Turning Teens Off Tobacco
SATURDAY, July 28 (HealthScoutNews) -- It's a baffling situation for doctors, parents, teachers and scientists: While increasing numbers of adults have stopped smoking, an even-greater percentage of teen-agers have started.
From 1988 to 1998, according to the American Lung Association, the number of American adults who smoked dropped 14.2 percent. But between 1991 and 1999, the number of teen-age smokers shot up by more than 25 percent. Overall, more than a third of the nation's high schoolers described themselves as smokers in 1999, the last year with full statistics.
The rise in teen smokers is not from a lack of education on the subject. A recent study of high school students, done by Northwestern University's Medical School in Chicago, confirmed that teens know smoking is bad for them.
"It was no surprise to our smokers that tobacco is harmful," says Dr. Irving Benuck, associate professor of clinical pediatrics at Northwestern and lead researcher on the study. "Our smokers, our experimenters and non-smokers all had equal awareness of the dangers of tobacco use. That tells me the schools are doing a good job with these programs, but it hasn't done much in reducing the number of kids who smoke. It's frustrating."
The root cause, one physician explains, isn't a lack of information for teens -- it's a lack of experience.
"In adolescents, the feeling of invincibility is almost inversely proportional to their wisdom," says Dr. Edward Truemper, medical director of the pediatric intensive care unit at St. Mary's Hospital in Athens, Ga.
The focus on teen smoking is intense for several reasons. The road to addiction is much shorter for teens than for adults, often as few as 40 cigarettes. Tobacco use is also viewed as a first, dangerous step toward other forms of substance abuse.
"Cigarettes are truly the initial experimental product," says Dr. Edward Jacobs, a pediatrician who is also chairman of the American Academy of Pediatrics (AAP) Committee on Substance Abuse. "You can't smoke pot or inhale crack until you know how to smoke. It doesn't mean that everyone who uses it will go on to be a full-blown addict, but it's clearly a risk-taking behavior."
New test can ID smokers
One new weapon now available to physicians is the short questionnaire and urine test that was used by Benuck's research team to find out which adolescents smoke.
The three-month study piloted the use of the questionnaire and urine test -- a first for teens -- in a suburban Chicago pediatric practice. Designed to identify adolescent smokers and determine the characteristics of tobacco users, the study involved 124 high school students -- 83 non-smokers, 28 experimenters and 13 smokers.
The questionnaire alone correctly identified 92 percent of the non-smokers, experimenters and regular smokers in the study. Not surprisingly, a "yes" answer to two questions -- "Do your parents smoke?" and "Do about half of your friends smoke?" -- almost invariably revealed that those teens were smokers themselves. A positive urine test was evidence of smoking at least six cigarettes a day.
Another important advancement is a new program to help teens quit smoking. Until recently, physicians who did identify teen smokers found themselves in the position of having little or nothing they could offer to help them quit. While adult smoking-cessation programs are plentiful, there were virtually no programs geared to adolescents.
But for the past three years, the American Lung Association has offered Not-On-Tobacco (NOT), a 10-week, school-based smoke-cessation program designed specifically for teens. The program involves a variety of activities, groups separated by gender and discussions that relate specifically to issues teens care about.
"Kids are not concerned with long-term health issues," says Shirley Westrate, a former high school teacher who piloted the program in Florida. "Their concerns are 'My girlfriend doesn't want me to smoke,' 'I can't be on the football team if I smoke,' or 'It's costing me too much money.' One of the greatest motivators is the day you figure out how much it costs and what you could do with that money -- how many CDs you could buy, or shoes, or tanks of gas."
Early results have shown that six months after finishing the program, more than 22 percent of teen participants had stopped smoking and another 64.5 percent "greatly reduced" the amount that they smoked.
If they stick with it, they'll have ample reason to brag: The American Lung Association reports that 70 percent of smokers want to stop, 34 percent try to quit each year, but only 2.5 percent succeed.
A different kind of parental pressure
In hopes of heading off the next generation of smokers, doctors also have decided that they can make the most headway with parents of newborns. This spring, the AAP is issuing "Tobacco's Toll: The Implication for Pediatricians," an official policy statement on the role of pediatricians in preventing smoking.
"It is our position that the battle against tobacco must begin with the first interview the pediatrician does whenever the patient enters your practice," Jacobs says.
"You hope it would be at the pre-natal interview prior to the birth. Just as you ask about other family illness and genetic influences, one of the questions one should ask is, 'Do you smoke? What are your attitudes?' and begin to provide some knowledge."
Benuck says that's the perfect time to reach parents with a message that could literally save their children's lives.
"When parents are young and have young children, they're much more likely to listen to a pediatrician," he says. "They have a perfect little baby and they want to keep them perfect.
"I think the thing to do is to go to the parents when they have this baby and say, 'You're smoking. Do you know that in 13 years, the chances are really good that he'll be picking up a cigarette?' "