Sliding a few bills across the counter at a 24-hour convenience store, the young girl makes her request: a pack of cigarettes. The sales clerk frowns and replies, “You need a little more, honey.”
The teen pauses, then rips off part of the skin on her cheek and hands it over.
The graphic TV ad is part of a first-of-its-kind national anti-smoking campaign spearheaded by the Food and Drug Administration and targeted at young people ages 12 to 17. The effort, being publicly unveiled Tuesday, aims to show teens that the cost of smoking is not just financial.
FDA Commissioner Margaret A. Hamburg, in an interview with a small group of reporters Monday, said the campaign is designed to speak to the estimated 10 million young people who are considering trying cigarettes or who may be experimenting with them already.
Starting on Feb. 11 and continuing for 12 months, the ads will air on radio stations, television outlets, such as MTV, and print outlets, such as Teen Vogue, that are popular with young people. They will also be featured in places teens congregate, from bus shelters to social-media channels such as Facebook and Twitter. FDA officials have even picked out a hashtag: #TheRealCost.
While the ads being unveiled this week are designed to appeal to a general audience of young people, subsequent efforts will focus on specific types of teenagers: rural youths, Native Americans, gay teens and those using smokeless tobacco. These initial ads cost $115 million; over the next five years, the campaign’s costs could grow to $600 million, paid for by the tobacco industry under a 2009 law.
Although much progress has been made in understanding the health effects of cigarettes since the first surgeon-general warning about smoking was issued in 1964, it remains the leading cause of preventable death in the United States. Studies have shown that the vast majority of adults who smoke started doing so as children.
As more and more of the smokers who grew up with the Marlboro Man quit or die, the focus has shifted to the next generation.
“Our kids are the replacement customers,” said Mitch Zeller, director of the FDA’s Center for Tobacco Products.
Zeller said the agency took a scientific approach to developing the campaign. FDA researchers studied published literature about cigarette use, dissected previous public education campaigns and even conducted quantitative testing with 1,600 youths before settling on the group of ads.
Zeller said the campaign takes a two-pronged approach in trying to reach teens. One set of ads focuses on what smoking can do to your appearance. There is a print ad showing an otherwise gorgeous model with yellowed teeth and wrinkled skin and another resembling a video-game promotion, with cigarettes acting as weapons that knock out teeth. In one video, a teenage boy pulls out a tooth with pliers.
The narrative behind the other set of ads is about how cigarettes can take away teens’ ability to control their own lives. The star of these ads is a miniature, potbellied man with long hair who looks as though he badly needs a shower. He chases teens around their schools and homes and orders them to pause TV shows, go outside in the rain or give up their money. The tagline on these ads: “You wouldn’t take it from a tiny bully, but when you’re hooked on tobacco, you’re taking it from a cigarette.”
To evaluate the effectiveness of the campaign, the FDA has put together a study involving 8,000 youths. Researchers have already conducted baseline face-to-face interviews with them about their knowledge about smoking, attitudes, behaviors and beliefs and will continue to follow up with them for the next two years.