Since 1997, research has consistently pointed to a slow but steady decline in youth smoking. The share of high school seniors who smoke daily decreased from 22 percent in 1997 to 19 percent in 2001, with similar decreases for 10th- and eighth-graders, according to the U.S. Department of Health and Human Services (HHS). The American Legacy Foundation’s National Youth Tobacco Survey (NYTS) showed an 18 percent drop in smoking among high schoolers from 2000 to 2002.
Those declines have coincided with new funding for local tobacco prevention programs for youth that work to dispel myths and dismiss the supposed coolness of smoking. Ironically, the money has come largely from a source that many in the youth service field view as an adversary: the tobacco industry.
In 1998, attorneys general in 46 states reached a Master Settlement Agreement (MSA) with six major tobacco companies. Part of the $246 billion that the companies agreed to pay was set aside for programs in each state that focus on tobacco prevention.
It’s impossible to say whether that funding has contributed to the smoking decline. And even with that decline, an estimated 15 percent of teens smoke weekly, according to a 2002 poll by Pride Surveys. Data from the NYTS found that 80 percent of all smokers started before age 18, and one-third had their first cigarette before age 14.
Smoking prevalence varies widely among ethnic groups. According to the National Survey on Drug Use and Health, conducted by HHS, the share of Native American 12- to 17-year-olds who reported smoking within the past 30 days was 30 percent between 1999 and 2001– twice as high as the next highest group, white males. On the other end of the spectrum, only 8 percent of African-American youth reported smoking.
Meanwhile, money for local programs may soon become more scarce. The tobacco companies’ obligations under the MSA to the Legacy Foundation, which funds smoking prevention programs, has expired, although the nonprofit has kept nearly half of the $1.4 billion it received to create an endowment. (See “As $300m Disappears, Legacy Glides Off Financial Cliff,” May 2003.)
Whether funded through Legacy or the states, almost all the prevention programs include education about the health risks of tobacco. Some go further by tackling the touchier issue of tobacco product marketing, alleging that tobacco companies target new, underage smokers illegally. Some employ even more aggressive tactics, including pressing political leaders for policy changes and conducting undercover stings and research on youth.
Research by Child Trends, the Washington-based research organization, indicates early success for programs that challenge tobacco marketing tactics or provide a community-based balance of media messages and local activities.
These types of programs work best, Child Trends says, if they supplement a multi-component, school-based program like Project TNT (Toward No Tobacco Use). Such school-based programs typically include a mix of building self-efficacy with exercises in resisting peer pressure and making good health decisions.
What hasn’t worked? According to Child Trends, providing a just-the-facts health message and measuring retailer compliance with tobacco sales laws show little evidence of being effective.
What local programs have most in common is that they try to leave as much control as possible in the hands of youth leaders.
While many drug and alcohol prevention programs rely on the experiences of adults or the authority of police officers to deliver their messages, the most effective anti-tobacco programs use peer influence as their strongest tool.
Following are profiles of four such efforts:
Reality Check – Clinton County
20 Ampersand Dr.
Plattsburgh, NY 12901
“Do you have any smoke-free movies?”
The words are familiar to video rental clerks in Plattsburgh, N.Y., a town next to a former Air Force base near the state’s borders with Vermont and Canada.
That’s because youth from the Reality Check program pose that question to clerks every time they walk in to rent a video. The determined (albeit pesky) teenagers are part of a statewide effort to call attention to what New York public health officials see as the tobacco industry’s advertising assault on teens.
The 3-year-old Clinton County program is run under contract by the Champlain Valley Family Center in Plattsburgh. The program is funded through a $65,000 youth empowerment grant from the New York Department of Health’s Tobacco Control Program, which distributes similar grants to one agency in each of New York’s 62 counties.
The health department wants the projects to run with minimal adult involvement. “There’s one adult involved in the program here: There’s me,” says Dana Isabella, the center’s youth empowerment coordinator.
Isabella spent the first year recruiting teenagers wherever she found them, with help from seven charter-member youths. (The program now has 75 members.) She focused on attracting those who did not typically lead in other youth projects, “the kind of kids many considered ‘followers,’ or kids detached from the mainstream social net.”
To get the word out, the group hosted community events, such as a monthly coffee house. “Music has been a big draw for us,” Isabella adds. “We would regularly do things like ‘battle of the bands’ to get kids in one place.”
Reality Check’s first campaign, “Stick It To ’Em,” drew attention to tobacco advertisements in magazines often read by youth. Many tobacco firms have policies against advertising in magazines with a youth readership of more than 15 percent, but Isabella says those policies rely too much on subscriber information, rather than readers who pass magazines around.
Reality Check surveyed its members to find out what magazines they read. Then the kids rooted through those magazines in doctors’ offices and public libraries (with permission). When they found a tobacco ad, they put a sticker on it bearing one of five messages criticizing the company for advertising in a magazine read by youth.
That project was “a great way to get their feet wet,” Isabella says, because it was local enough that youth could see the results, without the politicking and drawn-out frustration of fighting for legislative change.
Stick It To ’Em was the only project that youth members had no part in developing. The project was recommended to administrators by Golin Harris International, a Chicago-based public relations firm that has worked with anti-tobacco groups since the 1998 master settlement.
Since then, most of the decisions have been made by the youth. There’s a statewide group composed of two youth representatives from each county, with a regional panel of 18 selected from that group. The panel develops ideas for programs, which are then fleshed out at larger summit meetings.
The panel’s first initiative, begun in the fall of 2002, took aim at the movie industry. The Hollywood Project balanced local events with an intentionally annoying letter-writing campaign to Tinseltown glitterati. The mission: Draw attention to how often movies rated appropriate for youth show characters using tobacco.
According to research led by Stan Glantz, director of the Center for Tobacco Control Research at the University of California San Francisco, 66 percent of moves rated PG-13, PG and G included at least one smoking scene in 2003, double the rate from 2001.
On the local level, the Clinton County program took a two-pronged approach. The first was the video rental store operation. Then it hosted “Stomp” events, in which the group rented a local movie theater and showed popular teen movies for free.
Each time a smoking scene occurred, members would stomp their feet and cough to drive home how many times such scenes appeared. “We screened ‘Daredevil’ once,” Isabella recalls. “It’s based on a comic book, of all things, and it has 38 instances of smoking.”
The campaigns have raised public awareness while developing leadership skills in some teens, but it’s impossible to measure its precise impact on youth smoking. A survey by the state health department shows that between 2000 and 2002, the number of youth reporting tobacco use dropped by 34 percent among middle schoolers and by 23 percent among high schoolers.
Isabella gives most of the credit for the lower figures to the health component of the state’s youth tobacco program, along with factors, such as higher cigarette prices.
Reality Check was recently funded by the New York state for another five years at a total of $25 million. Isabella expects the Family Center to secure the Clinton County contract again.
Youth Tobacco Prevention Corps
c/o San Dieguito Drug-Free Alliance (SDA)
4691 Cypress Glen
San Diego, CA 92130
Political change is a heavy wheel to get rolling. But after two years, the Youth Tobacco Prevention Corps (YTPC) is gaining momentum.
Program Director Candice Porter is not surprised by the impact of her group on keeping cigarettes out of the hands of youth. The group’s first victory came last fall, when YTPC engineered a highly publicized beach smoking ban in the city of Solana Beach.
Porter has been working with underage substance abusers for 12 years, all for the San Dieguito Alliance for Drug-Free Youth.
The small operation is composed predominantly of volunteer parents, educators and policy-makers from the community. “All of the directors run their programs out of their kitchen,” Porter says.
While most youth tobacco programs focus on bringing a message to youth, the corps sends a message from them.
The tobacco corps began within the drug-free alliance in 2002, with a $120,000 grant from San Diego’s Tobacco Control Resource Program (TCRP), part of San Diego’s health and human services office. Funding was cut to $78,000 for the past year, but was boosted by another TCRP grant in June for $50,000. Funding for this year is still pending.
Porter says last year’s staff of nine youths set the goals that the corps pursues today, with its staff having grown to 18: working with council members from the cities of Solana Beach, Del Mar and Encinitas to ban smoking on public beaches, and requiring tobacco retailers to register with those cities.
The group started by addressing the councils in September. The Solana council was “impressed” by the youths’ knowledge and research of the issue, says Porter, and it agreed to have city maintenance workers measure the amount of tobacco-related waste (namely, cigarette butts) on the beach.
The findings were staggering: Roughly 40 percent of the trash collected from Solana Beach’s 1.7 miles of public beach consisted of discarded cigarette butts. To bolster the study, the corps did its own cleanup. At one Solana beach, the group reported picking up 6,347 butts in one hour.
Proving the problem existed was simple enough. The challenge was proving there was public will behind the group’s call for a beach smoking ban. “So the kids took cameras and interviewed people, asking them if they’d support smoke-free beaches and parks,” says Porter. “Ninety percent said yes.”
The group convinced more than 300 people to sign and mail postcards to the cities explaining why they wanted smoke-free beaches and parks.
Last October, the corps scored its first victory. The Solana City Council voted unanimously to ban smoking on the city’s public beach and related parking lots. The ban made headlines from the San Diego Union-Tribune to the Sunday Times of London.
The youth are still working with the Del Mar council to institute a similar measure. The Encinitas council rejected their pitch for a beach smoking ban, but the city’s new mayor said she would put the issue on the city council agenda this spring, Porter says.
But for all the beaches and parks they could rid of cigarette butts, the real prize for the youth is the retail licensing proposal. It would require all tobacco vendors to register with the cities in which they do business and would ban mobile retailers. “We have ice cream trucks here selling cigarettes,” Porter says.
Vendors would pay a fee to help law enforcement officers see whether vendors are complying with age limits on tobacco purchases. Thirty-two California municipalities, including San Luis Obispo and Pasadena, have passed similar ordinances.
Anticipating resistance from vendors, the corps created a carrot-and-stick game plan. Last year, underage corps members tried to buy cigarettes at 64 outlets without showing proof of age. They succeeded at 19 sites. The teens plan to inform store managers of the results and ask them to support the proposed regulation. Porter and the youths figure the managers of the 19 sellers have to show outrage over their mistake and support the proposal.
The corps will also produce a catalog of stores that support the proposal, and give copies to such organizations as local PTAs.
The corps knows that pushing the legislation through will be difficult. “We’re talking about money here,” Porter says. “There is a money cost to merchants, so council members have constituents on board directly affected by this.”
She believes her greatest weapon is her human capital. “These kids are so jacked up and empowered,” Porter says. “They know they can get it done.”
Tulalip Tobacco Education Program
7520 36th Ave. NW
Tulalip, WA 98271
For as long as anyone can remember, growing up on the Tulalip reservation in Snohomish County, Wash., has meant growing up with tobacco. The tribe has depended for decades on income from tobacco farming.
Couple the crop’s economic payoff with its ties to certain tribal rituals, and at some point “it became completely acceptable that teens smoke,” says tribal member Debbie Parker. “Even adults would offer cigarettes to teens.”
That helps explain why Parker was shocked in January when police told her that not a single youth was seen smoking outside the teen dance held by her agency. Never mind that the event had been billed as a smoke-free dance. “I thought there would still be a few out there,” says Parker, the tobacco education coordinator for the Tulalip Health Clinic.
The dance followed the afternoon’s smoke-free basketball tournament, both creations of a new effort by the state, the Snohomish Health District and the clinic to change the minds of young adults about the role tobacco products play in their lives.
It’s a tough assignment on any reservation. The percentage of smokers among Native American teens – 30 percent – is twice as high as any other teen demographic group, according to a survey by the U.S. Department of Health and Human Services.
On the Tulalip reservation, the determination to change comes from the top. “Our chief, Teatmus Raymosef, told me, ‘What once helped us survive is now killing us,’ ” Parker says.
Her 2-year-old program employs two main strategies: using youth role models to influence the way other kids view smoking, and dispelling the popular myth that tobacco use is an extensive part of Tulalip culture and tradition.
The smoke-free basketball tournament was Parker’s first attempt to use the reservation’s most visible teens to make an impression. The players, she says, are “some of the community’s biggest heroes.”
Those players, whose captains obtained a $1,000 grant for the event from the Northwest Portland Area Indian Health Board, all pledged to stay smoke-free this year. With nearly 300 in attendance, Tulalip and teams from the Lome tribe split two games, while donning jerseys that read, “Keeping Tobacco Sacred.” Female competitor Lorraine Charley wrote the grant, with help from Parker.
It might seem odd to call tobacco “sacred” at an anti-smoking event. But Parker says she does not want to pretend tobacco is insignificant to the tribe.
Often, she says, tobacco is taken to the woods as an offering to spirits. In such rituals, the tobacco isn’t even smoked."
It is smoked in pipe ceremonies, where the pipe is passed for all to use, she notes. “Somewhere along the line, the fact that tobacco is used during ceremonies increased regular smoking,” she says. Sharing a cigarette grew into a social and habitual extension of old traditions.
Her campaign tries to get youth to associate tobacco more with ritual than with social custom, then to realize that its use in those rituals is infrequent, not something to be done out of habit.
The work is restricted by limited resources. Parker’s budget of $25,000 a year, through a grant from the state health department, covers her salary, travel expenses and supplies. It is supplemented by assistance and supplies from the Snohomish Health District, a contractor providing health services for the state.
She relies heavily on about 25 volunteers to help conduct educational forums in the community. For adolescents, the clinic puts on youth health fairs.
Aside from information on the rare instances of ceremonial tobacco use, the volunteers deliver a more standard message about health risks involved in cigarette use, complete with a demonstration showing the insides of a lung blackened by smoking (using either an actual lung or a photo). Parker trains a few of the more involved youth to deliver a similar presentation to elementary school students.
Teens are the major target of the campaign, but it tries to reach adults as well. For instance, the group mails to each home packets about the effects of second-hand smoking on youth. For preschoolers, Parker brought in a local troupe to put on puppet shows that deliver messages about making healthy choices.
The clinic has not been able to measure the success of the program in curbing youth smoking on the reservation, but Parker believes the program’s approach is bringing about change.
“Native kids, they know what it’s like going into schools and finding different value systems,” she says. By carrying a message anchored in both tribal heritage and health, “we’re not trying to become something we’re not. We’re trying to be us, just better."
African American Anti-Tobacco Alliance
George Washington Carver House
3035 Bell Ave.
St. Louis, Mo. 63106
For Brenda Mamon, enjoying the current low rate of smoking among black youth is like enjoying the weather in the eye of a
Behind her is a half-decade – from 1992 to 1997 – in which the smoking rate among African-American youth rose faster than among any of their peers, according to the U.S. Centers for Disease Control and Prevention.
Since 1997, the rate for African-American youth has dropped from 23 percent to 8 percent. But Mamon sees trouble, manifested by the aggressive advertising by tobacco companies in her neighborhood.
Borne of Mamon’s concern – and a 2002 startup grant of $82,000 from the Legacy Foundation’s Priority Populations Initiative – was the African-American Anti-Tobacco Alliance (AAATA), a peer-to-peer group trained in the particulars of tobacco health risks and energized to host community events to draw attention to the issue.
“There is not a lot of outreach into the black community about smoking,” says Mamon, CEO of the George Washington Carver House, a 65-year-old multiservice agency. “They say, ‘It’s OK, their numbers are low.’ But there is a tremendous marketing effort towards youth in our neighborhood. …
“I even saw a baby outfit with a Marlboro logo on it! We know we are a new market, and we’re being targeted.”
National research backs her up. Studies have found a higher density of tobacco billboards in predominantly black neighborhoods than in white ones. A 1998 study by the U.S. Surgeon General found that three African-American publications – Essence, Jet and Ebony – contained 12 percent more tobacco advertisements than did four popular general readership publications:
Newsweek, Time, People and Mademoiselle.
In 2001, Mamon convened focus groups at schools and churches, asking neighborhood youth to share their thoughts on what Carver House could do to combat negative behaviors like smoking. The youths overwhelmingly requested a youth-led program, she says.
“Who can educate African-American youth better than other African-American youth?” Mamon says. “They tend to listen to each other more than adults at the point we get them,” especially when the subject is trendy behavior many of them view as low-risk.
The alliance has about 40 members, all between the ages of 12 and 18. The program’s activities and agenda are governed primarily by the 10 youth officers, with staffers Kimberly Williams and Kenneth Dobson primarily providing technical assistance and other support. The alliance is actually headed by committee President Porsche Caldwell, a high school freshman who says she joined because she has grown up with two smoking parents.
Alliance members engage in two basic endeavors: community awareness and health education. The latter is generally performed at local education fairs, where youth speak to their peers about the harmful effects of smoking.
Caldwell says the message to her peers must include other tobacco products. “There are as many kids smoking cigars, or using cigars to roll weed, as there are smoking cigarettes,” she says. “And that’s even worse for them.”
A state survey shows that 2 percent more black youth report smoking cigars (such as Black and Milds or bidis) than report smoking cigarettes.
The teens receive training from alliance co-sponsors, such as the American Lung Association.
In bimonthly alliance meetings, Caldwell and the steering committee convene the rest of the group to pore over recent studies and statistics and to test games and presentations they plan to give at information sessions.
The community events create attention for the program (and more importantly, its message) while offering smoke-free activities to youth. One weekend, members took parents and grandparents apple-picking, forbidding the many adult smokers from getting their fix for the whole day. “It was tough for a lot of them,” Mamon says. “But everyone respected what the kids were trying to do.”
But most events focus on peer-to-peer activity. The alliance frequently hosts dances and movie nights, at Carver House or a nearby community center, for neighborhood teens.
Since the startup grant by Legacy, the program has been funded with $80,000 in grants from the Variety Club, the United Way of Greater St. Louis, and fund raising by Carver House. Mamon says in-kind resources have been the key to sustaining the program at minimal cost.