She’s Gotta Habit

“I was a wicked late bloomer,” Erin recalls. “Plus, I was always wearing these hand-me-down clothes from my cousin. People would say ‘Why do you wear those boy’s clothes all the time?’ And I was a year younger than everyone else. It was a really hard time for me.”

Then, on top of everything else, Erin’s parents divorced. Although money was never really a problem--Erin’s father teaches at Harvard, and her mother is a book critic--she felt out of place in Newton, one of Boston’s better-off suburbs. “I had a fine life, but by Newton standards I was poor,” she says. “I started to look for friends who were more like me, kids who lived rougher lives.”

Those kids were smokers. And when a boy she liked handed her a cigarette on one of the last days of 8th grade, she didn’t hesitate. “I remember a whole group of these people who were getting to be my close friends was hanging out by the bus stop,” she says. “When this guy asked me if I wanted to smoke, I said, ‘Sure,’ without even thinking about it. Then, all of a sudden, I was sitting under a tree all dizzy, with everything swirling around me, and we were all laughing.”

In the time it takes her to tell the story, Erin (the names of the teenagers in this article have been changed) has polished off a glass of cranberry juice and inhaled most of a cigarette. As she pauses to reflect, she raises what’s left of the slender cylinder to her lips, sucks the smoke into her lungs, and exhales slowly.

“You know, when I was 13, it wasn’t like smoking was something that all the kids I knew did,” she says. “It was more like I wanted to shock people. My parents would say, ‘Why are you hanging out with those bad kids?’ And I just wanted to tell them that I was bad, too.”

During the following summer, Erin and another friend regularly bought cigarettes and snuck down to a local stream to share them. By the winter of their first year of high school, both girls were two-pack-a-day smokers.

Now, five years later, Erin wants to quit. She thinks smoking is a “nasty, filthy habit.” She even raises money for the American Cancer Society. Still, she acknowledges that cigarettes eased her transformation from awkward to hip, and she can’t imagine herself without them. “I hate to admit it, but a lot of what got me started was wanting to be cool and look older,” she says. “It’s true that when I started smoking, I started meeting more people. And it’s also true that I didn’t have any self-confidence until I started testing the waters and acting out. The thing is--and this is the insidious part--I can’t picture myself doing anything, like walking down the street or sitting here in this cafe, without smoking. It’s like a piece of jewelry you always wear, a prop that’s become a part of me.”

Erin is not alone. Although smoking rates have flattened for the general population, the number of teenagers who smoke is on the rise. This is true for both boys and girls, regardless of socioeconomic status, but it’s particularly the case for young, white teenage girls. Girls, it seems, are resisting the country’s anti-smoking frenzy and shrugging off the many taboos associated with cigarettes.

Consider the evidence. In 1991, an annual study conducted at the University of Michigan found that a smaller percentage of 8th grade girls said they had smoked in the past 30 days than did 8th grade boys. The difference was slight: 15.6 percent for boys to 13.1 percent for girls. Over the next five years, both these figures swelled, but the percentage of girls smoking jumped 8 percentage points while the figure for boys grew only 5 percentage points. The result: By 1996, the percentage of girls smoking topped the percentage of boys smoking, 21.1 to 20.6.

The University of Michigan study found an even bigger jump in the percentage of smokers among 10th grade girls. Between 1991 and 1996, that number climbed from 20.7 to 30.8 percent--this despite a significant drop in the number of African-American girls who smoke.

Meanwhile, a 1995 study by the federal Centers for Disease Control and Prevention found that non-Hispanic white girls were the most likely of all students in grades 9-12 to be smokers--with 39.8 percent saying they had smoked in the past month. They were also the most likely to be frequent smokers, with nearly 21 percent saying they had lit up on at least 20 of the previous 30 days.

The rising numbers of youngsters turning on to cigarettes worry health officials. Smokers who get hooked on cigarettes as teens are more likely to stay hooked--no matter how easy they think it will be to quit later. That’s because the single best predictor for addiction, experts say, is the duration of a smoker’s habit. Teenagers who smoke into adulthood have more trouble stopping simply because they started earlier. At the same time, those who grow up without cigarettes don’t often pick up the habit later in life. “It’s absolutely clear that if you can get a kid to the age of 21 without smoking, the chances that he or she will start are very small,” says Jim Hyde, associate professor of family medicine and community health at Tufts University School of Medicine.

Thus teenage smokers like Erin are prime targets for a lifetime of tobacco addiction. Who are these girls, and why are they taking up a habit that they know carries numerous health risks? The reasons have important implications for school-related prevention efforts.

If the 20 teenagers interviewed for this article are any indication, girls smoke these days because they can think of more reasons to do it than reasons not to. Cigarettes provide needed swagger at parties and other social gatherings. They create an excuse to hang out with other kids who aren’t afraid of bending or breaking the rules. Many girls believe cigarettes can help them diet--or can at least prevent them from gaining weight. But most of all, cigarettes are still perceived as cool, despite, or perhaps because of, all the attempts to convince teenagers otherwise.

Most girls don’t head for the cigarette machine after watching popular actresses like Winona Ryder and Julia Roberts light up on the screen. But it’s not lost on them that for all the approbatory talk, smoking remains an accepted part of life--adult life. Stacked up against smoking’s immediate allure, the prospect of long-term health risks doesn’t seem to mean much.

“If smoking is so bad,” Erin asks, “why is it that you can do it anywhere, and wherever you go there’ll be older people smoking who are supposed to know better?”

Teens often see hypocrisy in adults’ hectoring about smoking, a fact that helps explain why government and school-sponsored tobacco-prevention programs often prove ineffective. “Smoking provides an odd and appealing juxtaposition for young people,” says William DeJong, a lecturer at the Harvard School of Public Health. “It both allows them to flaunt adult authority and at the same time think they are acting more adult. Most institutionally based prevention programs don’t address that.”

Many public service ads and prevention programs try to discourage teenagers from smoking by warning them of the attendant health risks or portraying them as dupes of the tobacco industry. The teenagers often go away laughing or irked at what they see as hokey cliches and patronizing speeches. “It just doesn’t affect me, hearing that I might get cancer in 20 or 40 years,” one 15-year-old says. “And what I hate the most--it’s just so annoying--is when adults keep telling you that you’re just totally naive.”

So by preaching, the best-laid anti-smoking plans can backfire. “Teenagers know that the anti-smoking ads they see and the rhetoric they hear is crafted by adults,” says DeJong, who sits on the Massachusetts Tobacco Control Oversight Council. Since 1992, Massachusetts has spent about $30 million a year on smoking prevention, including school-based programs and newspaper and television ads. The result of that massive commitment has been that teenage smoking rates haven’t climbed like the national averages, but they haven’t dropped either. DeJong thinks the state needs to change the way it delivers its anti-smoking message. “Until kids who are at risk of smoking hear in a convincing way from kids who they think are cool, we may not see these programs having much of an impact,” he says.

It’s a July afternoon, and Aviva Stern and Jessica Paley, both 15, are walking the streets of Wellesley, Massachusetts, looking for a place to smoke. The girls have a few hours off from the summer enrichment program they are attending at Wellesley College. The program, called Explorations, lets only students who have declared themselves smokers on the first day use tobacco, and then only in a small, roped-off area of the campus known as the “pigpen.” Aviva and Jessica enjoy hanging out there--"That’s where I’ve met all my friends,” Aviva says--but today they’re tired of baking in the hot sun. So they’ve wandered away to find a quiet, shady spot where they can smoke off-campus.

Both girls are dressed in baggy painter’s pants, close-fitting T-shirts, beaded chokers, and sneakers. Jessica, who goes to public school in Miami, wears her short, dark hair in two pink barrettes. Aviva, a soft-faced girl from Philadelphia, has a tiny gold stud in her nose and three matching gold balls in her left ear. While Jessica refers to herself as a “social smoker,” Aviva smokes a pack a day.

Aviva started smoking a year ago during a summer stay at the New Jersey shore. “It was kind of like there was nothing else to do, so we just went to the park and smoked,” she says. “If I’m jumpy or upset about something, smoking calms me down. And personally, I find it attractive. I mean, I’m not going to lie: Sometimes I think smoking makes me look better. And I guess this is pretty stupid of me, but if I see a guy smoking, I’ll be more likely to go up and try to talk to him.”

Back at the private Jewish high school she attends, Aviva cut back but kept smoking several cigarettes a day. Her parents, who both smoke, screamed and yelled when they found out, she says. Then they realized they couldn’t stop her. “Now my mom’s kind of like in denial,” Aviva says. “She says, ‘Just don’t smoke in front of me because I don’t want to know about it.’”

But Aviva does not hold her parents responsible for her behavior. “This is something I’m choosing to do,” she says. Nor does she blame the media. “When I see a movie actress with a cigarette, I don’t think, ‘Oh look, she’s smoking, so I should smoke,’” she says. “I just see it as normal. It’s just like one of a person’s traits, like some people have brown hair or blue eyes, and some people play soccer, and some people are smokers. It’s just that I happen to think the smokers look better.”

Aviva also rejects the notion that she’s fallen prey to clever tobacco ads. “This whole thing about how bad Joe Camel is supposed to be for kids is just the dumbest,” she says, rolling her eyes. “I smoke what tastes good to me, not because I like some dumb cartoon character. I mean, my brand is Marlboro, and their ads are supposed to be for men!”

As it turns out, Aviva and Jessica recently sat through a lecture on how images of smoking in advertising and the media influence teenagers. The summer program they are enrolled in required all smokers to attend. “They were trying to show how the tobacco companies lure children into smoking,” Jessica explains.

“It was the stupidest thing I’ve ever seen,” Aviva adds, rolling her eyes again. “You’d think that looking at ads would be kind of interesting, but these were all from the ‘80s. They were old and out-of-date and really, really boring.”

Jessica agrees. “The woman who gave the lecture gave us all these statistics, but they didn’t really mean anything,” she says.

“It’s just like at school, where all they do is pound in this message: ‘SMOKING IS BAD FOR YOU,’” Aviva continues. “Like we didn’t know all about that before we started.”

Aviva says she’s smoking more this summer than she did during the school year when she cut back to play on the soccer team. The pigpen, which is intended to be dirty and uninviting, has become a central--and desirable--place to hang out. “We’re there all the time because that’s where our friends are,” Aviva says. “And I have to say that of all the people in this program, I think the smokers are the coolest.”

“It’s like when you get all pushed in together with these people, you really get to know them, even if they’re different from you,” Jessica says. “That’s one of the things smoking does--it brings us together.”

So, of course, do a lot of other activities, like playing on a soccer team, acting in a school play, or studying hard for finals. And in fact, girls who play sports or who do well in school are less likely to smoke than other girls. (Research, however, suggests girls who are successful in school are more likely to smoke than successful boys.)

But many girls who smoke, experts say, are less interested in school-based, adult-sanctioned activities. They’re focused, instead, on appearing older, more sophisticated, than they are. “Girls who smoke early, particularly before the age of 16, are trying to be mature,” says researcher Lois Biener. “They want to look cool and old, and that’s the first reason they give for smoking.”

Biener, a senior fellow at the Center for Survey Research at the University of Massachusetts in Boston, has found that girls who smoke are more likely than others to start dating early. They also are more likely to say they are trying to lose weight, though they don’t link cigarette use directly to dieting. “They don’t say that they smoke in order to lose weight,” Biener says. “But they say that smoking helps them control their weight, and they’re worried that if they stop, they’ll start to gain.”

Erin, Aviva, and Jessica fit Biener’s statistical profile. So do many of the girls who participate in a tobacco-cessation program at Cambridge Rindge & Latin High School. Every September, the school encourages student smokers to sign up for the 10-week program designed to help them quit. About 100 of the school’s 2,200 students indicate interest, and about 20 actually attend. “Most of them,” school nurse Maureen Hanlon Gulati says, “are what I’d call the cool kids.”

Much of Gulati’s task is to help the group bond over quitting instead of over smoking. “The kids come with their friends, and that’s what can make the group work,” she says. She also tries to connect the kids to adults who are trying to stop smoking. Last year, Gulati made a videotape of 12 school staff members--teachers, janitors, and health aides--discussing their struggles with nicotine.

Gulati spends time discussing other forms of addiction, as well. Addiction experts say that tobacco use cannot be addressed in isolation because so many kids who smoke also experiment with alcohol and drugs. That’s the case with Erin, who was one of Gulati’s students last year. By the middle of 9th grade, Erin was a heavy drinker and marijuana user. Her parents enrolled her in a six-month drug rehabilitation program. “If I hadn’t smoked cigarettes, I don’t think I would have smoked pot,” she says. “My mentality was like, ‘Well, I’m already smoking something, so why not?’”

Erin came to Cambridge Rindge & Latin in 11th grade after moving in with her father. She no longer drank or smoked pot, but she couldn’t kick her cigarette habit. Gulati’s cessation program helped, Erin says. “The best part was when we did hypnosis. Also, it was helpful to find out about things that can help you quit on your own, like the patch.” Erin credits Maureen for not talking down to the group. “Maureen is really awesome,” Erin says. “I went to see her all the time to talk about a lot of different things.”

But like the vast majority of students in the program, Erin went back to smoking soon after the sessions ended. “I quit for five days,” she says. “But then this friend of mine who I’d joined the group with was like, ‘Come on, you know you want one.’ She was just kidding, but I said OK, and that was it.”

Gulati says that only two of her 20 students managed to quit last year. But she takes a long view of the program’s effectiveness. “It takes the average person five to seven attempts to quit, so I figure if I can give them one or two early tries, I can cut years off their smoking,” she says. “Admitting that they’re powerless is taking the first step.”

After graduating in June, Erin got a nicotine patch and tried a second time to quit. The patch took care of her physical withdrawal, but a personal crisis plunged her back into smoking. This year, she’s enrolled at the University of Massachusetts in Boston, and she plans to look for another cessation program. But while she’s determined to succeed next time, she no longer thinks quitting will be easy. “The addiction tricks you,” she says. “I always used to say, ‘I’m choosing to smoke.’ But the truth is you’re really not. It’s like smoking is something I used to do then, that I still do now because I can’t make myself stop.”

The long-term health risks of smoking haven’t been enough to get Erin to conquer her addiction--"Even if you told me I’d have cancer in five years, it would be hard,” she says--but a strong desire to get fit might. Erin likes to work out and lift weights. When she goes to the gym regularly, she tends to smoke less because she can feel the effects on her heart and lungs. It’s a powerful awareness, she says, and one that smoking-cessation efforts could use to better advantage.

“If you ask me, the best thing the government can do to stop kids from smoking is to promote healthy activities like sports,” she says. “You might not reach everyone, but remember, I’m not a jock girl who hangs out with the football team, and I still love to work out. I think if you could get the message out to more girls that sports are a great way to meet people and feel good about yourself, it could be really effective.”

Erin agrees with Harvard’s William DeJong that anti-smoking media campaigns too often preach rather than enlighten. Instead of gloomy sound bites, DeJong would like to see funding for longer television spots that feature teens--the kind of teens with the power to sway their peers--talking honestly about addiction. “We need to hear more from kids who can ground what they’re saying in real experience,” he says. “But that’s hard for the government to do because it involves relinquishing control over the message and trusting kids to have good, open communication with each other.”

Both Aviva and Jessica give this kind of media approach a tentative thumbs-up. And they suggest a similar approach for school-based cessation programs. “They should force anyone who gets caught smoking at school to be in a group where you talk about addiction,” Aviva says. “I’d hate to have to go, but I think that could really work.”

Jessica picks up on Aviva’s point: “Or if they got speakers to come in who were more our age, who we could relate to, I think we would listen more to them. If you saw young people who were recovering addicts, I think that would be very powerful. It might not stop you, but it would make you think more about what you were doing.”