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Prevention of Teen Smoking

Readers might turn to this seeking answers to three obvious questions about the prevention of

 teen smoking. Why do teenagers smoke? How can we prevent them from smoking? And how can we help them to quit? Unfortunately, the evidence carefully assembled and reviewed in this book cannot answer these questions with certainty — a reflection of the current state of this vexing public health problem. The book offers a research agenda to remedy the gaps in our knowledge and calls for comprehensive strategies for controlling smoking by young people, but it can only suggest a menu of possible options. The authors, tobacco-control veterans, are optimistic and pragmatic, and they appropriately propose action in spite of uncertainty even as research and surveillance provide further insights. Readers seeking an up-to-date picture of teenage smoking will find the book useful. Its chapters cover the full spectrum of data relevant to the topic. They are based on a comprehensive review of the literature and a detailed characterization of the current picture of teen smoking from survey data. An introductory chapter sets out the policy context, which has continually evolved, most recently with the Master Settlement Agreement between the states and the tobacco industry. As a consequence of that agreement, an unprecedented level of funding is now available for tobacco control, at the state and local level through funds received by the states and at the national level through the American Legacy Foundation. The second chapter offers a detailed and troubling picture of the continued high rate of teenage smoking, which declined but then increased during the 1990s before falling back in the past several years. Risk factors for teenage smoking have been identified, and these risk factors offer points for intervention: smoking among peers, parental smoking and other familial influences, latent susceptibility, and beliefs, attitudes, and self-image. The substantial body of evidence on prevention methods and the far more limited data on cessation provide a gloomy picture of mixed evidence in spite of decades of research. Readers may be surprised to learn of the limited success of health education in schools.

Parents Helping the Prevention of Teen Smoking

 The foundation for the control of teenage smoking through antismoking interventions in the mass media, tax increases, and regulation is set out in three separate chapters. Although the authors conclude that research does not definitively link advertising by the tobacco industry to the initiation of smoking by young people, they suggest that we should learn from the tobacco industry and develop mass-media campaigns based on social marketing principles. Increases in the price of cigarettes are thought to have the potential for only minor effects on teenage smoking, whereas regulation is viewed as having good potential. The evidence presented in these chapters is the foundation for recommendations for a comprehensive tobacco-control program with elements matching the needs of the locale, whether at the state or the community level. The authors are hopeful that a variety of interventions, through synergy, would have an enhanced effect. The menu of elements for the comprehensive strategy is offered, but without principles for selecting among the options. And, of course, more research is needed, as pointed out in the last chapter. The authors’ frustration with mixed evidence and uncertainty shows, but with a dynamic public health problem such as teenage smoking, evidence can never be definitive and policies must always evolve to match the context. The authors’ documentation of the strategies of the tobacco industry highlights one element of the challenge: a successful intervention seems to be followed inevitably by a new tactic to ensure that no decrease in sales occurs. And, over the decades covered in this book, the factors affecting teenage smoking, ranging from personal to societal, have changed continually. We need sustained research to support evidence-based policies and continued evaluation and surveillance to redirect strategies for control as necessary. Jonathan Samet, M.D.

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