Story by Julia Rafferty
Photos by Ellie Crowther-Dias
Graphic by Layna Hong
Audio by Sophia Ramirez
CHAPEL HILL N.C.— In this smoky bar the lights are so low Caroline Smith has to pull her phone flashlight out to read the drink menu. At the bottom of the laminated sheet, there’s the special: “Please Don’t go Downtown Tonight.” She can’t resist ordering.
The bartender slams down her tequila shot, a pack of Marlboro Reds, and tosses a lime at her.
“It’ll be $12.00. You need a match?”
Smith nods and sends the shot back as fast as she can. She tosses the matches in her purse and heads to 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 one or two cigarettes on a weekend?” said Smith. “I know it’s bad for me and it’s not a great justification, but it’s where I’m at.”
For Smith, a 22-year-old Chapel Hill native, the shot and cigarettes have that whiff of careless rebellion tobacco ads have long promoted. But this scene is also a jarring reminder that after decades of anti-smoking campaigns and declining cigarette sales, smoking is on the rise, particularly among young people.
Cigarette sales increased from $202.9 billion in 2019 to $203.7 billion in 2020, according to the Federal Trade Commission Cigarette Report. The first time in two decades that cigarette sales increased. Experts say that number is expected to jump even more in the 2021 report.
“We know that advertising and promotion increased in that time,” says Dr. Adam O. Goldstein, Director of Tobacco Intervention Programs at UNC Family Medicine. “And from research, we know that is definitely a causal influence of youth and young adult smoking.”
Medical experts say an increase in targeted marketing could be one of the reasons for the rise in smoking, which is still the number one cause of preventable death in the United States, according to the Centers for Disease Control and Prevention. They also point to characters in popular shows like HBO’s Euphoria vaping in high school bathrooms and Instagram shots of influencers with vapes in hand.
But many young adults have their own reasons for smoking, and it has nothing to do with heavy advertising. Yes, they know cigarettes cause lung cancer and that kills thousands each year, but young North Carolinians say why worry about a few cigs when a pandemic can turn your whole life upside down?
“There’s a lot of nihilism in our generation right now,” said Jake Gerardi, a 20-year-old Chapel Hill student. “That immediate little buzz or rush is more important than the vague future possible circumstances.”
Tobacco and North Carolina
Is smoking an easy sale in North Carolina?
It always has been.
The Tar Heel state maintains one of the lowest taxes on tobacco nationwide, at $0.45 per 20-pack, the 47th lowest tobacco tax in the country. Compare that to the District of Columbia at $4.98 for a pack of 20.
The state is still one of the nation’s top tobacco producers, harvesting 252 million pounds of flue-cured tobacco. The estimated portion of annual tobacco industry marketing expenditures spent for North Carolina each year is $391.6 million out of the $8.4 billion nationwide.
With prices so low and marketing so high, it’s no wonder young North Carolinians have such easy access to cigarettes. Goldstein says price matters a lot when it comes to addiction, so much that tobacco companies have even used coupons and discounts to attract buyers.
“What we can say is that we have seen different approaches of those trying to addict people to those products. And this would include an increase in the marketing and price discounts to help reduce the price of these products,” said Goldstein. “And we know the single greatest determinant of use is the price.”
What is a “nicotine-fluencer?”
While price is a large contributor, Goldstein says social media and “nicotine-fluencers” might be causing even more trouble.
Tobacco companies have always used celebrities and fake medical endorsements to hook the American public on their products. But, to evolve alongside the twenty-something demographic, companies have turned to social media to promote smoking. These “nicotine-fluencers” are paid by tobacco companies to work cigarettes and vapes into their online aesthetic, creating an appealing look of what the 2022 smoker looks like.
“Everyone I know who smokes knows how horrible they are for you,” said Smith. “A lot of people just smoke to fit the new look of the cool, edgy smoker we see on social media.”
Tobacco companies had a hand in creating this edgy character. The industry has used perfectly staged social media posts and event sponsorship to deliberately attract young people and work smoking back into mainstream culture. This is especially true of e-cigarettes and vapes.
“So much of the association with smoking has less to do with the health impacts and more of the influence of social and cultural norms of current party culture,” says Gerardi. “You go up to someone at a party and ask to hit their vape then start talking, it’s totally a social thing.”
Smith said that while she once thought vaping was only a cessation tactic, she now more associates them with partying and younger smokers.
“When I was younger I totally bought into cigarettes being disgusting cancer-causing, the education worked,” says Smith. “But starting with a few kids vaping in high school, it became easier to find nicotine, over the past couple of years the look associated with smoking has changed.”
But today, Smith and Gerardi both agree that the look of vaping feels very “un-cool” in comparison to a pack of Marlboro Reds. To them, cigarettes have a more appealing look than any Juul or Puff Bar.
“I will hit a vape every now and then but it has always felt kind of fake,” said Smith. “I would much rather just have a real cigarette and taste tobacco over some mint-flavored plastic stick.”
Smith and Gerardi both said they associate vapes with addiction and partying, where cigarettes instead provide a more mysterious look. Gerardi said cigarettes feel more relaxed than owning and charging a vape.
“The grunge, alternative look is back and cigarettes totally fit that vibe over a vape,” said Jake Gerardi. “A large part of it in my eyes is people thinking it’s not a long-term thing, it’s that youth invincibility complex.”
But Goldstein says this 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,” said Goldstein. “You have social smokers, and those people aren’t going to have the same level of health problems as those who are smoking heavily, but do they think that there is going to be a free ride?”
The Pandemic and Mental Health
Whether it is 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, the social isolation, the mental health challenges have contributed to an increase in substance use broadly, “he. “And it’s not just nicotine, it’s also alcohol and opioids, it’s across the spectrum and so we cannot isolate tobacco specifically from that.”
Young people like Smith And Gerardi acknowledge that their stress surrounding the future lessens their willingness to invest in it. Gerardi and Smith all said one of the main reasons they smoke has nothing to do with advertisements or a lack of education, but instead a lack of motivation to care about the uncertain future.
So, how does tobacco prevention go up against this fatalism? Goldstein said the current public health environment is struggling to mobilize fast enough to work against this new smoking culture.
“Part of it is these things are so new and they’re happening so fast it is so difficult,” said Goldstein. “Let’s look at COVID and see how slow the public health movement moved to deal with this, so think about devising a public health campaign for tobacco prevention.”
Some of the new tactics tobacco control organizations like the Truth Initiative have tried to target young people through social media ads. However, Gerardi said these ads feel out of touch and don’t have much of an impact.
“Those ads feel like something generated for Gen Z by someone, not Gen Z,” said Gerardi. “What I do remember working when I was younger was those ads with the lady with the box in her throat, that did scare me.”
Gerardi is referring to a series of ads created by the Centers for Disease Control and Prevention (CDC) from the early 2010s which showed Terrie, a real smoker with several smoking-related health issues. Goldstein said that instead of ads that ridicule users, the way to combat the fatalism of the current generation of smokers is transparency and storytelling similar to these ads.
“One of the issues is the target of those ads, someone who is already using and is addicted to tobacco, those ads are not going to be really influential, because addiction is not going to respond to a message to quit easily,” said Goldstein. “We know that true stories by people from North Carolina, that just say their experience, is probably one of the most effective ways of dissuading the true consequences of this.”
Back at the Bar
Caroline and her friends have collected on the sidewalk outside, dimly lit only by a streetlight and passing cars. They laugh together in the cold air, exchanging warmth and stories from their evening out. Smoke clouds and the passing of a single shared lighter backdrop their laughs. This smoke circle is a scene found outside bars throughout time.
But the impact of smoking is not glamorous.
When asked what would get her to stop smoking, Smith said an ad or a doctor probably wouldn’t work, but a friend might.
“I think if someone I love sat me down and told them I was hurting them by smoking, I would feel awful,” said Smith. “Because if it was my brother or my roommate, not some doctor I don’t know, I would probably care.”
