Preventing Tobacco Use Among Young People

A report of the US Surgeon General

At a Glance

More than 400,000 premature deaths occur each year in the United States from tobacco-related causes. This epidemic is totally preventable - and the key opportunities for prevention are childhood and adolescence.

"Most people who are going to smoke are hooked by the time they are 20 years old".

- M. Joycelyn Elders, M.D. Surgeon General

Why Keeping Kids Tobacco-Free Is Important

Tobacco use usually begins in early adolescence, typically by age 16. Almost all first use occurs before young people graduate from high school. If adolescents can be kept tobacco-free, most will remain tobacco-free for the rest of their lives.

• At least 3.1 million adolescents are current smokers. Smoking is most common among 17 - 18 year olds; about 25% of these young people smoke.

• By age 18 about two-thirds of young people in the United States have tried smoking.

• Nicotine is generally the first drug used by young people who use alcohol, marijuana and harder drugs.

• Adolescent tobacco use is associated with being in fights, carrying weapons and engaging in higher-risk sexual behaviour.

Major Conclusions

1. Nearly all first use of tobacco occurs before high school graduation.

1. Most young people who smoke are addicted to nicotine and report that they want to quit but are unable to do so.

1. Tobacco is often the first drug used by young people who use alcohol and illegal drugs.

1. Among young people, those with poorer grades and lower self-images are most likely to begin using tobacco.

1. Cigarette advertising appears to increase young people's risk of smoking by conveying that smoking has social benefits and that it is far more common than it really is.

1. The most effective preventive programmes are community-wide ones that combine education and public policy approaches.

Early Smoking, Early Consequences

The younger a person begins smoking, the greater the risk for developing the numerous illnesses associated with smoking. And even teens experience adverse health effects:

• General decrease in physical fitness.

• Increased coughing and phlegm.

• Greater susceptibility to and severity of respiratory illnesses.

• Early development of artery disease, a possible precursor of heart disease.

• Slower rate of lung growth - and by adulthood possible reduced level of normal lung function.

Tobacco Use: It's an ADDICTION, Not just a "Bad Habit"

Nicotine addiction makes quitting smoking as hard as quitting heroin, cocaine or alcohol. For most smokers, nicotine addiction begins during childhood or adolescence.

• Most young people who have smoked as few as 100 cigarettes in their lifetime report that they would like to quit - but can't.

• Young people develop tolerance for, and become dependent on, nicotine as quickly as adults do and young people have just as hard a time quitting.

• A long-term national study found that 70% of high school senior who smoked as few as one to five cigarettes a day were still smoking five years later and most of these were smoking more cigarettes a day.

Smokeless Tobacco: Unsafe Alternative

Smokeless tobacco is definitely not a safe alternative to smoking. Many young people, however, do ot know that even in the short term, smokeless tobacco is a dangerous alternative to cigarettes. Adolescent users of smokeless tobacco:

• Have early signs of gum disease.
• Develop lesions in their oral soft tissue - a possible warning sign of cancer.

• Are much more likely than non-users to become cigarette smokers.

Pressures to Use Tobacco

Almost all adolescents will at some time feel pressured to try tobacco.

• Peers, siblings and friends are powerful influences. The most common situation for first trying a cigarette is with a friend who already smokes.

• Young people are sensitive to perceived signals that smoking is the norm. These signals include visible public smoking, the availability of cigarettes to minors and the widespread promotion and advertising of tobacco products.

• A 1992 national sample found that 87% of the adolescents surveyed could recall recently seeing one or more advertisements for tobacco products.

Tobacco Sales: In Search of New Customers

The tobacco industry - and therefore must replace - some two million consumers each year, either because they quit smoking or because they die. Studies show that the vast majority of new consumers will come from the ranks of young people. Intentionally or not, then, successful tobacco marketing influences adolescents.

• Print media remain an important source of tobacco advertising. After automobiles, cigarettes are the most heavily advertised retail product.

• Especially in inner-city neighbourhoods, young people may be repeatedly exposed to outdoor billboards portraying apparent benefits of tobacco use.

• Increasingly, tobacco companies market their products through promotional activities that reach youth. These activities include sponsoring sporting and musical events, distributing specialty items that bear brand names and encouraging stores to carry point-of-sale displays.

"Clearly, young people are being indoctrinated with tobacco promotion at a susceptible time in their lives".

- M. Joycelyn Elders, M.D. Surgeon General

Pictures of Health? Misleading Images in Tobacco Advertising

Ads for tobacco products have become short on words and facts - and long on visual images that suggest positive associations.

• Cigarette ads visually associate smoking with independence, healthfulness, adventure-seeking and physical attractiveness - themes that appeal to young people.

• These attractive pictures suggest that smoking is a powerful tool for improving self-image. Young people with low self-esteem are particularly receptive to this message.

• The pervasiveness of cigarette advertising may suggest that smoking is more common than it really is. Young people are far more likely than adults to greatly over-estimate the prevalence of smoking.

Prevention - Programmes That Work for Young People

Promising results have been seen in school-based programmes that teach young people how to resist social influences to smoke. Such programmes are even more successful when they are support in the adolescent's home and community.

Other measures that appear to discourage youth from trying tobacco include:

• Taxes that raise the price of cigarettes.

• Strongly enforced laws that prohibit the sale of tobacco to young people.

• Policies in the school, workplace and community that restrict smoking.

• Most Americans strongly favour policies that might prevent tobacco use among youth.

Facts at a Glance

• Male and female adolescents are equally likely to smoke cigarettes. Males are much more likely than females to use smokeless tobacco.
• White adolescents are more likely to use tobacco than are black and Hispanic adolescents; whites are much more likely to be heavy or frequent smokers.
• Over the past decade, there has been virtually no decline in:
• smoking rates among all teens. Among black adolescents, however, the prevalence of smoking has declined dramatically.
• A 1992 survey found that 32% of high school students had tried smokeless tobacco. Most of these were males.
• Young people who come from a low-income family and have fewer than two adults living in their household are especially at risk for becoming smokers.
• In various studies of minors' access to tobacco products, from 32 to 87% of underage youths were able to purchase cigarettes over the counter. When the minors tried to purchase cigarettes through vending machines, they were almost always successful.