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Excerpts from TWO different articles:

Excerpts from SCIENCE STARTING TO TACKLE TEEN SMOKING;
BEHAVIOR: RESEARCHERS KNOW ADOLESCENTS KICK THE HABIT FOR DIFFERENT REASONS THAN ADULTS,
BUT THERE'S LITTLE DATA TO SHOW WHICH METHODS WORK AND WHY.

by KATHLEEN DOHENY, Los Angeles Time [05/06/98]

How can a teen be convinced to stop smoking--or persuaded never to take up the habit at all?

Those questions became even more crucial last week, when the Centers for Disease Control and Prevention reported that tobacco use among teenagers increased by nearly one-third in the last six years. In 1991, 27.5% of teens used cigarettes, smokeless tobacco or cigars. In 1997, 36.4% did.

Teens have their own issues, their own persuasion trigger points, their own pressures. What works for adult smokers--and researchers are still trying to figure out that problem too--may backfire for adolescents.

The format has been fine-tuned for teens "who get turned off if you ask them a lot of direct questions," says April Roeseler, a health educator and chief of local programs for the Tobacco Control Section of the California Department of Health Services, which runs the California Smokers' Helpline. With teenagers, counselors aim to be more conversational.

The first call generally takes about 45 minutes, with discussion about why the teen began smoking and the extent of the habit. In the next few weeks, the counselor sets up additional telephone appointments, with up to eight sessions total.

Now 260 teens who have participated in the program are being followed, says Shu-Hong Zhu, assistant professor of family and preventive medicine at the UC San Diego School of Medicine and the principal investigator for the project. Researchers want to see whether the teens who quit remain nonsmokers.

"Things are looking promising," he says, but he could offer no success-rate figures.

*

From data collected so far, Roeseler says, "teens tend to be less addicted than adults but find it harder to quit." About 70% of teen smokers report that a family member smokes, she says. And if a mother smokes, it seems to have a bigger influence on teens taking up the habit than if a father smokes, she says.

Another smoking cessation expert has found that teens who enroll in formal cessation programs have much less success than adults.

Steve Sussman, USC associate professor of preventive medicine, recently reviewed 34 programs (half of which focused on prevention, half on cessation) and discovered that 21% of the teens were able to quit immediately after the program. In general, the adult "quit rate" after such a program is about 50%, he says.

At six months, 13% of the teens who graduated from cessation programs were still nonsmokers, Sussman found. (His review is due to be published in the journal Substance Use & Misuse.) At six months, in general, about 25% of adult program graduates are still not smoking.

"Kids don't stay in the programs. The best likelihood of success is to tie in the cessation program with an activity the kid likes," Benowitz says. That might be athletics, he says, or a church youth group or other activity, making participation in one dependent on the other. What's also worth a try, in his view, is nicotine patches for teens 15 or older.

*

Meanwhile, other efforts are focusing on prevention.

In Project Towards No Tobacco Use, a prevention program funded by the National Cancer Institute and tested on 7,000 12-year-olds by Sussman's group, researchers found that teaching assertion skills can help young people refuse offers of tobacco. In another strategy, the program leader takes an anonymous classroom poll of smokers, demonstrating that far fewer 12-year-olds smoke than many think.

Reducing exposure to tobacco promotional materials can go a long way toward preventing youth smoking, says John Pierce, professor of cancer research at UC San Diego School of Medicine and head of cancer prevention at the UCSD Cancer Center.

In a study published in February in the Journal of the American Medical Assn., Pierce and his colleagues followed 1,752 teens who had never smoked over a three-year period, taking into account their exposure to tobacco ads and trendy promotional materials such as T-shirts and workout bags, and concluded that "tobacco promotional activities are causally related to the onset of smoking."

Pierce estimates 34% of California teens' experimentation with tobacco in his 1993-96 study can be attributed to tobacco promotions.

His best advice for parents?

"Don't give tobacco promotional items to your children," he says.

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EXCERPTS FROM

EXPERTS BAFFLED BY RISE IN TEEN SMOKING
OFFICIALS TRY TO SNUFF OUT ADS, PEER PRESSURE

By Joe Manning and Jack Norman, Journal Sentinel [04/06/98]

The three girls are 14 years old -- they look not a day older -- and have been smoking cigarettes since they were 10. They represent a bewildering puzzle to health authorities. It's against the rules to smoke on school grounds, so the girls crossed E. Locust St. before lighting up one day last week. One cigarette among the three freshmen, passed puff-to-puff as they shivered in the cold afternoon wind across the street from Milwaukee's Riverside University High School.

Even though smoking is known to cause disease and early death, the growing number of teen smokers baffles experts seeking ways to stamp out cigarette and tobacco use among youth.

What's fueling the nearly one-third jump over six years in the number of teenagers admitting to the nasty habit? The likely ingredients include: peer pressure; low self-esteem; wanting to be cool; keeping weight down; Joe Camel and the Marlboro man and other advertising and promotions; smoking by actors on television and in movies; parental smoking; defiance of adults and authority; and the teenager's view that the health consequences of smoking are a long way off. But, one consequence of smoking is not off in the distant, smoky future -- addiction.

Teens get hooked easily, and it's harder for them to break the habit than adults, said Douglas Jorenby, a clinical psychologist in charge of clinical services at the Center for Tobacco Research and Intervention at the University of Wisconsin Medical School. Smoking teens are under a lot of peer pressure to keep smoking, Jorenby said. They aren't fully aware of the tragic consequences of smoking, and being cool is currently more important, he said. Older smokers trying to quit have supporters who are not sabotaging their efforts, Jorenby said. The center runs stop-smoking clinics for teens, and the percentage of teens that go back to smoking exceeds that of adults.

According to the Centers for Disease Control and Prevention, 36.4% of high school students used some form of tobacco last year, up from 27.5% in 1991. Among blacks, the numbers rose from 12.6% to 22.7%.

Michael Fiore, director of the University of Wisconsin-Milwaukee tobacco center, blamed increases in smoking directly on tobacco companies. "The numbers reflect the pattern of the tobacco companies marketing successfully to children. With the lack of limits on advertising and little effective counter-advertising -- as well as the absence of enforcement of laws preventing children under 18 purchasing cigarettes -- we are leading another generation of kids into addiction," he said.

The dire warning to kids -- and the one they seem not to get -- is: "Fully half of those who begin smoking will die prematurely of a disease caused by that addiction," Fiore said. So what to do? "Are we reaching kids? We are not as effective as we want to be.

We don't have all the answers," said Jeff Propp, public health educator with the Milwaukee Health Department. "We try to reach them at a level they can accept and understand. But, you have to second-guess yourself when you look at the climbing numbers. "We are not standing still. We are trying. It takes time. You cannot just walk up to a kid and expect him to stop smoking," Propp said.

 Not one of the three smokers has a problem acquiring cigarettes. Sometimes they walk into a store and buy a pack. Other times, they have an older-looking friend make the purchase.

Experts agreed that little has been done to stop tobacco advertising to youths, and a counter-ad campaign is feeble in comparison.

As advertising has undoubtedly contributed to tobacco abuse among teens, Dick McDonald, managing officer for BVK/McDonald, said an effective ad campaign could offset much of the damage. But McDonald said he was unaware how to wage a campaign that would be effective in reaching kids. "How do you reach that 10-year-old boy and 12-year-old girl? What research tells me what works? There would have to be a lot of trial and error to discover the appeal avenue to get there," he said.

"We need to give adolescents a new message, but we don't have that message yet," said Heather Cecil, assistant professor in the department of psychiatry and behavioral medicine at the Medical College of Wisconsin. She said when she did a study of the health warning labels on cigarette packages she found that teenagers did not believe them or did not feel they applied to them.

Also, many did not know what carbon monoxide was. Cancer, a consequence of smoking, was "far too remote for kids. Adolescents don't have a real appreciation of harmful consequences, and it is hard to believe that something will happen in the future." "They tend to live here and now," she said.

The "easy solution" to reducing teen smoking is to raise the price of cigarettes, Cecil said. Parents need to stop smoking too and get involved in their children's lives, she said. "Give them a future to work for. Promote a healthy lifestyle. We need to get the message across that smoking is not a cool thing to do," said Cecil. "Teens don't realize how addicted they are until they try to quit. It is very sad." Said Christine, "Cigarettes could go to $5 a pack, that'd be OK."

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