She's Gotta Habit

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One school nurse made a videotape of school staff members—teachers, janitors, and health aides—discussing their struggles with nicotine.

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."

'If you ask me, the best thing the government can do to stop kids from smoking is to promote healthy activites like sports.'

Erin Maguire,
18 years old

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."

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