Why it’s time to get tough on teenage tobacco

Published: March 28, 2011
The writer is a graduate of Aga Khan University and a research associate at Interactive Research and Development

The writer is a graduate of Aga Khan University and a research associate at Interactive Research and Development

Fans of the American TV series “Mad Men” must have already learnt a thing or two about advertising. The show, set in the 1960s, revolves around the exploits of its protagonist, Don Draper, an advertising spin doctor who, in the show’s pilot, is seen conjuring up methods to counter the recently discovered cancerous effects of smoking tobacco. The series may have won accolades for its portrayal of life in America’s Golden Decade but it also sheds insight on one of the most powerful and deadly media campaigns in world history. Don’s character is loosely based on Draper Daniels, an advertising agent who created an icon that would become synonymous with the image of tobacco, the Marlboro Man.

The Marlboro Man came at an important time in the history of tobacco, when the health consequences of smoking were becoming increasingly clearer. Marlboro was initially created with the idea of a safe filtered cigarette, as a brand that targeted women. However, the image of tobacco that Daniels help create was that of assuredness, an indomitable figure, someone who always brought the cattle safely home, someone whose rugged confidence symbolised the quintessential free American sprit — a cowboy. The idea was to entirely deflect the public’s thinking from the lethal and addictive potential of tobacco altogether — and it worked. Marlboro’s sales jumped several fold following the campaign, the world’s most imitated advert was created and the global tobacco epidemic was born.

Later in the series, Don reveals an important trade secret — it’s all about getting new smokers to pick up the cigarette because it is almost impossible to get people to change their brands. A quote from Marlboro’s parent company, Philip Morris, will makes things clearer: “Smoking the cigarette for a beginner is a symbolic act. I am no longer my mother’s child. I am an adventurer, I’m not a square.” The mind of a teenager lighting his first cigarette suddenly comes before us where he is compounded by emotional disturbances, peer pressure and societal stresses and tobacco is there as the most obvious escape.

It is difficult to find a teenager in Pakistan who has not faced such circumstances. It is not by coincidence that tobacco has become an integral part our adolescents’ lives. As anti-tobacco laws became stricter in the West, their focus shifted to developing countries like Pakistan with young populations and poorer law enforcement. What resulted was a sustained campaign by tobacco companies targeting the youth for decades. Two of the defining sporting events of our generation, the 1992 and 1996 Cricket World Cups, one where Pakistan was triumphant and the other where we were the hosts, were sponsored by tobacco companies. Brands like K2 became “Janbazon ki pasand”, Gold Leaf, with its maritime theme, symbolised discovery and adventure, while smoking Dunhill was synonymous with distinction and prestige. Whilst tobacco advertising may have now become restricted, the created image still remains. This, combined with tobacco’s ubiquitous presence and exceedingly low prices, makes it easily accessible to the youth of this country. Evidence indicates that two-thirds of all males and a fifth of all females will experiment with various forms of tobacco before turning 21. Nearly half will go on to become chronic smokers and the remaining half will succumb to diseases directly attributable to tobacco. Pakistan’s median age is only 21 years, and a cataclysmic scenario presents itself before us where huge numbers of the coming generation could prematurely die as a consequence of tobacco.

Fortunately, crises also provide opportunity. A young population also means that actions right now can help prevent this future disaster. Efforts made by the current government deserve appreciation, such as the introduction of pictorial health warnings on cigarette packs. Our nationwide survey of high school students recently published in the medical journal BMC Public Health shows that whilst graphic health warnings such as pictures of oral cavity cancers were perceived as the most effective anti-smoking messages, their impact was significantly lower in adolescents that had already initiated the habit. This seems to suggest that targeted interventions such as relevant curricular material during late primary or early secondary school will prove to be more beneficial. The media must also make an effort to reinforce this message through a sustained campaign as a child progresses through his adolescence. Some of the other effective anti-tobacco messages in our study included videos of a throat cancer patient using an electronic voice box and a patient on a ventilator. Finally, greater efforts need to be made to help prevent under-age sales and to increase taxation, making cigarettes out of reach of teenagers.

Critics argue that tobacco production should be expanded in the country because it is beneficial to the economy. They say that it will provide employment and increase government revenue through greater taxes paid and higher exports. This, too, is false. A report by the World Bank shows that even developing nations that are heavily dependent on tobacco farming could significantly benefit from tobacco control policies through reduced healthcare costs, improved life expectancies and worker productivities and by diversification of agricultural production. Tobacco constitutes only a small fraction of our GDP, where a handful of large corporations gain profit with little trickle-down effect to ordinary people. Its impact on the poor man, however, is the hardest as it erodes disposable incomes and leads to diseases against which he has little hope of coming out alive.

Ultimately, this is not an economic, political or social issue — it is a moral issue. Tobacco is amongst the finest examples of unregulated capitalistic greed in the country, a product which, if used exactly as intended, leads to a powerful addiction and deadly disease. The future of thousands of young Pakistanis is at risk and we simply cannot allow this to happen.

Postscript: Three actors posing as the Marlboro Man died of lung cancer, two later became prominent anti-tobacco activists.

Published in The Express Tribune, March 28th, 2011.

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Reader Comments (19)

  • Khan
    Mar 28, 2011 - 12:48AM

    Nice article!
    “Ultimately, this is not an economic, political or social issue — it is a moral issue.”-
    I wish it wasn’t so because unfortunately, our legislators seem to be least concerned about morals.

    My concern is that the swelling younger population of Pakistan has started to ignore tobacco awareness programs. Except for this month’s cricket epidemic, most viewed and commented articles on the tribune are about scandals and political statements.
    There is a strong bias generating among young readers in prioritizing issues that are really affecting us and I believe this contribution will partly go in vain as well.Recommend

  • Mar 28, 2011 - 4:46AM

    We need to start at the top. For one, when you have a COAS whose first order was to undo the smoking ban in the GHQ, doesn’t really set the best example. As a demerit good, individuals and society underestimate the costs of consumption of tobacco items, as you have highlighted above. Where have all the anti-smoking campaigns gone? where are the positive archetypes? If Wasim Akram’s “nahi, mai cigarette nahi peeta” could become nationally recognizable, where are the same archetypes now? Sadly, there is so much money in the tobacco industry who form a very strong and influential lobby in Pakistan. The incentives to put a cigarette in every man and womens mouth is overwhelming. Recommend

  • A Thinker
    Mar 28, 2011 - 5:40AM

    Excellent column. Recommend

  • Mar 28, 2011 - 6:12AM

    @Assad, I like you piece alot dewwwwd
    Its just right. The content, the style and the cause – all good, plus …

    the fact that you are a doctor and that fact that your went to the most prestigious medical school in Pakistan and the fact that your are not just doing some meager practice and the fact that you are working with a research institute does make me more prone to believe what you are saying …

    lets keep those lil buggers off them fags!

    ps. when i was a smoker, I had two steady girlfriends… since i quite smoking I have had the pleasure of intimately knowing 8 female individuals. Kids, I contend there is a co-relation between non-smoking and sexual vitality.

    If you are a smoker, contact me via twitter. I can help.Recommend

  • Supportive
    Mar 28, 2011 - 10:36AM

    Tobacco industries are trying to being ‘responsible.’ They are made to advertise the ill-effects of smoking and cannot market their products in most countries. Adults are old enough to choose whether they want to smoke or not. The problem is that if governments raise taxes on tobacco (cigarettes are expensive enough already) consumers will shift to illicit products, which can be more harmful than normal cigarettes. Unfortunately, there is no win-win situation. Recommend

  • Sarjeel Mowahid
    Mar 28, 2011 - 10:38AM

    At the very outset I would like to state I am not a smoker. However I see no reason why it should not be fair and reasonable for law/society/parents/doctors to leave an adult to assume responsibility for his own actions in smoking a cigarette. Mind you no one is better placed to control his or her own interest as well as the interest of others.

    This is not a question about morality, health or even societal norms its about your right of choice i.e. to do whatever you deem fit with your ownself. As long as its something you choose to do by the exercise of free will.

    What is worse is the fact that you being a doctor are not suppose to co-relate your philosphies or your idea of morality with health. Just say its unhealthy it would suffice. Pictures or messages wont stop anyone. In fact the more you demonize the very act the more it sounds like the forbidden fruit.

    The truth is cigarettes are an alternative to other vices like drugs and alcohol. Its like a soft drink compared to those. What do you suppose smokers will turn to when they cant find a smoke. And last but not the least who died and made you the king. Recommend

  • Saad Durrani
    Mar 28, 2011 - 10:38AM

    Well. How come, I never saw a fatwa against smoking and seesha. Furthermore, I would have liked it if the learned writer would have talked about Seesha. There are no comprehensive studies on this matter that I know.Recommend

  • Drummer Aku
    Mar 28, 2011 - 6:11PM

    Dude thx for the indepth synopsis of Mad Men, can you write the Gossip Girl synopsis after this and end that with a brush on teenage fashion in society.Recommend

  • Prof Javaid Khan FRCP(Edin)
    Mar 29, 2011 - 1:02PM

    Dear Asad

    As your teacher I feel proud to read this article.I am sure you will continuue to spread anti tobacco message in the society.Keep up the name of your parents and this country.May God bless you,Recommend

  • veeda saleem
    Mar 31, 2011 - 2:26AM

    awesome effort asadRecommend

  • Prof Javaid Khan FRCP(Edin)
    Mar 31, 2011 - 11:20AM

    I read the comments with interest.As a practicing chest physician I see the victoms of smoking every day.Last week I met an engineer in his forties with advanced lung cancer.I asked his him if he knew weather smoking could cause lung cancer .His response was “I used to read on cigarette pack that smoking is harm ful but I never thought that it would affect me”.This is the fact that most teenagers who start to smoke never think that it will harm their heath in any way.With current smoking patterns, about 500 million people alive today will eventually be killed by tobacco use. More than half of these are now children and teenagers.Over 90% of lung cancer is preventible if smoking is avoided.
    It is wrong to assume that if we prevent teenagers from smoking then they will resort to other drugs.Infact smoking is the first step to other drug addictions.As adults its our responsibilty to be good role models for our juniors.It is not about choice.Choice is only for the first cigarette.Later it is the powerful addictive substance called nicotine which maintain the smoking behaviour.Making public places like hotels and restaurant smoke free is the single most important strategy which can help reducing the prevalence of smoking in the country.In Newyork when restaurants were made smoke free in 2002 teenage smoking dropped from 19% to 8% with a year.We all can play our role in implemting the ban on smoking at public places in Pakistan.A famous Pizza chain in Pakistan is still allowing smoking in its premesis.This fast food chain is smoke free all over the world but not in Pakistan.Recommend

  • Atif
    Apr 1, 2011 - 3:19PM

    @tightdhoti: its amazing how you involve army in everything. Now you want COAS to have anti smoking Bn too.Recommend

  • Dee
    Apr 1, 2011 - 3:52PM

    Dr. Javaid,

    Can you please tell the name of this pizza chain? In my personal experience, there is no such place in Pakistan. So looking forward to hearing from you.

    Thank you.Recommend

  • Ashan
    Apr 1, 2011 - 3:56PM

    Good piece, although a bit pretentious at times. Ultimately, what people indulge in is a personal choice. It is a civil liberty that can be exercised at will. Medical professionals can only inform. But the final say has to be the public’s. Recommend

  • Aleena
    Apr 1, 2011 - 3:57PM

    Dr. Javaid,

    What is this pizza chain you refer to in your post? We need to generate more awareness.Recommend

  • Professor JAVAID KHAN FRCP
    Apr 1, 2011 - 11:23PM

    For legal reason I can not name in the newspaper, but it is the most famous American chain.They still allow designated smoking areas with in their restaurants.I have written to them and met managers personally,given the copy of the law but till last week smoking is still going on.With the help of a machine we have measured tobacco smoke while sitting at the Tariq Road Karachi Branch.The level came very high.Our paper on this is to be published very soon in International Journal.Recommend

  • AJ
    Apr 4, 2011 - 11:06AM

    I fully concur with Dr. Javaid’s observations. We have a legal framework in place against these things but we dont have any means of enforcing it unfortunately. I think its very important to create awareness among people as laws have been fruitless and unmotivated so far. I look forward to reading Dr. Javaid’s paper on this issue in the international journal. If he would be so kind as to provide us with the name of the publication or the link where it could be accessed, I am sure a lot of people will appreciate that.

    Asad, good job with the article no doubt. Although, I am not sure what demographic you are attempting to reach out to through this piece. 60% or more of the public in Pakistan is struggling to make ends meet. They do not know (or care) what happens in the most recent season or episode of Mad Men or Gossip Girl. Even though you certainly have a good understanding of these shows, gained through a faithful following, and have provided a good link of these shows to the points you raise in your paper. But the points you mention cant be expected to strike a cord with the Pakistani youth. Providing more relevant examples with contextual significance to Pakistani youth would have been a much better approach. Recommend

  • Asfa
    Apr 4, 2011 - 3:09PM

    OMG! Asad, you are just so amazing and so dreamy. And you are from AKU and a doctor! WOW! That is simply out of this world! On a side note, the article you wrote is okay too. Recommend

  • Dr Salma Hussain
    Apr 4, 2011 - 6:09PM

    Well Asfa, he is my professor too. Have also done post graduation in Pulmonary medicine under his supervision. Being worked with patients having lung disease, it really hurts to see young girls & boys smoking just for fun. So many cigarettes studs lying outside public institutions like high schools,universities, govt offices, resturants,
    Life is stressful no doubt but it should not be dealt with another form of stress.
    At the moment it looks cool but after few yrs this smoke will use your reserve & give you nothing but darkness.Recommend

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