Stopping the Tobacco Industry's Influence on Our Children and Young Adults

By Evangeline Coleman Crawford

As more and more people in Western nations stamp out their last cigarettes having realized the negative impact smoking has on their own health and that of people around them, the tobacco industry continues to aggressively promote its products—particularly in the newly-emerging market economies of Central and Eastern Europe and Eurasia and in developing countries around the world. All too effective, these slick advertising campaigns have resulted in a more than 30 percent increase in tobacco use in most countries throughout the NIS/CEE, according to statistics reported by the World Health Organization (WHO).

This increase translates into grave health predictions for the future. While some 515,000 deaths were attributable to tobacco in the region in 1990, WHO estimates that number will exceed 1.1 million by 2020. Within the same timeframe, the Disability Adjusted Life Years (DALYs) lost to tobacco-related illnesses are expected to skyrocket from 7.8 million to 12.6 million.

In her foreword to The Tobacco Atlas published by WHO in 2002, Gro Harlem Brundtland, WHO director-general, notes: "More people smoke today than at any other time in human history. One person dies every 10 seconds due to smoking-related diseases. Tobacco is the biggest killer, much bigger in dimension than all other forms of pollution [and] children are the most vulnerable. Habits start in youth. The tobacco industry knows this and acts accordingly."

Banding together with the World Bank, the American Medical Association, and other global public health leaders, WHO is challenging two other industries, film and fashion, to reduce the role they play in national and international tobacco marketing.

"Tobacco Free Film, Tobacco Free Fashion Action!" is the message being launched on May 31, 2003—World No Tobacco Day—in a campaign designed to put pressure on both trades to be socially responsible is a manner commensurate with their global influence. Calling upon film and fashion leaders to stop promoting and glamorizing tobacco use, Brundtland stated, "Adolescents should not be allowed to mortgage their lives to the seductive advertisements of these industries. Girls and women are being targeted all over the world by expensive and seductive images of freedom, emancipation, slimness, glamour, and wealth."

In response to both the falsely glamorized images projected in the media and in ad campaigns and the growing health epidemic stemming from tobacco use, 171 member states of WHO have finalized a groundbreaking public health treaty—The Framework Convention on Tobacco Control (FCTC)—to help control tobacco supply and consumption. The Convention, part of a global strategy to reduce tobacco-related deaths and disease around the world, sets for guidelines on issues including tobacco taxation, smoking prevention and treatment, illicit trade, advertising, sponsorship and promotion, and product regulation.

"Tobacco kills in every country of the world and most of us know someone who has died as a result. Due to the actions that will follow from our shared commitments, millions and millions of lives will be saved," Brundtland professed last February when the Convention was announced. Calling the treaty a first step in a long process, she challenged those present to turn their attention to creating protocols that address specific issues. "Back in our countries, laws need to be written, advocated, passed, and enforced. Budgets with the right tax provisions for tobacco products will have to be upheld every year. Smuggling must be fought, not once and for all, but every day of every year. Information campaigns and surveillance must be designed and carried out, not only once, but time and time again."

AIHA Partners Spread the "No Tobacco" Message to Youth in Their Communities

Whether it is through a peer mentoring group in Uzhgorod, Ukraine; a community Non-smoking Promotion Center in Martin, Slovakia; or various conferences and patient education programs at primary care centers throughout the region, AIHA partners have implemented a number of approaches that have had measurable impact on tobacco use in their respective communities.

With tobacco-related deaths already numbering almost 5 million annually and expected to increase dramatically, youth are a main target for anti-smoking messages. Recognizing that lifestyle habits are formed at an early age—in fact, more than 80 percent of adult smokers admit they started using tobacco before the age of 18—partners continuously strive to create programs that curb tobacco use among children and young adults, stopping the problem before it starts.

According to Elena Kavcova, staff physician at Martin Faculty Hospital and member of AIHA's graduated Banska Bystrica-Martin/Cleveland partnership, studies of smoking habits and trends conducted in 1998-1999 suggest that prevention activities should target children as early as kindergarten. The Non-smoking Promotion Center established by partners in Martin focuses on prevention and community outreach programs—including some that bring doctors, nurses, and medical students into classrooms at local schools—and also offers smoking cessation courses.

Indeed, school-based education has proved to be an important tool in sustaining progress in tobacco control and more and more programs are teaching children and young adults about the harmful effects of tobacco use. These community approaches to prevention and smoking cessation ultimately help reduce the number of diseases and deaths from tobacco use as well as mitigate the harm of secondhand smoke.

In Ukraine for example, AIHA's Uzhgorod/Corvallis partners implemented the Peer Mentoring Group, a program in which tenth, eleventh, and twelfth-grade student volunteers are trained to serve as academic and life-skills mentors to younger students. Explaining that Ukraine has the second-highest incidence of alcoholism and drug abuse in the NIS region, Louise Muscato, professor of public health at Western Oregon University in Monmouth, says the Peer Mentoring Group has been very effective in disseminating accurate health-related information to the younger set. "Students seem to be able to reach their peers on a level that adults cannot," Muscato notes. The Uzhgorod/Corvallis partners have also organized a Youth Smoking Prevention Coalition in both Uzhgorod and Velykyi Bereznyi, Ukraine, where high school students created anti-tobacco posters for a competition.

And, AIHA's Sarov/Los Alamos, with assistance from volunteer students, teachers, and local healthcare providers in Sarov, Russia, implemented "Kids for Kids," a program in which healthcare providers train students as peer educators to share accurate information on such topics as sex education, tobacco prevention, drug and alcohol abuse, and domestic violence. The partners also co-hosted a smoking cessation conference—the first event of its kind to be held in Russia—with the US Centers for Disease Control (CDC) in Atlanta, Georgia, in September 2002 where representatives from AIHA partnerships throughout the country gathered to discuss effective anti-tobacco strategies.

"The event was very well-received," says Jeri Hertzman, coordinator of the Sarov/Los Alamos partnership, noting that representatives from 10 other AIHA partnerships in Russia attended the conference. "The event raised the awareness of each participant through the use of interactive role-playing activities that illustrated various real-life scenarios such as a doctor/patient counseling session and how young people can be overwhelmed by peer pressure. These exercises gave healthcare providers some great ideas for implementing innovative intervention strategies to deal with tobacco use within their communities." Each partnership developed their own anti-tobacco program and had the opportunity to discuss it with experts from CDC.

Prior to the event, Hertzman and Irina Parfenova, an English teacher at Sarov School #2, were trained at the CDC to administer its Global Youth Tobacco Survey (GYTS), which tracks tobacco use among teens in Sarov. The GYTS, conducted last fall, is a school-based survey that was administered to a random sample of 1,500 Sarov students aged 13 to 16 years along with 1,000 school workers. The survey is designed to gather information about a host of tobacco- related issues such as smoking prevalence, knowledge and attitudes, impact of media and advertising, access to tobacco products, prevention education in school curricula, exposure to environmental tobacco smoke, and tobacco cessation. Hertzman says she hopes that the information gathered will be useful in the development of programs to encourage healthy lifestyles for students in Sarov.

AIHA's partners in the Caucasus are also working to curb tobacco use in their region. In Armenia, for example, Armavir/Galveston partners hosted a health fair at the Armavir Polyclinic in April 2002 as part of their efforts to improve community health. During the event, they disseminated information on hyperglycemia, hypoglycemia, strokes, high blood pressure, breast health, and eye care, as well as on the harmful effects of tobacco use. With a particular focus on children, the partners have also visited local high schools and conducted workshops on smoking cessation, personal hygiene, and disasters-preparedness. To complement the workshops, the partners hosted healthy lifestyles poster contests for the students.

Today's children and young adults are tomorrow's leaders. By continuing to promote strong prevention and cessation programs, community stakeholders can lead by example. Informing younger generations about the addictive nature of tobacco use and its health consequences—as well as leading by example and promoting strong prevention and cessation programs—community stakeholders ranging from government officials, civic and political leaders, and school teachers to parents, healthcare providers, and members of the clergy can inspire youth to lead a healthier lifestyle.

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