Chapel Hill, North Carolina — In this smoky bar, the lights are so dim that Caroline Smith has to take the flashlight out of her phone to read the drink menu. At the bottom of the laminated sheet is the special: “Please don’t go downtown tonight.” She can’t resist the command.
The bartender slams his shot of tequila, a pack of Marlboro Reds, and tosses him a lime.
“It will be $12.00. Do you need a match? »
Smith nods and returns the shot as fast as she can. She tosses the matches into her purse and heads for the smoking patio to light up.
“When there’s so much chaos and uncertainty in the world around us, can you blame people for not caring about a cigarette or two on the weekend?” said Smith. “I know it’s bad for me and it’s not a great vindication, but that’s where I’m at.”
For Smith, a 22-year-old Chapel Hill native, the vaccine and cigarettes have that smell of reckless rebellion that tobacco ads have long promoted. But this scene is also a shocking reminder that after decades of anti-smoking campaigns and declining cigarette sales, smoking is on the rise, especially among young people.
Tobacco and North Carolina
Is smoking an easy sell in North Carolina?
It always has been.
Tar Heel State maintains one of the lowest tobacco taxes nationwide, at $0.45 per pack of 20, the 47th lowest tobacco tax in the nation. Compare that to the District of Columbia at $4.98 for a 20-pack.
The state is still one of the top tobacco producers in the country, harvesting 252 million pounds of air-cured tobacco. The estimated share of annual tobacco industry marketing expenditures spent on North Carolina each year is $391.6 million of the $8.4 billion nationally.
With such low prices and high marketing, it’s no wonder young people in North Carolina have such easy access to cigarettes. Goldstein says price matters a lot when it comes to addiction, so much so that tobacco companies have even used coupons and discounts to entice buyers.
“What we can say is that we’ve seen different approaches from those trying to get people addicted to these products. And that would include increased marketing and price reductions to help lower the price of these products,” Goldstein said. “And we know the biggest determinant of usage is price.”
What is a “nicotinogen?”
While price is a big contributor, Goldstein says social media and “nicotine influencers” could cause even more trouble.
Tobacco companies have always used celebrities and fake medical claims to lure the American public to their products. But to grow alongside the 20-something population, companies have turned to social media to promote smoking. These “nicotine influencers” are paid by tobacco companies to incorporate cigarettes and vapes into their online aesthetic, creating an appealing look of what the smoker of 2022 looks like.
“Anyone I know who smokes knows how awful it is for you,” Smith said. “A lot of people smoke just to fit in with the new look of the cool, edgy smoker we see on social media.”
Tobacco companies helped create this edgy persona. The industry has used perfectly staged social media posts and event sponsorship to deliberately lure young people back into mainstream culture. This is particularly the case with e-cigarettes and vapes.
“Much of the association with smoking has less to do with health impacts and more to do with the influence of social and cultural norms of current party culture,” Gerardi says. “You walk up to someone at a party and ask them to hit their vape and then start talking, it’s totally a social thing.”
Smith said while she once thought vaping was just a quit tactic, she now associates them more with partying and younger smokers.
“When I was younger I totally believed cigarettes were gross and carcinogenic, the education worked,” Smith says. “But starting with a few kids who vaped in high school, it became easier to find nicotine, over the last couple of years the look associated with smoking has changed.”
But today Smith and Gerardi both agree that the look of vaping is very “uncool” compared to a Marlboro Reds pack. To them, cigarettes look more appealing than any Juul or Puff Bar.
“I’ll hit a vape once in a while, but it always felt a little off,” Smith said. “I would much rather just have a real cigarette and taste tobacco than a mint flavored plastic stick.”
Both Smith and Gerardi have said they associate vapes with addiction and partying, where cigarettes instead provide a more mysterious aspect. Gerardi said cigarettes were more relaxed than owning and charging a vape.
“The grunge, alternative look is back and cigarettes fit that vibe perfectly compared to a vape,” said Jake Gerardi. “In my eyes, a big part of it is people thinking it’s not a long-term thing, it’s this young invincibility complex.”
But Goldstein says that way of thinking doesn’t quite add up.
“If you ask most people when they started if they think they would be addicted, everyone would say no,” Goldstein said. “You have social smokers, and those people won’t have the same level of health problems as heavy smokers, but do they think there will be a free ride?”
The pandemic and mental health
Whether it’s months of isolation, an already existing addiction, boredom or anxiety, the pandemic has contributed to an increase in unhealthy coping behaviors, Goldstein said.
“Certainly the stress of the pandemic, social isolation, mental health issues have been major contributors to an increase in substance use,” he said. “And it’s not just nicotine, it’s also alcohol and opioids, it’s across the spectrum and so we can’t specifically isolate tobacco from that.”
Young people like Smith and Gerardi recognize that their stress surrounding the future diminishes their willingness to invest in it. Gerardi and Smith have all said that one of the main reasons they smoke has nothing to do with advertisements or a lack of education, but rather a lack of motivation to care about the uncertain future.
So how does smoking prevention come up against this fatalism? Goldstein said the current public health environment is struggling to mobilize quickly enough to address this new smoking culture.
“It’s partly because these things are so new and they’re happening so fast that it’s so difficult,” Goldstein said. “Let’s look at COVID and see how slowly the public health movement has evolved to deal with it, so consider designing a public health campaign for smoking prevention.”
Some of the new tactics from tobacco control organizations like the Truth Initiative have tried to target young people through social media ads. However, Gerardi said these ads seem disconnected and don’t have much impact.
“These ads look like something generated for Gen Z by someone, not Gen Z,” Gerardi said. “What I remember when I was younger were those commercials with the lady with the box in her throat, scaring the crap out of me.”
Gerardi is referring to a series of advertisements created by the Centers for Disease Control and Prevention (CDC) in the early 2010s that featured Terrie, an actual smoker with several smoking-related health issues. Goldstein said that instead of ads that ridicule users, the way to combat the fatalism of today’s generation of smokers is through transparency and storytelling similar to those ads.
“One of the issues is the target of these ads, someone who is already using and addicted to tobacco, these ads won’t really have an influence because the addiction won’t respond to a message to quit easily” , Goldstein said. . “We know that real stories from people in North Carolina, just telling their experiences, are probably one of the most effective ways to deter the true consequences of this.”
Back to the bar
Caroline and her friends gathered on the sidewalk outside, dimly lit only by a streetlight and passing cars. They laugh together in the cold air, exchanging warmth and stories of their evening. Clouds of smoke and the passing of a single lighter background shared their laughter. This smoke ring is a scene found outside bars throughout time.
But the impact of smoking is not glamorous.
When asked what would make her quit smoking, Smith replied that an advertisement or a doctor probably wouldn’t work, but a friend might.
“I think if someone I love sat me down and said I was hurting them by smoking, I would feel really bad,” Smith said. “Because if it was my brother or my roommate, not some doctor I don’t know, I’d probably care.”