Chapter 3
Teens, Tobacco, and Trade-Offs

Tobacco companies know that young people who become addicted to tobacco may use it for their lifetimes. Because of that, they have targeted advertising to young people and teenagers. Since most adult tobacco users started as teens or younger, the focus of many medical professionals and public-health officials is to prevent young people from ever starting.

Despite the health warnings on cigarettes and all the new anti-smoking education and advertisements over three thousand young people start smoking every day. More than one thousand of those will become addicted to nicotine, and over 70 percent will regret ever having started before they were eighteen. Mona Vanek, a historian and writer, says, "[I] struggled to learn [to smoke] from 16 until I was 19, and then, for years and years I could only stand the awful taste if I was chewing mint gum. Boy, what a dummy I was! Wanting to fit in with my peers!"¹⁸

Young People and Tobacco

Imagine a high-school classroom full of thirty young people. At least eleven of them are using tobacco. Now imagine the same class in a middle school. At least four are using tobacco.

High-school students have traditionally used tobacco in much higher percentages than adults have. The 1999 National Youth Tobacco Survey stated that more than one-third (35 percent) of high-school students used some form of tobacco in the past thirty days. Twenty-nine percent smoked cigarettes, 15 percent used cigars, and almost 7 percent used smokeless tobacco. The use of smokeless tobacco products was almost exclusively by young men—12 percent used them versus only 1.5 percent of high-school females. Use of other cigarette products varied—5 percent of high-school students used bidis, and 6 percent used kreteks. These numbers were significantly higher (16 percent) among urban youth.

Middle-school students used tobacco products in roughly one-third to one-half the rates of high-school students. About 13 percent of middle-school students had used some form of tobacco in the past thirty days. Nine percent smoked cigarettes, 6 percent used cigars, 3 percent used smokeless tobacco products, and about 2 percent used pipe tobacco, bidis, or kreteks.

The Adolescent Adventure

Teenagers use tobacco at a much higher rate than adults do for a number of reasons. Erik Erickson, a psychoanalyst in the early part of the twentieth century, proposed that adolescence is a time for teenagers to establish their identity. During this time they try out a number of different identities—they may copy the language of someone they admire, try different styles of dress, or try a variety of different activities.

Barb Chandler, a freelance writer and psychotherapist, started smoking as an adolescent. She believes young people may start smoking as a way to create their own identities. She says,

I think of myself at that age and realize how a person who smoked was considered "bohemian" or "worldly" and how I wanted to make this statement, so I smoked. Maybe that is why young people smoke—they want to make a statement and "march to the tune of a different drum." There are so many ways they can achieve their individuality today without having to risk their health and/or their lives.¹⁹

Psychologists have identified a number of other needs that teenagers have. Teenagers need to take risks and rebel, to be respected and liked, fit in with their peers, express themselves, and establish their independence. Some teens believe that they appear older, more mature, or more independent when they smoke a cigarette. Gaining the approval of their friends or having their friends offer cigarettes can encourage them to become and remain smokers. Smoking can also help teens fit in with peers who smoke.

Becky Brooks started smoking at age nine and quit before her thirtieth birthday. She cites her parents as one of the influences on her decision to try smoking. She says, "Peer pressure was a secondary factor—every other kid, and they were older kids, who had an influence on me came from parents who smoked."²⁰

Once young people have started to use tobacco, whether because of peers, or simply wanting to prove themselves, studies have shown that they may try other risky behaviors. Tobacco has often been called a "gateway" drug. A gateway drug is one that opens the gate to more extensive experimentation in drugs. Most states prohibit the sale of tobacco products to anyone under the age of eighteen as well as the use of tobacco by anyone who is underage. So young smokers are not only risking their health, they are taking a risk with the law. Risks can be exhilarating for anyone, and teenagers are no exception. It can be thrilling to do something illegal, and teens may want to prove wrong all the people who say tobacco is bad for their health. In fact, experts have found that teens engaging in risky behaviors like experimentation with drugs or sex are more likely to use tobacco regularly.

Using Tobacco to Cope

Many people, including teens, use tobacco as a way to deal with stress. Tobacco produces both stimulating and relaxing effects on the mind and body. Initially, a tobacco user may feel a burst of energy. But tobacco also acts like a tranquilizer or relaxant. During stressful circumstances, a stimulant can help provide someone the energy they need to deal with stressful situations. In addition, the relaxing effects help tobacco users keep their emotions under control, and their thinking becomes clearer and more focused. This ability to be energized, calmed, and also have clearer thought processes helps tobacco users to cope with stressful difficulties they encounter.

Ten Ways Teens Can Cope with Stress

Janice P. Teeter has been a counselor for over twenty years. In an interview with the author, Teeter suggests ten coping skills that teens can try instead of using nicotine:

1. Get enough sleep. Adults need 8–9 hours of sleep every night. Teenagers need even more than that, yet usually get substantially less.
2. Find a friend. Talk about things with a friend, counselor, or family member.
3. Write a diary. Write down thoughts and feelings in journals. Emails or letters can be written, and then can either be sent or saved without sending.
4. Take care of physical needs. Eat veggies, and work out or take walks on a regular basis. Take extra walks during stressful times.
5. Give yourself praise. Think of accomplishments daily, and recognize interests, talents, and skills.
6. Take some control. Choose how to react to what happens or what others do.
7. Make the stress "go away." Problem-solve to find workable solutions for big stressors, such as homework (get a tutor, do homework at lunch so evenings are free, etc.).
8. Recognize time limits on stress that can't change. It can offer hope that some stressors may not change but will eventually end (e.g., after graduation).
9. Deal with it. Learn how to deal with or accept permanent stressors.
10. Volunteer. Take a few hours a week to tutor a child or help a new mother. Helping others can help put one's own problems into perspective.

Tobacco users experience withdrawal symptoms when the amount of nicotine in their body falls below the level of need, which can vary from person to person. These symptoms—irritability, anxiety, restlessness, and tension—can actually contribute to a tobacco user's perception of a situation as stressful. A smoker who had just smoked might be able to handle, for example, a pop quiz in school better than a smoker who felt he or she needed to smoke. Using tobacco increases the level of nicotine in the blood and thereby relieves the symptoms of withdrawal. Later, when the nicotine level decreases and withdrawal symptoms return, tobacco users turn to tobacco to alleviate their physical and emotional distress, thus creating an endless cycle in which nicotine is the controlling factor.

Risk Factors

Evidence shows that most people are under stress when they start using tobacco. Adolescence itself can be quite stressful, which could explain why there is a higher rate of tobacco use among teens than among adults. Many of the risk factors that lead to smoking, are, in fact, stressful situations. For example, studies have shown that childhood traumas can lead to smoking. Teens subjected to childhood physical, emotional, or sexual abuse are more likely to smoke. Other studies show that teens with family members with substance abuse problems or family members who have been in jail

are at higher risk. Those whose parents are separated or divorced are also more likely to use tobacco. Additionally, those teens whose parents have mental illnesses, or those who have mental illnesses themselves, are more likely to begin using tobacco.

Besides these stress-related risk factors, studies have identified other teenagers most likely to become smokers. Males of any race have a higher risk; African American females have the lowest risk. There have been some studies which have indicated that children of smokers are much more likely to smoke. Other studies have indicated that this increased risk of tobacco use may be due to a hereditary predisposition to addiction. Yet others cite the environment the children of smokers are raised in. Babies whose mothers smoked during pregnancy are conditioned to respond to nicotine even before birth, and these children may be at higher risk of starting smoking as they get older. Nicotine also passes through breast milk, giving breast-fed babies of smoking mothers further exposure to the drug.

As children of smokers grow older, they may start smoking simply because it is familiar to them. Sometimes family members (parents, cousins, or older siblings) directly support a young person's smoking habit by purchasing the tobacco products for them. Or simply watching a mother, father, or grandparent smoke can be an additional risk factor. Approximately 9.8 percent of households have an adult smoker. Impressionable children admire virtually all aspects of their parents—even negative ones. Thomas Stanislao admired his grandfather, and it is this admiration that led to his twenty-year smoking habit. He tells of summer visits with his grandfather: "My grandfather had been a superb athlete … [and] a hero in WWI and WWII. I adored him. In the mornings, I liked to watch him shave—around the cigarette in his mouth. He chain-smoked unfiltered Chesterfields, probably three packs a day. He died at 77 of emphysema."²¹

Marketing to Young People

Young people exposed to tobacco advertising are more likely to start using tobacco products. The tobacco industry says it no

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longer markets to children or youth. Traditionally, however, tobacco companies have always looked to the youth market to increase their sales. They know, as scientists do, that over 90 percent of adults who smoke started when they were under the age of eighteen. They also know that they lose a number of adult smokers each year, primarily due to death or illness, and to maintain tobacco sales they must keep on marketing to gain new smokers.

In their marketing, tobacco sales representatives traditionally have paid special attention to cigarette outlets like convenience stores that are located near schools or places where young people congregate. They make certain that these outlets have better signage, prominent placement of tobacco items, and that they are well stocked at all times. One tobacco sales representative remembers that at an R.J. Reynolds company sales meeting, an employee asked the executive panel to clarify which young people were being targeted—junior-high kids or even younger children. The answer came back, "They got lips? We want 'em."²²

Tobacco marketers understand the basic needs of teenagers. They hire psychologists and conduct research to keep current with teen interests and fads. They know that many teenagers want to establish their independence. So in an ad, they may portray a smoking man or woman who is independent and loving it. Since teenagers have a need to rebel, tobacco companies might show an ad of a maverick "thumbing his nose" at the establishment. Or an ad may portray a smoker as sophisticated, cool, or sexy.

Adolescents often believe the propaganda that the tobacco companies put out, especially when that propaganda is delivered by a cartoon. The most recognized cartoon character in the 1990s, even better known than Mickey Mouse, was Joe Camel. Joe Camel, a cartoon character used to sell Camel cigarettes, has gone into retirement. In 1998, tobacco companies were banned from using cartoon characters and billboards to advertise tobacco.

In addition, they are restricted from offering promotional items, since studies have shown that teens who own tobacco-company giveaways like jackets or visors are more likely to smoke.

Some ads that tobacco companies are running in magazines now tell young people not to smoke. However, at the bottom of those ads is the name of the tobacco company. Young people remember the names in the ads, and studies have shown name recognition is important to them—those who can name a brand of tobacco are more likely to use it. The most common cigarettes young people buy are brand-name cigarettes, whereas adults are more price conscious and are not as loyal to a particular brand. So the tobacco companies' antitobacco ads may work in reverse on teens—while the ads are not actively encouraging tobacco use, they are promoting brand- and company-name awareness.

Other Factors to Consider

There are enough challenges facing teenagers without adding the dangers of tobacco. Many aspects of health are affected when a teen uses tobacco. The chemicals in tobacco affect teenagers' bodies and minds, just as they do adults'. And teens are still growing and developing.

Studies have shown that teen smokers are clinically depressed at a higher rate than other teens. There is still debate on whether depression causes teens to smoke or whether teens who smoke become depressed. Recent studies have argued that it is the latter: Teens who smoke are at a higher risk than other teens for depression. In fact, smoking is one of the highest predictors of depression among teens.

Other studies have shown teens who smoke at least a pack a day are more likely to develop agoraphobia (fear of open spaces), anxiety disorder, and panic disorder. Another study cites not only depressive behavior in teens who smoke, but increased aggression as well. Sometimes tobacco use leads to decreased ability to perform in school. Additionally, when young people are trying to hide their illegal habit, they must be dishonest with both authorities at school and with their parents.

Many teens feel they cannot tell their parents about their tobacco use because their parents will not condone it. As a result, many teens end up sneaking cigarettes from others or stealing the money to buy cigarettes and other tobacco products. Laurie Teeter, who was introduced to smoking at age six by an older brother, says, "In order to get cigarettes, I would steal money from my mother. I would take money out of her purse and then go buy cigarettes. No one ever caught me. I was 12 or 13 and smoking up to a pack a day, usually after school."²³

Prevention Efforts

Because of the lifelong effects and the difficulty in ridding themselves of this addiction, it is better for teens never to start using tobacco. Becky Brooks, who smoked for twenty years after starting at age nine, says, "Tobacco-related habits are dirty, smelly, expensive, and potentially destructive in a variety of other ways…. I think it is important to send a clear message to young people that it matters that they not smoke. I know both sides of this coin, life is better without the habit—and I loved my cigarettes…. Why not give ourselves a taste of better?"²⁴

Some positive public policies have been put in place to discourage teenagers from using tobacco. Taxes increase prices, and higher prices may place tobacco out of the reach of many teenagers. William Evans, of the University of Maryland, analyzed surveys of teen smoking in a number of states. He says, "A 10 percent increase in the price of a pack of cigarettes will result in a 5 percent reduction in teen smoking. The evidence is overwhelming—higher taxes reduce teen smoking."²⁵

Legal restrictions also help discourage smoking, and it helps even more if the laws are strictly enforced. Penalties for minors who are convicted for smoking vary from state to state—some states simply charge a fine, others require treatment programs. Amy Bloxham found out how serious it is to sell tobacco to minors after she lost her job because of it. She explains: "This guy looked like someone who regularly came in to purchase cigarettes. When I asked for ID, he said he had left it in the car. I said, 'Well, I really shouldn't do this, but just this once.' Well I really shouldn't have done it. It was a federal sting, and this young man was a minor. I was fired immediately."²⁶ The store Bloxham worked for was also fined for her mistake, and will now be more closely monitored by the Food and Drug Administration (FDA), which oversees tobacco sales.

Besides strict enforcement of the ban on tobacco sales to those who are underage, it helps to have restrictions and strict antismoking policies at home, at school, in places of employment, and in public places. Many restaurants and the majority of public places in the United States prohibit smoking. A majority of workplaces also restrict smoking in areas where it affects other employees or customers. The Boeing Company, which manufactures commercial and military aircraft among other products, restricts employees from smoking within twenty-five feet of the doorway of any building. This can be difficult for employees because Boeing factories are among the largest buildings in the world. Factory workers have ten-minute breaks, and much of that time can be spent walking in and out of the buildings to smoke. Many other companies have similar policies. Companies that have strict smoking policies often provide free or low-cost smoking-cessation programs.

Most schools recognize that smoking is illegal for minors. Some schools have very strict restrictions on smoking, and students caught smoking are suspended from school. Other schools will not allow students who are caught smoking to participate in extracurricular activities or sports. In some states, such as Oregon, the use of tobacco by minors is a misdemeanor crime, and schools must intervene with some sort of smoking-cessation program if students are caught.

School-based prevention programs can provide education to teens on the negative health effects, social consequences, and costs of tobacco use. In addition to education, counseling and intervention with young people most at risk can stop teens from using tobacco before they become addicted. Since most young people attend schools, schools are in a unique position to counsel, teach, and help them with this important health issue. School-based programs are especially effective in reducing the rate of smoking initiation when used in combination with community programs such as educating store clerks, involving parents, and using the media to provide antitobacco messages.

A survey of over seventeen thousand teenagers found that with increased restrictions, teens believed that smoking was inconvenient and often socially unacceptable as well. Myra Nelson, who has been a nonsmoker for five years, learned about the social consequences of being a smoker. She says, "Social prohibition was what made me quit. I began feeling like a social leper. Smoking became embarrassing."²⁷ As young people become more educated about the consequences of tobacco use, they start making better choices overall.

SWAT

A group of Florida youth decided to take tobacco education into their own hands. They started their own media campaign with money from the 1998 tobacco settlement, in which tobacco companies

agreed to pay money to compensate states for the expenses of sick smokers. Students Working Against Tobacco, or SWAT, was started, and the Florida teens developed an antismoking campaign directed at the reasons that young people smoked. Studies have shown that teens who regularly watch antismoking messages are half as likely to start smoking as other teens.

The Florida teens created an ad telling young people that the tobacco companies were manipulating facts and manipulating them with advertising. Instead of smoking to be rebellious against the establishment or their parents, teens should not smoke because by smoking they are conforming to the mass brainwashing and manipulation of the tobacco industry.

SWAT created a number of ads and a website (www.whole truth.com). Visitors to the website can play a game to show them how the tobacco industry manipulates them. They discover for themselves how tobacco ads address every one of the issues that teenagers often struggle with. Instead, SWAT seeks to tell teens the truth: Smoking will not solve problems, help young people fit in with their peers, or magically make the pain of adolescence go away. It simply causes more problems for the present and in the future.

Sean Marsee

Sean Marsee, of Ada, Oklahoma, was one of Talihina High School's most outstanding athletes. He had won twenty-eight track medals. However, as many races as he won, he lost the most important battle of all. He lost a ten-month battle against cancer.

Sean had been using moist snuff since he was twelve. But besides his tobacco habit, he took care of his body. He ran five miles a day, ate well, and lifted weights. When he was eighteen, he noticed a red spot on his tongue. The doctor took a biopsy, and the diagnosis was cancer.

Eventually Sean lost most of his cheek and his jawbone to the cancer. After three surgeries, radiation, and chemotherapy, the cancer finally won. Sean died quietly at home. He was nineteen years old.

In its first two years of operation, SWAT managed to convince thousands of teens not to smoke that first cigarette. In a study done in 2000, the number of Florida middle-school students who used tobacco declined from 15 percent in 1999 to 9.6 percent in 2000. The number of high-school students who used tobacco declined from 26.2 percent in 1999 (after one year of SWAT's operations) to 20.9 percent in 2000. This is well below the national average of 35 percent. SWAT's successful antitobacco advertising campaign led officials to believe that implementing statewide programs could be effective in preventing and reducing tobacco use among teens.

Never Starting

The message of SWAT and others is clear. The first cigarette causes damage. Nicotine in the first cigarette can cause addiction. It is very important for teens never to smoke the first cigarette. Jennifer Nelson, a freelance writer, says,

I've spent most of my adult life addicted to nicotine…. My kids have seen my husband's and my struggle to quit-and-stay-quit and they lost their grandmother at a much too early age. I am fairly confident I've conveyed the fact that never starting is the only way to make sure that they will not have to spend their entire adult lives "beating" the addiction. I'm pretty sure my two won't ever light up. But if every young person could "get that" by age 16 or 17, the odds would be very favorable for keeping them smoke-free.²⁸

Never starting to use tobacco products may not be easy for some teens. Young people may have to defend their choice not to smoke or use other tobacco products to their peers. It is hard for young people to do things differently from friends. It is much easier to give in to peer pressure than to give in to the subsequent addiction. To many teens the negative consequences related to tobacco use seem too far into the future to be a reality.

Yet, it is important to make a stand against tobacco use, because the alternatives are some very difficult fights—the fight for good health, and potentially, the fight to quit. Once someone has started using tobacco, nicotine will keep him or her addicted. If that person ever decides to quit, he or she will make an average of five to seven quit attempts before they are successful. The struggle to quit can literally encompass an entire lifetime.