BUTT OUT
From the White House to the schoolhouse, turning teens on to putting out their smokes is the burning issue
by Monika Guttman
Joe Camel, according to the Centers for Disease Control and Prevention (CDC), is as familiar to 6-year-olds as Mickey Mouse. Government statistics show that more than 3,000 teens and pre-teens are lighting up for the first time each day. And research concludes that the younger the smoker, the greater the chance of continuing to smoke through adulthood-75 percent of teens who smoke daily will smoke as adults.Statistics like these are motivating everyone from the White House to the American Medical Association to figure out how to stop kids from starting to smoke. Also hot: determining what programs and messages will inspire them to give up the habit once they've started, since 70 percent of teens who smoke consider themselves addicted.
"There's a need for much more research," says Leonard Lamkin, manager of the AMA's Interventions for Adolescents Using Tobacco Project. Lamkin and others divide teen-targeted anti-smoking efforts into two separate categories: prevention (geared to teens not yet smoking or not smoking heavily) and cessation (getting teens who already smoke to stop).
"The initial conclusions show that there are some good preventive programs available today, particularly those that take a holistic approach and involve the community, the media and school curricula," says Lamkin. "But we need much more research on cessation programs. It's too early to make a general conclusion."
The good news, according to researchers at USC, is that information about what works in both smoking prevention and smoking cessation programs for teens is being collected in studies and pilot programs already under way here.
Part of that research was presented at an AMA/CDC sponsored conference last year to highlight the research findings of the past few years. Those findings will be published in a special upcoming edition of Preventive Medicine, and include a paper by Steve Sussman, Ph.D., USC associate professor of preventive medicine, whose years of investigation in this area resulted in the 1995 book "Developing School-Based Tobacco Use Prevention and Cessation Programs," Sage Publications.
Sussman and his colleagues have been working on prevention and cessation pilot programs in local high schools for the past two decades. Research in this area has lagged, he speculates, because "we tend to live by various folk wisdom. One is that adolescence is too soon to focus on cessation. The other is, for the regular adolescent user, the consequences are too distant, so, just wait until they hit adulthood and they're ready to quit."
Actually, says Sussman, teens are interested in quitting. The challenge lies in communication. "You have to tailor the messages to teens," he says. For example, how you round up teens and get them to a stop-smoking clinic is different from how you would approach adults. "Teens don't use appointment books, and they live in the moment," he says. What has worked: holding the meetings at school, going to lunch areas and recruiting students the day before and the day of a clinic, and public address system announcements. "If it's happening now, they'll come," he says.
Another difference with teens: the approach for getting them to believe in quitting or to not start in the first place. "For adults, a long-term health impact message might work. For teens, that means little. It has to be tied into their life goals, like 'if you want a job, smokers are ostracized to a certain extent and have to go outside to smoke.'"
One of the biggest challenges that still needs to be addressed in research, according to Sussman, is how to convince teens to go through the pain of withdrawal and not resume smoking. "A teenager is less likely to tolerate feeling irritable and cranky because of nicotine withdrawal," says Sussman. "It's harder to get them to stay stopped."
Sussman feels it may be possible if there is increased community support for the cessation: teachers and parents allowing for the withdrawal symptoms, for example, and nonsmoking friends involved in the anti-smoking clinics as emotional support.
Another effective means for reaching teens, USC researchers have found, is communicating to them at special events or during regularly scheduled medical visits. For the past five years, the USC School of Dentistry has incorporated training for smoking cessation into the curriculum for both dental students and dental hygiene students. "We train them to intervene with their patients that smoke by explaining some of the negative results of smoking, urging them to stop and referring them to agencies and community groups that help stop smoking," says Niel Nathason, M.P.H., assistant professor of community dentistry and public health.
The dental school also holds approximately 30 health fairs a year. "We take information about tobacco and smoking cessation to places like Olvera Street, the West Hollywood Kid's Faire, and the Family Resource Center near Exposition Park," says Nathason. "When teens come up and say, 'I can't quit because I've been smoking since I was 14,' we tell them, 'It's a lot easier to quit now than it will be at 24.'"
Among the materials geared to teens distributed at the fairs: brochures and comic books in English and Spanish that talk about the harm of smoking, and stickers that say kissing a smoker "is like licking an ashtray."
Whatever the individual research concludes, says the AMA's Lamkin, there is no doubt tackling the teen smoking problem requires simultaneous efforts on multiple fronts, including enforcement of laws prohibiting the sale of cigarettes to minors and some sort of restriction on cigarette advertising that reaches teens. "Hopefully," Lamkin says, "further research will give us better ideas about what those approaches should be."
For more information about the teen smoking cessation project, please contact Sande Craig at 1-800-USC-CARE.