1. How One Good Marketing Idea Can Lead to Millions of Premature Deaths: The Battle for Market Share Among Adolescent Smokers Joseph R DiFranza, MD Department of Family Medicine and Community Health University of Massachusetts Medical School

3. Adolescent Developmental Tasks Establish masculine/feminine identity Establish individuality Establish independence Feel accepted by peers

4. Tobacco companies commissioned research to discover the psychological vulnerabilities of children. Young males are “going through a stage where they are seeking to express their independence and individuality under constant pressure of being accepted by their peers.” –Imperial Tobacco Cigarette ads were designed to exploit adolescents’ psychological vulnerabilities to foster addiction.

5. The Tempo brand is targeted at… Individuals who are “extremely influenced by their peer group.” –RJR MacDonald

6. “Export smokers will be perceived as… characterized by their self-confidence, strength of character and individuality that makes them popular and admired by their peers.” –RJR MacDonald

7. “Very young starter smokers chose Export A because it provides them with an instant badge of masculinity, appeals to their rebellious nature, and establishes their position amongst their peers.”- RJR MacDonald

8. Peer acceptance

9. Only smooth characters allowed

10. Independence

12. Individuality

13. Feminine Identity

14. Masculine Identity

15. Research shows Children as young as age 3 can match cigarettes with ads for cigarettes. -Richards Kids understand the message of advertising before they understand the purpose of advertising. -Aitken Children who like cigarette ads are more likely to intend to smoke when they are older. -Aitken Children who approve of cigarette advertising are twice as likely to begin smoking in the coming year. – Alexander

16. Children get their positive images of smoking from advertising British experience Children who had favorite cigarette ads were twice as likely to believe there are benefits to smoking. Children who believe that smoking will make them more popular are 4.7 times more likely to smoke.

26. 1988

38. RJ Reynolds internal documents “The 81 documents contrast sharply with the company's repeated public declarations that it does not target young people, collectively sketching a picture of a company that seemed decades ago to determine that its financial future depended on recruiting a new generation of smokers.” – The Washington Post

46. What was the impact of this competition for the youth market?

54. <18 sales worth $476 million /year

55. My complaint to the Federal Trade Commission RJ Reynolds was reaping profits from illegal underage sales amounting to $476 million/year

57. FTC decision May 29, 1997 The agency asserted in an administrative complaint that the company violated Federal fair trade practice laws by promoting a lethal and addictive product to children and adolescents who could not legally purchase or use it.

58. Joe Camel 1988 - 1997

61. In England smoking among 14-15 year old boys went up only in regions of the country where “Reg” advertisements were posted.

62. How many people will die from this marketing war? 1988: 1 million 16-17 yr old daily smokers 1997: 1.5 million 16-17 yr old daily smokers 0.5 million additional daily smokers

63. Joe Camel 1988 - 1997

64. How many people will die from this marketing war? 300,000 extra smokers/year over 15 years = an increase of 4.5 million smokers About half of smokers die from smoking 2.25 million premature deaths due to the youth market battle.

65. How One Good Marketing Idea Can Lead to Millions of Premature Deaths: The Battle for Market Share Among Adolescent Smokers Joseph R DiFranza, MD Department of Family Medicine and Community Health University of Massachusetts Medical School