Smoking Prevention: The Good, the Bad and the Ugly

While smoking prevention is a worthy goal, a recent study published in the Journal of the National Cancer Institute, December 20, 2000, reported results that are nothing short of disappointing.

The “good” is that there is a dedicated effort to offer smoking cessation programs for our youth. The “bad” is that one of our nation’s largest and best-controlled prevention trials is a failure. The “ugly” is that we’re kidding ourselves, and our politicians don’t really care!

The rigorous study which is the subject of this column was conducted by the world-renowned Fred Hutchinson Cancer Center in Seattle over a 15-year period from 1984 through 1999 in 40 Washington state school districts. Roughly 8,000 students were involved with an impressive 94 percent follow-up rate.

Students participated in a coordinated curriculum-based social-influence program that extended from grades 3 through 10. Additional components were available to students from 9th through 12th grade.

The program involved a comprehensive effort including motivational and self-help cessation materials, faculty training on how to encourage and support teen smoking cessation efforts, as well as posters and school newspaper advertisements with anti-smoking elements. The curriculum which met the Centers for Disease Control (CDC) recommended prevention guidelines incorporated multiple social-influence components. Children were taught by their teachers to improve the recognition of the social influences of smoking with a focus on advertising and peer pressure. They were also taught to develop increased awareness and to resist influences to smoke.

Smoking rates of students in the program were systematically compared with children from other school districts where only the usual health promotion and tobacco prevention activities were already in place.

The team of scientists led by Arthur V. Peterson Jr., Ph.D., and colleagues established 2 end points. The first was the determination of daily smoking rates at grade 12 and the second was established 2 years after high school. The researchers reported 25.7 percent of students in the control group were daily smokers compared with 25.4 percent in the intervention group. Two years after high school, 29.1 percent in the control group were daily smokers compared with 28.4 percent in the intervention group.

Essentially the program didn’t work.

“Although the study demonstrated that this approach alone had no effect, it provides a valuable contribution to our knowledge about youth smoking behavior,” said Richard Klausner, M.D., director of the National Cancer Institute (NCI). “Carefully conducted studies such as this one help us to understand what works and what does not in preventing youth smoking.”

Richard Clayton, Ph.D., and his colleagues at the Kentucky Prevention Research Center and the Kentucky School of Public Health wrote an accompanying editorial which called for “a re-examination of health behavior theories to identify new and more robust models.”

Personally I’m disgusted.

Are we going to stand by and allow another 15 years to pass in order to evaluate “new and more robust models?” Are we going to spend millions of dollars testing social theories when the real issue is staring us in the face? Are you convinced the Emperor really has clothes?

Let’s face itæ teacher and peer influence in schools cannot be expected to effectively counteract family and societal influences in the long run. Does anyone really believe that telling a child not to smoke makes the slightest bit of sense when he or she returns to a smoke-filled environment every day?

Haven’t we learned that spending money hiring athletes for anti-smoking presentations and enhancing awareness by designing new posters doesn’t work when it comes to tobacco. Kids have already become immune to anti-smoking propaganda. Why should they take the rhetoric seriously when our government does not?

If we really want to cut smoking-related death and disability, there’s only one solution that makes any practical sense.

Simply raise prices!

While you might doubt the effectiveness of this approach as well, an article published in the September 2000 issue of Preventive Medicine, a peer-reviewed medical journal substantiates my position. David Levy, Ph.D., a senior scientist at the Pacific Institute for Research and Evaluation in Rockville, Maryland and colleagues projected that more than 2.3 million smokers in the U.S. would not die prematurely from smoking-related diseases during the next 40 years if cigarette taxes were increased by $1.00 per pack (indexed to inflation). The research group also projected that a tax of 20 cents per pack is estimated to save more than a million lives in 40 years.

It’s time for our Legislators to get serious. If a buck a pack could save 2.3 million lives, imagine what a $5 tax increase per pack could do for a generation smoking itself to death. The resultant impact on our nation’s well-being and healthcare system would enable every concerned man, woman and child to finally breathe a sigh of relief
Mind Over Matter!

© 2000 Barry Bittman,
MD all rights reserved

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Written by Barry Bittman MD

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