Haze Over Youth Anti-Tobacco Lessons

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A study casting doubt on the effectiveness of anti-tobacco programs for youth has done something few would have thought possible: put anti-tobacco forces and Joe Camel on the same side.

The 15-year study tracking youths who'd been through stand-alone classroom programs, released in December by the Fred Hutchinson Cancer Research Center in Seattle, said the programs made no difference in whether the youths smoked as adults. Making headlines around the country (including USA Today and the Washington Post), the study was unwelcome news at a time when the states are debating how much of the $246 billion in lawsuit settlement money from the tobacco companies should go toward youth anti-tobacco efforts.

The news also comes at a nervous time for tobacco foes, because President Bush has criticized the federal government's court fight against tobacco companies and picked an attorney general, John Ashcroft, who has repeatedly voted against federal crackdowns on those companies.

Several newspaper editorials cited the Hutchinson research "to make a case against using tobacco settlement money to fund prevention programs," laments Joel Spivak, spokesman for the D.C.-based Campaign for Tobacco-Free Kids.

Tobacco companies weren't too happy, either; they funded the programs in the study.

Lost in the headlines, however, was a fine point: these were stand-alone classroom programs, an approach that has fallen out of favor. Their failure to curtail smoking, say anti-tobacco advocates, support the need for a more comprehensive approach that includes public education through the mass media, countermarketing, proper enforcement of youth access laws, and cessation programs for youths and adults.

"If you just say something in a classroom, and students go outside and see everything around them telling them something different, [the message] isn't going to be very effective," says Danny McGoldrick, research director for the Campaign for Tobacco-Free Kids.

"Evidence suggests that school-based programs have, in fact, been successful in impacting smoking among young people" when they're part of a more comprehensive approach, he said.

A 1989 Preventive Medicine study found that smoking prevalence among youth in schools that did not have smoking intervention programs increased 1.5 times as much as among those whose schools had both smoking prevention programs and a community-based component. And a 15-year study published in the American Journal of Public Health in 1998 showed that the reductions in tobacco use produced by a mass media intervention combined with a school and community-based education program last over time. Mean lifetime cigarette consumption was 22 percent lower among program subjects than among control subjects.

Cheryl Healton, president of the American Legacy Foundation (funded with the tobacco settlement money), says the more successful programs may be those where students are involved in crafting the message, rather than didactic programs where teachers stand at the head of the classroom taking on the mantle of authority figure.

American Legacy, which has launched an aggressive national media campaign against youth smoking, recently unveiled its own survey results to establish a benchmark for measuring the effectiveness of such campaigns. Based on questionnaire responses from 35,000 youth, the primary findings emphasize the incredible growth in smoking during the middle school years, pegging that as the most pivotal time for decisions regarding smoking. (The data indicate that Asian teens exhibit the steepest rise in smoking rates, from the lowest rates by ethnicity in sixth grade to among the highest six years later.) Stronger evidence of trends will come as the foundation tracks the progress of these youths over the next five years, and gauges the impact of its own campaign along with other factors that affect teen smoking.

Meanwhile, anti-tobacco foes see the federal government's crusade against Big Tobacco slowing under the Bush administration. For starters, Ashcroft, Bush's choice for attorney general, led the charge against Sen. John McCain's (R-Ariz.) 1998 tobacco regulation bill, which would have imposed huge penalties on tobacco companies unless they decreased rates of youth smoking. According to "ABC News," Ashcroft said at the time, "There is something that really hasn't been talked about in the debate: individual responsibility. ... People have known there are adverse health impacts."

Thus it would be surprising for Ashcroft to aggressively pursue the Justice Department's lawsuit against Philip Morris, R.J. Reynolds and seven other companies, which seeks to recover damages under federal racketeering laws. The lawsuit claims that the companies operated as criminal enterprises by misleading the public about the dangers of smoking. Congress has approved $24 million to pursue the lawsuit.

As a presidential candidate, Bush criticized the suit, saying that it appeared unlikely to succeed and "I don't think you can sue your way to policy."

"There is some feeling that this administration will let the lawsuit founder," says Spivak of Tobacco-Free Kids.

And the new secretary of Health and Human Services, former Wisconsin Governor Tommy Thompson, has had a relationship with Philip Morris that includes numerous trips funded by the company, which infuses millions of dollars into the Wisconsin economy with local production of food and alcohol products. As for smoking in the cheese state, in 1996 the National Cancer Institute ranked Wisconsin 49th of 50 states in its tobacco policies and programs to discourage youth smoking. On the other hand, Tobacco-Free Kids recently ranked Wisconsin 13th out of 46 states in distribution levels of tobacco settlement funds.

Contact: Fred Hutchinson Cancer Research Center in Seattle (206) 667-5000, or www.fhcrc.org; Campaign for Tobacco-Free Kids (202) 296-5469, or www.tobaccofreekids.org.

- Scott Kirkwood