U.S. Surgeon General Joycelyn Elders exempts no one from the responsibility of stopping adolescent smoking--not the tobacco industry, not lawmakers, not parents, and not schools.
“Less than 5 percent of the schools in this country have a comprehensive health-education program,’' Dr. Elders told reporters late last month at a news conference introducing the first surgeon general’s report on smoking to deal exclusively with young people. “Frequently children learn nothing about tobacco smoking except what they see in magazines or hear from their peers.’'
The report has focused renewed attention on what schools should be doing to discourage youths from smoking. And survey findings underscore what health experts say is the urgency of such efforts.
Surveys cited at the news conference suggest that, after years of decline, the rate at which young people take up smoking is growing and that tobacco-company advertising has contributed to that increase. The surgeon general’s report says that by age 18, about two-thirds of young people have tried cigarettes and that more than three million adolescents smoke regularly.
In her report, Dr. Elders addresses the effects of tobacco use on health, the role of cigarette advertising, and efforts to prevent tobacco use among young people.
To encourage schools to join anti-smoking efforts, Dr. Elders and the U.S. Centers for Disease Control and Prevention have released guidelines for school health programs designed to discourage tobacco use among students.
The guidelines say programs should start in the 6th or 7th grade and should emphasize social factors that lead to tobacco use, short-term consequences of smoking, and ways to refuse to use tobacco.
Few schools, however, currently have anti-tobacco-use programs that work, researchers say.
‘State of the Art’ Programs
Cheryl L. Perry, a University of Minnesota professor and senior scientific editor of the C.D.C. report, estimates that only 3 percent to 5 percent of schools use the kind of life-skills-training program she and other researchers believe works.
Most schools teach the physical effects of tobacco use, sometimes combined with lessons on building self-esteem, Ms. Perry said. “I think these are good foundations,’' she said, “but neither has shown an impact on smoking [and] behavior.’'
Smoking-prevention programs must have several core components to be effective, according to Steve Sussman, a professor at the University of Southern California’s School of Medicine.
Mr. Sussman, who studies and develops school-based smoking-prevention and -cessation programs, said that “state of the art’’ programs aim to change students’ perceptions of peer approval and of the prevalence of tobacco use among peers. The programs also must teach students to reject tobacco when it is offered, and must include information on the medical consequences of using tobacco and an analysis of media images of smoking, including advertising.
According to Mr. Sussman, such state-of-the-art programs should encourage students to take up “activist’’ activities, such as writing letters to people asking them to stop smoking, and should ask the students to pledge not to use tobacco.
While in recent years the emphasis in many programs was on “refusal assertion’'--role-playing activities that give children practice in saying no to tobacco--Mr. Sussman said that approach is seen as just one part of a comprehensive tobacco-education program.
“People are coming around and saying, ‘Don’t throw refusal-assertion training out, ... but it’s not as important as people used to think it was,’'' he said.
Emphasizing what students should do when offered tobacco suggests a greater prevalence of smoking than actually exists, he said.
While researchers believe that they are coming up with tested approaches that can stop young people from smoking, educators often develop programs at school sites, incorporating outside sources and adding their own ideas.
Researchers such as Mr. Sussman are concerned that without a program that includes the elements they have found to be effective, however, students will not learn to resist the lure of the cigarette.
Taking Aim at 2000
One program that has garnered a lot of attention and support is the Smoke Free Class of 2000. Sponsored by the American Lung Association, the American Heart Association, and the American Cancer Society, S.F.C. 2000 targets members of the graduating class of 2000, who are now in 6th grade.
The program has gone through several changes since it began six years ago.
“In the 1st grade, it was more of a [public-relations] effort’’ to increase the general public’s awareness of the problem of youth smoking, said Gail Joyce, S.F.C. 2000’s project coordinator. “Now we’ve stopped preaching to kids. Instead, we give them the skills they need so that they will choose not to smoke.’'
Students think smoking gives them control over part of their lives, she said. In S.F.C. 2000, they learn that “when you choose to smoke, you’re not in control,’' because of the addictive nature of cigarettes.
This year, S.F.C. 2000 sent out 135,000 teaching kits. Next year’s program will focus on how students can be activists and create change, in addition to providing information on the dangers of tobacco use.
Tobacco-Free Schools?
While students may find classroom arguments persuasive, some educators fear that the sight of smokers on campus may be viewed as tacit approval of tobacco use.
“A lot of teachers are smokers,’' Jim Bogden, a project associate at the National Association of State Boards of Education, noted. “And, whether they want to be or not, teachers are role models.’'
He pointed to state efforts to ban smoking in schools as an effective means of stopping tobacco use among the young.
In West Virginia, for example, where the relatively large number of young tobacco users includes many who use smokeless tobacco, the state school board two years ago adopted a ban on the use of tobacco products on school property.
The ban is still being implemented. But, according to Lenore Zenosky, the director of the state education department’s office of healthy schools, schools already are seeing some results that she attributes, at least in part, to the prohibition. In a 1990 statewide survey, for example, 21 percent of students reported using tobacco. In 1993, only 18 percent said they did.
