Smokin' in the Boys (and Girls) Room

At 13, Sophia Patelidas nicked a pack of her dad's cigarettes and took her first puff. She did it "just to see what it was like," she says. "I enjoyed it." She never expected to get hooked. But she is. Since that first drag, Patelidas, of Chicago, now 20, has tried to quit 10 times. "I don't want to get lung cancer," she says. The proposed legislation to raise the federal cigarette tax from 39 cents to $1 per pack, she says, could give her "more of a reason to quit." She plans to keep trying.

For most smokers, like Patelidas, it's a habit that starts young and is almost impossible to shake. About 25 percent of American high-school students now smoke despite laws that prohibit the sale of cigarettes to those under 18. Only an estimated 4 percent of those teens who try to quit each year are successful. "Virtually all smokers are hooked when they're teens," says Dr. Norman Edelman, chief medical officer for the American Lung Association. The consequences are sobering: smoking contributes to the deaths of 440,000 Americans a year.

But despite the dire statistics, health advocates may have some good news this week. Tomorrow Oregon voters will decide whether to approve an 84.5-cent-per-pack state tax hike, which would bring Oregon's total tax-per-pack to $2.03, in an effort to curb teen smoking. "The very best way to prevent children and teens from smoking is to increase the tax on them," says Edelman. And for teens who are already addicted, there may be new medical treatments; a study out today in the Archives of Pediatric and Adolescent Medicine indicates that the antidepressant bupropion, a medication that has helps adult smokers quit, also works for some teens.

"The good news is there's treatment," says Dr. Myra Muramoto, of the University of Arizona at Tucson, lead author of the antidepressant study. The bad news is that even with medical help it's still really tough for teens quit. After six weeks 6 percent of the placebo group and 15 percent of the group taking an adult level of bupropion had quit smoking. Unfortunately, at a 26-week follow-up, only 10 percent of the teens who took the placebo and 14 percent of those who took bupropion were still abstaining. (So far, nicotine patches have not been proven to work in teens, says Kimberley Elliott, director of clinical research for the Department of Family and Community Medicine at the University of Arizona.)

So how do public health officials help the 55 percent of current high-school smokers who say they've tried to quit, according to the Centers for Disease Control's Youth Risk Behavior Surveillance Survey? It's not easy. The tobacco industry spends $13 billion a year on promotions and advertising. And cigarettes are more potent than ever. Earlier this year Harvard University researchers confirmed a Massachusetts Department of Public Health finding that manufacturers increased the level of nicotine in popular cigarettes 11 percent between 1997 and 2005, making them more addictive.

One method of curbing the habit is to push the price of cigarettes beyond what the average teenager can afford. It's a tactic that appears to have been effective in New Jersey, which has the highest state tax, at $2.58 per 20-cigarette pack, and boasts the lowest prevalence of current smoking among middle-school and high-school students. In fact, the evidence that higher costs result in fewer smokers is so compelling that it may be one reason tobacco companies reportedly spent $10 million opposing the Oregon cigarette tax hike legislation. Advocates say the move would bring cigarette prices in line with neighboring Washington state and would also help fund health-care programs for uninsured kids in the state.

At the federal level, Congress is trying to put together a veto-proof majority on a bill that would fund the expansion of the State Children's Health Insurance Program through a 61-cent-a-pack tax hike—a measure previously vetoed by President Bush. "It would keep hundreds of thousands of kids from smoking and eventually from dying," says Frank Chaloupka, a professor of economics at the University of Illinois at Chicago who studies the effects of policies and prices on tobacco use. Experts estimate that a 10-percent increase in price reduces overall cigarette consumption 3 to 5 percent. (And kids are two to three times as sensitive to price as adults, according to Chaloupka.)