The tobacco industry has a long, well- documented history of targeting children and teens. Many of us can remember the original Flintstones cartoons, which ran on television from 1960 to 1966; the R. J. Reynolds Tobacco Company was an early sponsor. In one commercial, Fred and Barney lit up and said, “Winston tastes good, like a cigarette should.” In 1987, seeking to dethrone the Philip Morris brand Marlboro as a top seller among youths, R. J. Reynolds unveiled cartoon hipster Joe Camel to promote its Camel cigarettes. Within four years Camel's share of the youth cigarette market increased from 0.5% to 32.8%, according to a study published in the December 11, 1991, issue of the Journal of the American Medical Association ( JAMA ).

Figure. No caption available.

---

As part of a 1998 legal settlement between seven major tobacco companies and the attorneys general of 46 states, manufacturers were required to make millions of internal documents public (four other states reached individual settlements). An R. J. Reynolds memo from 1973 suggested that “comic strip type copy might get a much higher readership among younger people.” A Philip Morris memo from 1975 stated bluntly, “The teenage years are the most important because those are the years during which most smokers begin to smoke … [and] initial brand selections are made.” Although the settlement banned the use of cartoon characters in tobacco advertising, current campaigns for Camel and Kool, another R. J. Reynolds brand, feature comic book–style illustrations of seductive beauties and hip-hop characters.

Another disturbing trend is the promotion of cigarettes laced with candy flavorings, such as Twista Lime and Kauai Kolada of Camel's Exotic Blends line. “We call them training wheels for teen smokers,” said Sarah Davis, senior program director for the American Lung Association of Colorado. Nearly all new tobacco users—90%, according to the JAMA article—are children and teenagers. Their recruitment is essential to the growth of the industry. Children are susceptible to advertising: a 2004 government survey found that children who smoked were much more likely than adults to use three of the most heavily advertised brands. A 2001 survey of California retailers found that half of all tobacco ads were placed at children's eye level; a quarter of the retailers displayed cigarettes next to candy.

The following are ways nurses can confront the tobacco industry, influence public policy, and perhaps save some young lives.

Quit smoking. As health care professionals we're role models. Whether we're lighting up in hospital parking lots or smoking only at home, our actions speak loudly. If you smoke, kick the habit, and encourage your colleagues to quit, too. Start by visiting Tobacco Free Nurses ( www.tobaccofreenurses.org ), a smoking-cessation program created by nurses (in collaboration with QuitNet, an Internet-based program) and tailored to nursing professionals and students.

Call for accountability. In states in which tobacco settlement funds have been used as intended, in-your-face antismoking ad campaigns have paid off with reduced teen smoking rates. But most states don't use these funds as intended, according to the Campaign for Tobacco-Free Kids ( www.tobaccofreekids.org ). If that is the case where you live, call for accountability from the tobacco industry and policymakers. Consider joining the Nightingales ( www.nightingalesnurses.org ), self-described “nurse activists who work to focus public attention on the behavior of the tobacco industry and its contribution to the preventable epidemic of tobacco-caused disease and death.”

Act locally. Support smoke-free community and workplace policies. Lobby your elected officials to increase tobacco taxes. Encourage restrictions on promotions and advertising.

Children and teens continue to be attractive targets for an industry that functions utterly without conscience or compassion for its victims.

---