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We’ve heard the Surgeon General’s warnings for years. We’ve heard admonishment from doctors and studies on the evening news. Most adults know smoking is dangerous, and so do our kids. So, why are young people still smoking, and what can we do to help them stop?

Facts that might take your breath away

According to recent estimates by the Centers for Disease Control and Prevention (CDC), approximately 3900 people nationwide between the ages of 12 and 17 begin smoking every day. The CDC also estimates that 1500 young Americans in this age group become daily cigarette smokers. The facts at home don’t look great either. In Anne Arundel County, approximately 15 percent of teens smoke cigarettes daily, 34 percent have tried cigarettes, and 2 percent use smokeless tobacco.

Despite education and anti-tobacco awareness in the general population, in the teenage mind smoking is still connected to the adult world, according to Joanne Ebner, RN, a cancer prevention nurse at Anne Arundel Medical Center (AAMC). The desire to do adult things, when added to nicotine’s addictive qualities as a drug, is a powerful pull.

“It doesn’t take much to get addicted,” Ebner says. Plus, she adds, some teens are using nicotine as a way to calm the effects of disorders such as ADHD or to alleviate anxiety. The nature of nicotine, especially when combined with the independent mindset of many teens, can be tough to deal with because many teens think they have it under control. “They think they can stop whenever,” Ebner says, “but they can’t. After a few tries, they’re hooked.”

The hook and the bait

Lou Aymard, PhD, is a child psychologist and founding director of the Parenting Center at Anne Arundel Community College. The center works to increase and enhance discussion of parenting and family life issues through community outreach and classes.

Aymard believes that kids are victims of aggressive marketing by
tobacco companies. For the millions of dollars spent by tobacco companies on youth smoking prevention, much more is spent luring them in. Citing the book Childhood Lost: How American Culture is Failing Our Kids, by Sharna Olfman, Aymard states that young people 11–16 years of age are a billion-dollar market. Not only are they a lucrative market, they’re an easy target.

“There are so many vulnerabilities [in adolescents],” Aymard says. “They are vulnerable because of their naiveté as kids.” Adolescent development makes them more so, he adds. “They are immature neurologically; the maturation point is not complete until 25 years of age.”

Aymard explains that teen tobacco addiction has three hooks: physical, personal, and social. First of all, he agrees that nicotine is highly addictive. The effects of nicotine on a person’s physiology turn into a powerful physical need or addiction. Secondly, there’s the personal image factor: many teens still think that smoking makes them look cool. Finally, says Aymard, there’s a socially addictive quality to smoking. Other kids are doing it and it gives them a way to fit into a group.

Adolescence: An age for trying and a trying age

As any parent or teacher can tell you, working with the 13–18-year-old age group can be very challenging. Stopping teens from starting to smoke can be difficult if they see adult family members smoking at home. According to the Anne Arundel County Department of Health, approximately 32 percent of county minors live with adult smokers. Even if these children don’t begin smoking, a smoker at home increases their chance of diseases like bronchitis and asthma.

Nearly 29 percent of high school seniors, 18 percent of tenth graders, and 14 percent of eighth graders smoke. Unfortunately, according to Sherry Gately, director of the federally funded Safe and Drug Free Schools Project, smoking is a gateway drug and adolescent smokers are more likely to use other drugs and alcohol. Teens are still trying it and they quickly make it a habit.

Quitters always win: finding a way

In the teenage mind, smoking is still connected to the adult world.

Helping kids to quit can be tough for a variety of reasons, including issues surrounding access to quitting programs. In partnership with the Anne Arundel County Department of Health, AAMC offered smoking cessation classes geared toward teens at the hospital’s Sajak Pavilion. But the class had to be cancelled when the instructor backed out and the class had very low enrollment. Bill West, director of the Wellness Program at AAMC, says that offering the class in the hospital’s community-centered Sajak Building might not have been the best way to reach out to teens. “It’s a difficult population to get to come to class,” he says. Also, classes for teens must be offered only in the late afternoon or evenings or on weekends, because young people are in school during the weekdays. But West adds that there might be the possibility of taking the program to the teens, by partnering with the school system to bring classes to the schools in the future.

Another difficulty can be the teen mindset. According to AAMC’s Ebner, pointing out long-term effects such as lung disease often doesn’t work for teens, because most teens aren’t focused on long-term consequences of their actions. Instead, Ebner tries to point out the cosmetic effects, such as yellow teeth, smelly clothes and hair, and the adverse effect smoking has on athletic performance. But the biggest turnoff for teens, she says, is helping them to see that they are being manipulated, that the tobacco industry is taking advantage of them.

Helping teens kick the butts

Aymard sees one advantage to treating teens. “The good news is that the behavior [of smoking] hasn’t been [in] place that long,” he says. But, “we’re not going to treat it by preaching in class. We have to look at those hooks, the payoffs.” Aymard believes that the best smoking cessation programs for teens take a three-pronged approach, addressing the physical, social, and personal aspects of the addiction. Attacking the physical addiction by using a tool such as the nicotine patch to curb cravings is a start. Smoking cessation in a group gives the quitter social reinforcement, which is especially important for teens. A group that is going through the same challenge of quitting boosts the teen’s determination to kick the habit. The third part of a successful program is often the most difficult, but the most crucial, according to Aymard. It’s getting teens to see why they smoke and what they get out of it, to focus on what need is being fulfilled, or what payoff comes from the behavior, and how to get that need met in a healthy way instead of through smoking.

Local programs

In January, Ebner intends to kick off a hands-on program at AAMC for teens. Although the location might not be decided yet, the program will offer various approaches to help teens, including individualized treatment using different tools for each participant, such as the nicotine replacement patch or gum.
Currently, Baltimore Washington Medical Center offers smoking cessation classes but none designed specifically for teens just yet.

Anne Arundel Community College’s Health Services holds free 7-week Freedom from Smoking sessions, a multidisciplinary approach in conjunction with the American Lung Association. This course is open to the community and offered to all ages. The sessions include positive reinforcement, relaxation techniques, and group support. “The American Lung Association has found that groups mixed in age, socioeconomic level, and ethnicity are often the most successful,” says Carol Jacobsen, RN, the evening nurse at Anne Arundel Community College’s Health Services. “People are willing to talk when they’re with someone they don’t know.”

The Anne Arundel County Department of Health offers free publications about tobacco use and cessation though its Learn to Live program. Free resources include a Smoke Free Kids Kit and a Teen Quit Kit to help teens quit independently. The Department of Health also promotes antismoking awareness and a poster competition to students through its Tobacco-Free Kids Week program offered each spring.

The Safe and Drug Free Schools Project is a federally funded project offered to Anne Arundel County Schools through the Maryland State Department of Education. The project’s Keep a Clear Mind program contains a series of lessons designed for fifth graders about the dangers of drugs, violence, tobacco, and alcohol. The voluntary 4-week program offered to county elementary school principals encourages student-parent communication, with one week focusing on tobacco use. “It promotes wonderful communication between kids and parents,” says project director Gately.

That communication can be crucial. To help your child resist the temptation to smoke, the Anne Arundel County Department of Health suggests that parents get to know their child’s friends. Young people whose friends are nonsmokers seldom smoke, but those who smoke often have at least two friends who do. Also, model good behavior by not smoking or by quitting the habit. Encourage your child to take part in healthy group activities and point out that most young people don’t smoke. When talking with an adolescent, point out short-term effects, but also discuss the long-term dangers of emphysema; bronchitis; and mouth, throat, and lung cancers.

Signs of tobacco use include coughing, throat irritation, hoarseness, bad breath, stained teeth, and shortness of breath. If you think your child is smoking, talk to him or her about why smoking seems appealing. Finally, the Department of Health recommends that you reinforce your child’s decision to quit with praise, an increased allowance, or increased responsibility or freedom. As effective as programs are, teens need support at home too.

Karen McLaughlin is a freelance writer in Severn.