to 18-24 year olds
• For and about college students
• Tobacco control and unions
• For and about women
• Research articles on young adults

Trends among 18-24 year olds

Cigarette Smoking Among Adults—United States, 2001
This 2003 Morbidity Mortality Weekly Report examines prevalence data from the National Health Interview Survey on adult cigarette smoking. Current smoking prevalence was highest among persons aged 18--24 years.

Monitoring the Future: National Survey Results on Drug Use, 1975-2002. Volume II: College Students and Adults Ages 19-40
This 2002 report of the University of Michigan’s Monitoring the Future study covers trends in tobacco use among young adults, including comparisons between college students and adults not in college.

Prevalence of Current Cigarette Smoking Among Adults and Changes in Prevalence of Current and Some Day Smoking --- United States, 1996--2001
This 2003 Morbidity and Mortality Weekly Report examines data from the Behavioral Risk Factor Surveillance System on adult cigarette smoking, including young adult.

Results from the 2002 National Survey on Drug Use and Health: National Findings
This 2003 Substance Abuse and Mental Administration reports on cigarette use among young adults, including comparisons by gender and education level.

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Tobacco industry marketing to 18-24 year olds

Tobacco Company Marketing to College Students since the Multistate Settlement Agreement Was Signed
This 2003 Campaign for Tobacco-Free Kids fact sheet summarizes tobacco industry marketing to college students and others in the 18-21 year old age group since the MSA went into effect.

Why and How the Tobacco Industry Sells Cigarettes to Young Adults: Evidence from Industry Documents
This PowerPoint presentation outlines tobacco industry strategies that encourage young adults to smoke

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For and about college students

How to Launch a Smoke-Free College Campaign
American Cancer Society maintains this web page on smoke-free campuses includes fact sheets, a manual for students, and sample campus policies.

Journey of a Lifetime: One step at a Time to a Tobacco-Free Campus
This BACCHUS and GAMMA guide includes facts, campus programming ideas, and information on establishing smoke-free campus policies and campus cessation programs.

Position Statement on Tobacco on College and University Campuses
The American College Health Association has developed a No Smoking Policy and encourages colleges and universities to be diligent in their efforts to achieve a campus wide smoke-free environment.

Tobacco Free U
The official BACCHUS and GAMMA Peer Education web site on collegiate tobacco control includes information on campus policy successes, facts on college tobacco use, quit tips, and how to get involved.

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Tobacco control and unions

What Do I Need to Know about Labor Unions and Tobacco?
This fact sheet created by the Organized Labor and Tobacco Control Network includes statistics about blue-collar workers and outlines issues related to labor unions and tobacco control.

Role of Organized Labor in Diffusing Worksite Smoking Control Policies
A Robert Wood Johnson Foundation-funded survey of national and local labor union members produced findings regarding organized labor's positions on worksite smoking policies, factors that influenced those positions, and actions unions were taking in support of smoking cessation and smoking policies. It found that 43% of national unions and 48% of local unions supported either a complete ban on smoking or smoking restrictions in the worksite. One third of national and local unions reported efforts to jointly develop or implement smoking policies with management.

Organized Labor and Tobacco Control Network
The Organized Labor and Tobacco Control Network, in cooperation with labor unions and tobacco control organizations, seeks to reduce health disparities due to high levels of tobacco use and exposure among working people and their families. The Network’s capacity-building program aims to increase the capacity of the tobacco control and labor movements to work toward shared goals. The research component aims to find the most effective methods of working with labor unions to reduce tobacco use and promote tobacco control policies in worksites and communities.

Project BUILT
The State Building & Construction Trades Council of California is working with the building trades to reduce exposure to second hand smoke in union halls and members’ homes, encourage health and welfare funds to participate in anti-tobacco activities, increase smoking cessation among members, and educate their members about how the tobacco industry targets blue collar workers.

Workplace Smoking Policies in the United States: Results from a National Survey of More than 100,000 Workers
This Tobacco Control article reports the results of a National Cancer Institute study that found that although an overwhelming majority of US workplaces have some official smoking policy in place, blue-collar and service employees are the least likely to work under a smokefree policy.

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For And About Women

Circle of Friends
This media campaign developed by the American Legacy Foundation encourages women to quit smoking with the help of social support.

Fact Sheet on Young Women and Smoking
Developed by the American Legacy Foundation, this fact sheet reports the results of the Legacy Media Tracking Survey related to young women.

It’s Easier Not to Start . . . Than It Is to Stop
CDC developed this campaign featuring Christy Turlington to reach women, particularly those between the ages of 18 and 34. The campaign includes posters, advertisements, and a video, Women and Tobacco: Seven Deadly Myths.

Marketing Tobacco to Women
This PowerPoint presentation outlines the history of marketing to women and includes samples of advertising from around the world.

Women and Smoking: A National and State-by-State Report Card
Prepared by the National Women’s Law Center and the Center for Women’s Health at Oregon Health & Science University, this report is an assessment of women’s smoking-related health conditions and the policies that are proven to help reduce smoking among women and girls.

Women and Smoking: A Report of the Surgeon General
This 2001 comprehensive report on women and smoking includes a section in Chapter 2 about 18 to 24 year olds.

Women and the Tobacco Epidemic: Challenges for the 21st Century
This 2001 report published by World Health Organization is a review on women and smoking, including health effects, cessation, and policies and strategies for addressing this population.

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Research articles on young adults

Alcohol, Tobacco, and Drug Use Among Young Adults Prior to Entering the Military
Ames GM, Cunradi CB, Moore RS. Prevention Science. 2002. 3(2):135-144.
This study examined the prevalence and correlates of alcohol, tobacco, and drug use among military recruits prior to enlistment as part of a 5 year longitudinal study with 2,002 Naval recruits. This article reports the baseline survey that found about half of the recruits had used tobacco.

Bar and Club Tobacco Promotions in the Alternative Press: Targeting Young Adults
Sepe E, Glantz SA. American Journal of Public Health. 2002. 92(1):75-8.
http://www.tobaccoscam.ucsf.edu/pdf/9.2-SepeBars1.pdf
This article reports the changes in tobacco promotions in the alternative press in San Francisco and Philadelphia from 1994 to 1999. The authors found that the tobacco industry has increased its use of bars and clubs as promotional venues and has used the alternative press to reach the young adults who frequent these establishments.

Cigarette Use by College Students in Smoke-Free Housing: Results of a National Study
Wechsler H, Lee JE, Rigotti NA, American Journal of Preventive Medicine. 2001. 20(3): 202-7.
Data from the Harvard College Alcohol Study is examined to determine whether students residing in smoke-free residences are less likely to smoke cigarettes than students in other campus residences, and if such lower rates apply to all types of students and colleges. The study’s press release is available at http://www.hsph.harvard.edu/press/releases/press03222001.html

From Social Taboo to "Torch of Freedom": The Marketing of Cigarettes to Women
Amos A, Haglund A. Tobacco Control. 2000. 9:3-8.
http://tc.bmjjournals.com/cgi/content/full/9/1/3
The history of tobacco marketing to women is explored in this article.
Marketing to America’s Youth: Evidence from Corporate Documents
Cummings KM, Morley CP, Horan JK, Steger C, Leavell NR. Tobacco Control. 2002. Suppl 1:I5-17.
http://tc.bmjjournals.com/cgi/content/abstract/11/suppl_1/i5
Authors of this article examined internal tobacco document to uncover industry marketing activities to youth and young adults.

Public Health Impact of Changes in Smoking Behavior: Results From the Tobacco Policy Model
Tengs TO, Osgood ND, Lin TH. Medical Care. 2001. 39(10):1131-1141.
This study examined and compared the relative magnitude of the public health gains from preventing smoking initiation versus encouraging cessation or avoiding relapse in different ages and genders. Among youth and young adults, reducing initiation yields far more Quality-Adjusted Life Years than encouraging cessation or averting relapse.

Smoking on the Rise Among Young Adults: Implications for Research and Policy
Lantz PM. Tobacco Control. 2003. 12(Suppl 1):60i-70.
http://tc.bmjjournals.com/cgi/content/abstract/12/suppl_1/i60
This article investigates hypotheses regarding the cause of the recent apparent increase in young adult smoking, compares trends in smoking among young adults with trends in the use of other substances, and considers the implications for youth tobacco control research and policy.

Smooth Moves: Bar and Nightclub Tobacco Promotions that Target Young Adults
Sepe E, Ling PM, Glantz SA. American Journal of Public Health. 2002. 92(3):414-9.
http://www.tobaccoscam.ucsf.edu/pdf/9.2-SepeBars2.pdf
The authors of this article analyzed internal documents to examine the tobacco industry's use of bars and nightclubs to encourage smoking among young adults. They found that tobacco industry bar and nightclub promotions in the 1980s and 1990s included aggressive advertising, tobacco brand-sponsored activities, and distribution of samples.

Tobacco Related Bar Promotions: Insights from Tobacco Industry Documents
Katz SK, Lavack AM. Tobacco Control. 2002. 11:i92-i101
http://tc.bmjjournals.com/cgi/content/full/11/suppl_1/i92
This article examined industry documents to explore the tobacco industry's use of bar promotions. The documents indicate that bar promotions are important for creating and maintaining brand image, and are generally targeted at a young adult audience.

Students' Opinion of Tobacco Control Policies Recommended for US Colleges: A National Survey
Rigotti NA, Regan S, Moran SE, Wechsler, H. Tobacco Control. 2003.12:251-256
http://tc.bmjjournals.com/cgi/content/abstract/12/3/251
This article found that U.S. college students express strong support for tobacco control policies that aim to reduce cigarette smoking on college campuses. Press Release: http://www.mgh.harvard.edu/news/releases/091603smoking.htm

US College Students' Use of Tobacco Products: Results of a National Survey
Rigotti NA, Lee, JE, Wechsler H. JAMA. 2000. 284:699-705.
http://jama.ama-assn.org/cgi/content/abstract/284/6/699
Data from the Harvard College Alcohol Survey that assesses the prevalence of all forms of tobacco use (cigarettes, cigars, pipes, and smokeless tobacco) among US college students is reported. The study’s press release is available at:
http://www.hsph.harvard.edu/cas/Documents/tobacco_use/

US Public Universities' Compliance with Recommended Tobacco-Control Policies
Halperin AC, Rigotti NA. Journal of American College Health. 2003. 51(5):181-8.
The authors of this article interviewed key informants at 50 US public universities to assess the prevalence of campus smoking bans and policies that prohibit the sale, advertisement, and promotion of tobacco products on campus.

Why and How the Tobacco Industry Sells Cigarettes to Young Adults: Evidence from Industry Documents
Ling PM, Glantz SA. American Journal of Public Health. 2002. 92(6):908-16.
http://kstask.org/pdf/LingAJPHYoungAdults.pdf
The authors of this AJPH article reviewed tobacco industry strategies that encourage young adults to smoke to improve tobacco control campaigns. The authors found that cigarette advertisements encourage regular smoking and increased consumption by integrating smoking into activities and places where young adults' lives change (e.g., leaving home, college, jobs, the military, bars).

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We are especially interested in hearing about local and state level tobacco control activities.
If you have a story to share, contact us at exchange@ttac.org.

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Victoria Almquist
Campaign for Tobacco-Free Kids
valmquist@tobaccofreekids.org

Madeline Barrow
MBarrow Communications, Inc.
mbarrow@numail.org

Neena Chaudry
National Women’s Law Center
nchaudhry@nwlc.org

Reba Griffith
Centers for Disease Control and Prevention
Office on Smoking and Health
rkg4@cdc.gov

Deborah McLellan
Organized Labor and Tobacco Control Network
Deborah_McLellan@dfci.harvard.edu

Barbara A. Moeykens
Vermont Department of Health
Tobacco Control Program
bmoeyke@vdh.state.vt.us

Pam Redmon
Tobacco Technical Assistance Consortium
predmon@sph.emory.edu

Aliki P. Weakland, MPH, MSW
Editor-in-Chief

Samantha Helfert, MLS
Information Specialist

JoAnn Weiss, MPH, MA
Writer/Researcher

Lisbeth Klau, MPH
Writer/Researcher

* Adapted from: Centers for Disease Control and Prevention, Office on Smoking and Health. Focus Groups for Specific Populations: Smoking Among African Americans and White Young Adults: Part 1: Findings from College Smokers Focus Groups. Atlanta, GA: ORC Macro, 2002.

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