Posted on February 5, 2010

Many older adults grew up during a time when cigarette smoking was ubiquitous. Everywhere you went, people smoked. They smoked in cars, on buses, trains and airplanes, in the subway, on the street, in restaurants and malls, even in church vestibules. Famous TV advertising campaigns such as the Marlboro Man and Virginia Slims touted smoking’s macho or cool appeal. You couldn’t watch TV or a movie without seeing characters light up and enjoy tobacco products.

That all changed with mounting medical evidence that smoking is deadly. From the 1960s to today, consumers have been bombarded with statistics and information showing the harmful effects of nicotine and other toxins inhaled into the lungs. While tobacco companies came out with different types of filters, light cigarettes, and experimented with various kinds of tobacco, consumers still smoked. Interestingly, as smoking decreased among adults, adolescents and young adults took up smoking in record numbers.

Then, the federal government encouraged more concentrated efforts to target young people with anti-smoking messages and campaigns. The gist of these messages is: If you never start smoking, you can eliminate a lifetime of health-related problems.
Still, federal data show that tobacco use remains the leading cause of death and disease in the United States. More than 400,000 annual deaths are attributed to smoking.

The result of anti-smoking media campaigns and other influences is both a good news and bad news scenario. Adolescents now see smoking as a greater risk than illicit drugs or binge drinking.

New Report Highlights Adolescents’ Perceived Risks

In a new report, Perceptions of Risk from Substance Abuse Among Adolescents, based on a national survey by the Substance Abuse and Mental Health Services Administration (SAMHSA) and conducted by RTI International, adolescents across all age groups perceive a greater risk to smoking cigarettes than to using alcohol and other substances – including LSD and cocaine.
The annual National Survey on Drug Use and Health (NSDUH) asks adolescents (aged 12 to 17) how much risk they think people incur physically and in other ways by using cigarettes, alcohol and other illicit drugs. Survey response choices include (1) no risk, (2) slight risk, (3) moderate risk, and (4) great risk.

Key findings include the following:

• Among adolescents 12 to 17, nearly 70 percent (a rate stable across all age groups) perceived great risk from smoking one or more packs of cigarettes per day.
• Binge drinking (having five or more alcoholic drinks once or twice per week) was perceived as a great risk by only 40 percent of adolescents surveyed.
• Once-monthly smoked marijuana was considered great risk by just over one-third (34.2 percent).
• Half of adolescents surveyed perceived great risk in using LSD (50.9 percent) once or twice per month or cocaine once per month (49.7 percent).
• Females were more likely than males to perceive great risk from smoking one or more packs of cigarettes per day, consuming five or more alcoholic drinks once or twice a week, and smoking marijuana once in a month.
• Males, on the other hand, were more likely than females to see great risk in trying heroin once or twice.

As the most commonly abused substance by adolescents are tobacco products, alcohol, and marijuana, these new findings are an important indicator of awareness of the harmful effect of smoking.

Youth Tobacco Smoking Levels Down

Data from SAMHSA’s NDSUH points out the decline in overall tobacco smoking by adolescents. The report, Trends in Tobacco Use Among Adolescents: 2002 to 2008, highlights the fact that the decline in past-month tobacco use can be attributed mainly to the decline in past-month cigarette use, since cigarettes are the most commonly-used tobacco product. In 2002, 13.0 percent of adolescents aged 12 to 17 smoked cigarettes. In 2008, that percentage had decreased to 9.1 percent.

Survey questions on tobacco use covered cigarettes, chewing tobacco, pipe tobacco, cigars and snuff, with particular emphasis on the use of cigarettes.

As to type of cigarettes smoked, a recent short report, Use of Menthol Cigarettes, shows increases in smoking menthol cigarettes (among current smokers) were most pronounced for adolescents aged 12 to 17. The percentages were 43.5 percent in 2004, compared with 47.7 percent in 2008.

The report also showed that past-month menthol cigarette smoking was more likely with recent smoking initiates (those who began smoking in the past year) than with long-term smokers.

Recent research suggests that menthol cigarettes are more difficult to quit smoking than other types of cigarettes. The Family Smoking Prevention and Tobacco Control Act (H.R. 1256), which bans all flavors in cigarettes except menthol, calls for research on the impact of use of menthol in cigarettes on the public health.

Efforts to Decrease Tobacco Sales to Youth Paying Off

Pinpointing why today’s adolescents view smoking as a greater risk than illicit drugs or binge drinking is a little like trying to describe an elephant while blindfolded. If you only look at one parameter, you may get a distorted picture. The truth is that adolescents are impacted by a number of influences, the strongest, perhaps, being what they’re exposed to in the home.
But states have really stepped up their efforts to reduce sales of tobacco to minors, spurred in most part, by the Synar Amendment. Named for Oklahoma’s late Representative Mike Synar, the amendment requires states, the District of Columbia, and the eight U.S. jurisdictions to keep retailer violation rates (RVRs) below 20 percent or risk losing 40 percent of their federal
Substance Abuse Prevention and Treatment block grant funding.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has been monitoring retailer tobacco sales to youth under the age of 18 for the last 12 years. According to SAMHSA’s Center for Substance Abuse Prevention (CSAP), for fiscal year (FY) 2008, the national weighted average RVR for all 50 states and the District of Columbia was 9.9 percent, down from 40.1 percent in FY 1997.

CSAP recently set a new internal goal, to encourage all states to reduce the sales rate of tobacco to minors to less than 10 percent. This goal, says CSAP Director Frances M. Harding, “is in keeping with the initial intent of the Synar legislation – to reduce minors’ access to tobacco products.”

Other Approaches to Address the Problem of Adolescent Smoking

A variety of approaches have been implemented to help curb adolescent access to cigarettes and to the initiation of smoking. Schools provide health educational programs targeting the use and abuse of legal and illicit substances, including tobacco. Since nearly all first-use of cigarettes occurs before high school graduation, or the age of 18, efforts to encourage adolescents to avoid smoking altogether are a good first start.

Tobacco products are subject to taxes at the local, state and federal levels. These taxes have increased substantially in an effort to reduce adolescent use of cigarettes and tobacco products.

When New York City launched a comprehensive anti-smoking program in 2002, it came after a decade of no progress. They increased the tobacco tax, eliminated smoking in virtually all workplaces, and launched hard-hitting anti-smoking advertisements. By 2006, there was a 20 percent drop in smokers, a decline representing 240,000 fewer smokers than in 2002. Campaign ads graphically depicted tobacco smoke’s effects on arteries, lungs and brain, testimonials from those sick and dying, and from their children. One of the ads featured former smoker Ronaldo Martinez, now breathing through a hole in his throat, the result of smoke-related cancer. A survey conducted revealed that nine out of 10 smokers said they had seen the ad – and half of them said it made them want to quit.

Of particular interest in the results from the New York City anti-smoking campaign:

• Rates among young adults (ages 18 to 24) declined twice as much as rates among other adult age groups.

Smoke Free America Websites

The Foundation for a Smoke-Free America, available at http://www.anti-smoking.org/mission.htm, has a simple mission: to motivate youth to stay tobacco-free, and to empower smokers to quit.

The foundation accomplishes its goals through:

• Establishment of in-house programs to fight tobacco use at local, regional and national levels.
• Preventing youth smoking by educational programs in schools, and by information through the foundation’s websites.
• Helping to empower those wishing to quit smoking through websites and other educational materials.
• Peer teaching programs, helping to empower youth to defend themselves against the pressures from peers to smoke and the influences of advertising.
• Implementing programs to remind physicians to take a proactive role in helping their patients who smoke to quit.

The site for youth is No to Tobacco, located at http://www.notobacco.org/. Resources include:

• The Truth About Tobacco, an educational video for grades 7 through 12
• Motivational talks for grades 7 through 12 and colleges. The speaker is Patrick Reynolds, a nationally-known smoke-free advocate and grandson of the founder of the R.J. Reynolds tobacco company. Camel and Winston, the company’s products, killed his father and eldest brother.
• Quitting Tips
• Message to Youth
• Message to Adults
• Foundation for a Smoke Free America
• Anti-Smoking Links and Resources

Mayo Clinic’s 10 Ways to Help Teens Stay Smoke-Free

According to the Mayo Clinic, the way parents can help teens stay smoke-free is to first understand the attraction that cigarettes have for this impressionable population. Setting restrictions on smoking (“Smoking is not allowed.”) is another important step. Since our children often react to the example we set, as parents, we cannot smoke and hope that our children won’t pick up the habit. Parents who do smoke are urged to seek help from their doctor to quit – and to explain to their children how difficult it is to quit. Also, don’t smoke in the house or car or in front of the children.

Other arguments offered by the Mayo Clinic staff include appealing to your teen’s vanity. Who wants yellow teeth or unpleasant breath? And, cigarettes are expensive and becoming more so all the time with increasing taxes. Parents need to caution their teens about the pressures to smoke that they can expect from their peers – and give them ways to counter those pressures.
If teens become addicted to smoking cigarettes, it’s not as easy to quit as they think. Talk about that with your teens. It’s also instructive to discuss the negative health effects of smoking, including heart and lung disease, cancer and stroke. Smokeless tobacco, candy-flavored cigarettes and clove cigarettes are not harmless, either. Discourage your teen from any of these potentially-addictive products. Finally, according to the Mayo Clinic staff, parents should get involved in school and community-based educational programs to stop smoking.

Constant Vigilance Required

The bottom line is that coordinated efforts to increase awareness of the harmful effects of smoking need to continue. It’s heartening that adolescents perceive smoking at such a great risk, versus other illicit drugs and alcohol, but this is only the tip of the iceberg. While it’s true that great strides cannot be made overnight, constant vigilance – and not slacking off – may bring about ever more reduced rates of adolescent smoking. Perhaps the messages about the harmful effects of the other substances (alcohol, illicit drugs, over-the-counter prescription drugs used in nonmedical ways), will also get through.

We have come a long way since the Marlboro Man promoted his macho image and Virginia Slims touted woman’s equality in the smoking habit. But we still have a long way to go if we are to keep our youth from becoming enslaved to an addiction that can be prevented in the first place.

Wouldn’t the world be a better place without cigarettes altogether? We can only dream, but who knows? There may come a time in the not-too-distant future when smoking is considered socially unacceptable in any environment. It already is in a majority of restaurants and public places in numerous states. Young people, take note. You are the future. You can make a difference by deciding that smoking is not in the cards for you.

Article by Suzanne Kane