Tobacco Documents Online

NOT FOR REPRODUCTION, QUOTATION, OR CITATION WITHOUT AUTHOR'S PERMISSIbN Introduction In the period since the 1979 Surgeon General's report, adolescent smoking behavior has received as much research attention as almost any other health- risk behavior. We know a great deal about the prevalence and natural history of adolescent smoking as well as the correlates and predictors of smoking behavior. In addition, there have been a series of well designed,, theoretically based experiments to evaluate adolescent smoking prevention programs that match or exceed, in number and quality, program evaluation in any other area of health behavior. After a substantial decline in the late 1970's, smoking behavior among adolescents has not decreased appreciably over the past five years, and the most intensive intervention efforts have been judged to be of only modest success.. In this paper we review and summarize what we know about the natural history of adolescent smoking behavior and the results of smoking interventions directed at adolescents. Varied~intervention approaches have been attempted, but the most commonly evaluated programs focus primarily on social influences that are assumed to play a role in smoking initiation. Almost all interventions have placed a heavy emphasis on primary prevention: through the modification of peer influences and other social psychological correlates of smoking. We reexamine the appropriateness of these foci in light of the avaiLable theory and research results and make recommendations on research and public policies relevant to adolescent smoking. We think that the available data suggest a need to reassess the types of research and intervention programs directed at adolescent smoking. Specifically, we think that it is inappropriate to focus almost exclusively on

NOT FOR REPRODUCTION, QUOTATION, OR CITATION WITHOUT AUTHOR'S PERMISSI~ON questionnaire that their saliva would be analyzed for tobacco products. It is not possible to make definitive conclusions about trends among adolescents, but we think the accumulation of evidence showing a decrease in smoking prevalence, and the remarkable similarity of these trends to those among adults, as well as the results of this validity study, support the argument that changes in reported smoking rates reflect real changes. Despite the fact that smoking rates appear to be falling among adolescents in a way that mirrors adult trends, there is sti1L good~reason to be concerned with smoking among adolescents. It is usually assumed that it is better to prevent a disease or unhealthy behavior than to cure the disease or change the behavior once it has been learned (c.f. Johnson, 1982). However, this is not true if the incidence of the disease or behavior in the target population is relatively low or the preventive measures don't have a lasting effect. For smoking, the available data suggest that interest in prevention is justified because of the high risk of intitial use during a relatively brief span of years, and by the relationship that early smoking appears to have with later use of cigarettes. Wong-McCarthy and Gritz (1982) found that a substantial amount of first time smoking occurs after the transitions of entering junior high school or high school. Kandel and colleagues have been conducting longitudinal studies of substance use among adolescents for many years. They recently analyzed results from a ten year follow-up study of 1,325 people who were in the 10th and llth grades in the Fall of 1971 (Kandel and Logan, 1984). They calculated hazard functions for various substances and found that the period of major risk for initiation of cigarettes, alcohol, and marijuana were for the most part complete by age 20. For cigarette smoking, for example, they found that