As a whole, cigarette use in the Unite States still outweighs smokeless tobacco use by about 41 million people. However, that doesn’t mean it is any less deadly. Chewing tobacco has been linked to gum disease, various throat and mouth cancers, pancreatic cancer, and increased risk of heart disease and stroke. Nearly 28,000 incidences of oral cancer are identified every year, and almost all of these cancers can be linked to smokeless tobacco. Even scarier, one out of every three people diagnosed with oral cancer does not survive.

A major concern is that, of all users of smokeless tobacco, 92 percent are young men and teen-age boys. In fact, the Centers for Disease Control and Prevention (CDC) report that smokeless tobacco use among high school boys is up from 11 percent in 2003 to 15 percent in 2009. Another alarming statistic is that the use of smokeless tobacco has reportedly risen by about 36 percent since 2003.

Public health officials blame the sport of baseball and its players for glamorizing this bad habit. Many young kids look up to baseball players and dream of being just like them. There is a strong call for these role models to lead by example, and critics are demanding a ban on tobacco at the major league baseball parks.

Tobacco use has already been banned in the minor leagues; that occurred way back in 1993. The NCAA and the National Hockey League also forbid the use of tobacco. So why are the major leagues so slow to follow suite?

Major league baseball officials cite that the league does discourage the use of tobacco in the sport. In place of tobacco, it provides other alternatives such as gum and sunflower seeds. It also does not allow tobacco companies to distribute free product to players. Clubhouse employees are not allowed to purchase tobacco products for players either. In 1994, the league created the National Spit Tobacco Education Program to discourage the use of chewing tobacco.

Perhaps the answer lies with the players themselves. Many just do not want to quit and say that it is part of the game. Former player for the Milwaukee Brewers and member of the Players Union Executive Council, Craig Counsell, says that a tobacco ban by the players union is unlikely.

Counsell claims that freewill is celebrated and that these grown men are at liberty to make their own decisions. Nevertheless, Commissioner Bud Selig said that he intends to raise the issue during collective bargaining when new contracts are underway in 2012.

Dr. Karina Weichold of the Jena University in Germany said that information is not enough, as most people already know that substance abuse is dangerous yet engage in it anyway. This suggests that prevention needs to start elsewhere.

Dr. Weichold and colleagues from the Institute of Psychology and the Center of Applied Developmental Science of the Jena University want to improve prevention methods through a program they designed called IPSY (Information and Psychosocial Competence).

The researchers gathered data from about 1,700 children between the ages of 10 and 15 from Thuringia, Germany, and the data supported the effectiveness of the IPSY program in preventing alcohol and nicotine abuse in children and adolescents.

Dr. Weichold explained that the program can achieve long-term effects, and Professor Silbereisen, who works with Dr. Weichold, said that children who took part in the IPSY program were less likely to engage in substance abuse, and that the initiation age of substance use was delayed. Silbereisen added that the program is targeted at children before their first contact with alcohol and cigarettes.

The program has been introduced in more than 100 schools in Thuringia since 2003. Silbereisen said that children and teachers who take part in IPSY are positively affected.

The researchers also found that boys and girls equally benefit from the program, and that it helps increase self-confidence in girls and communication skills in boys.

The IPSY program teaches students general skills, such as how to deal with stress, anxiety, and their own self-image. Students work in interactive learning modules on relevant topics and discuss their results with classmates and teachers.

Dr. Weichold said that IPSY lessens the likelihood that children will be susceptible to peer pressure, and they find it easier to say no to alcohol and cigarettes. The program was also found to strengthen the students’ commitment to their school, as they feel safe and that they are taken seriously.

Source: Science Daily, How Children Learn to Say ‘No’: Gender-Specific Effectiveness of a Life Skills Program Against Alcohol Consumption in Early Adolescence, April 19, 2011

A study by Okoli, Torchalla, Ratner and Johnson (2011) looked at the gender differences in adolescent smokers regarding their tobacco use and their mental and physical dependence on tobacco. The researchers wanted to determine whether actual smoking behaviors were consistent with smoking identities.

The researchers recruited 7,185 teens whose median age was 15 years, all in middle school and high school. The teens were 51.6 percent female and selected from 86 schools within 14 school districts in British Columbia, Canada.

The students were asked to complete several self-report measures. Participants were asked to report the number of cigarettes they had smoked in the week prior to taking the survey, and to report the number of cigarettes they had smoked during the past 30 days.

Students who reported cigarette use in the past 30 days were asked to further explain their perceptions of their cigarette use. Participants used a 10-point scale to report their level of addiction and answered questions about how physically and mentally addicted they were to cigarettes. The participants were assessed using scales for tolerance and dependence and were asked to define themselves according to a list of nine descriptive smoking identities, such as occasional smoker, irregular smoker, heavy smoker and others.

The results of the study showed that there were no significant differences between girls and boys in regards to smoking identities. However, girls who identified themselves as "regular smokers" scored higher on measures of emotional dependence and lower on a social dependence dimension than boys who identified themselves as "social smokers."

The study’s results may be limited by the cross-section design or by the researchers’ lack of controlling for factors such as ethnicity and concurrent use of other substances. In addition, the results are highly dependent on self-report and the limitations that are associated with self-report measures.

The findings show that boys and girls largely endorse smoking identities in similar ways. However, among teens that have more developed smoking habits, such as "regular smokers" and "heavy smokers," gender differences are shown. Boys and girls may describe their smoking habits in similar terms, but the ways in which they think about the smoking habits may be different.

The results may be helpful in targeting boys and girls for different types of education and intervention in middle school and high school. Understanding how teen smokers view their behaviors and how they feel about them may make intervention more effective.

Industry statistics suggest that 80 percent of adult smokers got their start in their teen years. And, while 400,000 deaths occur from smoking each year, teens still light up. On the other hand, those teens who choose not to indulge are more likely to never start smoking.

Studies have found that there is a link between cigarette smoking and deficits in attention and memory in adults. Researchers from UCLA sought to compare brain function in adolescent smokers and non-smokers. Their main focus was on the prefrontal cortex, or the area of the brain that is responsible for guiding those executive functions that include decision-making. In teens, this part of the brain is still developing, both functionally and structurally.

This research team discovered that the greater the addiction the teen had to nicotine, the less active their prefrontal cortex. This finding suggests that smoking can affect brain function for teens, as well as adults.

The tests determined that the more a teen smoked, the lower the levels of activity in the prefrontal cortex. Even with this lower activity, however, the non-smoking and the smoking groups both performed similarly on the Stop-Signal Task. At the same time, teen smokers demonstrated a more difficult time making rational decisions regarding their well-being.

Teens apparently got the anti-smoking messages that cigarettes cause cancer and are addictive, but many believe that marijuana is safe to use because in some states, it can be prescribed as a medicine. Students told researchers that compared to cigarettes, they face less disapproval when they use marijuana, and it is easier to obtain and less risky.

Pot use is also up among eighth graders.

Over 20% of all high school seniors in the survey had used marijuana in the past 30 days.

The study, which examined 5,500 seventh and eighth graders at 16 middle schools in California, also found that some of the factors that influenced the risk of substance abuse varied by race and ethnicity. For example, personal factors contributed to the risk of substance abuse among Hispanic adolescents, such as their ability to say no and their perception of the negative consequences of drinking, smoking, and drug use.

Asian teens’ lower risk of substance abuse was tied to the same personal factors, in addition to their respect for the parents and their family members’ and peers’
lower rates of substance abuse.

Regina A. Shih, Ph.D., and her colleagues at the RAND Corporation said that the study highlights issues that could be used in substance abuse prevention programs in middle schools. Dr. Shih said that most interventions are not culturally tailored, so focusing on specific risk factors that are present in certain races and ethnicities could help better prevent substance abuse. For example, focusing on how to resist peer pressure could be helpful for Hispanic teens, while promoting positive communication among family members could help maintain lower substance abuse rates for Asian teens.

Dr. Shih noted that they aren’t suggesting that these targeted efforts be offered to only students of those ethnicities, but that they could be broadly applied to help reach a higher number of students.

In the study, 22 percent of students said they had tried alcohol, 10 percent said they had smoked cigarettes, and 7 percent said they had used marijuana. Among Hispanics, 26 percent had tried alcohol, compared to 21 percent of black students, 18 percent of white students, and about 10 percent of Asian students.

Hispanic students had the highest probability of substance abuse and Asian students had the lowest probability, even after accounting for factors such as gender and family backgrounds.

Shih and her team hope to use this sample to continue to examine adolescents over time to see which factors initiate or worsen substance abuse.

Source: Science Daily, Hispanic Kids Show Greater Risk of Substance Use, Study Suggests, September 1, 2010

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

Josh Humphries of the Daily Reflector writes that the Pitt County Substance Abuse Coalition recently conducted a survey of more than 6,000 students in grades 6-12 in Pitt County. The results will be used to create action plans with various community and government groups, said Margaret Blackmon, executive director of the Pitt County Substance Abuse Coalition.

Blackmon said that teens in the county perceive tobacco to be more risky than alcohol or marijuana and the perception of risk in general decreases as they get older.

“What we are finding is that kids are not smoking cigarettes as much as they are using alcohol and marijuana,” Blackmon said.

When asked how risky the students believe each substance to be, about 87 percent responded that tobacco is moderately or very risky compared to 73 percent for alcohol and 71 percent for marijuana.

Teens are exposed to more anti-smoking media than anti-drugs or alcohol media and perceive the risk of tobacco to be greater than marijuana or alcohol, Blackmon said.

Alcohol abuse is up in Pitt County compared to the rest of the nation. Comparing the new survey with data from 2003 shows that more Pitt County students are using alcohol, fewer are smoking cigarettes, and the numbers for marijuana are about the same.

Blackmon said it is important to know where students get dangerous substances, and that she was surprised to find that many get them from their parents.

About 31 percent of students said they got alcohol at home with their parents’ permission, and another 26 percent said they got marijuana the same way.

The teens also reported that parents disapprove more strongly of marijuana and cigarette use than alcohol use.

About 39 percent of high school students have consumed alcohol in the last 30 days compared to 26 percent who have used marijuana and 19 percent who have smoked a cigarette in the last 30 days, the survey results show.

Blackmon said that peer disapproval of substance abuse is not as high as it should be, and that the coalition will be working to create peer-to-peer programs for students in the county.

“We want to try to change the idea that everybody is doing it, because everybody is not,” she said. “We are trying to develop a core group of youth to take that message forward.”

“Retail displays have an impact on future smokers—not current ones. Removing displays may well incur a one-off cost, which I think the industry should bear if they want retailers to continue to stock their products,” said ASH Scotland chief Sheila Duffy.

"But it is a health measure that must be weighed against the cost to public health, lives and the NHS," she added.

Duffy will also tell a conference in Edinburgh today that despite a rise in the age to buy cigarettes to 18, 4 percent of Scotland’s 13-year-olds still smoke.

A ban on displays would be introduced under the Tobacco and Primary Medical Services (Scotland) Bill, which will be debated in Parliament tomorrow.

"A child who starts smoking at 14 or younger is 15 times more likely to die of lung cancer than someone who never smokes,” Duffy added. “Without tobacco, our youngsters have a bright future."

A recent Science Daily report found that a program called Tobacco-Free Duo, started in 1993 through collaboration between the Country Council of Västerbotten County and the schools in the county’s municipalities, demonstrated that a clear commitment from adults against the use of tobacco is expected by their children.

These findings were part of research from Umeå University in Sweden and also demonstrated that this commitment from adults can prevent teenagers from starting to smoke or use snuff.

A central component of the Tobacco-Free Duo program was to include adults in the task of supporting adolescents in saying no to tobacco. Maria Nilsson evaluates the effects of the program in her dissertation and examines how adults and especially parents should approach the use of tobacco among children.

While no change in smoking among children was observed at the national level, it did decline for Tobacco-Free Duo, which paired one adult with one teenager. The program has proven to be viable in the municipalities throughout the years.

An interview study was conducted which found that 15-year old smokers engage in the activity as a way to gain control of their feelings and their situation during the tumultuous teen years. These teens expect grown-ups to intervene against their smoking and attribute close adult relationships with smoking less or attempting to quit.

Maria Nilsson shared in the Science Daily report: “Children expect adults to work against tobacco. They say this is important and that grown-ups can make a difference by showing a clear and positive commitment.”