Science Starting to Tackle Teen Smoking

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.

Teen smoking prevention and cessation “is an area woefully understudied and underresearched,” says Dr. David Sachs, clinical associate professor of pulmonology and critical care medicine at Stanford University and a smoking cessation expert.

But that’s changing, he says, as more researchers become involved in the field, more research is funded and experts realize that teen smokers are not simply youthful versions of adult smokers.

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.

In California, a phone counseling program that has been in place since 1992 ([800] 7-NO BUTTS) began providing teen counseling in 1996.

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.

Since 1992, more than 3,000 teens, ages 14 to 17, have called, Roeseler says.

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.

Success has been elusive, says Dr. Neal Benowitz, chief of clinical pharmacology and toxicology in the department of medicine at UC San Francisco.

“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.