Tobacco Documents Online

0 Copyright 1995 St. Louis Post-Dispatch, Inc. St. Louis Post-Dispatch March 20,1995, Monday, FIVE STAR Edition SECTION: EVERYDAY MAGAZINE; Pg. 1E LENGTH: 1462 words HEADLINE: NEVER TOO YOUNG; STOP-SMOKING CAMPAIGNS HAVE LARGELY IGNORED KIDS WHO ARE ADDICTED BYLINE: Wayne Hearn BODY: THE ESCALATING debate over whether cigarettes are addictive is focusing attention on an almost forgotten group: America's adolescent smokers. 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 o past 30 days) was 30.5 percent in 1980 and 29.9 percent in 1993. 00 ~ . W y CC

~ 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. The tragedy suggested by surveys cited in the institute's report is that most adolescent smokers either plan to quit before adulthood but fail, or already have tried unsuccessfully to kick the habit. "Now we know that kids want to quit, and that they try and fail - just like adults," said Michael P. Eriksen, Sc.D. (doctor of science), and director of the federal Office on Smoking and Health at the U.S. Centers for Disease Control and Prevention (CDC). "That allows us to see the gap between how we have tended to view our work - which has been to focus on keeping kids from experimenting and helping adults to quit - and what the reality is." In one survey, 85 percent of high school seniors who smoked occasionally told University of Michigan researchers they would "probably" or "definitely" not be ~ smoking in five years, as did 32 percent of those who smoked a pack a day. Follow-up surveys five to six years later showed that 70 percent of the heavy smokers still went through a pack a day. Only 58 percent of the occasional smokers had managed to quit, while 37 percent had increased their cigarette consumption. In a 1992 survey by the George H. Gallup International Institute, two-thirds of adolescent smokers said they wanted to quit, and 70 percent said they regretted their decision to start smoking. In a 1989 survey of smokers ages 12 to 18, three-fourths said they had thought seriously about quitting and 64 percent had tried. There also is ample evidence that adolescents who try to quit are subject to the same withdrawal symptoms that adults face. Last October a CDC report showed that among more than 1,600 young smokers who have stopped or tried to stop, 73 percent reported quitting is "really hard." Among daily smokers in the same survey, 93 percent said they had experienced at least one of the following withdrawal symptoms: difficulty concentrating, hunger, irritability, cigarette cravings, restlessness and depression. The survey also found that once young people become regular smokers, 72 percent r say they continue the habit because it calms and relaxes them - another indicator of _ nicotine dependence.

0 While experimenting with high-risk behavior is part of growing up for most children and adolescents, it's the addictive nature of nicotine that makes smoking experimentation particularly dangerous. Skateboarding behind a truck, for example, may be more immediately dangerous to one's health, but it's an activity unlikely to hook someone for life. Experts say that youngsters begin smoking for social reasons, such as peer acceptance or rebellion against authority, and may continue to enjoy perceived benefits of smoking as they unknowingly become addicted. What hampers intervention is that adolescent smokers - even after they become hooked - experience few of the health problems that often help convince long-term adult smokers to quit. Richard D. Hurt, M.D., director of the Nicotine Dependence Center at Mayo Medical Center, Rochester, Minn., just finished what is believed to be the first pilot study of nicotine patch therapy on high school students: a non-random, six-month clinical trial involving 22 volunteers, ages 13 to 17. _ He emphasized that because so little is known about replacement therapy and w_ adolescents, the purposes of the study were to gauge teens' interest in the patch and assess its safety - not to measure its effectiveness as a cessation intervention. "We're still analyzing the results, but the point is that they accepted the patch and it was safe," he said. "We were able to engage them and keep them engaged, and their arms didn't fall off." He said the findings support the need for placebo clinical trials to study the efficacy of patch therapy for adolescents. IOM's Neal Benowitz, M.D., meanwhile, suggests another approach based on controlling young smokers' nicotine intake. Writing in the New England Journal of Medicine, he and colleague Jack E. Henningfield, M.D., proposed lowering cigarette nicotine content to below the threshold of addiction. "It is difficult to prevent adolescents from experimenting with cigarettes," they wrote. "However, by regulating the availability of nicotine in tobacco products, it may be possible to prevent the transition from experimental or occasional smoking to addiction." They acknowledge that an addiction threshold for nicotine is a "theoretical concept" ~ that needs to be empirically verified as a tool to reduce addiction rates. Most experts agree that a person who smokes more than five cigarettes a day is likely to be an addict,

~ but - again - a vast majority of the re~,earch has involved adult smokers, not children and adolescents. Ironically, the growing acceptance of the notion that adolescent nicotine addiction is widespread may provide the ultima e arguxnent for preventionists in their efforts to persuade young people not to take p the habit. - GRAPHIC: GRAPHIC; Graphic/ske ch shows two boys smoking, one is offering a cigarette to a girl blowing bubble gu . The kids are standing underneath a sign (illustrated with two "sexy" adults ho are smoking) that says, "JUST SAY NO" - the NO superimposed on a slashed 0, b~n-bar symbol. LANGUAGE: English LOAD-DATE: March 23,1995 0 N 00 ~- W C> - - ~ W