Project TEAM

In the United States, more than six million adolescents are smokers, or almost 30%. In Texas, about 10% of middle school students and 33% of high school students smoke. Overall, teen smoking rates are higher in Texas than they are in the nation. The percentage of high school students who smoke is 28.4% nationwide, and it is 32.8% in Texas. Rates among high school teens are also higher when measures go beyond smoking to encompass use of any type of tobacco (34.8%, nationwide; 42.1%, Texas). Within Texas, teen use of any tobacco is generally higher in boys than in girls, and it rises more dramatically in boys than in girls between middle school and high school. Use of any tobacco was found to be 18.7% in girls and 27.1% in boys in grades 6 to 8 in a 2002 report, but it rose to 35.7% in girls and 48.1% in boys in grades 9 to 12.

The good news from this 2002 report is that the prevalence of current tobacco use among Texas middle school and high school teens declined between 1999 and 2001. Overall, this was true across all grades 6 through 12, across both sexes, and across the three major racial and ethnic groups (white, African-American, and Hispanic). A few spikes, however, were found in subsets. Notable were an increase in cigar use by Asian children in middle school and in current cigarette use by Asians in high school Hispanic teens also reported data indicating an increase in cigar smoking and pipe smoking, although overall rates were about 12% and 5%, respectively, and increases were less than a percentage point. Increases were similarly small among African-American teens in smokeless tobacco (high school) and pipe use (middle school and high school).

While they are in high school, adolescents who smoke believe that in the future— say, five years after graduation—they will not be smoking—but, in fact, 75% of them are still smoking at that time. Clearly, teens find it difficult to quit, with 84% of smokers 12 to 17 years of age in one study reporting they "needed" or "were dependent" on cigarettes, and in another, fewer than 20% were able to remain free of tobacco for more than one month. In one study of girls in Britain, researchers found that 74% of girls who smoked daily and 47% of girls who smoked occasionally (63% overall) reported withdrawal symptoms similar to those of adults when they try to quit. Smokers with four or more withdrawal symptoms—dysphoria, anxiety, irritability, difficulty concentrating, restlessness, increased appetite, or insomnia—are identified as experiencing nicotine withdrawal symptoms. Some of these teens, who when they started smoking may have believed they were " too young to be hooked," discovered differently.

The seriousness of an adolescent's nicotine dependence is a significant factor in his or her ability to become tobacco free. Nicotine dependence has been rated in teen smokers from 20% to 70%, with such variables as the age of the population, the number of cigarettes smoked each day, the instrument used to measure nicotine dependence, and the scoring criteria affecting the measure. In the mid 1990s, researchers at The University of Texas M. D. Anderson Cancer Center adapted for adolescents the Fagerström Tolerance Questionnaire, which had been developed in 1978 to gauge adult dependence. Simple and quick to administer and score, this seven-question test has been psychometrically and biologically validated, and its test-retest reliability confirmed.

The nicotine dependence the test measures provides an index to teens' readiness to quit and the difficulty they will encounter when they attempt to quit. Time is not on the side of these young smokers, because the longer they smoke, the greater their dependence, and the greater their dependence, the less likely they are to be ready to attempt to quit. Findings also indicate that failing at quitting was likely to lead adolescents to give up trying, which is especially distressing inasmuch as research has shown that, on average, most successful cessation attempts come after four or five failures. It is not surprising, then, that success is rare: only 1 teen smoker in 50 who attempts to quit does so successfully.

The costs of teen addiction are great. Theoretically, teens who start smoking at 15 and pick up a pack-a-day habit will, if they smoke till age 65 years and pay $3.75 per pack, spend $363,423 over 50 years. If that habit is a three pack–a–day habit, the cost is well over $1 million. This does not also take into account the costs of lost productivity— approximately $3.75 per pack—and medical costs attributable to smoking—$3.45 per pack. Add to this the estimated years of life lost, which for men is 13.2 years and for women is 14.5 years. Unestimated remain the frustration and depression associated with a lifetime of smoking, which, like other costs associated with early smoking, are great.

Despite these high economic and emotional costs, selling to teens, say critics, remains a major aim of the tobacco companies, even though they agreed as part of the 1998 tobacco settlement with states to reduce advertising and promotional programs aimed at teens. The New England Journal of Medicine reported that two years later, in 2000, tobacco companies spent $59.6 million in advertising their most popular youth brands in magazines intended for the young. In fact, these same researchers estimated that more than 80% of U.S. youth were reached by tobacco ads an average of 17 times in 2000.

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