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National Cancer Institute

Countering Young Adult Tobacco Marketing in Bars

Project Title: Countering Young Adult Tobacco Marketing in Bars

Organization: University of California, San Francisco

Grant Number: 1U01CA154240

Principal Investigator: Pamela Ling

Note: The descriptions in this section were provided by the principal investigator and are not maintained or updated by NCI.

Co-Investigator: Bonnie Halpern-Felsher, Stanford University

Study Summary
Dr. Ling and her research team evaluated the effectiveness of an anti-tobacco intervention designed to make smoking less socially acceptable among social leaders in local bar and nightclub scenes with high rates of smoking. The interventions, which are tailored to specific “psychographic” psychological mindsets and bar cultures, are coordinated with tobacco control programs in New Mexico, California, and Oklahoma. The team used a series of cross-sectional surveys to address the specific research aims below.

Research Aims and Methods
1.    Evaluate the effect of a social marketing intervention on segments of the young adult population attending bars and nightclubs in four cities, compared to young adults with a similar smoking prevalence in comparison cities.
2a.  Evaluate the effect of the intervention on potential mechanisms of change, such as attitudes about the tobacco industry or tobacco social norms.
2b.  Evaluate the effect of these expected mechanisms of change on smoking behavior.
3. Qualitatively observe and describe the social mechanisms through which exposure to the smoke-free brand occurs and how these influence smoking behavior.

Target Population: Young adult smokers

Key Findings

  • Young adult bar patrons are a priority population with high rates of tobacco use. They also characterize the leading edge of the tobacco epidemic, as “early adopters” of novel tobacco products. Young adult bar patrons report high rates of use for hookah, electronic cigarettes, cigars/cigarillos, and smokeless tobacco products, and interventions are needed to address these novel products.
  • Tobacco control and smoking cessation programs face unique challenges to reach the young adult population. These include a high prevalence of light, intermittent, nondaily, and “social” smoking, polyuse of multiple tobacco products, and frequent pairing of tobacco with alcohol and marijuana. These patterns of co-use and polyuse make it difficult to address only cigarette smoking without addressing other tobacco products or other allied substances.
  • Social branding interventions can compete successfully with tobacco industry brand marketing to reach and encourage high-risk young adult bar patrons to decrease smoking behavior. Four published pilot studies of social branding interventions in San Diego, Oklahoma City, Las Vegas, and New Mexico have all shown significant decreases in smoking behavior associated with the intervention. High levels of exposure and understanding of the tobacco-free message were associated with less smoking.
  • Secondhand smoke exposure continues to be an important issue among young adults. Even in smoke-free bars, young adults report frequent exposure to secondhand smoke in social venues and in their workplaces. Young adult bar patrons also support smoke-free bar policies.

Key Implications

  • Young adults should remain a high priority for tobacco control, particularly high-risk groups such as bar patrons where tobacco use is concentrated.
  • Psychographic segmentation paired with a focus on bar patrons dramatically increases the efficiency to reach tobacco users in the population.  Psychographic segments predict tobacco use independent of demographic factors and facilitate the development of relevant anti-tobacco messaging.
  • Research is urgently needed to address new patterns of tobacco use that are particularly common among young adults. Specifically, we need to understand multiple tobacco product use, cigarette and other tobacco product co-use, and tobacco use with other nicotine products including electronic cigarettes, alcohol, and marijuana, and what strategies may be effective to support tobacco cessation in this context.
  • Tobacco control policies affecting young adults, including smoke-free bar policies, limits on aggressive marketing of novel tobacco products, and smoke-free policies in workplaces most common among young adults should be pursued.

Original Abstract
This project addresses the prevention of tobacco related diseases by developing an intervention to block tobacco industry marketing to young adults (age 18-25). Almost all tobacco prevention efforts concentrate on preventing children and adolescents from experimenting with cigarettes despite the fact that the transition from experimentation to regular smoking and addiction often occurs during young adulthood. The tobacco industry has invested millions of dollars in sophisticated marketing research on young adults. Because of current restrictions on marketing to youth, young adults have become an even more important focus of tobacco marketing efforts, which often emphasize events at "adult only" venues (bars, nightclubs and casinos), which are exempt from these restrictions. We hypothesize that successfully competing with industry promotion in these venues will prevent smoking among young adults, preventing both long term morbidity and mortality from smoking. Preliminary data: In our prior research, we identified a high risk subpopulation of young adults in San Diego, CA: the "hipster" subculture, a group focused on the alternative music scene, local artists and designers, and eclectic self expression. We developed a yearlong pilot social branding intervention to decrease smoking among this group, using social events and social leaders to promote a strong nonsmoking lifestyle. The intervention rationale is based on utilizing industry market research tools to define the target audience and directly countering tobacco industry lifestyle marketing strategies. We now propose to leverage contracts from three additional States to extend this intervention and evaluate it in a multicenter quasi-experimental controlled trial. Study Design: 1) cross-sectional repeated measures design with random samples of the population attending bars and nightclubs in four intervention cities and four comparison communities at baseline, during, and after the intervention. The main outcome is self-reported past 30 day smoking prevalence. Cessation by age 30 avoids nearly all the long term health consequences of smoking. The results of this research will improve approaches to young adult targeted messaging both for public health campaigns and for clinical patient counseling to block the transition from experimentation to becoming established addicted smokers.