New Efforts to Curb Teen Smoking

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. On November 6th 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.)

Another program that advocates hope will prevent kids from getting hooked in the first place is the American Legacy Foundation's "truth" campaign, which reaches out to teens with edgy antismoking ads. The program features pictures of low-birth-weight babies and 1,200 dead bodies outside a tobacco company's office to represent the Americans who die daily from smoking-related diseases. "[But] there isn't a sustained national media campaign for youth tobacco prevention," says Cathy Backinger, acting chief of the Tobacco Control Research Branch at the National Cancer Institute. Such a campaign would need to focus on teens' motivations for starting, and stopping. Backinger says kids cite reasons for quitting like "I quit smoking because my boyfriend didn't want me to smoke" or that they'd rather spend their money on music or clothes.

Sixteen percent of adolescents say they smoked a whole cigarette for the first time before age 13, and by the end of high school 54.3 percent of kids will have tried smoking. And yet teens aren't in the dark about the risks. "Kids know the health effects," says the NCI's Backinger. "Most kids don't think about the consequences." They know, "'I may get lung cancer 40, 50 years from now if I start smoking'," she says. "You don't think you're going to get addicted." They do it to be cool, rebellious or one of the gang. "They want to be more grown-up," she says. "One way to express being a grown-up is to do this independent thing that's an adult thing." Then they're hooked. "Kids try to quit and then find they can't," she says. "They experiment, and they think they can quit anytime."

But there are moves to squelch marketing that seems directly aimed at younger smokers. Currently the National Association of Attorneys General takes action if tobacco makers market anything directly toward kids. In October the attorneys general announced that R.J. Reynolds had agreed to a settlement that would prohibit selling cigarettes with candy, fruit or alcoholic beverage names and from giving out scratch-and-sniff ads or promotions.

Tobacco companies deny targeting teens. "We make a product that's intended for adults to smoke," says Bill Phelps, a spokesman for Philip Morris USA. "Our business is based on competing for the largest share of the adult tobacco market." Their advertising is mostly through direct mail, using adult-smoking databases of current smokers age 21 and older, and through convenience stores, says Phelps. However, they are allowed to advertise in the convenience stores that many teens frequent.

And while Philip Morris has not advertised in magazines or newspapers since 2005, its competitors do. "There's a lot of advertising in sports magazines, which boys read, and in glamour magazines, which girls read," says the ALA's Edelman. R.J. Reynolds' new Camel No. 9, with its pink packaging and "stiletto"-length cigarettes, would seem to appeal to teen girls—especially those who see the ads for it in Cosmopolitan, Glamour and Vogue.

And then there's the glamorization of smoking in movies, which has been shown to influence kids' choices. Smoking occurred in more than half of the most youth-oriented popular movies, according to reports published in the Lancet in 2003, Pediatrics in 2005 and in the Archives of Pediatric Adolescent Medicine this year. And through phone interviews with kids aged 10 to 14, Dartmouth researchers found that kids were more likely to light up if they had seen more movies with smoking. (The Dartmouth group, like many experts, would like to see the rating system changed so that smoking is forbidden in G, PG and PG-13 films.) And this year the National Academy of Sciences said exposure to smoking in movies increases the risk of starting to smoke.

Nonetheless, there's hope for a less smoky future for U.S. teens. Sure, nearly a quarter of high-school students smoke—but that's down from 36 percent in 1997. And it means three-quarters of high-school students abstain. "Why would I waste my time doing something that would eventually kill me," says Will Peterson, 16, of Elmhurst, Ill. "I think I would let a lot of people down, including my little sister. It's a waste of money, too." He also watched his grandma die of lung cancer and saw "how crushing it was" for his family. It goes to show that even the influence of celebrity smokers and tobacco companies has its limits.