Tobacco use is the chief preventable cause of premature disease and death in the United States (An, O'Malley, Schulenberg, Bachman, & Johnston, 1999; Centers for Disease Control and Prevention [CDC], 1994). Tobacco use causes almost 1 out of every 5 deaths (McGinnis & Foege, 1993) and the annual health care expenditure for treating smoking-related illnesses was estimated at $274 for each American adult in 1993 (Miller, Ernst, & Collins, 1999). Every year more than 400,000 Americans die from smoking-related illnesses and 2 million die in all developing countries combined (Peto, Lopez, Boreham, Thun, & Heath, 1994). Smoking kills more Americans annually than AIDS, automobile accidents, suicide, murder, fire, alcohol, and illegal drugs combined (CDC, 1994).
Early adolescence (eleven through fifteen years of age) is the crucial life stage for prevention of tobacco use, since it is uncommon for tobacco use to begin after high school (Johnston, O'Malley, & Bachman, 1995). Each day, nearly 3,000 American youths begin smoking (An et al., 1999). Smoking rates among teenagers in the United States have increased from 27.5% in 1991 to 36.4% in 1997 (Morbidity and Mortality Weekly, 1998) with a similar trend seen in Canada (Spurgeon, 1999). It is estimated that between one-third and one-half of adolescents who try cigarettes will become regular smokers, a process that takes an average of 2 to 3 years (Henningfield, Cohen, & Slade, 1991).
Tobacco is associated with the increased likelihood of using other addictive substances, acting for some as a "gateway drug" (Elders, Perry, Erikson, & Giovino, 1994). It is generally the first substance used by teens who later use alcohol and illicit drugs. The Surgeon General found that 12- to 17-year-olds that claimed to have smoked in the past 30 days were three times more likely to have used alcohol, eight times more likely to have smoked marijuana, and 22 times more likely to have used cocaine within the past 30 days compared to those teens who had not smoked (Elders et al., 1994).
The tobacco industry spends billions of dollars on advertising, product promotion, and promotional items, such as clothing and catalogue products that directly appeal to adolescents (Altman, Levine, Coeytano, Slade, & Jaffe, 1996). Research has shown that teens exposed to these promotions are more likely to be smokers (Altman et al., 1996).
In the United States, annual sales of tobacco products to minors total 950 million packs of cigarettes and 26 million containers of smokeless tobacco (Heishman, Kozlowski, & Henningfield, 1997). About one-half of minors who attempt to purchase tobacco products in stores report never being asked for proof of age (Centers for Disease Control and Prevention [CDC], 1996). Minors have even easier access to cigarettes via the Internet because many Internet vendors have weak or nonexistent age-verification procedures. In a recent study, minors successfully received cigarettes 93.6% of the times they attempted to purchase them with a credit card (Ribisl, Williams, & Kim, 2003) and Internet vendors sent 1,650 packs of cigarettes to these underage adolescents (Ribisl et al., 2003) without verifying their ages.
Greater religious involvement was found to be associated with lower risk of use of tobacco and other addictive substances in 26 separate studies (Koenig, McCullough, & Larson, 2001). Blyth and Leffert (1995) cite a number of studies specifically on teen drug use (including nicotine) that report an inverse relationship between drug use and religious involvement among teens and young adults.
Some examples of the nature of this effect are provided in the results of the National Study of Youth and Religion that the University of North Carolina began in 2001 (Smith & Faris, 2002). The survey of a national sample of 2,478 teens found that religious high school seniors were less likely to smoke, and those who do smoke started smoking at an older age than their less religious counterparts. …