In the Mouths of Babes

Why does anyone younger than 30 start smoking these days?

You’d think with everything we know now about the harmful effects of smoking and all the good work that has been done to dissuade children and young adults, relatively few of them would start in 2012.

But that’s not the case.

Nearly one in four high school seniors and one in three young adults younger than 26 smokes, according to the Surgeon General 2012 report “Preventing Tobacco Use Among Youth and Young Adults.” At least 3 million high school students and 600,000 middle school students smoke.

More than 80 percent of adult smokers begin smoking by 18 years old — 99 percent start by age 26.

The 1998 Tobacco Master Settlement Agreement eliminated most cigarette billboards, transit advertising and print advertising directed at underage youth; it also limited brand sponsorship. Internal tobacco industry documents were released and analyzed by scientists. At the same time, the prices of cigarettes and smokeless tobacco products increased. These and other developments created a sharp decrease in tobacco use among adults and youth.

After years of steady decrease following the Tobacco Master Settlement Agreement, the surgeon general’s report shows declines in youth tobacco use have slowed for cigarette smoking and stalled for use of smokeless tobacco.

That is really bad news if you consider that of every three young smokers, only one will quit and one of those remaining smokers will die from tobacco-related causes.

And the report states that young people are using multiple tobacco products, such as smokeless tobacco, which is increasing among white males. Some might be under the mistaken impression that these alternatives to cigarettes are healthier.

Hookah water pipes have been in vogue for the last several years, and health experts agree that they are not safer than cigarette smoking. According to the Centers for Disease Control and Prevention, “Due to the mode of smoking — including frequency of puffing, depth of inhalation and length of the smoking session — hookah smokers may absorb higher concentrations of the toxins found in cigarette smoke.”

And then there are e-cigarettes, electronic devices that produce a vapor inhaled like cigarette smoke. While some claim e-cigarettes help them cut back on the use of the deadlier cigarettes, health officials are not convinced that e-cigarettes are safe at all. You can read more about that in our cover story on page 13.

Most young people never consider the long-term health consequences when they start smoking. Nicotine, as highly addictive as heroin or cocaine, causes many to continue smoking well into adulthood, often with deadly consequences.

As the overall percentage of smokers has declined and older smokers die, tobacco companies recruit “replacement smokers” from youth and young adults — the age groups in which 99 percent of tobacco use begins.

And they’re very good at it. Faced with having to curtail previous marketing that targeted young people, tobacco companies innovated new ways to attract new smokers. In 2008, cigarette makers spent nearly $10 billion on marketing, the surgeon general’s report states. And $6 out of every $7 helped pay for price cuts through coupons, sales and giveaways ($3 out of every $4 of the $547 million spent by smokeless tobacco makers). As you can imagine, teens are very sensitive to pricing.

Laws limit face-to-face and vending machine sales of tobacco products to young people, but it’s a different story online, where very few shipments require proof of age at the time of delivery of the tobacco product.

Teens and young adults face a barrage of marketing from packaging to flavors to convenience store placement to cigarette company websites that feature video games to social media to magazine ads. All of it is tested to appeal directly to them.

Even movies and television shows that feature smoking play a role. We even struggled with whether this week’s Folio Weekly cover made smoking look too glamorous.

Adolescents and young adults are the most susceptible to starting tobacco use — and more vulnerable and more influenced by marketing than adults. They take more risks and are heavily influenced by friends or siblings who smoke.

Northeast Florida has been a leader in this area with groups like the Tobacco Free Jacksonville Coalition. It spearheaded a Jacksonville ordinance, that was subsequently adopted statewide, making possession of tobacco by minors illegal. First and second offenses include tobacco education programs, $25 fines or community service, but the third offense can mean losing your driver’s license. That’s a serious threat to a teenager.

The coalition also tackled secondhand smoke, which led to the Florida Clean Indoor Air Act enacted in 1985 by the Florida Legislature. In November 2002, 71 percent voted for a Florida constitutional amendment to prohibit smoking in all enclosed indoor workplaces. Since the law became effective July 1, 2003, no one ever asks “smoking or non-smoking?” at restaurants anymore.

Cigarette smoking is the leading cause of preventable death in the United States, at approximately 443,000 deaths, or about one of every five deaths, each year.

Mass media campaigns, price increases and community protections against secondhand smoke help reduce the initiation and prevalence of smoking among youth. But many of these programs are underfunded. Sustained investment in comprehensive tobacco control programs will lead to lower youth and adult smoking rates and, ultimately, save healthcare costs.

If you don’t start smoking before the age of 26, chances are you’ll never smoke. So the best way to solve one of our biggest health problems is to help young people to never start smoking.

Denise M. R