Surgeon General's Report Finds Youth Smoking Remains a Serious Concern
Smoking rates in the United States have dropped by half over the past four decades, due in large part to a diverse array of tobacco control efforts, including advertising campaigns and public smoking bans. This decline has been a rousing public health victory, marked by significant drops in lung cancer cases and death from the disease.
A new Surgeon General's report, however, clearly indicates that significant challenges remain. Preventing Tobacco Use among Youth and Young Adults highlights some disturbing trends, including a major slowdown in the falling rates of tobacco use among adolescents and young adults and an uptick in smokeless tobacco use among certain youth groups.
Much of the blame for the changing trends, the report states, lies at the feet of the tobacco industry and its heavy marketing of tobacco products using strategies that particularly appeal to adolescents and young adults.
During a March 8 briefing on the new report, Surgeon General Dr. Regina Benjamin stressed that the stakes are high. "This report challenges us to end the [tobacco] epidemic among young people," she stated.
Tobacco control efforts must focus on adolescents and young adults, Dr. Benjamin said. Overall, about 600,000 middle school students and 3 million high school students currently smoke. Ninety percent of smokers begin before the age of 18, she added, and one-third of 18- to 26-year-olds smoke.
"That's a higher rate than any other age group," Dr. Benjamin said. "So this is a serious public health issue."
The last Surgeon General's report on youth and tobacco was issued in 1994.
"Since then we've learned a lot about the science of nicotine addiction, the health consequences of tobacco use among youth, patterns of youth tobacco use, how addiction develops, and determinants of addiction," said Dr. Yvonne Hunt of NCI's Tobacco Control Research Branch.
For example, there is sufficient evidence to conclude that smoking reduces lung function and impairs lung growth in children and adolescents, the report stated, and that it can lead to abdominal aortic atherosclerosis—the thickening of the portion of the aorta that runs through the abdomen—increasing the risk of heart disease and aortic aneurysms in young adults.
The new report is also the first to comprehensively analyze tobacco use behaviors among young adults. "That's important because this age group hasn't been a major focus of prevention efforts in the past," Dr. Hunt continued. "And yet it's a group where we see a significant amount of tobacco initiation, as well as escalation to nicotine dependence."
The portrayal of smoking in movies and other popular culture is a substantial cause of youth tobacco use, the report found, and tobacco industry marketing plays a large role in encouraging young people to smoke.
Despite legal limitations on tobacco marketing to youth, the tobacco industry still spends $29 million a day to market tobacco products, much of it aimed at counteracting taxes on cigarettes. As young smokers are more price-sensitive than older smokers, the report found, this kind of marketing tactic has a larger impact on youth.
In a major racketeering case, for example, a federal court found in 2006 that the country's biggest cigarette companies had known for decades that recruiting new, teenage smokers was essential for their continued profitability, and for that reason, they designed their marketing campaigns to target young people and to entice them to become lifelong smokers.
The marketing works, particularly on adolescents, stressed Assistant Secretary of Health Dr. Howard Koh. And, the report showed, adolescents are more susceptible to the addictive effects of nicotine.
"It's not an accident" when a teenager starts smoking, Dr. Koh said during the briefing.
Packaging all of the findings into a Surgeon General's report is important, noted Dr. Jean Forster of the University of Minnesota, whose research focuses on health policy and adolescent smoking. "It really highlights the weight of the evidence about the factors that influence tobacco use," Dr. Forster said. "And it emphasizes that we have not solved the problem."
The report comes at a time when many U.S. states have slashed spending on tobacco control, said Matthew Myers, president of the Campaign for Tobacco-Free Kids.
"Recent studies show that these programs not only reduce smoking and save lives, but also save money by reducing tobacco-related health care costs," Myers said in a statement.
Future gains will require a mix of proven tools and more research, Dr. Hunt said. "We know that there are important policy measures that can have an impact when implemented as part of a broad, coordinated strategy," she said. "But we also need research that will help us better understand how to intervene, especially during those early stages, to prevent experimental use of tobacco from escalating to more regular use.