Kids desire to quit
Jan. 11 - They come into schoolbased clinics coughing, with yellow fingers and stinky clothes. They smoke but want to quit.
Nurse practitioner Nina McNeill at Kearney and Adams City middle schools has seen 11-year-olds who've been smoking for years. They can't run as fast as their non-smoking schoolmates, they say, and they want to be normal again.
Help is on the way for these little addicts.
As states across the country begin spending their tobacco-settlement money on programs to reduce teen and preteen smoking - those ages at which 89 percent of smokers start - more and more is being learned about what works with kids and what doesn't.
Colorado is behind, one of only two states that don't have a statesanctioned smoking cessation program for public schools, and, so far, none is in the offing. We've also missed a year in spending tobacco settlement funds - legislators in last year's session couldn't agree on how to spend the settlement. They'll try again this session.
This month, a statewide report announced that Colorado has high rates of teen tobacco use - slightly more than 36 percent of all teens in grades nine through 12 - while adult use has tapered to about 24 percent.
McNeill's mission includes helping kids to stop smoking.
One 14-year-old girl, who asked to be identified only as Christina, hooked up with a smoking girlfriend at Adams City Middle School and suggested that they start seeing McNeill on Wednesdays.
"Maybe she could help us," Christina said at the time. Both were able to quit after attending the school's cessation group. McNeill has been running cessation groups for years and is getting a sense of what works with kids and what doesn't.
Setting a target date doesn't, for example, though that's common in adult programs.
"They stop when they want to stop," McNeill says. Until that happens, she works with them to cut back on the frequency.
Most have parents or family members who smoke. Usually, they start with friends who are the same age or older, "so it's helpful if they quit with a friend," she says.
Recent research indicates patches also are virtually useless with adolescent patients, says Eric Sigel, a pediatrician at Children's Hospital who is boardcertified in adolescent medicine. Teens cut back a little bit when they're on the patch, but three to six months later, 5 percent at most have stopped smoking.
"It's not a recommended intervention," Sigel says. "The one thing that seems to truly influence teen smoking is the cost. When Canada put a huge tax on cigarettes, kid smoking went down because they couldn't afford it."
The money should go to anti-smoking efforts in equal installments of $21.2 million for two years, Brackett said.
Kentucky is expecting more than $350 million from the settlement between cigarette manufacturers and the states.
Patton said Tuesday that he wants to use half of the money for farmers, 25 percent for health care and 25 percent for early childhood development. "It was a disappointment" because it didn't stipulate a dollar amount for anti-smoking efforts aimed at children, Brackett said.
Mark Pfeiffer, Patton's spokesman, said yesterday that the 25 percent was a "proper" amount for child development. How much would go to smoking prevention "still has to be worked out," Pfeiffer said.
Brackett said she believed the tobacco settlement was designed to help states like Kentucky deal with the health consequences of smoking.
According to the Centers for Disease Control and Prevention, Kentucky has the highest percentage of adults who smoke -- 30.8. The state also has the highest percentage of teens who say they've smoked at least once in the past month -- 47.
The governor wants the prevention money to come from the 50 percent of the settlement that would go to farmers. Brackett said that has the potential of forcing anti-smoking advocates and tobacco farmers to battle for dollars.
Rod Kuegel, president of the Burley Tobacco Growers Cooperative, said last night that farmers should get at least half of the settlement money, and that $42.4 million should be set aside for prevention efforts aimed at teens and other young smokers.
Taxes work, agreed Danny McGoldrick, director of research at the Campaign for Tobacco-Free Kids in Washington, D.C.
But so do a variety of other strategies put to the test in Massachusetts, Florida, Oregon and California, all states that have seen a reduction in smoking.
In California, voters approved Proposition 99 in 1988, which increased state cigarette taxes by 25 cents a pack, with 20 percent of revenues (more than $100 million a year) earmarked for health education against tobacco use.
Since passage of Proposition 99, cigarette consumption in California has declined 38 percent, twice the decline experienced by the rest of the country. While teen smoking increased significantly across the U.S. from 1990 to 1993, smoking among California teenagers remained constant.
With funding from its 1997 tobacco settlement, Florida funded a comprehensive tobacco program targeted at youth and modeled on programs in California and Massachusetts. The ad campaign involved youth, who said they hated it when adults told them what to do.
The resulting ads encouraged natural teen rebellion by showing kids how the tobacco industry had gotten rich by manipulating them into addiction. In less than a year, smoking was reduced by more than 19 percent among middle schoolers and 8 percent among high school students, according to McGoldrick.
There's no magic bullet, McGoldrick says. "Different kids respond to different messages." However, the message that "tobacco is bad for you and you shouldn't do it" doesn't work, he says. "And the last thing you want to do is position smoking as an adult habit," an insidious way for the tobacco and liquor industries to make substance abuse even more attractive to kids.
It makes sense to separate male and female smokers and appeal to their gender-specific issues, adds Karen DeLeeuw, program manager for the Colorado Tobacco Education and Prevention Partnership.
"Young women may smoke to keep their weight down," she says. And although new research indicates women's genes for lung cancer are more easily activated by tobacco smoke than men's, health consequences seem remote to young women. Arguments about premature wrinkles and the smell associated with smoking may be more effective.
With young men, some states have had success with the appearance message, others appeal to their desire to be physically fit athletes. "California has developed a program that specifically deals with the relationship between smoking and impotence," DeLeeuw says.
Successful programs have five essential components, says McGoldrick at Tobacco-Free Youth:
- Public education targeting youth and adults must be as clever and sophisticated as the efforts of the tobacco industry and must use TV, radio, print, public relations, special events and promotions.
- Community-based programs that engage people where they work, live, play and worship should include direct counseling for prevention and to help people quit, youth tobacco education programs, interventions for special populations, worksite programs, training for health professionals and enforcement of youth access ordinances.
- Cessation programs must have products and services readily available and affordable.
- School-based programs must exist to prevent and reduce tobacco use, especially those based on the Centers for Disease Control's "Guidelines for School Health Programs to Prevent Tobacco Use and Addiction." - Rigorous laws must prohibit tobacco sales to youth and limit exposure to secondhand smoke.
On average, comprehensive programs require only a third of a state's tobacco settlement money, says McGoldrick. "Let us have a third and we'll save you lives, we'll save you money." For more information on helping kids kick tobacco, visit www.tobaccofreekids.org.
For a look at Florida's campaign, go to www.wholetruth.com. The campaign is so edgy, many adult Floridians hate it, McGoldrick adds.
Industry statements telling
Tobacco industry statements gleaned from tobacco-litigation documents about young smokers, as reported by the Campaign for Tobacco-Free Kids.
"Evidence is now available to indicate that the 14(to)-18-year-old group is an increasing segment of the smoking population. RJR-T must soon establish a successful new brain in this market if our position in the industry is to be maintained in the long term. "
- ( "Planned Assumptions and Forecasts for the Period 1977-1986"" for R.J. Reynolds Tobacco Co.,March 16, 1976) "This young adult market, the 14-24 group ... represent(s) tomorrow's cigarette business. As this 14-(to)-24 age group matures, they will account for a key share of the total cigarette volume - for at least the next 25 years. "" - (Presentation from C.A. Tucker, vice president of marketing, to the board of directors of RJR Industries, Sept. 30, 1974)
"To ensure increased and longer-term growth for the Camel Filter, the brand must increase its share penetration among the 14-(to) 24 group, which have a new set of more liberal values and which represent tomorrow's tobacco business. " - (1975 memo to C.A. Tucker, vice president for marketing, RJR)
"Cherry Skoal is for somebody who likes the taste of candy, if you know what I'm saying. " - (Former UST sales representative, quoted in a 1974 Wall Street Journal article)