Tobacco Documents Online

TESTIMONY P'RESENTED B'EFORE THE SENATE SUBCD:ILIITTEE' ON HEA'LTHi AN'D SCIENTIFIC R,ESEAkCK ON MAY 25, 19'78, CONCERNING THE NATIONAL DISf ASE PREVENTION AN'Di HEALTH PROr10TI0N' ACT OF 1978. My name is James W'. Swinehart., I am a social psychologist,, and d'uring, the past 15 years my work has involved' teaching, research, and practice in deterrence of smoking among children and adolescents. ~ I favor all the provisions of the bill under consideration„ but would like to comment particularly on that part of Title IV which concerns the fieldd of health communications.,- This section of the bill proposes research on the determinants of smoking, and support for community and' school-based programs. Ideally, of' course, one should know a great deal about the determinants of a problem before undertaking efforts to control it; in the case of smoF:ing„ our present knowledge provides an adequate basis for program planning but needs to bee expanded if control prog,rams are to be made more effective. For example, we know that modeling,and' peer influence are closely related to smoking behavior. The boy or girl most likely to begin smoking has two parents whusmoke, an older brother or sister who srnokes, and' a close friend who~smokes; the presence of a nonsmoking parent or sibling,or friendd is associiated with markedly lower rates of smoking in children. This suggests that a d'eterrence effort shouldiaddress parents, teachers, and other adult role models rather than focusing,excl!usively on children and adolescents. As part of alprojA€t carried out by young people in San Diego, teenagers were asked' why they smokedi., the j'acgon of biiomedical' or The eight reasons given most often are not in behavioral research, but they cover a lot of ground and' provide obvious cTues for the design of control prog,rams: "I'm young now--why not smoke? I can quit later.'"' "I don't inhate, so smoking can't hurt me."' "My folks smoke--why shouldn' t' I?"

In summary,, the following, should characterize new~ community programs: Plans based' on accurate and current knowled'ge of chitd'ren"s beliefs and attitudes regarding smoking,(der'ived from surveys, focus groups, etc.) results evaluated clearly U'se of specific objectivesr so that efforts can be kept on track and agencies, and other interested groups. • Extensive cooperation among school systems, voluntary and public health. • Involvement of health professionals, particularly practicing physicians and dentists • Use of a variety of' media behavior, and avoidance of exhortation or sermorrizing, Emphasis on immediate personal and social reinforcement of nonsmoking, of materials • Involvement of children and adolescents in program planning, and design Pretesting of materials with revisions made as needed Use of athletes andr other valued figures as nonsmoking, exemplars. • related to physical health Use of multiple appeals, including social and personal themes un- assessment of different approaches and programs • U'se of' rigorous evaluation techniques which permit comparative • Reinforcement of basic messages over a period'of years + Controlled placement of advertisements in print and'broadcast mediai I t has been es timated that one-f if th of the cos t of medical care today ariises because of tobacco and alcohol abuse. Even if smoking,-related problems accounted for only one-hundredth of the $1601billion spent on heqlth care in this country last year, that would be $'1.6 billion. Clearly the potential cost savings that could result from effective smoking, control progra-Ams, apart from the values in terms of personal health andiproductivity, are enormous.

print media, such as news stories, feature articles, editorials, cartoons, and letters to the editor. Commercial advertisers typically p1acq , their materials where they will be seen or heard by persons in the market for their products. It makes sense for smoking control programs to do the same. Some examples of inedia'whi:ch reach children and adolescents,r in addition to those listed above, are comicc books, posters for schools (and for kids° rooms at home), shorts or "'trailers" for use in movie theaters, placemats in fast-food restaurants„ bumper stickers, buttons, milk cartons, and T-shirt imprints. All of these could be used in a comprehensive community program--not to provide d'etailed' information but to, serve as reminders and perhaps to help establish nonsmoking as a norm. A special note should be added here regarding the scale of advertising and related elements of smoking control progra.ms. In anienviironment where a tobacco company can spend $40 million to develiop and promote a single new brand of cigarette, and where well over $250 million a year is spent to ad- vertise the top 20 brands, the odds are slight that a small counter-effort can have much impact on the "cl'imate"' regarding smoking,. By the age of 12 a cniild has experienced a long period of exposure to cigarette advertising d and the example of adult smoking;, thus it seems unrealistic to expect sig- nificant results from fragmented programs of small size or duration., Whatever the nature of the interventions employed', all programs funded r ~ under the proposed bill should be required to (1) characterize in detail the methods and approaches used; (2) use evaluation designs which meet specified criteria for appropriateness and scientific rigor;; and' (3) use outcome measures which incTude~ behavioral assessments as~~ well as self-reports from chii:ldrem., The purpose of these requirements wouLd'be to make program results cumuT3tive;' that is„ to make possible an accurate determination of the relative value of various approaches so that those found 'to be most effective caan

"'if I don't spend' the money on cigarettes, I'd spend is of ten superf ici al„ and that they are concerned about personal attractive- "All my friends smoke--why shouLdh't I?"' "StnokinG can't lrurt mu--T ramoka, f'iltcr ci(;;tcettc!s." "'Smoking is better than putting on a lot of weight.", ~,'Smoking makes me loolc grown up and mature." These comments confirm the view that teens' tmderstanding of smoking risks vary, but I believe most health professionals would regard the foTlowing Given some knowledge of reasons why children begin scaoking, what should be done in community.programs developed under the proposed bill? How would they differ from programs naw, operating?' Opinions on these questions will ness, being accepted, being,"normal,,"" and becoming independent. answers as reasonable. Many control programs are now being,implemented in school systems approaches, including the development.of coping,skills which could enable results. New programs should be encouraged to utilize a wide variety of throughout the country. Some of these, particularly the ones which cover smoking as a part of a general orientation to health, have shown promising, children to resist pressures to engage in various other behaviors harmful to A number of current programs offer only a singie brief exposure to "'innoculate'° children against subsequent pressures to smoke. Since the information about smoking, presumably on the assumption that this will somehow E. 4, decision not to smoke must be made periodically rather than only once, efforts . . . .. . • _. . . . S of smokina are apvropriate as part of a general education, but they are cl'early Programs which provide information about physiology and the specific effects from the primary grades through high school. to support this decision shoulidibe provided on a continuing or periodic basis inadequate as means of deterring smoking iniadolescents. There is a need' to _,`

supplement' this information with non-tlealth appeals, since most teenagers outweigh the perceived health risks. Nine out of ten, teenagers believe that who start smoking,do so because this provides other values which seem to they also see smoking as a source of peer approval and a symbol of'adulthoodf smoking,is harmful to health, but they are in a conflict situation, because The design of control programs in, this area is made especially difficult of nonsmoking behavior if control programs are to become genuinely effective. are immediate, while the negative he'al.th consequences may not appear until years later. It may be necessary to d'evise forms of' imrnediate reinforcement by the fact that' the positive consequences of smoking (such as peer acceptance) New community-based programs should involve greater cooperation on the and American Lung Association), and'other appropriate community groups. organizations (such as the American Cancer Society, American Heart Association, part of school systems, health departments, affiliates of voluntary healthh Whenever possible, children or adolescents should participate in the development of neW program materials directed'to them, and such materials should be tested for appeal and'effectilveness before being produced in quantity. The number of anti-smoking,spots broadcast onradio and television has (especially during time periods when a large audience is available), community service time contributed by radio and TV stations, which is extremely l'imited, dropped sharply over the past few years. Rather than relying solely on public programs should be: permitted to, purchase time and thus control thre frequency .. and' times of placement. Persons responsible for these programs should seek to supplement paid commercials through appropriate use of talk shows, editorials, segments on news shows, documentary features, and special children''s progrananing. I!n the same way, local control programs shoul'd'be able to purchase space for display advertising in newspapers and in ,metropolitan mag,azines. Compre- - - ~ hensive programs should also include attempts to utiTize other vehicles in the