This presentation includes product advertisements for educational - - PowerPoint PPT Presentation

▶
this presentation includes product
SMART_READER_LITE
LIVE PREVIEW

This presentation includes product advertisements for educational - - PowerPoint PPT Presentation

May 08, 2023 369 likes •2.04k views

Center for Tobacco UCSF School Control Research and of Medicine Education The Future of Smoking: The Changing Context of Smoking Cessation Pamela M Ling, MD MPH Division of General Internal Medicine Department of Medicine Integrated Care

slide-1
SLIDE 1

UCSF School

  • f Medicine

Center for Tobacco Control Research and Education

The Future of Smoking: The

Changing Context of Smoking Cessation

Integrated Care Conference Keynote October 26, 2017

Pamela M Ling, MD MPH Division of General Internal Medicine Department of Medicine

slide-2
SLIDE 2
  • I have no financial interests to disclose
  • This presentation includes product

advertisements for educational purposes

  • I do not endorse the use of any of these

products

slide-3
SLIDE 3

Thanks to …

3

▪ Stan Glantz ▪ Tor Neilands ▪ Nadra Lisha ▪ Danielle Ramo ▪ Nicolas Sheon ▪ Bonnie Halpern-Felsher ▪ Janice Tsoh ▪ Sarah Rosen ▪ Stacey Anderson

  • Nan Jiang
  • Youn OK Lee
  • Rachel Grana
  • Emily McDonald
  • Lucy Popova
  • Sara Kalkhoran
  • Amanda Fallin
  • Louisa Holmes
  • Johannes Thrul
  • Cati Brown-Johnson
  • Jeff Jordan
  • Jenny Kondrasky
  • Andrew Ermlick
  • Tyler Janssen
  • Sohrab Sidhu
  • Tracey Maruyama
  • Rachel Barry
  • Yogi Hendlin
slide-4
SLIDE 4
slide-5
SLIDE 5

“If you want to reach me as a young gay man, and especially a young gay man of color, then you need to give me information in a vocabulary I can understand and relate to.''

Photo: Ken Probst

slide-6
SLIDE 6

6

Photo: Richard Castro

slide-7
SLIDE 7

7

slide-8
SLIDE 8

Cigarette Consumption USA 1900-2012

slide-9
SLIDE 9

9

slide-10
SLIDE 10

10

Why study tobacco marketing?

slide-11
SLIDE 11

industrydocuments.library.ucsf.edu/tobacco

slide-12
SLIDE 12
slide-13
SLIDE 13

http://www.mediavisioninteractive.com

slide-14
SLIDE 14

Philip Morris, 1994, tid:leg76e00

slide-15
SLIDE 15
slide-16
SLIDE 16
slide-17
SLIDE 17
slide-18
SLIDE 18

www.trinketsandtrash.org

slide-19
SLIDE 19

http://tobaccodocuments.org/pollay_ads/Came20.04.html

slide-20
SLIDE 20
slide-21
SLIDE 21
slide-22
SLIDE 22

22

slide-23
SLIDE 23
slide-24
SLIDE 24

Philip Morris, 1994, tid: leg76e00

slide-25
SLIDE 25
slide-26
SLIDE 26
slide-27
SLIDE 27

1976: Coupons with foodstamps

▪ Coupons in manila envelope distributed with foodstamps ▪ RJ Reynolds wanted to be embedded with other industry coupons (e.g., Campbell’s soup) ▪ RJ Reynolds had concerns that other people might perceive RJR as unethical:

27

RJR, 1976, TID: grh76a00

slide-28
SLIDE 28
slide-29
SLIDE 29

African American women according to RJ Reynolds (1985)

RJR, 1985, TID: kwb15d00

slide-30
SLIDE 30
  • Luxury
  • Alternative advertising and branding
  • Smaller packs
  • Lowering costs at retail
  • Menthol

Targeting African American women

slide-31
SLIDE 31

31

slide-32
SLIDE 32

32

slide-33
SLIDE 33
slide-34
SLIDE 34

Tobacco Industry Bar Promotions

▪ Have been a focus for over 20 years ▪ Increased dramatically in the 1990s ▪ Continue to reach young adults effectively

www.camelsmokes.com

slide-35
SLIDE 35
slide-36
SLIDE 36
slide-37
SLIDE 37
slide-38
SLIDE 38
slide-39
SLIDE 39

RJR, 1995 Camel Club Program Strategy, tid: alo41d00

slide-40
SLIDE 40

RJR, 1995 Camel Club Program Strategy, tid: alo41d00

slide-41
SLIDE 41

RJR 2006, tid: gyc87h00

“…They’re all plugged in to the now…these people are trend setters themselves…they’re the ones who got iPods and TiVos back when none of us understood why we needed them…” “…as thought leaders, they often serve as brand ambassadors, oftentimes recommending new smokes to their friends.”

slide-42
SLIDE 42
slide-43
SLIDE 43
slide-44
SLIDE 44
slide-45
SLIDE 45
slide-46
SLIDE 46
slide-47
SLIDE 47
slide-48
SLIDE 48
slide-49
SLIDE 49

49

Source: SRITA

slide-50
SLIDE 50

50

Source: SRITA

slide-51
SLIDE 51

51

slide-52
SLIDE 52

www.blucigs.com Increased social status (44%)

slide-53
SLIDE 53

Fruit 73% Candy 71% Alcohol 10%

slide-54
SLIDE 54
slide-55
SLIDE 55
slide-56
SLIDE 56
slide-57
SLIDE 57

Celebrity Endorsements – 22%

Thanks to: Jaime Jensen

slide-58
SLIDE 58
slide-59
SLIDE 59
slide-60
SLIDE 60

Health Claims – 95%

slide-61
SLIDE 61

Doctors = 22% of websites

Videos from www.smokestik.com Image from www.ecigaretteschoice.com; www.v2cigs.com

slide-62
SLIDE 62

Cessation claim – 64%

Health Claims: 95%, Cessation 64% of websites

slide-63
SLIDE 63

“I have been able to quit smoking because of your product.”

  • -Debbie from Sacramento, CA
slide-64
SLIDE 64

www.blucigs.com, Accessed September 25, 2011

slide-65
SLIDE 65
slide-66
SLIDE 66

Circumvent smokefree laws

Circumvent laws: 71% of websites

slide-67
SLIDE 67

http://www.v2cigs.com/

User recruitment programs

Cheaper claims: 93% of websites

slide-68
SLIDE 68

Cost savings

Tobacco.stanford.edu

slide-69
SLIDE 69
slide-70
SLIDE 70
slide-71
SLIDE 71
slide-72
SLIDE 72

Kalkhoran and Glantz, Lancet Respir Medicine, 2016

slide-73
SLIDE 73
slide-74
SLIDE 74

Vapingcheap.com

slide-75
SLIDE 75

Vaping360.com

slide-76
SLIDE 76

76

“We’ve Changed!”

Photo: Sebastian Dooris

slide-77
SLIDE 77
slide-78
SLIDE 78
slide-79
SLIDE 79

79

slide-80
SLIDE 80

80

RAI investors day, November 12, 2012

slide-81
SLIDE 81

BAT “Next Generation Products”

slide-82
SLIDE 82
slide-83
SLIDE 83
slide-84
SLIDE 84
slide-85
SLIDE 85
slide-86
SLIDE 86
  • Test-marketed in Poland and Japan as

“HeatSticks” (2015)

  • Intended $6 per pack in the US
  • Heated just below combustion, 660 degrees F
  • Heavy investment: $500 million factory in Italy
  • pened in 2016

iQOS (PMI, 2014-)

slide-87
SLIDE 87
  • 2-3 million page Modified Risk Tobacco Product (MRTP)

application submitted Dec. 5 2016 to FDA

  • PMI, through Altria, also submitting “pre-market tobacco

product application in the first quarter of 2017”

  • Premium market positioning (like e-cigs)
  • Wells Fargo analyst Bonnie Herzog predicts iQOS and other

HnB technologies “could displace up to 30% of the combustible cigarette industry in developed markets by 2025”

http://www.fool.com/investing/2016/07/22/philip-morris-international-proves-that-heated-cig.aspx

iQOS – Why is it important?

slide-88
SLIDE 88
  • Glo iFuse (Romania only, e-cig/HnB hybrid)
  • Glo (Sendai, Japan, HnB)
  • “iQOS is more like a cigarette while the iFuse is more like an e-cig”

Glo iFuse (BAT)

  • Because of price point:
  • hoping to quit  go for iFuse
  • If no quitting intentions  iQOS

https://www.ileanachermenschi.com/blog/2016/6/12/behavioral-economics-used-for-the-worst-glo-ifuse-and-iqos-what-marketers-should-never-do

slide-89
SLIDE 89
slide-90
SLIDE 90

vaping360.com/best-vape-pen/

slide-91
SLIDE 91

Photo: Gaby Butcher

slide-92
SLIDE 92
slide-93
SLIDE 93

93

http://bymuza.deviantart.com/art/godzilla-212114211

slide-94
SLIDE 94

BAT Harm Reduction Report 2017

slide-95
SLIDE 95

BAT Harm Reduction Report 2017

slide-96
SLIDE 96
slide-97
SLIDE 97
slide-98
SLIDE 98

98

“Business as Usual!”

Photo: Sebastian Dooris

slide-99
SLIDE 99
slide-100
SLIDE 100
slide-101
SLIDE 101
slide-102
SLIDE 102

www,ecigclick.co.uk

slide-103
SLIDE 103

Nicotine or Cannabis?

103

slide-104
SLIDE 104
slide-105
SLIDE 105

Tobacco Risk According to Altria

slide-106
SLIDE 106

Data collection

  • One-on-one interviews (1 hour)
  • 32 young adults
  • 25 2ND interviews
slide-107
SLIDE 107

Picture sorting task

slide-108
SLIDE 108

Participants (N=32)

▪ Age 18-26, mean age 23 ▪ 44% women

Hispanic, 34% NH White, 31% NH Black, 19% >1 race NH, 13%

94% Cannabis, 44% daily 44% Smokers, 16% daily

slide-109
SLIDE 109

Results

Combustion Medicinal Potency Chemicals Addiction

slide-110
SLIDE 110

Combustion

▪ “In terms of [marijuana] edibles…there’s no carcinogens, no pathogens or anything going into your lungs. [With] vaporization, there is really no smoke…eliminating the same thing that the edibles eliminate. It’s safer for your lungs.”

Smoking was considered more harmful than non- combustible products

slide-111
SLIDE 111

Medicinal

Health risks of combusted marijuana were balanced by perceived medicinal benefits

“I know smoking in general is bad for your lungs… but weed out

  • f all these, to me, is not as harmful… because they suggest it

to cancer patients. It's medicinal.”

slide-112
SLIDE 112

Potency

Edibles and marijuana concentrates were perceived as more dangerous than smoking marijuana flower because

  • f the potential to receive too high a dose of THC

(tetrahydrocannabinol)

“I still think that the dangers of a panic attack from a vaporizer or an edible outweigh possible dangers of inhaling smoke from cannabis.”

slide-113
SLIDE 113

Potency

Using marijuana concentrates through a “dab rig” was associated with harder drugs for some

“…it just feels very meth-like to me, or looks like something the FBI could kick down my door for. So it's just not something I have any desire to do.”

slide-114
SLIDE 114

Chemicals

Products containing chemical additives were more harmful than “pure” or “natural” plant products (marijuana flower)

“They do say marijuana has more tar than

  • tobacco. But I don't know if the body can break

that down easier, because it's just a natural tar, as opposed to a chemical-filled tobacco product.”

slide-115
SLIDE 115

Addiction

Participants recognized physiological addiction to nicotine, but primarily talked about psychological or lifestyle dependence on marijuana

“I feel that for a lot of people, especially in Colorado, it's very much emotionally dependent, mentally dependent, on marijuana…”

slide-116
SLIDE 116

Source of knowledge

Personal experiences, warning labels, campaigns, the media, and opinions of product retailers and medical practitioners

“”Generally when things make you feel bad, they’re bad for you.”

slide-117
SLIDE 117
slide-118
SLIDE 118

Combustion Non-combustible

slide-119
SLIDE 119

Addiction Chemicals Potency Natural Medicinal Combustion Non-combustible Adverse Effects

slide-120
SLIDE 120

Fighting Back

slide-121
SLIDE 121
slide-122
SLIDE 122

Peer Crowd Segmentation

▪5 minute intercept surveys ▪Fast and easy ▪Select pictures to identify friends ▪Affiliation with different peer crowds is scored

slide-123
SLIDE 123

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Hipster Partier Hip Hop Young Professional Homebody Country

Smoking Among Bay Area Young Adults 2014

Current Smoker

slide-124
SLIDE 124

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Hipster Partier Hip Hop Young Professional Homebody Country

Smoking Among Bay Area Young Adults 2014

Smoker Attends Bars Current Smoker

slide-125
SLIDE 125

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Hipster Partier Hip Hop Young Professional Homebody Country

Smoking Among Bay Area Young Adults 2014

Smoker Attends Bars Current Smoker

slide-126
SLIDE 126
slide-127
SLIDE 127

Who are Hipsters?

Qualitative Research ▪Perceived as “the smokers” ▪Focus on local art and music scene ▪Authenticity - Skeptical about ‘wannabees’ ▪Experiential ▪Anti-corporate sentiment ▪Pro-environment, animals

slide-128
SLIDE 128

130

slide-129
SLIDE 129

131

slide-130
SLIDE 130
slide-131
SLIDE 131

133

Insert Commune Video Here video

slide-132
SLIDE 132
slide-133
SLIDE 133
slide-134
SLIDE 134
slide-135
SLIDE 135

Brian Zager

slide-136
SLIDE 136

Design: Oh Nori

slide-137
SLIDE 137

Lucy Duarte

slide-138
SLIDE 138
slide-139
SLIDE 139

Mikey Dead

slide-140
SLIDE 140

142

30 35 40 45 50 55 60 65 70 75 80 Baseline FU1 FU2 FU3 Current Smoking (%)

Smoking Prevalence in Hipster Bars in San Diego

Trend Sensitive Hipsters Hipsters All bar patrons Non-Hipster bar patrons

slide-141
SLIDE 141

143

slide-142
SLIDE 142

Study Design

144

San Diego San Francisco Albuquerque Oklahoma City Los Angeles Tucson Nashville

slide-143
SLIDE 143

145

slide-144
SLIDE 144
slide-145
SLIDE 145

Smoking Cessation for Young Adults is Important

▪ 99% of smokers start by age 26 ▪ Quitting smoking before age 30 avoids most morbidity/mortality

  • Young adults are equally likely to try to quit
  • Most quit attempts are unplanned and unassisted

147

slide-146
SLIDE 146

Calls to Quitline by Young Adults

5 10 15 20 25 30 35 40 45 50 Jan Feb Mar Apr May June

148

San Francisco County, 2016

slide-147
SLIDE 147
slide-148
SLIDE 148

Danielle Ramo

slide-149
SLIDE 149
slide-150
SLIDE 150

How confident are YOU that you could quit smoking?

New Designed Image Old Image

slide-151
SLIDE 151

New Designed Image Old Image

slide-152
SLIDE 152

Young Adult Smoking Cessation Access 2016-2017

5 10 15 20 25 30 35 40 45 50 Jan Feb Mar Apr May June Nov Dec Jan Feb Mar Apr May

154

San Francisco county, 2016-2017 Facebook Quitline

slide-153
SLIDE 153

Key lessons learned

▪ Tobacco marketing causes initiation and continuation of smoking ▪ Targeted marketing exacerbates tobacco disparities ▪ New products claim harm reduction ▪ Marketing of new products suggests business as usual ▪ Marijuana legalization is going to affect tobacco use ▪ Creative, scalable counter-marketing interventions are feasible

  • Significant decreases in smoking and binge drinking
  • Psychographic segmentation adopted by States and the FDA

▪ We can make smoking cessation cooler!

155

slide-154
SLIDE 154

Supporting your patients

▪ Ask all patients about ALL tobacco product use (cigarettes, little cigars, e-cigarettes) ▪ Personalize counseling to their medical conditions and life context ▪ Create environments that support cessation

  • Smoke-free homes and cars
  • Smoke-free substance use and mental health treatment settings

▪ Suggest smokers remove themselves from tobacco mailing lists

  • Direct mail, email, apps
  • Coupons are designed to keep them smoking
slide-155
SLIDE 155

Clinical advice on e-cigarettes

▪Questions about e-cigarettes may signal willingness to quit

  • Opportunity for discussion
  • Support quit attempt

▪Correct misperceptions

  • Not “harmless water vapor”
  • Not approved for smoking cessation

▪If patient insists on using e-cigarettes

  • Discourage dual use of cigarettes and e-cigarettes
  • Set a quit date for e-cigarettes
  • Do not expose others to the aerosol
slide-156
SLIDE 156

Advocacy and Community Action

▪Include e-cigarettes in tobacco free policies ▪Prohibit cessation and health claims ▪Apply cigarette advertising restrictions to electronic cigarettes ▪Support local flavor and menthol bans ▪Beware the pharmaceuticalization of tobacco companies ▪Apply lessons learned from tobacco to marijuana

  • Warning labels
  • Strong media campaigns
  • Include in smoke-free policies
  • Advertising and retailer density limits
slide-157
SLIDE 157

159

slide-158
SLIDE 158
slide-159
SLIDE 159
slide-160
SLIDE 160

Photo: Gerard Van der Leun via Flickr

slide-161
SLIDE 161

Artist: Ubin Li

slide-162
SLIDE 162

Heather Katsoulis via Flickr

slide-163
SLIDE 163
slide-164
SLIDE 164

“…a ‘community’ is simply any collection of people who are or feel connected, who help and depend on one another...community is the foundation of longevity and happiness”

Recovery includes becoming responsible members of the community

slide-165
SLIDE 165