For the conference’s last session, participants were divided into small groups designed to encourage interdisciplinary cooperation. The groups were asked to identify the most crucial areas for research and programme intervention. They were also asked to offer ideas about the process of conducting research and translating research into policy. And we encouraged the groups to offer their wildest ideas (called “wild cards”), regardless of current feasibility, that they would love to see become reality. The goal was not to create consensus within the breakout groups or for the conference as a whole, although several consistent themes emerged. The results of this process are listed below under the heading Topics for future consideration.

The teen panelists made a final presentation to the group on their observations and recommendations in various areas; they are included below. We also include a forward looking topic summary from the final day plenary session.

We offer these summaries for interested researchers, policy makers, and tobacco control advocates to consider while framing future research or practice questions.

1. TOPICS FOR FUTURE CONSIDERATION

   1. Areas where research is most needed

   2. Cessation and prevention

      • Long term studies on the effects of cessation and prevention

      • Autonomy as a motivation for cessation

      • How to craft messages to influence cessation?

      • Definitions of contributions of community based programmes as part of prevention

   3. Environmental and indoor air laws

      • Effects of clean indoor air laws on youth smoking

      • Best practices for implementing smoke free laws in youth venues (school, parks, stores)

      • How might indoor air laws interrupt the process of smoking consolidation among young adults?

   4. Internet surveillance

      • Impact of internet marketing themes and advertisements on prevention and cessation

      • Surveillance, monitoring the industry, interventions

      • Relationship between internet sales and prevalence of cigarette dealing

   5. Marketing and media campaigns

      • Tracking and understanding new promotion methods within the tobacco industry

      • What makes anti-tobacco advertisements effective? Is it the style?

      • What media messages motivate occasional youth smokers to quit?

      • What are some effective countermarketing methods?

      • Variations in media imagery to communicate absolute and relative risks

      • Monitoring “truth” campaigns using evaluation designs similar to those used in the federal anti-drug media campaign

      • Campaign for “smokefree colleges”

      • What characteristics of anti-smoke ads make youth more/less likely to engage in smoking?

      • How can we make tobacco products less attractive to youth?

   6. Youth

      • Intervention research with high school and college students based on a multi-behavioural approach

      • How to reach teens outside the school setting?

      • How big is the population of youth who begin use after 18 and become regular users?

      • Determination of encouragements/incentives for cessation

      • If adults quit, does that discourage youth from starting?

      • What is a practical and minimal intervention for teens?

      • Research on effective harm reduction strategies for youth

   7. Process suggestions for research translation into policy

   8. Coalition building

      • Increase among the research community

      • Involve youth in the design of youth groups

      • Establish groups to develop and examine what regulation should look like

   9. Communication

      • Enhance communication between funding agencies

      • Survey and circulate available data sources

   10. Education among researchers

       • Integrate other disciplines such as history, anthropology, and biology into our practice

       • Bring the expertise of academic and government researchers to work with tobacco control advocates—that is, create more opportunities to mix research with practice

       • Act fast

   11. Funding

       • Fund secondary data analysis

       • Fund more studies of real life programmes in naturalistic settings

       • Fund a networking conference

       • Coordinate research across NCI, CDC, Legacy, RWJF, and other funding agencies

   12. Communication via internet

       • Establish website for this conference where people can share ideas

       • Develop chat room programmes

       • Develop a Tobacco Control Activities intranet to allow comprehensive and searchable access for us to use as guidance

   13. Media and marketing databases

       • Use to coordinate national/regional media campaigns (for example, franchising of “truth”)

       • Improve sharing of media effects data—national, state, global

       • Create state media database (ad names, target, message, theme)

       • Establish a digital library

       • Make better use of publicly available documents

       • Establish list-serv to share data more frequently and effectively

       • Establish a user friendly database to identify what is being done in the field

       • Set up system to be able to conduct surveillance

       • Develop system to have a detailed accounting of tobacco control expenditures in states

       • Develop countermarketing system

   14. Policy

       • Develop policy briefings/testimony

       • Use the internet to develop policy positions

       • Use polling data (for example, Tobacco Free Kids) to assess opinion reader/policy maker “temperatures” on tobacco

       • Translate research findings into realistic policy goals

       • Coordinate research initiations more closely with policy strategy

       • Get NIH to make tobacco policy a priority in RFPs

       • Invite non-tobacco researchers to participate in our research

       • Implement state-by-state political mobilisation strategy

       • Enhance the work of TERN (Tobacco Evidence Research Network)

   15. Public health

       • Draw from related public health issues for clues (anti-drug, HIV, alcohol)

       • Encourage FDA to realise treating tobacco dependence is as important as HIV

   16. Crucial areas for programme intervention

   17. Internet

       • Interactive web development

       • Getting kids currently involved in tobacco control to join chat groups in the pro-smoking domain and see if they can turn the topic around to anti-smoking

       • Regulation of sales on internet for youth and young adults

   18. Media

       • Multiple mass media campaigns

       • Use of the media for educating the public

       • Mass media campaigns coupled with quit line and cessation services for youth and young adults

       • Peer-led structured attachments to media programmes

       • Mass media countermarketing

       • More “truth” campaigns

       • Media advocacy around issues of industry behaviour and harm reduction

   19. Smokefree environments

       • Smokefree ordinances

       • Smokefree dorms and workplaces for 18–24 year olds

   20. Other

       • Higher tobacco taxes

       • Improved smoking cessation programmes among youth and young adults

       • Political mobilisation of the tobacco control movement, including researchers and advocates

       • Examination of alternative approaches for how smokers are recruited

       • Policies to discourage transitions from occasional to regular use

       • Expanded OSHA regulation for clean indoor air

       • More healthcare practitioners involved in prevention/cessation

       • Expansion of clean indoor air policies

   21. Wild cards

       • A set date by which all tobacco products must be either non-addictive and/or non-harmful

       • Ban on the sale of tobacco products

       • FDA regulation of tobacco products

       • Ban on smoking on TV and in movies

       • Major anti-industry truth campaign aimed at adults

       • Part-time paid tobacco control activist in every US county to build a national political network

       • Addition of harm reduction goals to comprehensive tobacco control—but only with a strong research component

       • A research project to determine if suboptimal nutrition is associated with the trajectories of developing regular smoking and nicotine dependence

       • Tougher penalties, tougher fines for selling tobacco products to minors

       • A law restricting use of Medicaid funds to states not meeting CDC guidelines in spending settlement funds on tobacco control

       • Suit against the industry for “light” cigarettes

       • Access for tobacco control activist groups to graphic designers, media, and the internet

       • Tobacco product regulation before harm reduction claims could be made

       • Famous public figures taking strong positions and speaking out against tobacco products

       • Defeat of prominent candidate for office who is “bad on tobacco”

       • The internet as a tool to spread anti-tobacco message

2. SUMMARY OF TEEN PANEL’S FINAL PRESENTATION

   1. Teen penalties

      • Waste of time/resources

      • Best left on books, not enforced

      • Not worth researching

      • Ineffective in dropping smoking rates

   2. Regulatory

      • Harm reduction may encourage new smokers—potentially helpful to current smokers

      • “Safer cigarette” might mask dangers of smoking

      • Careful with products appealing to kids (for example, lollipops, candy)—not a threat right now because not marketing to kids, but need to be wary

   3. Cessation

      • Research needed regarding addictive differences (youth v adults, males v females)

      • Only helpful on voluntary basis—pushing cessation on someone is not the way to go

      • Must be adapted to participants

      • Information needed for smokers on benefits of quitting—kids really don’t know about the benefits

      • Investigation needed on effectiveness of other avenues to implement (for example, quit lines, internet)—make them personal

      • Division among panel members on topic of ad campaign to publicise and where to put resources between prevention and cessation (some thought media campaign should focus on prevention, others on cessation)

   4. Broadcast media

      • Effective—creates teen buzz, not enough credit (“People talk about it and it’s working”)

      • Less research, more actions

   5. Internet

      • Need to stay aware—be wary of tobacco companies

      • Overestimating threat from “club” sites

      • Current anti-smoking sites—great potential

   6. Young adults

      • Efforts focused on young adults who are unemployed and not attending school—need to think of innovative ways to reach them

      • Clean indoor air on campus—very effective

      • Grassroots campaigns in every state

   7. Wild cards

      • Attendance at tobacco stockholder meetings—powerful statement if a bunch of teenagers show up

      • “Go to schools” campaigns, with “cool” role models spreading truth message v health (Having someone who is cool—and maybe even a smoker, saying “Listen, this is what I went through. If you want to do this, it’s all right. But I’m telling you, it’s not a good thing and I’m miserable. I shouldn’t have done it. I made a big mistake”)

      • Grassroots campaign

      • Mixing of anti-tobacco message with other messages (for example, sports, self-esteem); hidden prevention message

      • Attendance at tobacco industry recruitment meetings at colleges to discourage students from working for the industry

3. FORWARD LOOKING TOPIC SUMMARY FROM FINAL DAY OPEN DISCUSSION

   1. California Digital Library as a repository of scholarly research on the internet?

      • Rapid publication

      • Repository for data sets

      • Tobacco as one of the selected areas (www.escholarship.cdlib.org/tobacco)

      • Place for “fugitive” data (for example, hard to find state surveys and evaluations, which rarely get noticed or published)

   2. Marketing nicotine to everyone including youth?

      • For—would help adults

      • Against—like putting youth on oral codeine to prevent intravenous heroin use; not an innocuous drug, especially during pregnancy

   3. Do not dilute truth name in any activities other than ad campaign for youth

   4. Examine the psychology of youth and ability to defend against industry marketing and promotions (as well as other social forces)

      • How does maturing mind develop ability to analyse/respond to pressures?

      • Link to developing area of cognitive neuroscience (that is, what’s going on in the developing brain as linked to social and cognitive forces)

      • Tremendous implications for regulation and anti-marketing campaigns

   5. Seed and develop college advocacy groups (edgy, confrontational)

      • Smokefree dorms

      • Coordinated across campuses through the internet

      • Stock divestment strategies led by students

   6. Counter pessimism of youth cessation by focusing on interventions for young adults

      • Trickle-down effects

      • Lots of support during the discussion for an aggressive programme (including countermarketing strategies) aimed at young adults

      • Redefine young adults to beyond age 24?

   7. Focus on:

      • High risk states (that is, tobacco producing states) in both research and advocacy

      • Non-student adolescent populations—cultural sensitivities important

      • Clean indoor air strategies

      • Interactive internet (perhaps through Legacy) for individuals to have access to personalised cessation programmes

      • Research intersections regarding trajectories, intermittent smokers, differences in people, and how these factor into intervention designs

   8. Consensus around need to be engaged in harm reduction

      • Product design and harm reduction

      • Physiological and perceptional consequences

      • What will people think about smoking when these products are available?

   9. Interventions

      • Web cessation (similar to Saul Shiffman’s Palm Pilot cessation project)

      • Book club idea—applied to youth who get together for self-directed activities on cessation

      • Line extensions of media campaigns—extend reach beyond adolescents

   10. Process priorities

       • End the internecine bickering regarding communicating with what real people need to be able to do in making real decisions

       • Offer training in how to deliver more positive messages

       • Make more use of secondary data sets and getting data online for sharing

       • Do a better job of collaborating with one another on projects

   11. Focus on cost effective utilisation of resources