Focus on Pediatrics-Teens prove vulnerable to the 'virtues' of cigarettes

The proof is in the numbers!

The facts are alarming: According to the New York City-based American Lung Association, more than 4,800 U.S. teen-agers ages 11 to 17 experiment with cigarettes each day. About 2,000 of these first-time smokers form the habit of smoking, totaling about 720,000 new teen smokers annually. Currently, about 4.5 million adolescents smoke.

Research shows that most teens first light up with a friend who already smokes. Advertising provides incentive by emphasizing youthful vigor, sexual attraction, and themes of independence, all of which are important to teens. The American Lung Association also reports that the earlier someone begins smoking, the more likely he or she is to develop severe levels of nicotine addiction.

About one-third of the teens who start smoking each year will die of smoking-related illnesses. Teens who smoke experience health problems such as cough and phlegm production, more respiratory illnesses, a poor lipid profile, and an increased potential for retardation in the rate of lung growth and the level of maximum lung function.

Tobacco is known as a gateway drug. According to a 1994 report by the office of the Surgeon General, teens who had smoked in the past 30 days were three times more likely to use alcohol, eight times more likely to smoke marijuana, and 22 times more likely to use cocaine within that time period than teens who did not smoke.

In this issue of Focus on Pediatrics, we profile two Ohio programs that are employing unusual methods to prevent teen-age tobacco use. One focuses on improving awareness of cigarette advertising that targets children; the second is using legislative means to prevent teen smoking.

Focus on Pediatrics-Cigarette ads focus of prevention program

Effort made to raise awareness about ads' influence

Just how persuasive are cigarette ads? Research has shown that cigarette ads are more likely than peer pressure to persuade kids to smoke, says Julia Spears, MPA, coordinator of the Southside Initiative in Columbus, OH. That's why this neighborhood organization, formed to reduce the use of alcohol, tobacco, and hard drugs among community teens, participates in Operation Storefront.

"In tobacco prevention, there is a lot we want to focus on," Spears notes. "One method is a personal development program to give young people the skills they need to be confident and resistant to tobacco use. In addition, we want to look at the community as a whole and see how it contributes or helps to insulate young people from tobacco messages."

Operation Storefront is a community research project in which stores in the Southside neighborhood are surveyed to determine the extent of their participation in cigarette promotions that influence young people. To determine the influence of those promotions, surveyors count the number and placement of tobacco advertisements in each store.

Every promotional item is assessed, from posters to clocks with a cigarette logo. One red flag for surveyors is when the product or ad is located next to candy; another is when the ad or product is located at a height of three feet or below. "Those two spots, next to candy or three feet or below, are really targeted at children," says Spears.

To complete the project, the Southside Initiative partnered with a class called Career Connection at the local high school. Thirty-two students were trained and sent to 50 stores that had been identified as selling tobacco products. Students asked permission to survey the store, explaining to merchants that they were conducting a research project on advertisements. When given permission, the student stood in one location, carefully looking for tobacco ads and products and marking their locations on the survey.

Following each survey, a letter was sent to the store manager explaining the results. The letter gave merchants information on why they need to be sensitive to tobacco marketing practices that might influence children. In the process, the students who conducted the survey also became more aware of the amount of cigarette advertising in the community geared towards teens.

About 80% of the stores had either products or ads next to candy or at a height of three feet or below. The survey provided a baseline against which to measure progress each year, says Spears.

"Most people think it is peer pressure that gets kids to smoke, but in reality it is the subliminal messages they take for granted every time they go in and out of the corner store that influences a child on whether or not it is okay to smoke," says Spears.

High school role models give classes

In addition to Operation Storefront, the Southside Initiative uses a couple of other tactics in their efforts to prevent teens from smoking. In conjunction with the Atlanta-based American Cancer Society and the Columbus Tobacco Free Collaborative, the Southside Initiative has implemented the STAMP program (Stay Tobacco Free Athletic Mentoring Program). This program trains high school athletes and other outstanding students who are viewed as role models to provide smoking prevention classes for sixth-graders.

The high school students conduct four 45-minute sessions that are skills-based, fun, and interactive. One session covers the reasons people smoke and the health risks associated with it; another focuses on peer pressure and how to resist cigarettes; a third session covers the fact that not everyone uses tobacco; and a fourth session teaches teens how to be media-savvy by assessing the message a cigarette ad conveys.

The Teen Institute, the Southside Initiative's third tobacco prevention project, is an after-school drug prevention program that is really a social club, although some tobacco prevention activities take place.

"We are trying to build a lot of different opportunities for students to take a leadership role in tobacco prevention. We also hire students to work in our office, and they are the student leaders in some of the programs," says Spears.

For more information about the teen smoking prevention programs at the Southside Initiative, contact:

Julie Spears, MPA, Coordinator, Southside Initiative, 1086 Oakwood Ave., Columbus, OH 43206. Telephone: (614) 445-0618. Fax: (614) 449-6433. E-mail: jspears@