Utilizing Bars and Clubs as Effective Messaging Channels to Address Young Adult Tobacco Use: A San Diego Case Study

Theoretical Background and research questions/hypothesis: In 2008, young adults in California had the highest tobacco use rate of all age groups at 16.8% (BRFSS), and bars or clubs attendance is associated with increased smoking. We counter-engineered tobacco industry strategies to conduct innovative psychographic market segmentation and develop a prevention campaign integrating branding with hard hitting anti-tobacco messaging to foster passionate, market-driven resistance against tobacco industry bar/club promotions. We hypothesize that young adults who prioritize social success are more likely to use tobacco to express membership in a pro-smoking subculture and they will be early adopters in anti-tobacco campaign focused on culture and identity. We identified a pro-smoking subculture in San Diego (i.e. “Hipsters”) with a smoking prevalence of 56%.  A branded intervention, "Commune," was developed specifically for this subculture using cultural experiences, social leaders, and values-driven messaging to decrease tobacco use.

Methods: Multiple cross-sectional samples of young adults (age 18-29) using random venue-based sampling at San Diego Hipster bars and clubs. We collected surveys at baseline (N=1198), at 10 months (N=1174) after intervention launched, and starting at 22 months after launch, 300 surveys every 3 months, (to total at least 1000 subjects per year). To date, baseline, 10-month follow-up, and first 300-person follow-up samples have been gathered.

Results:  At baseline, 30-day smoking prevalence in the bar/club sample was 56%.  Campaign exposure was measured using Commune brand recognition, liking, and having attended an event or visited campaign website. Hipsters reported higher levels of exposure than the rest of the sample. Significantly more of those exposed reported liking Commune than those not exposed, and Hipsters liked Commune more frequently than the general sample.  Hipsters with high levels of social concern were most likely to desire to go to Commune events, increasing from 19% at 10 months to 44% at 22 months. Young adults exposed to Commune at 22 months were more likely to associate Commune with Hipsters, like Commune a lot, go to a Commune event, and believe Commune is against big corporations than those who were not exposed.  Smoking rate was 55% for the overall sample and 60% for Hipsters across all data points. Hipsters with high levels of social concern have shown a reduction in smoking from 77% at baseline to 70% at 22 months (P=0.11).

Conclusions:  We observed significant changes in exposure and attitudinal variables, consistent with the earlier stages of the logic model for behavioral change, which is anticipated as the intervention continues.  The intervention appears to reach and have the most powerful effect among the highest risk subgroup: Hipsters with the highest levels of social concern.

Implications for research and/or practice:  Tobacco industry market research strategies can be counter-engineered to develop tailored young adult tobacco control strategies to reach those at highest risk. Tobacco prevention efforts can be implemented at bars and clubs, reaching a segment of the young adult population that is disproportionately using tobacco. These interventions should strategically redirect the socio-cultural group towards healthier lifestyles in a manner consistent with their own values and priorities.