It is my belief that adolescence is the most difficult age to endure. Not for angst, as one might assume, nor the incessant torment of existential uncertainty or the insatiable void of unresolved identity. Rather, adolescents are trapped in between the intellectual capacity to understand stupid decisions and the youthful obligation to rebel. Thus, if a parent or guardian insists, “Do not walk around the city in bare feet, you’ll step on a needle”, what choice does the youth have but to walk around the city barefoot? As stupid as they may recognise this decision to be, the alternative does not bear thought. Though of course purely hypothetical (what can I say?–the example just came to me), we each lived this season of our lives with questionable sagacity. Yet despite shared trauma, Big Tobacco takes advantage of this phenomenon by targeting the resignedly rebellious youth population [Carpenter et al. 2005].
The Partnership For A Tobacco-Free Maine (though they do not abbreviate, we’ll call them TFM) is a top-down, state funded, youth targeted anti-tobacco initiative which illustrates the core flaws in methodology for social design today. Through a poorly designed web-interface, the initiative prioritises health impact awareness, announcing the damning effects of tobacco, the psychology of youth-influence and the evil of the industry, with no academic support. Though their practical initiatives, such as the LifeSkills Training program or the Real Talk About Smoking video, have had some success, they bypass the crux of the issue; the prohibition of tobacco increases its appeal [Johnson et al. 2003]. Credit where credit is due: their programs in response to the detrimental health impact of the industry have been more significant, providing services to assist in overcoming addiction, and training healthcare providers to do the same. Their counter-marketing and awareness campaigns have been effective in their base purpose, to reinforce the health risks of tobacco, but even so, they’re locked in the past and fail to address present challenges.
Big Tobacco spends millions of dollars on slick marketing tactics to replace those customers who die from using their product or who have quit smoking. –TFM
What has design to learn from the experience of TFM? Conventionally, our inclination has been to draw a direct line from problem to solution; from a lack of awareness to mass-marketing. Yet the vacillation of society interferes with this rigidity, as typified by the shortcoming of TFM. Brown offers a new lens through which to consider our approach to wicked problem solving, “Design thinking taps into capacities we all have but that are overlooked by more conventional problem-solving practices. It is not only human-centered; it is deeply human in and of itself.” [Brown 2009]. Drawing from this order, by prioritising people and celebrating their expertise and values, we construct a methodology unconstrained by traditional faults. Fluid, inclusive, collaborative, thorough and equitable, deeply human design offers an approach to challenge Big Tobacco and positively redesign our world.
Perhaps we never quite overcome our youthful defiance. I, for one, recall fondly my return home, triumphantly unshod and needle free. Still, it would be a comfort to know that those redesigning our world were doing so for our sake… designing to protect the vulnerability of our obdurate orientation between a rock and a hard place.
Brown, T. 2009, Change by Design: How Design Thinking Transforms Organizations and Inspires Innovation, HarperCollins Publishers, New York, NY, p. 4.
Carpenter, C. M., Wayne, G. F., Pauly, J. L., Koh, H. K., Connolly, G. N. 2005, ‘New Cigarette Brands With Flavors That Appeal To Youth: Tobacco Marketing Strategies’, Health Affairs, vol. 24, no. 6
Johnson, J. L., Bottorff, J. L., Moffat, B., Ratner, P. A., Shoveller, J. A., Lovatoc, C. Y. 2003, ‘Tobacco dependence: adolescents’ perspectives on the need to smoke’, Social Science & Medicine, vol. 56, no. 7
Growing up in Australia today, the harsh consequences of smoking are regularly advertised. This is completely different to how my parents grew up in the 1970s, a time where the diseases linked to smoking were only just being discovered by scientists and doctors. Studies show that still only a few people understand the specific health risks of tobacco use. For example, a 2009 survey conducted by the World Health Organisation in China revealed that “only 38% of smokers knew that smoking causes coronary heart disease and only 27% knew that it causes stroke”. (World Health Organisation 2017.)
As part of an initiative to “make Australia the healthiest country by the year 2020”, (Cancer Council Victoria 2011) and knowing the cigarette pack has become an important means of communicating the risks of smoking, the Australian Government decided to fund a project to introduce what is known as plain packaging. From December 1 2012 all tobacco products were legally required to be in plain packaging, making Australia the first country in the world to introduce this top-down design led initiative. (The Department of Health 2017.) This initiative requires all tobacco products in Australia to be standardised and sold in uniform plain green boxes, typefaces and “contain graphic images of diseased smokers”. (White, V. Williams, T. & Wakefield, M. 2015.) It requires the removal of all branding such as colours, imagery, logos and trademarks. (2015.)
These were all done in support of the Tobacco Plain Packaging Regulations Act 2011. (Federal Register of Legislation 2016.) Its objectives were to “improve public health by discouraging people from using tobacco products or starting, increase the number of smokers who quit and reduce exposure to tobacco smoke.” (The Department of Health 2017.) Increasing the effectiveness of health warnings helps to reduce the ability that previous “glamorised” (2017) retail packaging had on consumers. I believe these improvements in how tobacco products are promoted through packaging are essential to reducing the unacceptable level of death and disability caused by smoking in Australia. This is because people are more likely to understand the side effects through confronting imagery as oppose to text.
Two years after the Act was introduced in 2012, the Australian Government commenced a “Post-Implementation Review” (2017) of tobacco plain packaging to “assess its effectiveness.” (2017.) The results concluded the Act is having a positive impact because in results released by the Australian Bureau of Statistics, there was a general decrease in the smoking rate, dropping from 15.1% in 2012 to 12.8% in 2014. (2017.) Cancer Council researcher Professor Melanie Wakefield also commented “about 20% of people who smoke made attempts to quit over the course of a month…after plain packaging, that went up to nearly 27% of people who made quit attempts”. (Wakefield, M. 2017.) Furthermore, Doctor Tasneem Chipty, an expert in econometric analysis says from December 2012 to September 2015, “the 2012 packaging changes resulted in 108, 228 fewer smokers”. (Chipty, Dr T. 2017.) It is evident that plain packaging in Australia has been successful when it is compared to countries like Indonesia, where this incentive has not been introduced. While the number of smokers in Australia is decreasing, statistics show that the number of smokers in Indonesia rose over the last year, from 31.8% in 2015 to 34.1% in 2016. (Reddy, K.S. Yadav, A. Arora, M. 2017.)
Although plain packaging has shown positive results in Australia, it also highlights problems. The World Trade Organisation granted Indonesia the right to challenge Australia’s plain packaging laws in 2014. (Moore, S. 2014.) Indonesia’s Trade Ministry director Bachrul Chairi believes Australia “breaches international trade rules and the intellectual property rights of brands.” (Chairi, B. 2014.) Chairi further comments that it removes an available avenue of brand advertising for cigarette companies. (2014.) Since Indonesia is the “sixth biggest tobacco exporter and provides jobs to more than six million people”, (Moore, S. 2014) there is an incentive to promote the tobacco industry. The final ruling is yet to be made.
On a universal level, the UK has followed Australia in the plain packaging laws as of May 2016, (Bourke, L. 2016) citing the decline in Australia’s smoking rate as proof that it works. In the future, Ireland, France and New Zealand are among several countries committed to following Australia and the UK in introducing plain packaging. (2016.) Consequently, with other countries coming on board, I strongly believe that plain packaging will continue to globally succeed in battling the tobacco epidemic as its graphic imagery showing the diseases smoking causes provides a much more powerful message than words on the old packaging ever will. We just need to convince Indonesia to follow this trend.
White, V. Williams, T. & Wakefield, M. 2015, ‘Has the Introduction of Plain Packaging with Larger Graphic Health Warnings Changed Adolescents Perceptions of Cigarette Packs and Brands?’, Tobacco Control, vol. 24, no. 1, pp. 06-11, viewed 11 December 2017.
World Health Organisation. 2017, ‘WHO Report On The Global Tobacco Epidemic: Monitoring Tobacco Use and Prevention Policies’, Bloomberg Philanthropies, vol. 1, no. 1, pp. 19-25, viewed 10 December 2017.
Cigarette butts contain carcinogenic chemicals, pesticides, and nicotine, and most filters are made up of plastic fibres (cellulose acetate). Accordingly, the 5.6 trillion cigarette butts that are littered into the global environment each year (Healton et al 2011) have a large – and negative – effect on the environment.
Whilst cigarette butts may be small, they contain materials that are not biodegradable and are littered in large volumes, which is proving detrimental to the environment. Damage from this includes bio-accumulation of poisons up the food chain and harm to water supplies (ANRF 2017). However, a Dutch start-up called Crowded Cities have come up with a design solution to combat the impact of tobacco waste on the environment.
Crows are highly intelligent animals and are able to make and use tools. Using this knowledge, and taking inspiration from the design ‘The Crow Box’, industrial designers Ruben van der Vleuten and Bob Spikman came up with the idea of the Crowbar; a device that teaches crows to pick up cigarette butts in exchange for food. When a crow brings a cigarette butt to the Crowbar and drops it into the funnel, the device recognises whether it is in fact a cigarette butt and then dispenses a bit of food for the crow to take.
Hypothetically, the crow will continue to collect cigarette butts in return for food and let other crows know to do the same. Thus, the Crowbar proposes a solution to the major problem of littered cigarette butts by harnessing nature to do most of the work, and creating a mutualistic relationship between local crows and the machine. The next step for researchers will be to examine how collecting cigarette butts affects crows, i.e. whether carrying the butts in their mouths will have a negative effect on them.
However, substantial issues and challenges arise from the design: for instance, the Crowbar would have to be purchased by a local council; the machine would need to be set up, supplied with food and emptied of butts on a regular basis; and wild cows would initially need to learn how to use the Crowbar. As different crows learn at different speeds and in different ways (Crow Box n.d.), potentially the Crowbar would have to be implemented in different ways depending on where in the world it is being used.
Future potentials permutations of the Crowbar could include collection by the crows of other small pieces of litter, including gum, various plastics, etc. The machine could either encourage locals to litter less, but it also has the potential to validate their littering, and incentivise them to litter, as they may feel like they are helping or feeding the crows by producing waste for them to clean up.
COLOGNE, GERMANY. 1939 — scientist Franz Müller presents the first epidemiological study linking tobacco use and cancer. Five years later, German scientists Eberhard Schairer and Erich Schöniger at Jena University confirmed this study — convincingly establishing for the first time that cigarette smoking is a direct cause of lung cancer. These findings became the basis for the “first and most broadly-reaching anti-smoking campaign of modern times.” (Hamilton, 2014).
Smoking was discouraged in the workplace, banned in cinemas, and also in schools. Policemen and servicemen could not smoke in uniform, and it was not permitted to sell women cigarettes in cafes and other public places. As well as this, advertising tobacco products was restricted. According to Proctor (2000), “Nazi officials moved aggressively in an all-out campaign against cigarette smoking in which tobacco was proclaimed ‘an enemy of the people,’”. The scope of this can be seen in many of the posters and slogans produced for the campaign, the anti-tobacco journal Reine Luft (Pure Air), for instance, used puns and propaganda to suggest smoking was promoted by the devil (Weindling 1989).
Cartoon From a 1941 Issue of Reine Luft (Pure Air) 1941 (image: AJPH)
This tobacco control approach can be seen as a top-down method, in which the totalitarian National Socialists enforced what they saw as an issue in the best interest of the people. Research into the effects of tobacco were funded by the Institute for the Struggle Against Tobacco, which was founded in 1941 and funded by Hitler’s Reich Chancellery (Hamilton 2014). The campaign can be seen as an interdisciplinary initiative that compounded anti-capitalist propaganda, public health research, and quite often — anti-Semitism. It’s enforcement however, was reportedly inconsistent, where “measures were often not enforced, and cigarettes were actively distributed to ‘deserving’ groups” (Bachinger et al 2009). Later statistics suggest that despite the volume of the lasting effects of the initiative prevented approximately 20,000 German women from lung cancer deaths due to Nazi paternalism, which discouraged women from smoking, often with police force (Proctor 2000).
The Institute for the Struggle Against Tobacco was shut down after the second world war. A decade later, the American Cancer society published findings confirming the link between lung cancer and smoking; as well as the risk of second-hand smoke. Though enterprising, Aboul-Enein (2012) reminds us that these aggressive campaigns were “less concerned with the universal dimensions of public health practices and ethics than they were towards a pursuit of a lifestyle that was worthy of a ‘master race.’”
Aboul-Enein, B. 2012, ‘The Anti-tobacco Movement of Nazi Germany: A Historiographical Re-Examination’, Global Journal of Health Education and Promotion, vol. 15.
Bachinger, E. Gilmore, E. Mckee, M. 2001, ‘Tobacco policies in Germany: not as simple as it seems’, London School of Hygiene and Tropical Medicine, London.
Anti-smoking campaigns need to target a specific audience, and use hard-hitting emotional tactics to successfully inspire a change in behaviour. It has long been thought that most campaigns are aimed at the family or friends of the smoker, who have more leverage than the often ignorant and stubborn smokers themselves.
In Williams’ and Allan’s study, it is proposed that marginalised communities are more likely to resist smoking campaigns. The behaviours associated with smoking ‘signify risk taking, independence, and an anti-authoritarian attitude.’ [Pampel 2006]. this temperament is among the most difficult to approach with marketing tactics, as it is all about resistance, and is often formed via cultural influences. Smoking is encouraged in the ‘inter-exchange and sharing of tobacco; sharing between family and friends may act as reinforcement.’ [Williams & Allan 2014, pg 4].
The Center for Disease Control and Prevention’s (CDC) 2012 campaign featuring anti-smoking advocate Terrie Hall depicts the harsh, unglamorous, confronting reality of the potential, and more importantly, preventable, effects of smoking. It is done through a harrowingly personal recount of her experience of tobacco-related disease in a series of public service announcements titled “Terrie’s tips”. She speaks with a horrifying rasp using an artificial voicebox, and takes us through her daily routine, allowing us to compare our own. The repeated message “she was 53” throughout the campaign emphasises Terrie’s lost opportunities and the tragedy of her premature death. The print advertisement (shown below) highlights the tragedy of losing something so paramount as speaking; torn away by a preventable action.
“My fear now is that I won’t be around to see my grandchildren graduate or get married.”
To target the “thoroughly integrated, embedded behaviour” [Booth-Butterfield, 2003] that is smoking, the approach must be evocative and realistic, as fear-based appeals can lead to rejection of the message and trigger a defensive response [Devlin 2007]. Terrie’s campaign drove 1.6 million smokers to try to quit, and helped more than 100,000 to succeed, inspiring millions of others to encourage friends and family members to quit. The initiative was eminent in that it was the first ever federally-funded national anti-smoking campaign. Healthcare costs related to smoking reached $93 million in 2013, and it remains the number one cause of preventable death in America.
From the CDC campaign, it is evident that an emotionally distressing personal narrative, combined with a sustained coverage, is effective in encouraging smokers to quit. Sandhu (2009) described strategic communication in this context as multidisciplinary “intentional” communication that requires a purposeful actor. The choice of Terrie, who dedicated most of her life in various anti-smoking pursuits, was an apt choice and a brave human to bare her experiences on the line to reach out to others.
Regarded as the key factor to cause a wide range of diseases including many types of cancer, heart disease and stroke, chest and lung illnesses and stomach ulcers, tobacco smoking leads to over 7 million (WHO 2017) deaths annually. It does not only destroy the health of the smokers, but also ‘…exacerbates poverty, reduces economic productivity, contributes to poor household food choices, and pollutes indoor air’ (Chan 2017).
In December 2012, Australia successfully became the first country to introduce the legislation of Tobacco Plain Packaging Act 2011 that requires all cigarettes sold from July 2012 to be packed in olive brown packages without brand design elements except for their brand names and product names displayed in a standardised font, colour and location (Wakefield 2011). Plain packaging eliminates the function of cigarette packs as portable advertising methods for tobacco companies, by smokers conveniently disseminating branding and imagery wherever they go. The Act went further to include large warning depictions of diseases caused by tobacco smoking, which was required by FCTC to cover at least 30% or 50% of the front and back of the packages (Hammond 2011). It aims to improve the public health by discouraging people from using tobacco products, discouraging relapse of tobacco use and reducing exposure to tobacco smoke (The Department of Health 2017).
The government’s announcement of Plain Packaging Act showed Australia’s serious commitment to the WHO Framework Convention on Tobacco Control. However, the paths through its realisation have continued to be opposed and attacked by tobacco companies, who are desperate to prevent its implementation in Australia. (Wakefield 2011) The victory of Philip Morris’ case against plain packaging law, which was criticised by the court as an ‘abuse’ (Knaus 2017) of trade agreements, was invigorated and it established an important precedent for plain packaging to be implemented elsewhere.
Following the treaty of plain packaging and comprehensive graphic health warnings on cigarette and tobacco packs, the pack display declined by 15% (Zacher 2014). It has effectively minimised the exposure to tobacco promotion and has increased attention of health knowledge and perceptions of risk by smokers and non-smokers to promote smoking cessation (Hammond 2011). The drop of 0.55% points (Belluz 2016) of smoking rates between 2012 and 2015 attributed to the packaging changes that shows the success of plain packaging. The expectation aims to accrue the benefits of the Act overtime to protect young people from the tobacco industry.
Wakefield, M. 2011, Welcome to cardboard country: how plain packaging could change the subjective experience of smoking, Tobacco Control 2011,Tobacco Control, viewed 14 December 2017, http://tobaccocontrol.bmj.com/content/20/5/321
Zacher, M., Bayly, M., Brennan, E., Dono, J., Miller, C., Durkin, S., Scollo, M. & Wakefield, M. 2014, Personal tobacco pack display before and after the introduction of plain packaging with larger pictorial health warnings in Australia: an observational study of outdoor café strips, Wiley Online Library, pp. 653–662, viewed 14 December 2017, http://onlinelibrary.wiley.com/doi/10.1111/add.12466/full
“The bottom line is smoking cool and you know it,” Chandler Bing (Friends 1994).
With a long of history of stigma with smoking equalling ‘being cool’ this type of association had led tobacco companies to frequently direct their advertising to youth with the message of ‘smoking is cool.’ Initiatives around the world have worked hard in order to oppose and overcome this type of advertising and social illusion.
The California Tobacco Control Program or the CTCP is a leading example of how targeting this specific tobacco trend can lead to a long-term reduction of tobacco use. The California Department of Public Health; the founder and funder of the CTCP, have estimated through their work for over 30 years now in overcoming social challenges with tobacco use in California, has reduced the number of tobacco users from 1 in 5 persons, to 1 in 8 (CTCP 2017). CTCP’s aim is it ‘denormalise’ social acceptance of tobacco use (CTCP 2017). With their deep understanding and experience with tobacco use and studying the emerging trends in society, the CTCP have recently directed their fight to e-cigarettes.
Electronic cigarettes or e-cigarettes are a handheld electronic device which mimics the experience of normal tobacco smoking. E-cigarettes come in a range of types such as with or without nicotine and also in a variety of flavours such as fruit or candy. In recent years, the ‘smoking is cool’ trend has directed its path to the act of smoking an e-cigarette called vaping, which has rapidly increased as a social trend, particularly within youth. This trend has led tobacco companies to directly advertise e-cigarettes to young people (American Academy of Paediatrics 2014). However, as CTCP explores, there is a social disillusion with the safety of e-cigarette, with users ignoring that e-cigarettes most frequently possess nicotine.
CTCP has launched a campaign ‘Still Blowing Smoke’ in order to fight the use of e-cigarettes and the blurred understanding of what an e-cigarette is. The aim of this campaign is to educate the youth in particular to the potential dangerous harms of e-cigarette use. The campaign encompasses online advertising, a website and TV commercials, and is also a high school program to educate the youth before they start. These platforms make explicit of the potential harms of e-cigarette use and the need to dissociate vaping with ‘being cool.’
‘Smoking is cool’ is a statement that the majority would argue now is not applicable. However, through exploring campaigns that counter oppose current trends with tobacco use, such as ‘Still Blowing Smoke’ by the CTCP, it is clear that the trend it still alive, but has just manifested into new markets within the tobacco industry.