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Teen Smoking
Background on Smoking and Youth
Smoking cigarettes is the most important preventable cause of death in the United States and is responsible for over 430,000 deaths each year or 19.5% of all deaths (CDC, 1997). Long-term cigarette use results in heart disease, chronic lung disease, and various forms of cancer. It is estimated that the direct medical cost attributable to smoking totals about $50 billion per year. Research clearly has shown that nicotine is the addictive substance in tobacco and that addiction occurs in most smokers during adolescence (USDHHS, 2000).
How Many Teens Smoke?
Most smokers begin smoking in childhood or adolescence while those who graduate from high school without smoking are unlikely to take up the habit. Among US adult daily smokers, 82% tried their first cigarette and 53% became daily smokers before the age of 18 (USDHHS, 1994). It has been estimated that 1.266 million US daily smokers are under the age of 18 (CDC, 1998a). Of those that were under the age of 18 in 1995, 5 million are expected to die prematurely from smoking-related illnesses if current patterns of tobacco use persist (CDC, 1996).
According to the 1999 Youth Risk Behavior Survey (YRBS) conducted by the Centers for Disease Control and Prevention (CDC), the latest national estimate of any tobacco use is 40% and current cigarette use is 35% among students in grades 9-12 (CDC, 2000). In 1998, the Texas Department of Health conducted the Texas Youth Tobacco Survey, in cooperation with both the Texas Education Agency and the CDC (TDH, 1998). Approximately 43% (440,411) of high school students in Texas public schools reported using some form of tobacco. In addition, about 33% (326, 000) of high school students reported current smoking. Other important findings from the Texas survey showed that 75% of high school students have tried cigarette smoking, 19% tried cigar smoking, 9% used smokeless tobacco, and 8% reported pipe smoking.
Do Teens Want To Quit Smoking?
In the past ten years, smoking declined among the adult population, but not among teens (Lamkin, Davis, Kamen, 1998). While most teens who smoke want to quit, they lack the ability or support necessary to quit smoking. Most adolescents who smoke have made numerous and usually unsuccessful attempts to quit smoking. The 1997 YRBS indicated that almost 73% of students who had ever smoked daily tried to quit smoking (CDC, 1998b). Among high school seniors in 1976-1988, 44% believed they would not be smoking 5 years later but at 5-6 year follow-up, 73% remained daily smokers (USDHHS, 1994). According to a national survey, only about 1.5% of adolescents who ever smoked were successful at quitting. (Moss et al., 1992). While social reasons such as 'to bond with peers' and 'to appear mature' are strong influences for adolescents to smoke, nicotine addiction seems to be the better predictor of continued use (Perry & Staufacker, 1996). Because of the high prevalence of smoking among adolescents and their difficulty in quitting, effective smoking cessation programs are urgently needed.
What Programs Help Teens Stop Smoking?
Seventeen teen smoking cessation programs have been evaluated from 1975-1997. Twelve programs reported quit rates of around 20% but this dropped to 13% at follow-up. Not all the studies used biochemical validation of smoking status so these percentages may be inflated (Horn et al, 1999). It has been recommended that cessation programs for teens need more rigorous evaluation and biochemical validation so that programs can be improved (Lynch & Bonnie, 1994; Horn, et al.1999; Fiore, et al. 2000). A recently evaluated school-based teen smoking cessation program is the N-O-T (Not on Tobacco) Program (Horn, et al, 1999). The 10-week program was based on theory and research evidence, includes 4 booster sessions, and was implemented by specifically trained, school-based facilitators. Biochemical validation was used to assess smoking status. Program efficacy of N-O-T with 163 teens showed a significantly higher quit rate (20.8%) for the N-O-T group compared to a brief intervention group (4.4%).
Conclusion
The increase in smoking prevalence among adolescents is a significant problem in San Antonio, with ramifications in terms of health and healthcare costs. Many teens want to quit smoking but have difficulty in doing so. Research evidence can guide in the selection of "best practice" smoking cessation programs for our youth. Such programs can assist our teens to stop smoking and reduce the risk of associated long-term health effects such as debilitating chronic diseases and early death.
References
Centers for Disease Control and Prevention. (2000). CDC Surveillance Summaries. Youth Risk Behavior
Surveillance-United States,.1999. Morbidity and Mortality Weekly Report, 49 (SS-5).
Centers for Disease Control and Prevention. (1999). Tobacco use among middle and high school students-
Florida, 1988 and 1999. Morbidity and Mortality Weekly Report,48 (12) 248-253.
Centers for Disease Control and Prevention. (1998a). Incidence of initiation of cigarette smoking-United States,
1965-1996. Morbidity and Mortality Weekly Report, 47 (39) 837-840.
Centers for Disease Control and Prevention. (1998b). Selected cigarette smoking initiation and quitting behaviors
among high school students-United States, 1997. Morbidity and Mortality Weekly Report, 47 (19) 386-389.
Centers for Disease Control and Prevention. (1997). Smoking-Attributable Mortality and Years of Potential Life
Lost-United States, 1984. Morbidity and Mortality Weekly Report, 46 (20) 434-451.
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Fiore, M. C., Bailey, W. C., Cohen, S. J., et al. (2000). Treating tobacco use and dependence. Clinical Practice
Guideline. Rockville, MD: US Department of Health and Human Services, Public Health Service.
Horn, K., Dino, G., Gao, X., & Momani, A. (1999). Feasibility evaluation of Not On Tobacco: The American Lung
Association's new stop smoking program for adolescents. Health Education, 5 , 192-206.
Lamkin, L, Davis, B., & Kamen, A. (1998). Rationale for tobacco cessation interventions for youth. Preventive
Medicine, 27 , 5, A3-A8.
Lynch, B. S. & Bonnie, R. J. (Eds.). (1994). Growing up tobacco free: Preventing nicotine addiction in children
and youth. Washington, D.C.: National Academy Press.
Moss, J. A., Allen, K. F., Giovino, G. A., & Mills, S. L. (1992). Recent trends in adolescent smoking, smoking-
uptake correlates, and expectations about the future. Advance Data, 221, 1-28.
Perry, C. L. & Staufacker, M. J. (1996). Tobacco use. In R. J. DiClemente, W. B. Hansen, & L.E. Ponton, (Eds.),
Handbook of adolescent health risk behavior (pp. 53-81). New York: Plenum Press.
Texas Department of Health (TDH). (1998). Texas Youth Tobacco Survey-1998, Report I: Current Tobacco Use.
Bureau of Disease, Injury and Tobacco Prevention. Texas Department of Health.
US Department of Health and Human Services. (2000). Health People 2010 (Conference Edition, in Two
Volumes). Washington, DC: US Department of Health and Human Services.
US Department of Health and Human Services. (1994). Preventing tobacco use among young people: A report
of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Public Health
Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention
and Health Promotion, Office on Smoking and Health.
Prepared July 2000, by the Academic Center for Evidence-Based Practice, School of Nursing , UTHSCSA
TEEN SMOKING: BIBLIOGRAPHY OF SELECTED RESEARCH
© 2000 Kathleen R. Stevens, Carol A. Ledbetter, A. Marie Barron, Laura R. Munoz
This bibliography was produced by the Academic Center for Evidence-based Nursing (ACE). Recent research literature was searched using the bibliographic databases, Medline, CINAHL, and PsycInfo through the years 1992 to present. Primary search terms used were: smoking, smoking cessation, and adolescence. Citations were selected and included for relevance in two primary areas: smoking prevention/cessation and prevalence, trends, policy/general information about youth and tobacco.
A. Smoking prevention and cessation
This bibliography is predominantly treatment focused but includes prevention articles.
Balch, G. I. (1998). Exploring perceptions of smoking cessation among high school smokers: input and
feedback from focus groups. Preventive Medicine, 27 (5 Pt 3), A55-63.
Bauer, U. E., Johnson, T. M., Hopkins, R. S., & Brooks, R. G. (2000). Changes in youth cigarette use and
intentions following implementation of a tobacco control program: findings from the Florida Youth
Tobacco Survey, 1998-2000. Journal of the American Medical Association, 284 (6), 723-728.
Burt, R. D., & Peterson, A. V., Jr. (1998). Smoking cessation among high school seniors. Preventive Medicine,
27 (3), 319-327.
Centers for Disease Control and Prevention. (1996). Projected smoking-related deaths among youth--United
States. Morbidity and Mortality Weekly Report, 45 (44), 971-974.
Centers for Disease Control and Prevention. (1998). Selected cigarette smoking initiation and quitting
behaviors among high school students--United States, 1997. Morbidity and Mortality Weekly Report,
47 (19), 386-389.
Chen, J., & Millar, W. J. (1998). Age of smoking initiation: implications for quitting. Health Reports, 9 (4), 39-46.
Colby, S. M., Tiffany, S. T., Shiffman, S., & Niaura, R. S. (2000). Measuring nicotine dependence among youth:
a review of available approaches and instruments. Drug and Alcohol Dependence, 59 (Suppl 1), S23-39.
Des Vaux Oakes, J. (1998). Forming community coalitions: "smoking stinks". Tobacco Control, 7 (Suppl), S27-28.
DuRant, R. H., & Smith, J. A. (1999). Adolescent tobacco use and cessation. Primary Care, 26 (3), 553-575.
Engels, R. C., Knibbe, R. A., de Vries, H., & Drop, M. J. (1998). Antecedents of smoking cessation among
adolescents: who is motivated to change? Preventive Medicine, 27 (3), 348-357.
Epps, R. P., Manley, M. W., & Glynn, T. J. (1995). Tobacco use among adolescents. Strategies for prevention.
Pediatric Clinics of North America, 42 (2), 389-402.
Farkas, A. J., Gilpin, E. A., White, M. M., & Pierce, J. P. (2000). Association between household and workplace
smoking restrictions and adolescent smoking. Journal of the American Medical Association, 284 (6),
717-722.
Flay, B. R., Phil, D., Hu, F. B., & Richardson, J. (1998). Psychosocial predictors of different stages of cigarette
smoking among high school students. Preventive Medicine, 27 (5 Pt 3), A9-18.
Forster, J. L., Murray, D. M., Wolfson, M., Blaine, T. M., Wagenaar, A. C., & Hennrikus, D. J. (1998). The effects of
community policies to reduce youth access to tobacco. American Journal of Public Health, 88 (8),
1193-1198.
Givel, M. S., & Glantz, S. A. (2000). Failure to defend a successful state tobacco control program: policy lessons
from Florida. American Journal of Public Health, 90 (5), 762-767.
Horn, K., Dino, G., Gao, X., & Momani, A. (1999). Feasibility evaluation of Not On Tobacco: The American Lung
Association's new stop smoking programme for adolescents. Health Education, 99 (5), 192-206.
Retrieved August 3, 2000, from the World Wide Web: http://www.emerald-library.com
Houston, T., Kolbe, L. J., & Eriksen, M. P. (1998). Tobacco-use cessation in the '90s--not "adults only" anymore.
Preventive Medicine, 27 (5 Pt 3), A1-2.
Hu, T. W., Lin, Z., & Keeler, T. E. (1998). Teenage smoking, attempts to quit, and school performance. American
Journal of Public Health, 88 (6), 940-943.
Hurt, R. D., Croghan, G. A., Beede, S. D., Wolter, T. D., Croghan, I. T., & Patten, C. A. (2000). Nicotine patch
therapy in 101 adolescent smokers: efficacy, withdrawal symptom relief, and carbon monoxide and
plasma cotinine levels. Archives of Pediatrics and Adolescent Medicine, 154 (1), 31-37.
Lamkin, L., Davis, B., & Kamen, A. (1998). Rationale for tobacco cessation interventions for youth. Preventive
Medicine, 27 (5 Pt 3), A3-8.
Lawendowski, L. A. (1998). A motivational intervention for adolescent smokers. Preventive Medicine, 27
(5 Pt 3), A39-46.
Mackie, J. W., & Oickle, P. (1997). School-based health promotion: the physician as advocate. Canadian
Medical Association Journal, 156 (9), 1301-1305.
O'Malley, P. M., Johnston, L. D., & Bachman, J. G. (1995). Adolescent substance use. Epidemiology and
implications for public policy. Pediatric Clinics of North America, 42 (2), 241-260.
Pallonen, U. E. (1998). Transtheoretical measures for adolescent and adult smokers: similarities and
differences. Preventive Medicine, 27 (5 Pt 3), A29-38.
Pallonen, U. E., Prochaska, J. O., Velicer, W. F., Prokhorov, A. V., & Smith, N. F. (1998). Stages of acquisition
and cessation for adolescent smoking: an empirical integration. Addictive Behaviors, 23 (3), 303-324.
Perez-Stable, E. J., & Fuentes-Afflick, E. (1998). Role of clinicians in cigarette smoking prevention. Western
Journal of Medicine, 169 (1), 23-29.
Rojas, N. L., Killen, J. D., Haydel, K. F., & Robinson, T. N. (1998). Nicotine dependence among adolescent
smokers. Archives of Pediatrics and Adolescent Medicine, 152 (2), 151-156.
Sargent, J. D., Mott, L. A., & Stevens, M. (1998). Predictors of smoking cessation in adolescents. Archives of
Pediatrics and Adolescent Medicine, 152 (4), 388-393.
Schubiner, H., Herrold, A., & Hurt, R. (1998). Tobacco cessation and youth: the feasibility of brief office
interventions for adolescents. Preventive Medicine, 27 (5 Pt 3), A47-54.
Smith, T. A., House, R. F., Jr., Croghan, I. T., Gauvin, T. R., Colligan, R. C., Offord, K. P., Gomez-Dahl, L. C.,
& Hurt, R. D. (1996). Nicotine patch therapy in adolescent smokers. Pediatrics, 98 (4 Pt 1), 659-667.
Sussman, S., Dent, C. W., Severson, H., Burton, D., & Flay, B. R. (1998). Self-initiated quitting among
adolescent smokers. Preventive Medicine, 27 (5 Pt 3), A19-28.
Sussman, S., Lichtman, K., Ritt, A., & Pallonen, U. E. (1999). Effects of thirty-four adolescent tobacco use
cessation and prevention trials on regular users of tobacco products. Substance Use and Misuse, 34
(11), 1469-1503.
Zhu, S. H., Sun, J., Billings, S. C., Choi, W. S., & Malarcher, A. (1999). Predictors of smoking cessation in U.S.
adolescents. American Journal of Preventive Medicine, 16 (3), 202-207.
B. General literature including: prevalence, trends, policy implications and nicotine addiction
An, L. C., O'Malley, P. M., Schulenberg, J. E., Bachman, J. G., & Johnston, L. D. (1999). Changes at the high end
of risk in cigarette smoking among US high school seniors, 1976-1995. American Journal of Public
Health, 89 (5), 699-705.
Anderson, C., & Burns, D. M. (2000). Patterns of adolescent smoking initiation rates by ethnicity and sex.
Tobacco Control, 9 (Suppl 2), II4-8.
Balch, G. I. (1998). Exploring perceptions of smoking cessation among high school smokers: input and
feedback from focus groups. Preventive Medicine, 27 (5 Pt 3), A55-63.
Centers for Disease Control and Prevention. (1996). Projected smoking-related deaths among
youth--United States. Morbidity and Mortality Weekly Report, 45 (44), 971-974.
Centers for Disease Control and Prevention. (1997). Smoking-attributable mortality and years of potential life
lost--United States, 1984. Morbidity and Mortality Weekly Report, 46 (20), 444-451.
Centers for Disease Control and Prevention. (1998a). CDC Surveillance Summaries. Youth Risk Behavior
Surveillance--United States, 1997. Morbidity and Mortality Weekly Report, 47 (SS-3).
Centers for Disease Control and Prevention. (1998b). Incidence of initiation of cigarette smoking--United States,
1965-1996. Morbidity and Mortality Weekly Report, 47 (39), 837-840.
Centers for Disease Control and Prevention. (1999a). Best Practices for Comprehensive Tobacco Control
Programs--1999 . Atlanta, GA: US Department of Health and Human Services, Public Health Service,
Centers for Disease Prevention and Control, National Center for Chronic Disease Prevention and
Health Promotion, Office on Smoking and Health.
Centers for Disease Control and Prevention. (1999b). Tobacco use among middle and high school students--
Florida, 1998 and 1999. Morbidity and Mortality Weekly Report, 48 (12), 248-253.
Centers for Disease Control and Prevention. (2000a). Assessing health risk behaviors among young people:
Youth Risk Behavior Surveillance System, At-A-Glance 2000. Retrieved September 26, 2000, from the
World Wide Web: http://www.cdc.gov/nccdphp/dash/yrbs/yrbsaag.
Centers for Disease Control and Prevention. (2000b). CDC Surveillance Summaries. Youth Risk Behavior
Surveillance--United States, 1999. Morbidity and Mortality Weekly Report, 49 (SS-5).
Centers for Disease Control and Prevention. (2000c). CDC Surveillance Summaries. Youth Tobacco
Surveillance--United States, 1998-1999. Morbidity and Mortality Weekly Report, 49 (SS-10).
Centers for Disease Control and Prevention. (2000d). Costs of smoking among active duty U.S. Air Force
personnel--United States, 1997. Morbidity and Mortality Weekly Report, 49 (20), 441-445.
Centers for Disease Control and Prevention. (2000e). Tobacco use among middle and high school
students--United States, 1999. Morbidity and Mortality Weekly Report, 49 (3), 49-53.
Choi, W. S., Pierce, J. P., Gilpin, E. A., Farkas, A. J., & Berry, C. C. (1997). Which adolescent experimenters
progress to established smoking in the United States. American Journal of Preventive Medicine, 13
(5), 385-391.
Colby, S. M., Tiffany, S. T., Shiffman, S., & Niaura, R. S. (2000a). Are adolescent smokers dependent on
nicotine? A review of the evidence. Drug and Alcohol Dependence, 59 (Suppl 1), S83-95.
Colby, S. M., Tiffany, S. T., Shiffman, S., & Niaura, R. S. (2000b). Measuring nicotine dependence among youth:
a review of available approaches and instruments. Drug and Alcohol Dependence, 59 (Suppl 1), S23-39.
Coogan, P. F., Adams, M., Geller, A. C., Brooks, D., Miller, D. R., Lew, R. A., & Koh, H. K. (1998). Factors
associated with smoking among children and adolescents in Connecticut. American Journal of
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Des Vaux Oakes, J. (1998). Forming community coalitions: "smoking stinks". Tobacco Control, 7 (Suppl),
S27-28.
DiFranza, J. R., & Lew, R. A. (1996). Morbidity and mortality in children associated with the use of tobacco
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DuRant, R. H., & Smith, J. A. (1999). Adolescent tobacco use and cessation. Primary Care, 26 (3), 553-575.
Escobedo, L. G., Reddy, M., & DuRant, R. H. (1997). Relationship between cigarette smoking and health risk
and problem behaviors among US adolescents. Archives of Pediatrics and Adolescent Medicine, 151
(1), 66-71.
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school students in the United States, 1991-1995. Journal of School Health, 68 (4), 137-140.
Farkas, A. J., Gilpin, E. A., White, M. M., & Pierce, J. P. (2000). Association between household and workplace
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Flay, B. R., Phil, D., Hu, F. B., & Richardson, J. (1998). Psychosocial predictors of different stages of cigarette
smoking among high school students. Preventive Medicine, 27 (5 Pt 3), A9-18.
Forster, J. L., Murray, D. M., Wolfson, M., Blaine, T. M., Wagenaar, A. C., & Hennrikus, D. J. (1998). The effects
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Gilpin, E. A., Choi, W. S., Berry, C., & Pierce, J. P. (1999). How many adolescents start smoking each day in the
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Givel, M. S., & Glantz, S. A. (2000). Failure to defend a successful state tobacco control program: policy lessons
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Helyer, A. J., Brehm, W. T., & Perino, L. (1998). Economic consequences of tobacco use for the Department of
Defense, 1995. Military Medicine, 163 (4), 217-221.
Houston, T., Kolbe, L. J., & Eriksen, M. P. (1998). Tobacco-use cessation in the '90s--not "adults only" anymore.
Preventive Medicine, 27 (5 Pt 3), A1-2.
Hu, T. W., Lin, Z., & Keeler, T. E. (1998). Teenage smoking, attempts to quit, and school performance. American
Journal of Public Health, 88 (6), 940-943.
Igra, V., & Irwin, C. E., Jr. (1996). Theories of adolescent risk-taking behavior. In R. J. DiClemente & W. B.
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Lynch, B. S., & Bonnie, R. J. (Eds.). (1994). Growing up tobacco free: Preventing nicotine addiction in children
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Mackie, J. W., & Oickle, P. (1997). School-based health promotion: the physician as advocate. Canadian
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Mayhew, K. P., Flay, B. R., & Mott, J. A. (2000). Stages in the development of adolescent smoking. Drug and
Alcohol Dependence, 59 (Suppl 1), S61-81.
Moss, J. A., Allen, K. F., Giovino, G. A., & Mills, S. L. (1992). Recent trends in adolescent smoking,
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Pallonen, U. E. (1998). Transtheoretical measures for adolescent and adult smokers: similarities and
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Pentz, M. A., Sussman, S., & Newman, T. (1997). The conflict between least harm and no-use tobacco policy
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