Tobacco company sponsors teen cessation conference

A few weeks ago I listened to a webinar about reducing teen smoking rates. I knew it was sponsored by Altria (formerly known as Phillip Morris, AKA Marlboro land). It wasn't so much what was said but what was NOT said. There was no disclosure for this webinar that Altria was paying for it and I bet that if it had been disclosed, many of the call participants would have hung up.

Next, I started receiving notices about a two day conference in Tennessee in November, again sponsored by Altria. Is this an attempt to rectify their past misdeeds? Or just a brilliant marketing message--anyone who attends this conference is given a message that is used when returning to work with teens. The message will be one that is shaped to least harmful for the tobacco companies.

Does anyone really believe they don't want our children to smoke? They don't want their children to smoke but they sure do want your children and the billions of children around the world to pick it up. In Indonesia, there are no age restrictions for selling cigarettes and it's routine to market to teens. In the United States, we have tried to stop sales to children and stop the blatant youth marketing, such as with Joe Camel, but all our tobacco control efforts has done is to make the tobacco companies become masters of manipulation where ever their product is discussed--even under the guise of "cessation".

The tobacco companies have lied for years and have been convicted for racketeering-- the same charges the mafia have been convicted under. The judge ruled that the culture of deceit was so prevalent within the company structure that deceit was likely to continue. Which means we all need to be vigilant against their vast billions of dollars used to get teens addicted to tobacco products before they are legally able to buy them.

For related stories click here: A Wolf in Sheep's Clothing   Smoking Baby  Cigarette advertising to teens

The best way to quit smoking is to never start

For the past seven years I have been visiting Mrs. Smith's health education classes at Coachella Valley High School as a guest speaker. It's one of the most important talks I do and one of the most rewarding. Mrs. Smith handed me an envelope full of letters from students that attended my last talk. Each thanked me for for talking to them and listed what they learned that was most important to them. Several letters touched me.

I have a brother who smokes and his (wife is) having a baby. We have both tried to tell him to stop but he doesn't listen. One thing I learned (from) your presentation is how to talk to some who smokes and you want them to stop. It seemed like my brother understood what I was trying to tell him and it surprised me because he didn't get mad at all when I told him that maybe him not having enough money came from his smoking habit. Ana

I will stop smoking from now on because I learned that the younger you are to pick up smoking the greater chances I will continue smoking when I am older. Paola

One thing I learned is that smoking causes more damage than I thought. I knew that by smoking you can get lung cancer but I know now that you can cause more damage to yourself. One thing that I will do is try to make sure my little brother and sister don't grow up smoking. Mariana

I learned about that it may not seem like much but little by little smoking does it's effect on the body. Also it could be expensive. Jose.

Other letters just suprised me:

I will not smoke because it's not healthy for me and I won't smoke because I still want to talk and not burp. Eric

( When talking about cancer of the voicebox, I tell them that in the past if your voicebox was removed, you learned how to speak again by sucking in air and burping it up to talk.)

One thing I learned was that there are 30% of cancer's caused by smoking, and that if you get cancer in your lips they can take them off and put fake one's on. Deisy

( I tell the story of Peck who had lip cancer. He was given new lips by a plastic surgeon but he had to be careful not to drool when drinking since his lips were numb-like having novacaine from a dentist. Peck also told me that it took all the fun out of kissing).

Every day I speak to smokers struggling to quit and each one will say the easiest way to quit smoking is to never start. Someday I hope I'm out of business and the next generation will not have to struggle with a nicotine addiction like me and so many other smokers.

We Don't Want Our Kids to Smoke

Mary's father started her smoking at 16 because he thought it made her look sophisticated, now at 70, she finds it almost impossible to quit.
We've come a long way baby, from an attitude like Mary's father yet even today when a teenager is caught with cigarettes, that parent breathes a sign of relief that it wasn't something stronger, "It's just cigarettes, a right of a passage instead of drugs". Yet cigarettes are more likely to kill the kid that starts smoking than all of the other addictive drugs put together. Our brains don't fully develop until we're in our 20's and the younger a smoker starts, the more likely they develop changes to the structure of brain caused by the exposure to nicotine which is "addiction". It would seem that as a society we would want to protect our children from access to nicotine. Yet sales to minors happen all the time, from the mom and pop stores to the big name box stores, all have sold cigarettes to minors at one time or another. A local store in La Quinta was cited for selling individual cigarettes. Even the tobacco companies don't want single cigarette sales, because with no warning label on singles,the tobacco companies are open to lawsuits claiming the smoker might not have known of the dangers of smoking. That's the real reason why there is a warning label on every pack. But warning labels aren't enough to stop a teen with that optimistic bias that nothing bad will ever happen and that he will live forever. It's time for society to recognize cigarettes for what they are: an addiction delivery devise and not just a right of passage.

Parental Influence on Adolescent Smoking

Condensed version: Most smokers start as a teenagers and if they become addicted, they become lifelong smokers and have a high risk of dying from smoking. The teen doesn't become addicted with the first cigarette but follows a path that can lead to addiction. The first step is thinking about trying a cigarette, then experimentation, a cigarette every now and then, which progresses to a regular pattern of usage, whether one every day after school, one every Saturday or one every time with a friend that smokes. Once this pattern is set, addiction is already being conditioned for structural brain changes that lead to addiction. Parents can influence whether their child will progress from one step to the next, those teens who are at greatest risk of continuing to smoke have parents that are uninvolved with the teens life, have friends or older siblings that smoke. Unfortunately a large number of teens that smoke are at risk for mental disorders such as depression, conduct disorder, ADHD, schizophrenia and future substance abuse.

For the full text reading:
Parental Influence on Adolescent Smoking

Smoking is one of the most preventable causes of death in the United States. Every day approximately 6000 adolescents will try smoking a cigarette for the first time, half will become a habitual smoker as an adult (U.S. Department of Health and Human Services, 2000; cited in Abroms, Haynie 2004). Over one quarter will die from the effects of their habitual smoking. (Orleans & Slade, 1993). Almost ninety percent of adult smokers started before they reached the age of 18, with 30% (Flay 1993) to 71% (U.S. Department of Health and Human Services, 2000) being habitual smokers before they were legally able to purchase cigarettes. The U.S. Department of Health and Human Services, (2000) estimates that only 7% of adult smokers who try to quit are still smoke free after one year.

It would be unethical to conduct experiments with adolescents and nicotine to assess exactly how long it takes to become addicted to nicotine after the adolescent is exposed to nicotine for the first time or exactly the changes that smoking has on the developing brain of a adolescent, however it is clear that adolescents do smoke and a large percentage will become addicted and this will decrease their life expectancy. This is the reason why it is important to look at adolescent smoking to develop strategies to prevent youth from becoming a smoker in the first place and to develop effective intervention techniques to stop the escalation into habitual adult smoking. Understanding who will quit as an adolescent and who will become an adult smoker is also important in developing these prevention and intervention strategies.

There are many reasons why an adolescent may start smoking such as peer pressure and marketing techniques of the tobacco industry. The purpose of this paper is to present a limited number of peer reviewed articles that discuss the influence of parents on adolescent smoking.

Differences have been identified as to how an adolescent relates to cigarettes and stages have been identified as to the progression of smoking which is called a tobacco trajectory.A tobacco trajectory is identified as the several stages or sequences of events that lead to the adoption of smoking by adolescents (cited in Flay, 1993, Avenevili & Merikangas, 2003): Preparatory, initiation, experimentation, regular use and nicotine dependence.The preparation stage happens when an adolescent or child begins to think about cigarettes and what meaning the cigarettes have for this child. Influences can be marketing by the tobacco companies, information about the health effects and the smoking status of parents, peers and siblings.The first one or two attempts at smoking are the initiation stage. Often there are unfavorable physical sensations such as coughing and dizziness. The next stage is experimentation, which can last for many years. It is the use of tobacco on an irregular basis. Maybe a few times a month or only with certain peers but no regular habit has been established.Regular use is the repeated use of tobacco on a regular basis whether by day, week, on weekends or just after school but with a predictable pattern.

It is important to study if parental influence is different at these different stages and to determine what truly is effective.Avenevoli & Merikangas (2003) did a literature search of published studies to see if whether parents who smoked had an influence on whether their children would smoke. They reviewed articles written after 1980 and which were mainly written in the United States. The age range was from six years old to college age, and were mainly school-based studies with predominately Caucasian subjects.The results they received are inconsistent as to whether the smoking status of a parent influences their adolescent. Several reasons were cited such as lack of standardized definitions, and the absence of adolescent that are not in school. Adolescents who drop out of school may have a higher smoking rate than those who complete high school. They did find that parents of European and Asian decent who smoke, may have an effect of their children. Significant findings were found with mothers who smoked a pack a day of cigarettes, influencing their daughters especially. More consistently they found that having an older brother or sister who smoked was predictive of both current and lifetime smoking. Having friends who smoked was an even greater predictive factor across all stages of the smoking trajectory than either having parents who smoked or older siblings whereas parental smoking was predictive in the regular use stage.

A genetic influence from twin studies (cited in Avenevoli, 2003) may lead to nicotine addiction but was not predictive for initiation.Many of the studies that Avenevoli et al (2003) reviewed did not use the stages of the tobacco trajectory so it is not known whether the effect of parental smoking may be different at different stages or whether the adult had been a former smoker or a current smoker. However, Adalbjarnardottir & Hafsteinsson (2001) did find that parental smoking was predictive of whether an adolescent became a daily smoker.Adalbjarnardottir etal (2001) looked at four different parenting styles and their influence on adolescent smoking. The four styles studied were authoritative, authoritarian, indulgent and neglectful. Theirs was a longitudinal study of 347 adolescents that they followed from age 14 to 17 in Iceland. Their results showed that adolescents whose parents were authoritative, authoritarian or indulgent were less likely to experiment with smoking at age 14 than adolescents who parents were labeled neglectful. By age 17 though, the influence on parenting styles had no effect on whether the adolescent was a daily smoker. They did exclude the daily smokers at age 14 from this progression. With cultural and attitudinal differences between the United States and Iceland it may be difficult to generalize from this study.Miller & Volk (2002) also found significant predictors among parenting styles. They used data from the National Youth Survey, which was a national longitudinal study over seven years with adolescents aged 11 to 17 with the initial information from 1976 with four subsequent follow ups. Miller et al (2202) did find that family relations were more predictive of daily use than for either the earlier stages of initiation or experimentation. Unlike Adalbjarnardottir, Miller et al (2002) did not find any significant findings when looking at how a parent disciplined their child nor their level of honesty.

The activities that Miller et al (2002) found predictive of daily smoking by the age of seventeen were: “Negative labeling of the child by the parent, perceived lack of value towards parental relationship, perceived importance of family activities, lack of time spent with one’s family, average number of weekday evenings spent with the parent and frequency of participation in family activities in the last year”. They also found that having an older sibling who smoked increased the chance of becoming a daily smoker and there was more experimentation with smoking. Miller et al (2002) also concluded that positive family relationships may reduce the risk that the adolescent becomes a daily smoker even if they have passed initiation and experimentation on the tobacco trajectory. However, the data for Miller’s study are from the late 1970’s through mid 1980. Social norm changes towards smoking and current laws against smoking may render these data outdated.In a more recent study, Simons-Miller, Chen, Abroms & Haynie (2004) also concluded that parental relations continue to influence both directly and indirectly whether an adolescent moves along the tobacco trajectory to become a daily smoker.Simon-Miller et al (2004) used data from 1996 from 1320 students in one Maryland school district with racial break down of 66% Caucasian, 25% black and 9% other for subjects. The aspects they studied were peer affiliation, parental influences and smoking stage progression. (Simons-Morton et al, 2004).They found that parental involvement, monitoring and expectations decreased the chance of child progressing forward on the tobacco trajectory but that these traits needed to be sustained over a period of time and not just exhibited at the initiation stage to be protective. They also found that parental influence had an indirect effect in protection against stage progression.

Simons-Morton et al (2004) found that adolescents that start out higher on the tobacco trajectory at earlier ages, tend to have more friends who smoke and the number increases over time. Adolescents who smoke are more likely to want to associate with other adolescents who smoke. Parents who place limits on the friendships formed with these new adolescent friends that smoke indirectly influence their adolescent’s progression . This may be limited to early adolescence since at this age many do not smoke and as the adolescent ages exposure to others who do smoke either on a regular basis or through experimentation increases. Stanton, Flay, Colder and Meta (2004) hypothesized that the escalation of smoking along the tobacco trajectory may be different than just at the initiation stage. They identified six stages: early rapid escalators, late rapid escalators, late moderate escalators, late slow escalators-smokers, stable puffers, and late slow escalators-puffers. The different stages depending on the age the adolescent started smoking and if the smoking increased quickly or over a longer period of time.The data used was from a longitudinal study from the Dunedin Multidisciplinary Health and Development Study in New Zealand. The subjects were interviewed at ages 9, 11, 13, 15, and 18 for a total of 306 subjects with 96% being Caucasian.Early predictors of future smoking at ages 11-13 included attention deficit and conduct disorders. At age 15, behavioral problems, depression scores and change of address were predictors. By age 18, poor school performance, not belonging to organized clubs and attachment to friends were predictors of smoking behavior. Intention to smoke or preparatory stage was indicated for future puffers at age 9 but not leading into rapid escalation of smoking behavior. However, the mother’s psychological symptoms when the child was 9, were an early predictor of smoking behavior. However, all of the factors mentioned may not be related to smoking specifically but may be indicative of underlying problems in the family unit.

The purpose of this paper was to investigate whether parents have an influence on whether their adolescent smokes or not. Although some parental factors do influence their adolescent no pattern was observed and it is not apparent which factors have the greatest influence.It is evident that there are inherent problems with studies in this area, due to lack of standardized definitions and inability to conduct double blind studies due to ethical reasons. Even the studies mentioned suffered from attrition of subjects, which may under estimate actual smoking rates and behaviors because most data are collected from schools. This eliminates those adolescents who do not attend school or who were absent when the initial testing was done. Adolescents who have dropped out of school, have frequent address changes or absenteeism may have higher smoking rates than students that are able to be followed for longitudinal studies. It may be that students who are stable enough to be followed, may have a more stable family life also which may influence smoking behavior.Further studies could be structured to show gender, racial and social-economic differences. Of further interest is the reason why smoking mothers influence their daughters but not their sons (Avenevoli et al 2003).Another avenue for research could look at these different factors along with social norm changes that have happened with smoking over the past decade and whether these changes affect adolescent smoking. Another area could be whether a parent has been a never-smoker or a ex-smoker or a current smoker struggling to quit, how this may influence the preparatory stage.This area of study is important in understanding how an adolescent moves from one stage of the tobacco trajectory to the next and what influences the progression and how parental influences changes with the different stages. This can lead to better prevention and intervention techniques, which over a life time will reduce the death toll from smoking.
References:
Adalbjarnardottir, S. & Hafsteinsson, L. G. (2001). Adolescents’ Perceived Parenting Styles and Their Substance Use: Concurrent and Longitudinal Analyses. Journal of Research on Adolescence, 11 (4), 401-423.Avenevoli, S. & Merikangas, K. R. (2003). Familial Influences on Adolescent Smoking. Addiction, 98 (Suppl 1), 1-20.Flay, B. R. (1993). Youth Tobacco Use: Risks, Patterns, and Control. In C. T. Orleans & J. Slade (Eds.), Nicotine Addiction, Principles and Management, (pp 365 – 384). New York: Oxford University Press.Miller, T. Q. & Volk, R. J. (2002). Family Relationships and Adolescent Cigarette Smoking: Results form a National Longitudinal Survey. Journal of Drug Issues 0022-0426/02/03, 945-972.Simons-Morton, B., Chen, R., Abroms, L. & Hanyie, D. L. (2004) Latent Growth Curve Analyses of Peer and Parent Influences on Smoking Progression Among Early Adolescents. Health Psychology, 23 (6), 612-621.Stanton, W. R. Flay, B. R., Colder, C. R. & Mahta, P. (2004). Identifying and Predicting Adolesecent Smokers’ developmental trajectories. Nicotine & Tobacco Research 6 (5), 843-852.U.S. Department of Health and Human Services. (2000). Clinical Practice Guideline: Treating Tobacco Use and Dependence. Public Health Service.

Teen Smokers, part two

As a follow up to yesterday's post, here is a blog that gives some good information for parents of teen smokers.

http://opsnewsletters.blogspot.com/2008/07/teens-tobacco.html

Teen Smokers Get Addicted Quickly

The average age that kids will light up that first cigarette is about 12 years old. It starts with experimentation but within 6 to 9 months a pattern has already developed where this child is smoking on a semi-regular basis--the first hint of addiction. Less than 24 months after that first cigarette, the teen smoker is smoking on a daily basis and is addicted. A Canadian study recently showed that most of these teen smokers do want to quit but find it too hard. The study was sponsored by the Canadian Cancer Society and most teen smokers will try to quit the first time within a couple of months of the first cigarette. If they relapse though, they begin to see that quitting is harder than they had thought and if they are still smoking within two years, the cravings and withdrawal symptoms have increased that many doubt their ability to stop.
This study shows the need to take aggressive measures early on if they think their child is experimenting wtih smoking. the child is more likely to smoke if they have an older sibling who smokes or one or both parents smoke. It is never too early to talk to your child about the dangers of nicotine addiction.

How Kid Nicotine Deceives Teenagers

Most smokers start as teenagers or younger and they ALWAYS think that they won't become addicted or that they will stop before they have any harmful effects from smoking but this is just another way that Kid Nicotine worms it's way into a person's life. The child starts by experimenting with one cigarette here and there but soon a pattern develops--maybe one every day after school, or one every Saturday, regardless as soon as ANY pattern shows up, that person is already showing signs of brain changes caused by the use of nicotine. The younger the person starts smoking the more likely they are to become addicted because their brain is still developing and Kid Nicotine changes that growing brain into one that NEEDS nicotine. Our brains don't fully develop until we are in our 20's (for women, about 20-21, for men 24-25). These brain changes can occur within a few months of experimenting with that first cigarette.

Stops Smoking: Are We Losing the War on Drugs?

In our War on Drugs, we do everything we can to protect our children from illegal substances, we destroy the crops, execute the pushers and rehabilitate the users, yet with tobacco we subsidize the crops, exonerate the pushers and blame the users.

The Desert Sun newspaper in Palm Springs, CA reported on May 17th that 22% of retail businesses in the City of Palm Desert sold cigarettes to underage decoys (Businesses cited for selling tobacco products to teens). While it is illegal to sell cigarettes to minors in all 50 states, this law is being ignored in Palm Desert.

Would we ignore these statistics if it were alcohol that was being sold to minors? As a society, we see teen smoking as a right of passage and say “Thank God it’s only cigarettes and not something worse.” Yet tobacco kills more alcoholics and substance abusers than all other drugs put together and is more addictive than heroin.

Where is the outrage?

Underage smoking is the first addictive substance for individuals who later become addicted to alcohol and other substances. Smoking kills 50% of it’s habitual users. Those with mental illness are more likely to start using tobacco early in life. Most smokers start before they are legally able to buy them. We need to do everything we can to stop this.

It is time for society to step up to the plate and stop teens from buying a substance that is likely to kill them. It's time to stop thinking of smoking as a bad habit and recognize the killer it is. It's time for all parents to truly protect their children from tobacco.

Tobacco is the only deadly substance that is almost totally unregulated. In California, as an effort to stop sales to minors and enforce compliance, cities, statewide have partnered with the local Health Departments to set up sting operations and catch those selling to minors. Each city or county has set up a procedure to license the right to sell tobacco and when retailers fail to comply, that right can be revoked. This has worked so well for the City of Desert Hot Springs, that in less than a year they went from 48% of retail stores selling to underage decoys to ZERO selling tobacco to minors.

It can be said that if they want to smoke, they will find a way but it's time for us to stop making it easy for them.

Smoking Bans Encourage Smokers to Quit

In the past it was socially acceptable to smoke, it is now becoming not acceptable because of the effects of environmental tobacco smoke, which does affect the bodies of non-smokers that are exposed to it. There is NO controversy about the effects of environmental tobacco smoke, except from the tobacco companies, the same companies that for 50 years lied to us about nicotine being not addictive, lied in front of Congress and now admit they knew of the harmful effects since the 1950's but were protecting their profits. They are using the same arguments now for environmental tobacco smoke. don't believe them again.

Another city in California is extending the smoking ban to parks and beaches. Part of the reason is that smokers consider the outdoors a giant ashtray and at beaches, the butts make it into the water and can poison the wildlife, burn the feet of barefoot beach goers and expose our children to addictive behavior. Some smokers consider this an infringement of their "right to smoke" yet their "right to smoke" ends where my nose begins.

A recent study showed that in cities with bans on smoking in restaurants, teenagers are less likely to to become smokers. The theory is that these kids are being shown that as a society, smoking is unacceptable, while the perception in towns where smoking is allowed, the teens see smoking as the norm and that it is acceptable behavior.

Passing and enforcing laws limiting smoking encourages our kids not to start smoking and it encourages smokers to self reflect about their behavior and possibly encourages them to the think about quitting, if for no other reason than the hassle factor.

I would encourage all non-smokers to contract their local officials and encourage them to pass smoke-free areas for the health of everyone.