Tylenol, Twinkies

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Tylenol, Twinkies the Tobacco PuzzleChanging
the way young adults look at tobacco addiction

• Linda Hancock, FNP, PhD
• Wellness Resource Center
• 804 828-WELL
• Quit_at_vcu.edu
• Virginia Commonwealth University

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The tobacco epidemic, like the flu is always
mutating. -Jack Henningfield

• Tobacco Companies and others out to make money on
  nicotine are always changing-
• what they market
• how they market
• to whom they market

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Tobacco products use changes over time in
cultures
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Understanding developmental stages Age of Reason
7-12 Age of Rebellion 13-25
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What is the most devastating drug?
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No problem can be solved by the same
consciousness that created it.
- Albert Einstein
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Because I got high.Afroman Meets America

• A framework for understanding all molecules
• and deciding what you want!

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Rank order these 5 substancesTYLENOL, TWINKIES,
EGGS, BEER, CIGARETTES

• MOST TOXIC
• 1
• 2
• 3
• 4
• 5
• LEAST TOXIC

• MOST HEALTHY
• 1
• LEAST HEALTHY

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Genetic Snowflakes
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Quantity Frequency MATTER!

• Bio Q/F Risk
• Adapted from www.askpri.org Lifestyle risk
  reduction model

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I love smokers!Quit_at_vcu.edu

• Quitting PILLS
• Bupropion
• Chantix

• Remember, smoking doesnt kill people. People
  who are quitting smoking kill people.

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Rank order these 5 substancesTYLENOL,
TWINKIES, EGGS, BEER, CIGARETTES

• MOST TOXIC
• 1 Tylenol
• 2 Beer
• 3 Cigarettes
• 4 Eggs
• 5 Twinkies
• LEAST TOXIC

• MOST HEALTHY
• ?
• LEAST HEALTHY

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Low-Risk Drinking

• 0 - 1 - 3 (4)

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Addictive Potential of Chemicals

• A. ALCOHOL (85 try)
• 1 in 10 who use get addicted
• B. HEROIN (only about 1-3 try)
• 9 in 10 who use get addicted
• C. NICOTINE (about 50-55 try)
• 5 in 10 who use get addicted
• D. MARIJUANA (about 50-60 try)
• Can you get addicted to marijuana?

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What is the most devastating drug?
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Innovators smoking/cessation
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Diffusion of innovation Theory

• Research by Redmond
• The diffusion of smoking initiation
• The diffusion of cessation

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The 3 Ds of tobacco prevention

• DEGLAMORIZE
• DELEGITIMIZE
• DENORMALIZE

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Deglamorizing

• Not the most effective strategy with young
  adults.
• They like their friends who smoke.
• They can see they are being manipulated.
• It alienates the trend setters you want to come
  in for cessation services.

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Trends in ads
NOW
1990s
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Delegitimizing
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Denormalizing
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How many ADULT Virginians smoke cigarettes daily?

• Behavioral Risk Factor Surveillance System
• CDC annual survey
• Results easy to access by state

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MISPERCEPTIONS
Overestimate Unhealthy visible behaviors
-smokers, drunks, violence, goofing off,
credit card debt, etc. Underestimate
Healthy less visible behaviors
-non-smokers, moderate drinkers academic
seriousness, prayer
Perception REALITY
GAP
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Video Clip Instructionsviscog video or go
totake the awareness test at YouTube

• This video is very short 30 seconds
• You will see a team of players
• One wearing white shirts one wearing black
  shirts
• Try to count the total number of times someone
  wearing a white shirt passes the ball.

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What you focus on expands!
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We need to stop making healthy teens feel like
they are the minority!
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Majority versusVisibility
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Social Norms marketingwww.socialnorms.orgwww.smo
kefreeVCU.org
Normalize NON-smoking Prevents starting and
Promotes demand for Cessation Services
Supports smoke-free policy change
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Motivational Interviewing is like Teaching an
old dog new tricks

• We have been taught
• -to fix
• -to educate
• -to tell people what to do
• Turns out that doesnt work.

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A client-centered, directive method for
enhancing intrinsic motivation to change by
exploring and resolving ambivalence.
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The Name of the Game isWIN AS MUCH AS YOU CAN!!!

• Stand up
• Find a partner
• place right feet side by side
• shake right hands

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What MI is NOT!

• Telling
• Preaching
• Nagging
• Terrorizing
• Not listening

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Understanding Exploringthe PICTURE BOOK of
someone elses life
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The MI way of being

• ACCURATE EMPATHY
• HUMOR and a light touch
• Genuine, sincere caring
• Focus on whats most important to that person,
  not to you!

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To change the way young adults see tobacco, we
must

• Listen to them
• Respect them
• Simultaneously address prevention cessation
• Collect data about what works for WHICH type of
  young adults
• Focus on both users and non-users
• Prevention Cessation are not one size fits all

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ARTISTS

• Target
• high-risk groups for both prevention early
  cessation

SEXUAL MINORITIES
RISK TAKERS LEADERS
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www.lgbtsmokefree.orgA high-risk population for
smoking!LGBTs smoke at rates 40 to almost 200
higher than the general populationPlease post
this poster
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We must also keep our eyes open for new product
changes

• Manipulation of current nicotine produces
• Development of new types of nicotine products
• New advertising strategies

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Brilliance in marketing
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Virginia Slims introduces Purse Packs

• In October 2008 Phillip Morris introduced "Purse
  Packs" for select Virginia Slims brands 
• The Purse Pack is pink, sleek rectangular
  packaging with square ends. It holds 20 sticks
  that are smaller in diameter than a typical smoke.

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New advertising and branding
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Camel Crush
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Increased Nicotine Levels in CigarettesAverage
Nicotine Yields Per Cigarette 1997-2005Harvard
School of Public Health, 2006
11.8 increase from 1997 to 2005
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Follow the

• 10 million less American smoke than did in 1983
• That translates into lost sales revenue in the
  U.S.

• However, the sales of moist snuff in the USA more
  than doubled in volume from 1986 to 2005
• 6.1 million Americans used moist snuff in 2006,
  up from 4.7 million in 2001. Most of the new
  users are smokers, some of whom still light up.

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Whats in smokeless tobacco?

• Smokeless tobacco contains sweeteners,
  flavorings, abrasives, salt and other chemicals.
• Over two dozen cancer-causing agents have been
  identified in traditional smokeless tobacco.
• The primary carcinogens are
• tobacco-specific nitrosamines (TSNAs)
• the level of TSNAs is affected by processing,
  refrigeration and length of storage.

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What is Snus?

• Rhymes with "goose"
• Cynics might say "noose
• Swedish type of smokeless tobacco
• Comes in teabag-like pouches
• User sticks between the upper lip and gum
• Use 30 minutes
• Then discards without spitting

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Snus goes under the UPPER LIPspitless-smokeless
tobacco
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New smokeless, dissolvable tobacco products from
R.J. Reynolds
Test marketing in Columbus, OH, Portland, OR, and
Indianapolis, IN starting in January 2009
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Nicogel
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Hard Snuff compressed tobacco lozenge

• ARIVA STONEWALL
• advertised as the alternative for smokers in a
  smokefree environment.
• Both products are made with tobacco cured by a
  process that minimizes nitrosamine formation.

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Whats this?
Not..
Hookah
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History of Hookahs

• 16th century
• Use declined, almost died out by 1980s
• 1990s maassel came on the market
• Maassel is tobacco fermented with molasses and
  fruit
• Easier to use with more pleasant taste and aroma

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Toxin Content of smoke(single hookah session
compared to a single cigarette)
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Please post this poster!
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Third-hand smoke-tar heavy metals left in
the environment long after the smoker has left
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Conclusion

• Tobacco products marketing strategies are
  constantly mutating and changing.
• We need to be vigilant for those changes.
• What works for young children and tweens is
  different than what works for young adults.
• Remember to do prevention cessation
  simultaneously.
• Get the early adopters to quit ASAP.
• Understand Motivational Interviewing,
  Delegitizing and Denormalizing.
• Always work with young adults both non-smokers
  and smokers when creating programs.
• Never give up we will make the world tobacco free