I. TOBACCO USE AMONG YOUTH

Every state bans the sale of tobacco to minors. Yet, every year, over half a billion packs of cigarettes and twenty six million containers of chewing tobacco are sold illegally to children under the age of eighteen. As a result, an estimated 3,100,000 American teenagers -- one out of every six -- are regular smokers. And each day, 3,000 children begin smoking -- a process that results in more than a million new underage, addicted smokers in the United States each year. One quarter of these new young smokers will eventually be among the more than 400,000 Americans who die of tobacco-related illness each year -- illnesses that burden our country with close to 65 billion dollars annually in health and economic costs. These numbers are tragic, but the real tragedy is, this epidemic is to a great extent preventable -- and the key opportunities for prevention are in childhood and adolescence.

Most Smokers Become Addicted To Tobacco As Children

Tobacco use usually begins in early adolescence -- on average by age 14 and in almost all cases before adulthood. By the time they reach age eighteen, about two-thirds of the young people in the United States try smoking, and many quickly become dependent. This is not surprising, because tobacco-delivered nicotine is highly addictive. The Surgeon General reports that nicotine dependency is the most common form of drug addiction and one of the most difficult to overcome. According to the Surgeon General, 20 million Americans try to quit smoking each year, but only three percent have any long-term success.

While tobacco use is extremely dangerous for everyone, young users face special risks. The earlier a person begins to use tobacco, the more difficult it is to quit. Early adolescent users are more likely to remain smokers for the rest of their lives, more likely to smoke heavily, and more likely to die prematurely than those who begin smoking at a later age. In addition, the earlier an individual begins smoking, the greater his or her risk of developing the numerous illnesses associated with smoking. Teens who smoke regularly experience a general decrease in physical fitness, increased coughing and phlegm, greater susceptibility to and severity of respiratory illnesses, earlier development of artery disease (a precursor to heart disease) and slower lung growth, which by adulthood, can reduce the level of lung function.

Restricting Youth Access Is The Key To Breaking The Cycle Of Smoking

What is most significant about teens and smoking is, from all indications, smoking is an addiction which is typically initiated during teenage years, or not at all. For the great majority of smokers, this addiction begins before they are old enough to purchase tobacco lawfully. In fact, 75% of all adult smokers report they became addicted to tobacco before they were 18. Very few smokers take up smoking for the first time as adults. If youth access to tobacco is to be controlled effectively, and the decision whether to smoke   delayed until adulthood, then over time, smoking will be greatly reduced as a major addiction in our society.

The Number Of Teen Smokers Is Not Decreasing

As a result of the public's increased awareness of the health hazards associated with smoking, the percentage of adult smokers has been declining over the years. Although initially, adolescent smoking rates dropped in parallel with the decreased usage in the adult population, beginning in the 1980's, this decline leveled off. Over the last decade, the incidence of smoking among adolescents has remained essentially constant.

There are many possible reasons why these numbers have not declined. Some are a matter of simple economics. The American tobacco industry loses, and therefore must replace, approximately two million customers each year who either quit smoking or die. The vast majority of new customers will come from the ranks of young people. This fact is not lost on the tobacco industry.

A. Tobacco Companies Target Young People

Every day our nation's youth are bombarded with commercial messages encouraging the use of tobacco. In 1991 alone, the tobacco industry spent over $4.6 billion dollars advertising and promoting tobacco products. Sophisticated multimillion dollar tobacco ad campaigns address the special psychological needs and concerns of youth, promising by implication, that coolness, sophistication and peer acceptance will come with the purchase of the right package of cigarettes.

These efforts have paid off. A recent study by the Centers for Disease Control shows the three most heavily advertised cigarette brands -- represented by Joe Camel, the Marlboro Man, and young Newport couples -- captured 86% of the illegal teen market. These same brands however, account for only 35% of overall tobacco sales, having far less appeal in the adult market.

The tobacco industry is also one of the biggest outdoor advertisers. In 1989, of the approximately three million billboards in the United States, 30% advertised tobacco and alcohol products. Inner city neighborhoods in particular are plastered with billboards portraying beautiful young smokers engaged in glamorous activities and lifestyles. Studies reveal the intensity of cigarette billboard advertising in some states is two to three times greater in African-American neighborhoods than in white neighborhoods. These billboards found next to homes, schools, churches, shopping centers,  stadiums and along rural as well as inner city streets, expose children over and over again to pro-tobacco messages, giving young people the impression that smoking is the social norm in this country.

Increasingly, tobacco companies are marketing their products through promotional activities likely to appeal to youth such as the sponsorship of sporting and musical events. The sponsorship of these events makes tobacco highly visible to youth and strengthens the association between cigarettes and athletic ability, artistic expression, entertainment, glamour, and individuality. Youth-oriented sports equipment, camping gear, boxer shorts, caps, and tee shirts, all carrying tobacco logos, are widely available for free, or at minimal cost, to those who smoke enough of a particular brand of cigarettes to collect the necessary coupons to redeem these products. Decked out in these items, kids become walking tobacco advertisements, carrying the industry's message into schoolrooms, playgrounds, parks and other places which would otherwise be off-limits to tobacco advertising.

B. Youth Are Less Likely To Be Concerned About The Dangers

These intense marketing campaigns are particularly effective with young adolescents, for whom peer acceptance holds great importance. Unfortunately, this same audience is the most likely to deny or ignore the proven dangers of tobacco. Adolescents as a group, are notoriously unconcerned about risks in what they view as the distant future, and are simply unequipped to understand or evaluate the long-term hazards of tobacco. Young smokers are much more likely than adults to underestimate the harmful effects of tobacco use. They do not recognize that experimentation with tobacco can quickly lead to addiction. Indeed, it is the inability of youngsters to make informed, mature decisions about potentially hazardous activities that has prompted states to outlaw the sale to minors of tobacco, alcohol and other dangerous products.

The available evidence demonstrates that young smokers believe they will be able to avoid the harmful consequences of tobacco use. Although they understand that a lifetime of smoking is dangerous, young people tend to believe that smoking for a few years will not be harmful. Among 12 through 18 year olds in the 1989 Teenage Attitudes and Practices Survey, 21% of teen smokers said they believed it is safe to smoke for only a year or two. Young people expect to smoke only for a few years, not over a lifetime. They believe they can escape the harmful consequences of an admittedly risky practice. What these youths do not appreciate is the power of nicotine addiction.

Adolescents' failure to appreciate the long-term consequences of the decision to smoke is dramatically demonstrated by the University of Michigan's Monitoring the Future Study. As high school seniors, the subjects were asked "Do you think you will be smoking cigarettes five years from now?" Among respondents who were occasional smokers (less than one cigarette per day), 85% predicted they probably or definitely would not be smoking in five years, as did 32% of those who smoked one pack per day. However, in a follow up study conducted five to six years later, of those who smoked one pack per day as seniors, only 12% had quit and 70% still smoked one pack or more per day. Of those who smoked occasionally as seniors only 58% had quit, while 37% had actually increased their cigarette consumption.

C. Minors Have Easy Access To Tobacco

Youth who want to experiment with smoking have easy access to tobacco. Tobacco is sold virtually everywhere -- at gas stations, convenience stores, grocery stores, drug stores, and from vending machines. Despite the fact that every state has laws prohibiting the sale of cigarettes to minors, study after study shows minors who want to smoke can purchase tobacco from almost any type of retail establishment.

This easy access has sent a message to youth that prevention of tobacco use by young people is not important in our society. Although school based education programs have been developed to discourage children and teenagers from using tobacco, in their daily lives adolescents observe an abundant supply of tobacco; merchants willing to sell to them; enticing advertisements; promotions and little evidence that society in general views underage tobacco use as a real problem or a priority.

Where Children Purchase Tobacco

Understanding how and where minors obtain tobacco is critical to any effort to reduce youth access to tobacco. Despite existing laws, youngsters who smoke are able to purchase cigarettes from every type of retailer. The Secretary of Health and Human Services has estimated that three-fourths of the approximately one million tobacco outlets in the United States sell tobacco to minors, garnering over one billion dollars in sales each year. The University of Michigan's Monitoring the Future Study in 1993 found,   75% of eighth graders and 89% of tenth graders reported cigarettes would be fairly easy or very easy to get - and they are correct. Nearly all teen smokers have purchased a pack of cigarettes at least once.

Studies show most minors who smoke purchase their own cigarettes. In a 1990 survey of ninth grade students, conducted as part of the National Cancer Institute's COMMIT trial, 67% of current smokers (those who had smoked at least once in the past month) reported they usually bought their own cigarettes. Regular smokers (defined as smoking daily within the past month) were nearly twice as likely as occasional smokers to report buying their own cigarettes. In a vending machine industry survey, 72% of teenage smokers reported they purchased their own cigarettes. In the COMMIT survey, 82% of ninth grade students said it would be easy for them to obtain cigarettes.

The accuracy of this perception has been confirmed in numerous trials designed to measure the prevalence of retail sales of tobacco to minors. The Surgeon General recently summarized 13 studies of over-the-counter sales, noting the weighted average of the percentage of minors able to purchase tobacco was 67% ranging from 32% to 87%. In studies that include vending machine sales, the weighted average of successful purchases was 88% ranging from 82% to 100%. The most prevalent sources of cigarettes for underage buyers are small convenience stores and gas stations, followed by larger stores such as supermarkets. Among the youngest of adolescents, vending machines are a popular source.