While smoking has decreased significantly among youth since the funding of anti-tobacco programs through the Master Settlement Agreement in 1998, data from the National Institute on Drug Abuse suggest that the decline has stalled over the past few years. Much of that stall can be attributed to two factors: More states reduced anti-tobacco program funding in recent years, and tobacco companies have stepped up their marketing toward young people.
Because more than 20 percent of high school seniors still smoke, youth advocates in the anti-tobacco field say now is not the time to stop funding anti-tobacco programs. But do those programs work?
Youth-focused anti-smoking programs have garnered some of the credit for a 40 percent decline in smoking among high schoolers from 1997 to 2003. But parsing out the contribution of such efforts is impossible. The approaches differ significantly, and youth workers don’t always agree on what’s effective.
April Kusper, director of youth advocacy for the Washington-based Campaign for Tobacco-Free Kids (CTFK), says efforts that take on “Big Tobacco” itself have been particularly successful. “Kids have a hard time connecting with ‘I’m going to die from tobacco use 40 years from now,’” she says. “But they don’t like the idea that they’re being targeted by Big Tobacco as a replacement market.”
That’s why the Saratoga County, N.Y., branch of Reality Check, a statewide youth-led program, focuses on attacking the tobacco industry. “The biggest issue is that teens believe they are invincible,” says Coordinator Lauren Rowland. “They’re not concerned with how doing something now will affect them in 20 years.”
Interactive, animated clips – here featuring siblings talking about the effects of smoking – are part of ASPIRE’s curriculum.
Photo: M.D. Anderson Cancer Center.
So Reality Check doesn’t really target smokers with messages about health. “We don’t hit them over the head with anti-tobacco facts,” Rowland says.
Does it work to hit the tobacco companies instead? Well, New York is one of the few states where the decline in youth tobacco use has not stalled. From 2000 to 2006, tobacco use among high school students there fell by 40 percent.
In Twin Falls, Idaho, local kids take a different approach, trying to influence legislation. The Magic Valley Tobacco-Free Coalition petitions state and federal legislators about anti-tobacco measures, and encourages local businesses and organizations to go smoke-free.
The group also runs elementary school programs taught by teens. Kusper at CTFK believes that campaigns are most effective when young people lead the charge. She says youth-led campaigns are better at jumping the hurdle of getting kids’ attention. “They have access to so much media,” Kusper says, that competing for their time is difficult. “Plus, their attention spans are short.”
An experimental program in Texas suggests that youth can be steered away from tobacco use on an individual level, involving minimal interaction with other youth or adults. The M.D. Anderson Cancer Center at the University of Texas developed a CD-Rom called ASPIRE, which allows kids on computers to select a program that best fits their specific circumstances. “Non-smokers get information on how never to become smokers, for example, and training on how to become tobacco control advocates,” says ASPIRE’s lead developer, Dr. Alexander Prokhorov. Smokers, on the other hand, learn behavior techniques to help them quit.
“We need to do this in a personalized way,” Prokhorov contends. “Kids all have different needs and cultural diversity. Computer technology lets us tailor the program better to individual circumstances.”
Some anti-tobacco programs still operate by the tried-and-true method of conducting outreach in classrooms. For example, at the Rockbridge County branch of the Virginia Tobacco Settlement Foundation program, prevention educators visit classrooms weekly to teach about the harm of tobacco use and healthier ways to handle stress and deal with peer pressure.
A crucial element, says Program Coordinator Kelly Shifflett, is delivering the program to the youths repeatedly, in different forms, year after year from second through ninth grades. “Kids need the reinforcement of positive social skills and managing their emotions,” she says. “It’s so much more comprehensive than just teaching kids not to light up.”
An increasing number of anti-tobacco programs focus on teaching youth about healthy emotional and physical lifestyles, as opposed to using scare tactics that show them what their lungs will look like in 30 years.
Regardless of their approach, just about all anti-tobacco programs are contending with funding cuts. Even the American Legacy Foundation’s popular “truth” campaign saw a decline, with the expiration of contributions from the Master Settlement Agreement. Most states are funding anti-tobacco programs at levels lower than those recommended by the Centers for Disease Control and Prevention.
The following programs are doing a lot with a little, in part by using youth themselves to get the word out.