Stewart Dietle was 8 when his friend stole one of his mother’s cigarettes and the boys wandered outside for a smoke.
“Usually, I think, it feels harsh the first time, but it wasn’t for me. I liked it. I got a head rush; it got me dizzy.”
Dietle believes he got hooked when he was 10. By 11, he had a smoker’s cough, he said.
Today, at 17, “When I cough, my lung comes out,” said Dietle, taking a deep drag from a cigarette outside a self-service laundry across from Taft High School. “I’ve had bronchitis three or four times. But I really don’t think about it all that much.
“You only live once.”
Dietle and more than 3 million other American adolescents-a new generation of avid smokers-are suddenly locked in the uneasy spotlight of the anti-smoking movement, the bane of social scientists who realize they are the key to a smoke-free future.
In the preface to her new 300-page report on preventing tobacco use among young people, Surgeon General M. Joycelyn Elders called kids the “new recruits in the continuing epidemic of disease, disability and death attributable to tobacco use.”
The facts are plain. Tobacco use is the leading cause of preventable death in the U.S., responsible for more than 400,000 deaths a year and millions of dollars in avoidable health-care costs.
Studies show that 82 percent of smokers start lighting up before they turn 18. When children are hooked early, the shrinking pool of American smokers is replenished with a new crop of lifelong devotees, according to Elders’ report.
The nonsmoking message clearly has gotten through to adult smokers, according to the National Cancer Institute, which reported in November that 28 percent of American men and 19 percent of American women had quit smoking, reducing the adult smoking population to 27 percent of men and 22 percent of women.
But while society has begun to shun smokers, and millions of adults are trying everything from the patch to hypnosis in trying to quit, an estimated 3,000 youths begin smoking every day in America, according to figures issued by the national Centers for Disease Control and Prevention.
Two-thirds of adolescents have tried smoking-almost one-third before they’re 14. By their senior year of high school, 28 percent of teenagers are confirmed smokers, the surgeon general’s report concluded.
While health experts take heart at statistics showing that more adults have quit smoking, they voice serious concern about an increase in smoking among the young.
A University of Michigan study released in January showed cigarettes, as well as drugs, are making a “clear comeback” among youths after a decade of declining or remaining steady.
The rate of daily smoking for 8th graders rose to 8 percent from 7 percent; for 10th graders it went to 14 percent from 12 percent; and for 12th graders it rose to 19 percent from 17 percent.
It may be that society’s blustering anti-smoking tone has had a backlash among young people, who find cigarettes a form of rebellion.
“For a lot of my friends, they just started out taking little puffs at a party or something and they got hooked,” said Jim Kuhns, 17, of West Covina High School. “It’s never a question of liking smoking, it’s a question of they’re addicted to it.”
But Kuhns said he hangs out with punkers, and many of them smoke “because we want to be rebels.”
“You’re looking for stereotypes, and that’s part of it,” he said.
The editor of the surgeon general’s report, professor Cheryl Perry of the University of Minnesota School of Public Health, said data included in the report stunned even tobacco researchers, because it pointed out how many children have already become hooked on smoking.
“What was very shocking for me in the report was the level of addiction among high school students-the number of kids who want to quit, have tried to quit and can’t quit,” Perry said.
Smoking-cessation efforts have been ineffective among teenagers, according to a National Cancer Institute report to physicians published this year. Researchers who formed adolescent smoking-cessation clinics found teenagers willing to quit but unwilling or unable to follow through on meetings or smoking-cessation plans.
Some social scientists believe they may lack the emotional maturity to go through withdrawal from the physical and behavioral addiction, while others believe smoking may be so interwoven with other social problems (family trouble, difficulties at school) that it cannot be addressed as a single issue.
Regardless, Perry said, preventive efforts are key to halting the trend.
And that’s not going to be easy, because kids are smoking at a younger age, smoking more cigarettes, and smoking them more openly than in the past, said Anthony Biglan, a research scientist who specializes in teenage-behavior studies at the Oregon Research Institute. However ostracized adult smokers have become, smoking is still pretty cool among today’s youth, Biglan said.
“My sense is, it’s generational,” said Biglan. “There’s been an upturn in marijuana use too. Times changed, and now they’re changing again.”
The question looms for scientists such as Perry and Biglan: How do you convince children smoking isn’t cool? How do you prevent them from taking the first puff?
One approach uses negative peer pressure, said Perry, who praised kid-driven campaigns that depict smoking as filthy, expensive and unhip. “The point is to create a peer norm that it is not cool to smoke, and that it is not acceptable,” Perry said.
In fact, a University of Michigan survey showed that in 1991, most high school seniors preferred to date nonsmokers (74 percent), think smoking is a “dirty habit” (71 percent) and believe pack-a-day smokers are putting themselves at great risk (69 percent).
The surgeon general’s report also warned that adolescent smoking is associated with later alcohol and illegal drug use, that younger smokers are more likely to become heavy smokers, and that people who begin smoking at an early age likely increase their lifetime chances of respiratory diseases, cardiovascular disease and many forms of cancer.
But younger kids aren’t getting those messages.
Curiosity is the No. 1 reason young smokers say they start, the report said.
Once they’re hooked, kids find plenty of reasons to keep puffing, according to a 1987 Minnesota study that found adolescent smokers were more likely than their nonsmoking peers to view smoking as “a way to act mature, be accepted by a peer group, have fun, cope with personal problems and boredom, or be rebellious.”
Barring changes in attitude, anti-smoking forces must look for ways to “erect barriers between kids and cigarettes,” Perry said. Parents, teachers and doctors must clearly voice their opposition to smoking, she said.
“A lot of parents are afraid of alienating their kids, but this is an area, just like alcohol, where I think they can be very firm, telling them, `You’re not allowed to smoke inside the house or out of the house, and this is the consequence if you do.’ “
Perry believes adolescents should not be left unsupervised to allow time for smoking, either at school or at home, since many studies show kids are more likely to smoke if adults are not around.
Access to cigarettes should also be blocked, at home and in society, she said.
“Kids sometimes get cigarettes from their friends or their parents, but the vast majority of the time, they buy them,” said Biglan of Oregon. “That is the thing the whole public-health community is focused on right now. It’s easy for kids to get cigarettes, and we’ve got to make it hard.”
One approach that seems certain to fail is drumming into children that smoking is bad for their health. They know.
Sarah Hardy, a 17-year-old senior at Henry David Thoreau Continuation High School in Woodland Hills, said she’s heard everything there is to hear about smoking and lung cancer, heart disease, emphysema, birth defects and wrinkles-and she believes it all.
Smoking Marlboros every day saps her energy, she said, and drains her body of vitamin C.
“Oh, I know it’s bad. I’ve tried to quit,” said Hardy. “I think I quit for three days once, but you get the craving for it. You feel stressed and tense.”
Hardy started smoking because her friends smoked, she said, and now she can’t stop.
“It’s pretty clear now that you can get a kid to learn the facts about smoking causing lung cancer or heart disease, but I’m not sure how much real relevance that has to kids,” said Biglan.
One problem with using scare tactics to convince kids of the dangers of smoking is that teens don’t die of smoking, even though they do suffer documented health problems-wheezing, shortness of breath, coughing up phlegm and suffering chest colds more often than their nonsmoking peers.
Almost all smoking-related deaths-from lung cancer, congestive heart failure, emphysema, stroke and other causes-occur after 40, according to the National Center for Health Statistics.
One way kids might be dissuaded of tobacco’s allure might be to ban cigarette advertising and tobacco-industry promotion of sporting events and concerts, Biglan said.
Today’s adolescents grew up with Joe Camel, who started appearing in ads in 1988, he said. In a study published in 1991 in the Journal of the American Medical Association, 6-year-olds were able to identify a picture of Old Joe Camel as readily as they recognized Mickey Mouse.
Although the tobacco industry has consistently denied that Joe Camel was designed to appeal to children, critics note that during the first four years of the Joe campaign, smokers younger than 18 who said they preferred Camels rose to 33 percent from one-half of 1 percent.
Peggy Carter, manager of media relations at R.J. Reynolds Tobacco Co., cited faults in the methods used in the Journal of the American Medical Association study and said recognition of Old Joe by children does not change their negative attitudes toward smoking.
“The predominant factor in teen smoking is peer pressure, not advertising. Research shows that across the board,” said Carter.
But Biglan believes that tobacco ads give children an impression during many formative years that smoking is something that cool, risk-taking, independent, attractive and svelte young adults do.
Much of that impression, he said, is created through $4 billion a year in advertising and promotions by the tobacco industry.
Philip Morris Inc.’s Marlboro and R.J. Reynolds’ Camel cigarettes-two of the most widely advertised and promoted brands-are favored by 70 percent of adolescent smokers, according to a 1992 Gallup survey.
Karen Daragan, a spokeswoman for Philip Morris Co., said children are “certainly not a market of ours.”
Daragan said the company does not study why children prefer smoking Marlboro cigarettes, but noted that the brand’s popularity crosses all age groups and is not limited to minors.
