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INTERview: Kim Worden

Massive UVM project fights youth smoking one tiny, belief-changing message at a time.

By Kevin Foley Article published February 27, 2002

Kim Worden
Tool of the anti-smoking trade: Kim Worden with a television displaying an anti-smoking message he helped develop. (Photo: Rose McNulty)

Why do kids start smoking? How can the media influence them to shun cigarettes?

John "Kim" Worden, research professor of family practice and a member of the Office of Health Promotion Research, has been tackling these knotty questions in Vermont since 1978. He’s now a key member of a team of UVM scientists who are using a $16 million, five-year grant testing the use of carefully calibrated mass-media messages to deter or stop kids from smoking. Other members of the team include Brian Flynn, director of the office, Laura Solomon, research professor in psychology, and Taka Ashikaga, director of the medical biostatistics unit.

Their study, dubbed PRYSM ("Program to Reduce Youth Smoking through Mass Media"), is funded by one of the largest grants at UVM. It is an extension of the team’s earlier work, which found that the right messages could reduce smoking. What are the right messages? We’ll let Worden explain, but their roots are in social cognitive theory. This approach holds that the way to change behaviors is to change beliefs about what’s normal and valuable within one’s peer group. This hits kids where they live — in their day-to-day interactions with friends and peers — and informs anti-smoking spots very different from the familiar doomsaying approach. These spots are airing in four geographically diverse areas between now and 2004, with the current research design concluding in 2005.

Our conversation with Worden, abridged here, covered everything from the anti-smoking potential of afterschool TV to how Big Macs differ from Marlboros.

THE VIEW: What are the goals of the PRYSM research?

KIM WORDEN: The goal of the project is to develop a mass-media campaign to prevent smoking among young people and help those who already are smoking quit.

It’s developed for use from ages nine through 17, but is segmented into three campaigns, for grades 4-6, 7-8 and 9-12. Each campaign is directed specifically at each of the age groups so that we can communicate most effectively with them. We also have a quit-smoking campaign for those who already are smoking.

Why is stopping kids from smoking so important?

Most people begin smoking between the ages 9 and 17. So if you can stop young people from beginning to smoke, you can almost inoculate them from smoking forever. All the health consequences come later — there are few immediate consequences. For kids, the consequences of smoking are mostly social.

Our job is to vividly point those out. Bad things happen to people who smoke – their hair smells, their teeth yellow, they’re less popular. Then we show that good things happen to people who don’t smoke, most of them social. Then we demonstrate skills for resisting smoking, specifically how easy it is to turn down a cigarette.

We want to demonstrate to kids that most kids don’t smoke, and that the norm is not smoking. This is a very important message. Most kids wildly overestimate how many other kids are smoking, especially when they think about older kids. So a middle school student may feel like he or she has to learn how to smoke to get along in high school.

One of your areas of focus is developing and rigorously testing anti-smoking messages. What messages help kids quit smoking?

If you ask someone off the top of his head how to get kids to not smoke, most people would say you need to show them that they would ruin their lives and health. But most kids don't think that far ahead. So the social cognitive approach focuses on modeling the positive consequences of not smoking.

This was first tried in school health education programs; we were the first group to adapt this theory to mass media. In our mid-1980s study, we had a campaign that reduced smoking by 35 percent. This confirmed the idea that young people are most interested in what’s going to happen to them in the next day. If you can portray that most attractive people around them don’t want to smoke cigarettes, lose friends and have smelly hair and yellow teeth, these are very important to young people who are unsure of their social standing.

It’s true that some other campaigns we’ve seen in the last 10 years have been trying to use other approaches — one of them vilifying the tobacco industry. This makes a lot sense to anti-tobacco advocates, but not necessarily to kids.

So the blizzard of ads we’re seeing in many states may not be doing the job?

Many of these campaigns have been pretty improvisational. We are not sure of whether they have had any measurable impact. One of the reasons we’re doing this large study now as a replication of earlier work is to demonstrate that the social-cognitive approach can have an impact on a national scale. We’re working in different states, with multi-ethnic audiences, southern as well as northern, with highly varied groups of young people in terms of race and ethnicity.

How does mass media influence kids’ decision to smoke or not smoke?

We are modeling positive behavior through the mass media. Instead of the kid next door, it’s someone on television and radio. It turns out that the mass media are particularly appropriate for reaching kids at higher risk of smoking. These are the kids that might not perform as well in school and that don’t have many anti-smoking influences around them. Many of these kids come home from school and turn on the television and radio; so the hours from 3 p.m. to 7 p.m. are very high priority for us. They come home, flip on the TV, and there we are with our messages. It’s a very targeted and cost-effective use of media.

Can anti-smoking ads have unintended consequences? Can too much of a good thing actually glamorize smoking and make it more appealing?

I hope not! I don’t think too many anti-tobacco ads will make smoking more appealing, but it might make anti-smoking more boring. Kids may get tired of hearing the message. That’s why we have 14 different production companies working with us right now, so we have great variety and creativity in our spots.

And yes, you really have to worry about unintended messages. I saw a billboard not long ago that attacked the tobacco industry by saying something like "every day 3,000 kids start smoking." An adult sees that and thinks "we have to get these guys." A kid sees that and may think, "I’m going to have to start smoking to fit in." So we are aware of unintended consequences all the time. When we have an ad of someone resisting a cigarette, we show it being proffered by someone who is unattractive, weird, no one you would want to be around. If we showed five attractive models ganging up on one kid, many young people would get the wrong message.

How can parents help their children decide not to smoke?

I think the most important thing is to let the kids clearly know where you stand on this issue. For people who have been smokers, or are still smoking, that might be difficult. But since tobacco is very addictive, a parent can say, "I’m hooked on these things. I’ve tried to quit and I can’t do it. The last thing I want is for you to get involved."

The other thing that parents can do is keep up on their children’s activities. Smoking marijuana or cigarettes or drinking usually takes place at unsupervised time. It’s very important to know what your kids are doing at those times. The after-school hours, when we reach kids through the media, are good candidates for scrutiny. It’s not necessary to keep track of their every movement, but they need to know that you might be monitoring their moves. You need to drop by occasionally and see what they’re doing, and ask them often where they’re going, what they’re doing and with whom. That can help a lot.

Devil’s advocate time: Why are cigarettes a special regulatory and public health education case? Given the obesity, heart disease and hypertension epidemic — and massive media campaigns from the fast food industry — shouldn’t we slap a sin tax on super-size burgers and ramp up our mass-media anti-fat campaigns?

I think cigarettes are special because they’ve been found to be the biggest single detriment to health there is, and there’s good scientific evidence to back that up. We aren’t born with a cigarette in our mouths (although there’s some evidence that you can be predisposed to smoking), smokers go through an indoctrination period. It’s actually a little repulsive to learn how to smoke. So smoking is preventable. Obesity is a little more complex. And, of course, smoking is addictive. Once the smoker begins smoking, there is a loss of control. In my view, any time someone is promoting something that has such an insidious, detrimental and lasting effect, it’s a public policy issue.