Getting Teens To Kick the Habit a Daunting Task
Ending it is one of President Clinton's top health priorities. The tobacco industry has pledged millions of dollars to extinguish it. And children's advocates are mobilizing their supporters to fight it.
But is stamping out youth smoking really possible? Can the government coax millions of rebellious teenagers to kick the smoking habit and persuade millions more not to light up in the first place?
Research suggests that hiking cigarette prices and curbing advertising may be the best ways to dampen teenagers' desire to smoke. There's even some evidence showing that the classroom can play at least a supporting role in deterring student smoking. But some skeptics, backed up by history, say it may prove impossible to achieve dramatic reductions in adolescent smoking even with an unprecedentedly powerful coalition of industry and government agencies behind the campaign.
Lawmakers in Congress are expected this month to draft measures to drive youth smoking down to the lowest point ever recorded as part of a landmark settlement reached last year between the nation's largest tobacco companies and the attorneys general of 40 states. Under the plan, which must win congressional approval, the R.J. Reynolds Tobacco Co., Philip Morris Inc., the Brown and Williamson Tobacco Corp., and the Lorillard Tobacco Co. agreed to reimburse the states more than $368 billion for smoking-related health costs over the next quarter-century in exchange for a moratorium on dozens of potentially costly lawsuits.
Doom for the Camel
A central part of the accord would require those companies to cut youth smoking rates by 30 percent in five years, 50 percent in seven years, and 60 percent in the next decade. If they missed the targets, the cigarette makers would be forced to pay a penalty of $80 million a year for each percentage point they fell short.
"We recognize that youth smoking is a real, real problem, and something has to be done about it," Geoffrey Bible, the chairman of Philip Morris, said in testimony before the House Commerce Committee last month. At the hearing, Mr. Bible and three other tobacco executives admitted for the first time in public that cigarette smoking can be addictive and have negative health consequences. "Tobacco is a risky product that should be restricted to adults," Mr. Bible said.
About 20 percent of 12- to 17-year-olds--more than 4 million youths--smoke cigarettes, and about 34 percent of high school seniors are regular smokers, according to the U.S. Centers for Disease Control and Prevention.
To shrink those numbers, the cigarette companies have agreed to unprecedented marketing restrictions on their products, such as eliminating advertising on billboards and other outdoor signs and removing human images and cartoon characters from cigarette ads and promotions. Those actions would doom the Marlboro Man and Joe Camel, the cartoon mascot for the Camel brand that has incensed anti-smoking activists who claim that the character was designed to appeal to young people.
The pact also calls for the industry to establish a nationwide licensing system to help monitor retailers' compliance with state and federal laws prohibiting tobacco-product sales to minors. The tobacco companies also agreed to spend $500 million over an unspecified period on anti-smoking education campaigns directed at young people and adults.
Doing What Works
Health researchers say that while the prospect of quashing youth smoking is daunting, it can be accomplished if campaign organizers learn from the past.
In the 1880s, schoolchildren were recruited to wear blue ribbons on their lapels proclaiming their sobriety, and the girls among them were asked to show their commitment to abstinence by pledging not to marry a man who drank.
Late-19th century temperance campaigns, which excoriated alcohol as the devil's brew and condemned tobacco use, failed to have an effect on drinking or smoking habits because they relied on moralistic, instead of medical, arguments, said Michael Eriksen, the director of the office on smoking and health for the CDC.
It was only after the watershed U.S. surgeon general's report came out in 1958 linking smoking to cancer and other diseases that adult smoking rates plummeted. Adult rates dropped from 50 percent in 1964 to 25 percent today, a 50 percent plunge, according to the CDC. The widely disseminated health disclosures have contributed to a 1990s environment in which many offices, restaurants, and even some bars are smoke-free, corporations sponsor smoking-cessation classes, and the market for anti-smoking remedies such as nicotine patches is booming.
Public-health campaigns, however, haven't had the same effect on young people: The daily smoking rate for teenagers went from 25 percent in the 1970s to 18 percent in the 1980s, then shot back up to the current 23 percent.
Because teenagers typically see themselves as immune from physical harm, it will take more than spelling out long-term health risks to persuade them to abstain, experts say. One study found, though, that raising the price of cigarettes can have a striking effect on teenage smoking. For every 10-cent increase in the per-pack cost, there is a 7 percent decline in the smoking rate among teenagers, a recent CDC study found.
Young people are also estimated to be more than twice as likely as adults to be influenced by cigarette advertising. Another recent CDC study showed that 85 percent of adolescents smoke the three most heavily advertised brands: Marlboro, Camel, and Newport. In contrast, 35 percent of adults who smoke choose those brands.The study did not address whether the ads led teenagers to smoke.
Education programs can also play an important part in anti-smoking campaigns, Mr. Eriksen said.
A 1995 study of 3,600 New York state students by Cornell University researchers found that students who took comprehensive anti-drug and alcohol classes in junior high school had by the time they reached 12th grade smoking rates that were as much as 33 percent lower than those of students who were not enrolled in them. ("Study Touts the Benefits of Anti-Drug Curriculum in Junior High," April 19, 1995.)
But it will take much more than banishing Joe Camel and teaching about the dangers of cigarettes to meet the terms of the industry's agreement with the attorneys general, experts on smoking say. The settlement calls for the industry and government to drive down youth smoking further and in one-third the time it took to reduce adult smoking.
"I'm not sure we can hit that target; it's huge," said William D. Novelli, the president of the National Center for Tobacco-Free Kids, an advocacy group based in Washington. Attacking social problems takes a comprehensive and coordinated effort, he said, and "groundswells are damn hard to manufacture."
Even if such a grand-scale social experiment is possible, some critics maintain that it's not the tobacco industry's job to bankroll it.
"It's ridiculous to suggest the tobacco companies have the responsibility to pay for anti-smoking campaigns. They're marketing a legal product," said Robert Levy, a senior fellow at the Cato Institute, a libertarian think tank in Washington. Mr. Levy said the government should concentrate on enforcing existing laws that prohibit sales to underage smokers.
Meanwhile, teenagers such as Matthew Carver, a high school senior from Madison, Tenn., who toured Capitol Hill with other students last month, say that government tactics are futile because teenagers will find a way to smoke if they want to. "The only way to get kids to quit would be a complete ban," the 17-year-old said.
A ban raises the specter of Prohibition and its repercussions--a black market and violence. It also may increase the attraction that a forbidden activity holds for many teenagers.
A Shaky Deal
Of course, the debate over strategy will be meaningless if the already shaky settlement fails to move through Congress.
Some longtime Republican allies of the tobacco industry backed away from granting the companies immunity from many lawsuits following the release of documents last month that showed R.J. Reynolds had geared its marketing toward consumers as young as 15.
For their part, tobacco companies have said that without immunity from prosecution, a deal cannot go forward.