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GROWING UP IN SMOKE

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"My sense is, it's generational," said Biglan. "There's been an upturn in marijuana use, too. Times changed, and now they're changing again."

The question looms for scientists such as Perry and Biglan: How do you convince children smoking isn't cool? How do you prevent them from taking the first puff, since one out of two of those experimenters will be regular smokers by the time they reach their senior year in high school?

One approach currently in vogue utilizes negative peer pressure, said Perry, who praised kid-driven campaigns that depict smoking as filthy, expensive and unhip.

"The point is to create a peer norm that it is not cool to smoke and that it is not acceptable," Perry said.

In fact, a University of Michigan survey showed that in 1991, most high school seniors preferred to date nonsmokers (74 percent), think smoking is a "dirty habit" (71 percent) and believe pack-a-day smokers are putting themselves at great risk (69 percent).T

The surgeon general's report also warned that adolescent smoking is associated with later alcohol and illegal drug use, that younger smokers are more likely to become heavy smokers and that people who begin smoking at an early age likely increase their lifetime chances of respiratory diseases, cardiovascular disease and many forms of cancer.

Younger kids aren't getting those messages, however.

Curiosity is the No. 1 reason young smokers say they start, the report said.

Once they're hooked, kids find plenty of reasons to keep puffing, according to a 1987 Minnesota study that found adolescent smokers were more likely than their nonsmoking peers to view smoking as "a way to act mature, be accepted by a peer group, have fun, cope with personal problems and boredom, or be rebellious."

Barring changes in attitude, anti-smoking forces must look for ways to "erect barriers between kids and cigarettes," Perry said.P

arents, teachers and doctors must clearly voice their opposition to smoking, she said.

"A lot of parents are afraid of alienating their kids, but this is an area, just like alcohol, where I think they can be very firm, telling them, `You're not allowed to smoke inside the house or out of the house, and this is the consequence if you do.' "

Giving a child a first cigar to puff or characterizing smoking as better than drug use gives children a mixed message, Perry said.

"There should be no inconsistency in their disapproval. That disapproval carries a lot of weight with kids, even if they scream and yell," she said.

Perry believes adolescents should not be left unsupervised to allow time for smoking, either at school or at home, since many studies show kids are more likely to smoke if adults are not around.

Access to cigarettes should also be blocked, at home and in society, she said.A

new federal law, the Synar Amendment, aims at curbing easy access to cigarettes by the nation's teens by threatening to withhold millions of dollars in federal money to states that do not enforce their laws prohibiting tobacco sales to minors.

A sting operation in April showed that teenagers were able to illegally buy cigarettes in more than 60 percent of 519 stores they visited in the Los Angeles region. Access to cigarettes in vending machines was less controlled, since teens were able to buy cigarettes in such machines 85 percent of the time during the two-day operation.

"Kids sometimes get cigarettes from their friends or their parents, but the vast majority of the time they buy them," said Biglan of Oregon.

"That is the thing the whole public-health community is focused on right now. It's easy for kids to get cigarettes, and we've got to make it hard."O

ne approach that seems certain to fail is drumming into children that smoking is bad for their health. They know.

Sarah Hardy, a 17-year-old senior at Henry David Thoreau Continuation High School in Wood-land Hills, Calif., said she's heard everything there is to hear about smoking and lung cancer, heart disease, emphysema, birth defects and wrinkles - and she believes it all.

Smoking Marlboros every day saps her energy, she said, and drains her body of vitamin C.

"Oh, I know it's bad. I've tried to quit," said Hardy. "I think I quit for three days once, but you get the craving for it. You feel stressed and tense."

Hardy started smoking because her friends smoked, she said, and now she can't stop.

"It's pretty clear now that you can get a kid to learn the facts about smoking causing lung cancer or heart disease, but I'm not sure how much real relevance that has to kids," said Biglan.

One problem with using scare tactics to convince kids of the dangers of smoking is that teens don't die of smoking, even though they do suffer documented health problems - wheezing, getting short of breath, coughing up phlegm and suffering chest colds more often than their nonsmoking peers.

Almost all smoking-related deaths - from lung cancer, congestive heart failure, emphysema, stroke and other causes - occur after the age of 40, according to the National Center for Health Statistics.

"The trouble with health educators like myself is that we think people place a high value on their health. We do, because we're getting older. But kids find it irrelevant," said Perry of the University of Minnesota."I

t is much, much more important to a teenager to appear sexually attractive or fit in with a peer group than to be in good health," she said.

One way kids might be dissuaded of tobacco's allure might be to ban cigarette advertising and tobacco industry promotion of sporting events and concerts, Big-lan said.

Today's adolescents grew up with Joe Camel, who started appearing in advertisements in 1988, he said.

In a study published in 1991 in the Journal of the American Medical Association, 6-year-olds were able to identify a picture of Old Joe Camel as readily as they recognized Mickey Mouse.

Although the tobacco industry has consistently denied that Joe Camel was designed to appeal to children, critics note that during the first four years of the Joe campaign, smokers under 18 who said they preferred Camels rose from half a percent to 33 percent.

Peggy Carter, manager of media relations at the R.J. Reynolds Tobacco Co., cited faults in the methods used in the Journal of the American Medical Association study and said recognition of Old Joe by children does not change their negative attitudes toward smoking.

"The predominant factor in teen smoking is peer pressure, not advertising. Research shows that across the board," said Carter.B

ut Biglan believes that tobacco advertisements give children an impression during many formative years that smoking is something that cool, risk-taking, independent, attractive and svelte young adults do.

Much of that impression, he said, is created through $4 billion a year in advertising and promotions by the tobacco industry.

Philip Morris Inc.'s Marlboro and R.J. Reynolds' Camel cigarettes - two of the most widely advertised and promoted brands - are favored by 70 percent of adolescent smokers, according to a 1992 Gallup Poll.

"All of this crap about not selling to kids is just that," Biglan said.

Karen Daragan, a spokeswoman for Philip Morris Co., said children are "certainly not a market of ours."

Daragan said the company does not study why children prefer smoking Marlboro cigarettes but noted that the brand's popularity crosses all age groups and is by no means limited to minors.

"Marlboro is the No. 1 brand in the world," Daragan said. "Its market share is more than the next six brands combined."

The trouble with health educators is that we think people place a high value on their health. We do, because we're getting older. But kids find it irrelevant.

Cheryl Perry

University of Minnesota

School of Public Health