When we think of the dangers facing children, most adults think of violence, illegal drugs, drunk driving, teen pregnancy and AIDS. We know that smoking is unhealthy, but most kids will try it, and many adults don't take it seriously. This latest Surgeon General's report reminds us that there has been a 600 percent increase in women's death rates from lung cancer since 1950, and that those deaths are a direct result of a smoking addiction that starts in childhood.
Smoking is a habit that almost always begins in youth, usually before age 16. If a child graduates from high school without ever smoking regularly, he or she will probably never will.
We think of smoking as an equal-opportunity bad habit, but the theme of the report is that smoking is a woman's issue. This theme has not yet been embraced by most women's organizations or advocates for girls and women, but the research is persuasive. Girls are more easily addicted to nicotine than are boys, and female smokers are more likely to die of lung cancer than are males who smoke the same number of cigarettes. And a great deal of advertising is aimed at persuading girls that smoking is sexy, fun and a way to show their independence.
Girls are as likely to smoke as are boys, and the decreases in smoking from the 1970s to the early 1990s were reversed a few years later. For example, the percent of girls who smoke dropped from 40 percent in 1977 to 26 percent in 1992, rose to 35 percent by 1997, then dropped to 30 percent by 2000.
The report points out racial discrepancies. Among high school
senior girls, smoking is most common among the American Indians and Alaskan Natives (39 percent) and whites (33 percent), and lowest among Hispanics (19 percent), Asians (14 percent) and African Americans (9 percent). The greatest reduction in smoking has been among black girls, going from 38 percent in 1977 to 7 percent in 1992, then up to 12 percent in 1998.
Girls who smoke are more likely to have parents or friends who smoke, and tend to have weaker attachments to parents and family and stronger attachments to peers and friends. They tend to take risks and to be rebellious, are less committed to school or religion, and are more likely to believe that smoking can control weight and negative moods. They also have a positive image of smokers, which can come from advertising, celebrities, or other role models (presumably including youth workers who smoke). This positive image may overcome concerns about the health risks.
Smoking continues into the young adult years, and those numbers are also rebounding: 37 percent of 18- to 24-year-olds smoked in 1965-6, compared to 25 percent in 1997-8. Recent trends suggest the numbers are increasing again.
Smokers may make the choice to start smoking, but not everyone who dies from smoking is a smoker. Second-hand smoke can cause death from lung cancer and heart disease among lifetime nonsmokers. Infants born to smoking mothers or to mothers exposed to second-hand smoke are at increased risk of small birth weight and other developmental problems.
The statistics in the report are somewhat overwhelming, and also a bit confusing - the trends are going down again, so why make such a fuss now? The reason, Surgeon General David Satcher reminds us, is that smoking causes more than 165,000 preventable deaths among women every year. The report has obvious implications for youth workers who smoke, and those exposed to smoking by their colleagues or by the youths with whom they work. But most important, the report is a reminder that smoking - the most common drug addiction in the U.S. - starts as an innocent experiment among youth, and becomes a potentially lethal habit that is very difficult to overcome. If youth workers tolerate it or shrug it off, they contribute to kids' perceptions that smoking is cool or at least acceptable, and not really dangerous.