THE ESCALATING debate over whether cigarettes are addictive is
focusing attention on an almost forgotten group: America's
Every year, 1 million adolescents light up for the first time,
constantly replenishing the ranks of the nation's approximately 3.1
million young smokers. Experts know that many - perhaps most - soon
become hooked, placing them at high risk for the grim health
consequences facing long-term smokers.
Yet most public health strategies focus on prevention, based on
the well-founded rationale that it's cheaper to head off a health
problem than to cure it.
That would be fine if other programs existed for youths who
already smoke - but they don't.
Most smoking-cessation interventions - from counseling to
nicotine patches - are geared to adult smokers.
And prevention efforts are not generally successful - they
often fail to reduce the number of young smokers.
While the rates of adult smoking have plummeted from 40.4
percent in 1964 to about 26 percent now, the rates for youths have
remained virtually unchanged for more than a decade. Continuing
research at the University of Michigan shows that among high school
seniors, the proportion of regular smokers (those who have smoked
within the past 30 days) was 30.5 percent in 1980 and 29.9 percent
The leaders of Stop Teenage Addiction to Tobacco (STAT), a
national advocacy group based in Springfield, Mass., reached a new
consensus at a planning meeting for STAT's annual conference,
coming this June.
Realizing that past conferences have focused almost exclusively
on prevention, they decided to schedule several sessions on
cessation, said executive director James A. Bergman.
"We've always focused more on prevention, because it's much
easier to prevent an addiction than it is to stop it once it's
started, but that clearly has left the kind of gap you're talking
about," Bergman said.
STAT treasurer Dr. John Slade, associate professor of medicine
at Robert Wood Johnson Medical School in New Brunswick, N.J., put
it more bluntly: "Young people who are already regular users have
been largely ignored" by the tobacco-control movement.
Slade, a nicotine addiction expert, has long argued the
inconsistency of treating nicotine addiction as an adult disease,
since 91.3 percent of adult smokers admit they tried cigarettes
before age 20, and 77 percent say they were daily smokers by then.
"Thus, even though most of the severe consequences appear only
after decades of use, addiction to nicotine is, at its core, a
pediatric disease," Slade wrote in the journal Adolescent Medicine
in June 1993.
But because so little attention has been paid to adolescent
smokers, there is no consensus on how to treat that group.
Before an effective intervention can be developed, basic
questions must be answered about the nature of adolescent addiction
and how it compares with the adult experience. Among those:
How quickly do adolescent smokers become addicted?
How addicted are they?
What psychosocial factors are present in adolescents that may
help or inhibit intervention?
The Institute of Medicine acknowledged this information gap in
its September 1994 report on youth and tobacco, "Growing Up Tobacco
Free, Preventing Nicotine Addiction in Children and Youths."
"Few studies have been conducted on adolescent cessation of
tobacco use, and those vary considerably in scientific quality,"
the report stated. "Therefore, at this time, no effective means are
known for helping youths to quit using tobacco or to remain
abstinent once they have attempted to quit."
The institute estimated that federal, state and private funding
sources spent $22.5 million on prevention studies aimed at children
and adolescents between 1990 and 1993. During that period, $6
million was spent on youth cessation studies. …