Today about 3,000 youth in the U.S. become regular smokers each day; 1,000 of these will die of tobacco related diseases approximately 20 years prematurely. On April 27, 1998, U.S. Surgeon General David Satcher, MD, issued the 24th Surgeon General's Report since 1964 on the hazards of tobacco use. This report documents a 33% increase in smoking among U.S. high school students since 1991. The average age of first use of cigarettes is 14.5 years and has been steadily decreasing.
David Kessler, MD, dean of the Yale Medical School and former commissioner of the FDA, called tobacco addiction a "pediatric disease." The addiction of our nation's youth to tobacco has remarkable effects. One out of five Americans die from tobacco use (more than 430,000 deaths each year). Smoking causes 87% of lung cancer deaths, 30% of all cancer deaths, and 21% of all coronary heart disease. Tobacco use is the number one cause of premature morbidity and mortality in our society.
What strategies can we use to reduce adolescent/teen tobacco use? Increasing prices: For every dime increase in a pack of cigarettes, the teen use rate has decreased by 4%. Limiting access: Between 25% and 50% of attempts by underage smokers in the U.S. to buy tobacco in stores and retail outlets are successful. Licensing and monitoring tobacco retailers decreases youth access. Many tobacco control and public health advocates favor raising the legal age for the sale of tobacco from 18 to 21 in all states. Reducing the appeal: The combination of community mass media campaig ns and school-based tobacco use prevention programs have been effective. Limiting advertisements/promos targeted at youth decreases adolescent/teen use. Expanding smoke-free zones: Smoke-free homes and public places send the message that tobacco is not something that "everyone does." Role models: Parents and relatives who use tobacco send the most powerful message to youth regarding what it is to be "grown up." Teachers, coaches, professional athletes and health professionals all are critical role models for youth and adults. Tobacco cessation programs: One-third of regular adult smokers were addicted to nicotine before they left high school. Smoking/smokeless tobacco cessation intervention programs aimed at our youth have only recently been developed in the U.S. Aggressive programs to reduce experimentation and periodic use of tobacco may decrease the numbers of young people who progress to regular daily use. Parent, school and community support for youth: Community-based tobacco control programs are dependent on strong, tenacious, and sustained leadership and involvement by parents, schools and communities. Public health departments, universities and the health professions are critical partners.
The Centers for Disease Control estimates that if youth tobacco use continues to increase, approximately five million persons now age 17 or under will die prematurely of a tobacco-attributable disease. The U.S. Department of Health and Human Services has set a goal for its national program, Healthy People 2010, to reduce the initiation of cigarette smoking among our youth so that no more that 15% become regular cigarette smokers by age 20. By implementing the strategies above, we will achieve this goal.
Today, however, some 40% of high school seniors smoke, and the rates are increasing. We have work to do!
Stephen Jay, MD '66, is professor of medicine, assistant dean for continuing medical education, and interim chairman of the Department of Public Health.