Despite Serious Consequences, Teens Still Start Smoking

by John Edward Gill

© Simone van den Berg – All rights reserved.

When Amanda first got curious enough about smoking to light up a cigarette, she was only 9. It was just a passing fancy; most of her friends didn’t smoke, so she didn’t pursue it. But when she was 12, the Hauppauge, New York, girl was depressed and looking for stress relief. She found it in a pack of cigarettes. Now at 15, dragging hard on a Newport, Amanda says she’s an addict.

She is one of more than 3 million 12- to 17-year olds who smoke in the United States, despite massive advertising campaigns about the risks involved. And those risks are clearly serious: 400,000 deaths a year – one in every five deaths in this country – are directly attributable to smoking.

Risks – What Risks?

“When you start smoking, you really don’t think about it; you’re just curious,” Amanda’s 15-year-old friend Ronnie explains. For this Hauppauge native, one cigarette a day quickly turned into daily smoking. Hauppauge is on Long Island, which is on the eastern coast of the United States.

“The more you hear about it, the more you want to take a chance,” adds Amanda. “You want to take a risk.”

Now that they realize doing without cigarettes isn’t easy, the teens admit some concern about the health risks involved. “When we think about quitting, we say, ‘You know, these are death sticks.’ We always think about it, but it’s never enough to stop,” Amanda says with a shrug.

Even the high cost of smoking, more than $5 a pack in this area, is not enough incentive – the girls explain that since all their friends smoke, they take turns buying packs or just bumming them off friends who have a few extra to share.

In 2001, a Centers for Disease Control study found that nearly 30% of high school students reported smoking one or more cigarettes a month.

“If current patterns of smoking persist, over 5 million people currently younger than 18 will die prematurely from a tobacco-related disease,” reports The Office on Smoking and Health (OSH), a division within the National Center for Chronic Disease Prevention and Health Promotion in the Atlanta, GA-based CDC.

Given that 90-percent of smokers start at or before age 18 – every day 5,000 youngsters light up their first cigarette – age is a critical factor. An estimated 2,000 young people become daily smokers. As a result, nearly 33-percent of them will die prematurely.

In New York State, the National Center for Tobacco-Free Kids reports a roughly 30-percent youth smoking rate.

Youth Become Addicted Quickly

While smoking just one cigarette a month may not seem particularly threatening, this is a case when appearances are clearly deceptive, fatally so. Within two months of starting to smoke occasionally, 40-percent of adolescent smokers in a study admitted to some symptoms of addiction. The study, conducted by a team of University of Massachusetts researchers led by Dr. J. R. DiFranza, and released in the international journal Tobacco Control in August 2002, queried 679 seventh-grade students (age 12-13 years); 332 of whom acknowledged some tobacco use. “Symptoms of tobacco dependence commonly develop rapidly after the onset of intermittent smoking,” the team concludes.

Symptoms considered signs of addiction include difficulty quitting and cravings.

“This study shows that, far from being a harmless rite of passage for teens, cigarette smoking can be highly addictive at a very early stage and lead to a lifetime of health problems and premature death,” said William V. Corr, Executive Vice President of the Campaign for Tobacco-Free Kids, which is based in Washington, D.C.

Lasting Effects of Early Smoking

“Individuals who begin smoking during adolescence are more likely to become dependent, to progress to daily smoking, to continue to smoke into adulthood, to smoke for a greater number of years, and to smoke more heavily as adults,” DiFranza, et al report. “The very first dose of nicotine can leave its mark in the brain for a long time.”

A key finding is that adolescents are more vulnerable to nicotine dependence because their brains are still developing. As a result, there is a “more serious disruption of neurological functioning” in younger smokers than mature ones. An additional consideration is psychological addiction. Like Amanda, many of the youngsters questioned by DiFranza said they started smoking as a coping mechanism to relieve stress, which leads quickly to a psychological dependence.

And quitting is not an easy option for this age set: “Proven smoking cessation approaches have had disappointing results with adolescent smokers,” DiFranza’s group learned.

Gender Plays Role

Particularly at risk are females. Signs of addiction become noticeable after only 21 days for young girls; but don’t until almost six months for boys. When symptoms first become evident, the average teen is smoking just two cigarettes, only one day a week.

“There does not appear to be a minimum nicotine dose or duration of use as a prerequisite for symptoms to appear,” the DiFranza team notes, adding, “The development of a single symptom strongly predicted continued use, supporting the theory that the loss of autonomy over tobacco use begins with the first symptom of dependence.”

The question of why girls are more susceptible earlier than boys is the focus of a new study, being sponsored by the National Institute on Drug Abuse in Bethesda, MD.

Hollywood/Parents Have Heavy Influence

Watching their favorite movie stars light up is having significant impacts on young people. So says a team of researchers led by Dr. James D. Sargent, a pediatrician at Dartmouth-Hitchock Medical Center (DHMC)in New Hampshire. The group studied 5,000 middle school students (ages 9 – 15) in the northeast and determined that nearly a third who had seen movies incorporating cigarette smoking had tried smoking themselves, compared to only 5-percent of those who saw movies with low cigarette exposure.

“This is the first population-based survey to measure teen exposure to smoking in movies. For better or worse, adolescents watch a lot of movies — so many that they might see more smoking in films than in the real world,” said Dr. Sargent, a pediatrician with the DHMC’s Norris Cotton Cancer Center. “These results might seem obvious to some, but until now we only had anecdotal information about how movies influence adolescent behavior. With this survey, we’ve shown that what teens see in the movies is statistically linked with what they do.” Such exposure is associated with trying smoking, which supports the hypothesis that films have a role in the initiation of smoking, he concludes.

A wide range of films were considered in the study. The research team counted cigarette smoking activity in 601 popular films released in the U.S. from 1988 to 1999, and they found an average of five occurrences of tobacco use per movie. Todd Heatherton, Professor of Psychological and Brain Sciences at Dartmouth and an author on the study, adds, “Our findings were surprisingly strong, and this may be due to the way Hollywood portrays smoking.”

Additional studies have shown that children of parents who smoke are also at higher risk of becoming addicts themselves. “If you smoke, it’s hard to expect your teenager not to smoke,” warns the American Academy of Pediatrics, based in Elk Grove Village, Illinois. “In fact, children from families who smoke are twice as likely to become smokers.”

One reason may be that it provides easy access. Both Amanda and Ronnie say their first cigarettes came from home. “I started taking them from my Mom,” Amanda admits. “She didn’t realize it.”

Advertising Still Attracts Adolescents to Smoking

Despite the highly publicized 1998 tobacco settlement in which the tobacco industry promised not to deliberately target youths through advertising, some agencies contend they are doing just that. “The evidence shows that if Big Tobacco has changed at all, it’s for the worse,” notes the National Center for Tobacco-Free Kids. Citing Federal Trade Commission findings, the group reports a whopping increase of nearly two-thirds in tobacco marketing outlay, most of which involves retail store marketing proven to be highly effective at reaching youngsters.

In addition, the group notes an increase in tobacco product advertising in youth-oriented magazines yielded a fine against R. J. Reynolds for $20 million. “While the tobacco industry claims its marketing is intended only to influence brand preferences of current smokers and does not play any role in kids’ decisions to start smoking, several recent studies show otherwise,” the Center contends, adding the federal government’s National Household Survey on Drug Abuse found that 87 percent of youth smokers smoke the three most heavily advertised brands – Philip Morris’ Marlboro, Lorillard’s Newport, and R.J. Reynolds’ Camel (55 percent of youth smokers prefer Marlboro) – compared to less than half of adult smokers who prefer these brands. A March 2002 study conducted by the Center determined that young people are twice as likely as adults to remember tobacco advertising.

With an estimated 65-percent of American children under age 17 accessing the Internet, the influence of the World Wide Web is the focus of several studies affecting children. Tobacco-Free Kids report more than 200 U.S. websites sell tobacco products, which is largely unregulated in terms of ensuring youngsters are not the buyers. Not only does this make it easy for kids to buy cigarettes, but also cheap because many sites do not charge tax. The group is calling on federal officials to beef up regulations and enforcement efforts to limit sales of tobacco to minors.

Other Steps to Stop Smoking

Believing that one person can make a difference, a Delaware teenager is behind an international anti-tobacco campaign. Meghan Pasrich earned a 2003 Tobacco-Free Kids International Advocate Award for her efforts. Among the 17-year-old’s many credits, Meghan is president and council member of Delaware’s Kick Butts Generation, as well as founder and president of the Sanford School’s Anti-Tobacco Action Club. She organized and conducted training sessions for Indian Youth Leaders during a recent trip to India, which led to over 1,500 youth there learning about the dangers of tobacco. She has set her sights on Mexico now (Meghan is multi-lingual: English, Hindi and Spanish), and plans to launch a Kick Butts Generation chapter there. She is also working on an international anti-tobacco effort via the Internet.

In the U.S., Meghan has been to Washington, D.C., to talk to elected officials about giving the Food and Drug administration regulatory powers over tobacco products.

“You could say I’m very passionate about this,” says Meghan.

Another program aimed directly at teens is N-O-T, Not on Tobacco, an initiative from the American Lung Association, headquartered in NY, NY. Adult coaches cheer on youngsters trying to quit. The teens meet weekly in their school, during the school day, to learn the best tips and strategies for stopping. “You’d do some neat things together that’ll help everyone to smoke less, deal with their friends and parents who still smoke, and keep healthy. If you want to quit, this could be your best chance,” program coordinators say.

Schools interested in hosting N-O-T programs can call their local American Lung Association at 1-800-LUNG-USA.

Getting the word out to smokers while they are still young is important, according to the American Academy of Pediatrics. Just as pivotal is how the message is presented: Focus on the short-term consequences of smoking when talking to young people, the experts recommend. These include stained teeth and fingers, bad breath, smelly clothes and cigarette burns. Smokers also have more colds, more sinus and ear infections, persistent coughing and shortness of breath, and decreased performance in athletics, singing and playing wind instruments.

In addition, smoking has been connected with poor school performance and depression. Tossing in the high cost of smoking in terms of dollars and cents (in some areas a pack costs up to $7) is a good idea, too.

The CDC also has suggestions for helping young people to stop smoking. “Got a Minute? Give It to Your Kid” is a parent-education program that encourages parents to become more involved with their preteens and early teenagers. The program includes clear messages and practical strategies for preventing tobacco use.

On a simple and very practical front, Dr. Steven E. Shive of California State University says adults must shoulder some responsibility and not become enablers for teen smoking. After conducting a study, Dr. Shive learned that most young people circumvent restrictions banning them from buying tobacco products by asking an older friend, family member or even stranger to buy the goods for them.

“If we can get these people to realize the harm they are causing to these minors, then we might have less of a problem with it,” Dr. Shive recently told Reuters Health, the New York-based healthcare news division of Reuters news agency.

For more information, please contact some of these websites:

American Academy of Pediatrics
American Lung Association
Centers for Disease Control
National Institute on Drug Abuse
Tobacco-Free Kids

Hooked On Nicotine Checklist

Have you ever tried to quit, but couldn’t?
Do you smoke now because it is really hard to quit?
Have you ever felt like you were addicted to tobacco?
Do you ever have strong cravings to smoke?
Have you ever felt like you really needed a cigarette?
Is it hard to keep from smoking in places where you are not
supposed to, like school?
When you tried to stop smoking . . .(or, when you haven’t used tobacco for a while …):
* did you find it hard to concentrate because you couldn’t smoke?
* did you feel more irritable because you couldn’t smoke?
* did you feel a strong need or urge to smoke?
* did you feel nervous, restless or anxious because you couldn’t smoke?

Development and Assessment of Nicotine Dependence in Youth (DANDY); answering yes to any of these questions indicates signs of addiction. For the full study by DiFranza et al, visit

If you think your child is abusing drugs, waste no time in enrolling him or her into a teen drug rehab program before all your lives are overtaken by addiction.

Jeanne Marie Schnupp contributed to this story.