Focus on helping smoking- addicted teens quit
Op/ed USA Today - October 8, 2003
By Patricia Pearson
My grandfather, a gregarious, life-loving and witty man, died before I was born as a result of smoking two packs of Lucky cigarettes a day.
By the time I was 17, there was nothing an anti-tobacco advertisement could have told me that I did not already know from that tragic family experience.

Nevertheless, I already was smoking 20 cigarettes a day.

As state legislatures across the USA slash their anti-tobacco-program funds in response to serious budget crunches, it is image worth considering whether that automatically calls for protests from anti-smoking organizations, or whether it is an opportunity to reconsider how to direct resources more effectively into the teen smoking wars.

An intriguing study out this month in the American Journal of Preventive Medicine explains what I always suspected, that exhorting teens to "just say no" to cigarettes is most effective with that small group of kids who never try smoking.

The reason surprise is that nicotine is powerfully addictive. To wit, the McGill University study reports that some adolescents show symptoms of addiction to nicotine after smoking only one or two cigarettes; in particular: physical cravings. That suggests that nicotine itself is a more decisive factor in teens starting to smoke regularly than the influence of their peers.

"This is important news because it challenges the current idea that it takes kids two to three years of daily smoking to develop nicotine dependence," the study's author, Jennifer O'Loughlin, a researcher at McGill said at a Montreal news conference last month.

Vast sums of money have been spent in the past 15 years on a strategy of either shaming or frightening teenagers out of smoking, while a minuscule fraction of that amount has been allocated to actually help them quit. That needs to change, given the addictive nature of tobacco.

Oregon is the only state to provide comprehensive Medicaid insurance coverage for such essential smoking-cessation aids (news - web sites) as the anti-depressant Wellbutrin, the NicoDerm patch and addiction counseling.

Yet, consider that last July the American Legacy Foundation reported that while 65% of female smokers between ages 16 and 24 wanted to quit, only 3% succeeded for a given year. The foundation was set up with money won by the 46 state attorneys general who sued the big tobacco companies in 1998. The suits resulted in a massive court settlement that was meant to be earmarked for tobacco programs. In fact, initially many of the states used their portions of the settlement funds to pay down budget deficits and upgrade government buildings, among other projects, according to a study by the National Conference of State Legislatures. Some, however, poured cash into the coffers of ad agencies to design the anti-tobacco posters and TV and radio spots we've grown familiar with.

The American Legacy Foundation continues to maintain that anti-tobacco advertising is an essential ingredient in persuading Americans to quit smoking or not start at all. To that end, the foundation alone has plowed upward of $60 million into such media campaigns.

Likewise, the Campaign for Tobacco-Free Kids, a national lobbying group based in Washington, adamantly insists that we keep beating the drums through advertising, community-awareness initiatives and in-school workshops.

While some research has shown that these ads and other programs are effective in some states in reducing smoking or keeping people from starting at all, there are the hard-core smokers, including teens, who need more than what they're getting.

Just look at the data. One in four students in 12th grade currently smoke cigarettes on at least a weekly basis in the United States, according to this year's annual Pride Survey, a Kentucky-based firm that tracks adolescent drug use. This notwithstanding years of anti-smoking censure. Indeed, the survey marks an increase in 12th-grade smoking rates since 1987, in terms of the number of kids who report having a cigarette "in the last year."

How many of these students are going to drift into a daily habit by the time they enter college? The ones who grow addicted and have no access to Wellbutrin, nicotine-replacement therapy and addiction counseling. That's how many. It is this core group for whom ads, alone, cannot work.

The one-in-four rate noted by the Pride Survey mirrors the number of people in the adult population who smoke regularly, and that percentage has remained rock steady since 1996, according to the Centers for Disease Control and Prevention (news - web sites) in Atlanta.

Believe me, these hard-core adult and teen smokers get the point. You don't have to show them a diseased lung or someone on a ventilator 80 times in the hopes that the 81st time they will notice. I have needed no further evidence than my grandfather's cancer to understand that smoking is bad for one's health. In fact, I still smoke.
What I could have used and what teenagers today can use is practical, hands-on help that extends well beyond the tepid, hopelessly ineffectual lists of "quitting tips" that pass nowadays for smoking-cessation programs.
Put the money where the addiction is. Teenagers already know what happened to the Marlboro Man.
They may not know that a combination of pharmaceuticals, NicoDerm and group therapy can give them a more positive fate.
Patricia Pearson is a freelance writer and author living in Toronto. She's also a member of USA TODAY's board of contributors.
Copyright © 2003 USA TODAY

A wonderful article and one of the very times I've seen any journalist question funding priorities. Although Patricia clearly has not had an opportunity to study and explore the efficacy behind her NRT recommendations, she's far from alone in that regard.
One thing I've come to recognize this past year is that the leadership at many national tobacco control organizations became involved as a result of anti-smoker crusades, as they battled for clean indoor air. To them smokers are the enemy.
I belong to two other organizations where any mention of spending additional funds to help those addicted to nicotine reclaim their freedom is met with almost immediate protest. They don't have a problem with fighting to help save children from getting hooked but once addicted they seem to tend to blame the children for not listening to the health warnings.
To spend money after the fact, to many of these well intended folks, is like giving aid and comfort to the enemy. It's in large part the same reason that lung cancer research gets so little attention and funding - they see it as our own fault for getting hooked in the first place and the natural price to be paid.
We need more journalists like Patricia, willing to dig into the meat of the problem. If we continue to refuse to teach our children the truth about the power of nicotine then what moral standing do we have to intentionally deny them meaningful assistance once enslaved? John