The first time Jenni Sarpalius picked up a cigarette, she was in the 6th or 7th grade. A holdout, she had watched many of her friends experiment as early as the 4th grade.
Now 16, Jenni said she finds it difficult to put cigarettes down, despite slipping scores in competitive swimming, falling grades in school and two very angry, very worried parents at home.
Her smoking habit got her in trouble at school, and one recent evening landed her — along with other teen smokers — in front of an addictions counselor at a south suburban hospital-based smoking cessation program for adolescents as young as age 12. Students from throughout the south suburbs get to the program in a variety of ways. Some are sent by parents. Others go in lieu of a ticket from police for underage smoking or perhaps are sent by a school counselor.
“I smoke with my friends,” said Jenni. “It’s a social thing.”
And an after-school thing.
“You’ve been sitting in there with a teacher that annoys you and it’s like, nag, nag, nag,” said Jenni. “You’re bored and you have to have one.”
And a first-thing-in-the-morning or last-thing-at-night thing.
“I have one,” she said, “before I go to bed.”
After rising throughout much of the 1990s, the smoking rate among teens started to decline in 1998, according to an interagency federal report issued last July. Among 10th graders, the percentage of daily smokers dropped from 18 percent in 1997 to 16 percent in 1998. For 12th graders, the drop was slightly more pronounced, from 25 percent in 1997 to 22 percent in 1998.
That statistical bright spot, health advocates caution, should not detract from other harsh facts.
Each day, at least 4,800 young people, ages 11-17, take their first drag on a cigarette, according to the American Lung Association. Almost 2,000 of them — or 720,000 annually — will develop into regular smokers. About one-third of these child smokers will one day die of a smoking-related illness.
Some hospitals, schools and organizations such as the American Lung Association are trying to drive teen smoking rates down further with a variety of programs to keep adolescents who haven’t started smoking from beginning, and to encourage those who do light up to quit.
It isn’t easy.
The program that Jenni and other teens attend at Christ Hospital and Medical Center in south suburban Oak Lawn began in 1994. Since then, only about one-third of the students who have gone through the program have quit-according to self reports after they leave the course. Melissa R. Catania, an addictions counselor who has been working with smoking teens at Christ Hospital for a year, has yet to see a single one quit.
Though she encourages adolescents to call her for additional help and moral support after the program ends, none has.
In three, two-hour sessions held weekly, Catania does not dwell on the long-term health effects of smoking. Instead, she stresses the things teens notice and care about today: foul-smelling clothes and breath; coughing: stained teeth; and the weekly cost of a habit in which a single pack costs about $3.75.
“Most of the adolescents in this program have been smoking for at least a year, and many say they are already up to a pack a day, although I take into consideration the fact that they might be exaggerating,” said Catania.
But she added, “My goal, as unreasonable as it might be, is that they will stop smoking.”
If not the day they leave the program, she said, perhaps some time in the near future.
“I do think they will think about smoking more, perhaps when they cough or when they get sick,” she added. “Maybe they’ll at least slow down.”
Parents have widely varying reactions to teen smoking, Catania said. Some of the teens in her classes have said their parents buy them cigarettes. One teen in the current program said his mother, a smoker herself, did not object if he also lit up in the house.
Other parents, however, are angry and have been known to do everything from forcing teens to eat their cigarette butts to revoking privileges.
“You want to kill them,” said Carol Sarpalius, Jenni’s mother.
She figured out her daughter was smoking about a year ago.
“You could smell it,” Sarpalius said. “Unfortunately, I’m a smoker myself and I could still smell it. And I’d find things like ashes where they shouldn’t be, usually in the bathroom.”
Carol Sarpalius, a smoker for nearly 30 years, said flatly, “I’m scared for her and I’m angry.”
But she is at a loss for how to handle the problem.
“We’ve tried talking with her,” Carol Sarpalius said. “As you can see, it got nowhere.
“We’ve tried the patches with her. We’ve tried grounding her. We’ve tried, `You can’t talk on the phone.’ We’ve tried everything we can think of,” said Sarpalius. “She has three brothers, one older two younger, and they are constantly calling her stupid (for smoking.)
“I don’t think she can be that thoroughly addicted yet. I think she’s doing it for another reason, whether to be cool or to fit in I don’t know.”
Sarpalius’ hunch–that adolescents are not thoroughly addicted–is right, said Dr. Osama El-Shafie, director of child and adolescent psychiatry at Loyola University Medical Center in Maywood. Adolescent physiology and brain chemistry differ from adults. Even teens who have been smoking for a few years and then try to quit do not experience withdrawal symptoms in the same way or with nearly the same severity as do adults.
“This is an experimental phase and we have to respect that phase of their life,” said El-Shafie. “If it’s more than experimentation, many of these behaviors are due to psychological and social factors. By addressing those factors, the behavior may be eliminated.”
Most teenagers, he said, smoke because of peer pressure. Teens are often irritated by that term. But peer pressure does not mean friends or siblings are forcing or strongly encouraging others to smoke–though that does happen. Instead, peer pressure merely means that smoking and fun group activities become linked in teens’ minds.
“If you hang around other kids and they are all smoking, you don’t see what’s wrong with smoking,” El-Shafie said. “The emotion associated with smoking becomes a fun one–you hang around at so-and-so’s house listening to music and smoking.”
There is no profile of a teen smoker, said El-Shafie. Counselors at Christ Hospital concur, saying they have had all kinds of kids in their programs: good students and poor ones, athletes and couch potatoes, students who participate in activities and those who join nothing. But there are a number of risk factors that may predispose adolescents to stick with smoking long after they’ve taken those first few experimental drags.
A parent who smokes in the house is one such risk factor.
“Smoking in the house gives kids the message that it’s OK,” said El-Shafie. “And the smell is there. They get used to it.”
As well, not doing well at school or feeling disconnected from the school community may also put an adolescent at risk.
Explained El-Shafie: “Students who are doing well at school are busy during the day getting work done, going to the library, going on the computer. The don’t have time to kill just hanging around with each other.”
But for other teens, the causes of smoking are more troubling and deeply rooted. Undiagnosed psychiatric disorders, most commonly attention deficient hyperactivity disorder, alter brain chemistry. Students who are not properly treated tend to self-medicate, El-Shafie said. One of the most common such “medications” is nicotine.
If parents suspect an adolescent is smoking, experts say, start talking openly, but do not forbid it.
“If you find they are smoking, it’s not the end of the world. Don’t make it a war,” El-Shafie said. “Ask what got them into it, when are they doing it and why do they think it’s right.
“It is much better to do that than to say, `I won’t tolerate this and you won’t ever do it in my house,’ ” he added.
At Christ Hospital’s smoking cessation program, counselor Catania tries to get students to think about why and when they are smoking, and substitute more positive behaviors. What, she asks, triggers them to reach for a cigarette?
“Nothing,” offers Gina Carbone, a 15-year-old Oak Lawn student.
“So it’s habit,” says Catania.
“Boredom,” suggests 17-year-old Matt Estelle.
Stress and depression, other teens say.
Catania then asks them to consider chewing gum or candy, gnawing on a toothpick, drinking a soda, going for a walk or calling a friend when the urge to smoke hits.
What, she asks the teens, could they do if they are surrounded by smoking friends?
“Turn the other way,” offers Jenni Sarpalius.
“Will that work?” asks Catania.
“No,” Jenni concedes.
But Jenni said she does plan to quit, and has cut back from more than a pack a day to a few cigarettes a day because of the stop-smoking program.
“I know I’ll eventually quit,” said Jenni Sarpalius. “I want to quit for my family and for my health.”
If Jenni’s conviction begins wavering, the Sarpalius’ have one more piece of ammunition that they will use with their 16-year-old daughter, who is enrolled in driver’s education and plans to get her license soon.
“She can’t drive until she quits,” said Carol Sarpalius flatly. “She’s not going to be able to just get in a car and go until she quits.”
