Prevention Practices

The vast majority of tobacco users began using during adolescence or young adulthood. Indeed, a 2012 U.S. Surgeon General report indicated that 99 percent of daily smokers began smoking by age twenty-six; 88 percent of these smokers started by the time they were just eighteen.¹ These statistics lead to the obvious conclusion that reducing the deadly effects of tobacco means preventing young people from using in the first place. And it’s true. If we can prevent teens and young adults from starting to smoke—and each day nearly 3,800 young people under age eighteen have their first cigarette—we can reduce the number of tobacco users, health problems, and financial costs in the future.

Yet, prevention encompasses much more when it comes to nicotine addiction. The Centers for Disease Control and Prevention recommends a comprehensive, statewide program for tobacco control to prevent tobacco’s “staggering toll” on society. More specifically, such programs would have the following goals:

• preventing initiation among youth and young adults
• promoting quitting among adults and youth
• eliminating exposure to secondhand smoke
• identifying and eliminating tobacco-related disparities among population groups²

The structure proposed by the CDC for this program includes numerous elements that work in concert. They include state and community interventions, health communication interventions, cessation interventions, program surveillance and evaluation, and effective and fiscally sound administration and management. This section will focus on preventing tobacco use in youth.

Youth Tobacco Prevention

Preventing tobacco use among youth would fall in the “state and community interventions” category. The recommendations put forth in the independent Task Force on Community Preventive Services’ Guide to Community Preventive Services include the following measures for youth tobacco prevention:

• increasing the unit price of tobacco products
• conducting mass media education campaigns combined with other community interventions
• mobilizing the community to restrict minors’ access to tobacco products when combined with additional interventions (stronger local laws directed at retailers, active enforcement of retailer sales laws, retailer education with reinforcement)
• implementing school-based interventions in combination with mass media campaigns and additional community efforts³

It’s clear that delaying the onset of tobacco use, or preventing it completely, has enormous benefits to people’s health as well as the economy: consider the costs of the associated health care. In recent years, youth prevention efforts have become more and more comprehensive, involving schools, parents, and communities. If it really takes a village to raise a child, it may also take one to keep that child free from the hazards of tobacco.

Although prevention in these early years is critical and plays an important role in overall tobacco control efforts, this is no easy task. As we’ve discussed, young people are uniquely susceptible to problematic tobacco use, due to their brain development (the impulse control and judgment part of the brain is not fully developed until around age twenty-two), the way their brains respond to nicotine, and to the effects of peer pressure.

Is Eighteen Too Young to Smoke?

While some contend that the number of options to further reduce use among minors is limited, others are now advocating that the legal age to buy tobacco products be raised to twenty-one.⁴ According to the American Lung Association, 85 percent of smokers begin smoking by age twenty-one. Several towns already have established twenty-one as the minimum age to buy tobacco products, and in a handful of states, nineteen is the minimum age. This effort is intended to reduce smoking by youth and to prevent them from picking up the habit later. Though eighteen has long been viewed as one benchmark of adulthood, the age when people acquire the right to vote, science is now indicating that true adulthood occurs later. Brain research confirms that the brain is still developing at eighteen—and continues until a person reaches her midtwenties. In particular, the last area of the brain to develop is the prefrontal cortex, the area where impulse control is housed. The legal age to drink was raised in the 1980s with the National Minimum Drinking Age Act of 1984 and now some efforts are under way to do the same with tobacco. In other countries around the world, the minimum age to use and buy tobacco ranges from fifteen to twenty-one.

Protective Factors and Risk Factors

At its core, youth tobacco prevention is about decreasing risk factors and increasing protective factors in youth.

Risk Factors

The more risk factors an adolescent has, the more likely he is to fall into the grips of nicotine use and addiction, and from there, possibly other drug use. Risk factors can include personal details, such as not doing well at school, or factors related to one’s family, such as having parents who smoke. An adolescent’s friends and environment can also set her up to begin using tobacco.

Here are some risk factors that the U.S. Office of Adolescent Health identified as increasing the likelihood that an adolescent will smoke:

• Older age. Smoking and tobacco use is more common among older adolescents.
• Being male. Most girls smoke fewer cigarettes a day than boys do.
• Being white. White teens are more likely to use tobacco than their black or Hispanic counterparts.
• Lacking college plans. Youth who plan to attend college smoke less than teens without such ambitions.
• Having parents who are not college educated. Adolescents whose parents had little or no college education are more likely to smoke than those whose parents graduated from college.
• Experiencing highly stressful events. The more stressful events that teens experience, the greater their risk of smoking. Highly stressful events include abuse, whether as a witness or victim, parental separation, or living with a family member who is mentally ill or incarcerated.⁵

Protective Factors

Having more protective factors makes it less likely that an adolescent will begin smoking. These include

• high parental expectations
• participation in religious activity
• involvement with sports programs⁶
• volunteering
• parental involvement

Factors that protect all youth against the perils of tobacco include the restrictions that have been placed on advertising in the past fifteen years. Increased taxes, and thus higher prices, have also made tobacco products unaffordable for many young people. These are all part of tobacco prevention.

Refusal Skills: How Do You “Just Say No”?

As we discussed in the treatment section, having refusal skills or knowing how to say no to offers of tobacco is key for adolescents who want to avoid tobacco use. Educators and parents offer youth these examples of positive and effective ways to say “no.”

Youth Tobacco Prevention Programs

A recent review of forty-nine studies on tobacco prevention programs used in schools found that they are highly effective, especially with youth who have never used up to that point.⁸ Comprehensive programs include classroom-based education, parental involvement, and community-wide efforts.

In these programs, students learn problem-solving and decision-making skills, learn about the short-term and long-term effects of tobacco use, and receive skills training. Individual programs are targeted at different age ranges, beginning in elementary school and continuing through college.

Some prevention programs include representatives from many sectors of the community, including police, school personnel, business owners, and religious leaders.

Parental Influence

Studies show that what parents say matters. When they express their thoughts about tobacco and other drug use, their kids do hear them and are affected. In fact the National Crime Prevention Council has found that parental influence is the main reason that kids don’t use tobacco or other drugs—they don’t want to disappoint their parents.⁹ Even parents who smoke can let their children know that they want and expect something different for them. They can explain that they are addicted to nicotine and are trying to quit, if that is indeed the case.

Here are some tips for parents on ways to prevent their teens from using tobacco:

• Talk to your child about tobacco.
• Discuss information about the dangers of tobacco. Share stories about people you know who have lost loved ones due to tobacco or who are struggling to quit. Emphasize that most young people who smoke wish they hadn’t started, and most didn’t realize tobacco was so addictive.
• Invite your child to talk about his views on tobacco.
• It’s important to have a two-way conversation with your child about tobacco. Allow your child to express her opinions about tobacco and to talk about the pressure she feels to use it. Avoid criticizing or arguing with your child during this conversation.
• Develop clear, consistent rules with appropriate consequences.
• Regardless of your child’s age, he still needs boundaries. Set no-smoking rules for your family and enforce those rules with reasonable consequences. Clearly state those rules up front and be prepared to follow through on the consequences.
• Encourage your child to use you as an excuse if she is ever invited to use tobacco. “My mom or dad will ground me” is a great excuse.
• Monitor your child’s activities and know his friends.
• Most adolescents are pressured to use tobacco by their peers. Make it a point to meet your child’s friends, know where your child is, and know what she is doing with these friends.
• Know how your child is using his money.
• If you give an allowance or your child has a job, make sure that your child is not using that money to buy tobacco. If you find out that a local store is selling tobacco to minors, report it to the store manager or the police.
• If you use tobacco, make sure it isn’t easily available to your child. Don’t ask your child to get tobacco products for you.
• Recognize that, as a parent, you are a role model.
• Two of the greatest tools you can use to help your child avoid tobacco use are love and support. If an adolescent feels good about herself, she is less likely to give in to the pressure to use tobacco.
• Seek outside help if your child is already using tobacco.¹⁰

Also, it’s important to be aware that children are exposed to tobacco marketing and other societal influences. Talk to your kids about advertising and media regarding tobacco use. Get involved in community programs to reduce youth tobacco use and support efforts to place further restrictions on tobacco.