July 1, 2005
Many Kids Still Don’t Think Tobacco Is Addictive
It's crucial to stop children from ever smoking, survey suggests
Although most children share a less-than-glowing opinion of smoking, a significant number -- about 25 percent -- believe cigarettes aren't addictive and kicking the habit is easy, a new study suggests.
Such views were part of a range of mixed opinions about smoking that were expressed by a group of 10- to 14-year-old boys and girls before and after participating in a family smoking-prevention program for the better part of two years.
While researchers found that less than 10 percent of the kids entered the program thinking that cigarettes can help people keep off weight or relax, about a quarter said they didn't mind being around smokers and thought smokers could quit anytime they wanted.
In the July/August edition of the American Journal of Health Promotion, the study authors report that the program produced some conflicting results. For example, they found that the most common positive attitude among kids about cigarettes -- that smoking can help you feel more comfortable at parties or other social activities -- actually rose by the program's end, from just under 20 percent to nearly 30 percent.
"Over the 20-month program, about half the children increased their positive attitudes about smoking," said Terry Bush, study lead author and research associate at the Center for Health Studies at Group Health Cooperative (GHC) in Seattle. "This information is coming from somewhere, so we need to think about teachable moments where we as health care providers, parents, youth leaders and teachers can talk about the risks involved."
Bush and her colleagues focused on children between the ages of 10 and 12 from 418 families in the northwestern United States who had health care coverage with either GHC or Kaiser Permanente -- two health maintenance organizations (HMOs).
Parent and child interviews were conducted just prior to beginning a smoking-prevention program, as well as at six months, 12 months and at the conclusion of the 20-month process. Participants were asked about their smoking habits, views on cigarettes and the frequency of family discussions about smoking, Bush said.
The parents were also asked about their level of involvement in and monitoring of their child's activities, as well as parenting and communication skills.
The prevention program provided written and video-taped educational material -- including an anti-tobacco comic book and stickers -- along with occasional telephone counseling, newsletter updates, and smoking-prevention information provided by health care professionals during routine parent-child visits to their HMO.
Bush and her team found that family discussions about smoking were common, as was strong parental monitoring of childhood activities.
Positive views about cigarettes appeared to be more prevalent among children living in homes where communication was relatively poor and parents were less involved.
A parent's specific opinion regarding cigarettes, however, did not seem to influence the opinions of the children, who were aged 11 to 14 by the study's end.
Still, the researchers observed that while just under one-third of the children said they had no favorable attitudes about smoking when the prevention program began, by the program's end just over half had adopted at least one positive tobacco-related opinion.
Deeds, not words, appeared to be the sole parental factor related to this change of heart, said the researchers. They noted that living with a parent who smoked promoted positive attitudes about tobacco among the children.
The authors concluded that a wide range of influences appear to be leading children as young as 10 to develop misconceived notions about cigarettes. And, the researchers said, a better understanding of the factors involved is urgently needed.
"The importance of this from a public health standpoint is that we need, as educators, to help parents and providers and teachers get the conversation flowing before the children pick up a cigarette that someone has offered them," said Bush. "They are getting positive information from somewhere. This influence probably does not come solely from parents, and the tobacco industry is ruthless about putting out a more positive reflection on their product."
Bush cautioned against exposing children to hard-sell scare tactics, however. "We have to counter these influences with facts they can digest," she said, "instead of just presenting them with how it will kill you. That concept is probably alien to them. They don't really conceive of long-term health effects and dying of a smoking-related disease."
Danny McGoldrick, research director for the Washington, D.C.-based Campaign for Tobacco-Free Kids, agreed.
"I think the general point is that addiction is a very powerful force that keeps people smoking. But kids in particular don't understand this until it's too late," he said. "And so I think the key is to do everything we can to prevent kids from ever starting. Once you're addicted, you're addicted -- and you have all the barriers and issues with trying to quit."
McGoldrick advocates helping kids steer clear of cigarettes via a three-pronged approach: combining prevention-education programs with tobacco tax hikes that make cigarettes too expensive for kids, along with legislation making public and work places tobacco-free.
"The key point," he said, "is to stop kids from ever starting. And the good news is that we know a lot about how to do that."
For more on teens and smoking, check out the Campaign for Tobacco-Free Kids.