"California Tobacco Control Program Fails To Stem Rising Tide Of Teen Smoking" by Rick Kropp
California Tobacco Control Program Fails To Stem Rising Tide Of Teen Smoking
by Rick KroppOctober 3, 1998
This has been a bad year for youth tobacco prevention efforts. National legislation to combat teen smoking died in the U.S. Senate, a federal appellate court in North Carolina nullified national youth tobacco prevention regulations issued by the Food and Drug Administration, and the tobacco industry continues to conduct a masterful misinformation campaign in the media that undermines state and local youth tobacco use prevention programs and policies. In the meantime, national and state youth smoking rates continue to go up, along with tobacco marketing that targets teens, especially retail tobacco advertising in stores.
Even here in California, we have failed to stop the increase in teen tobacco use. The much-heralded California Tobacco Control Program, created in 1989 through the Proposition 99 tobacco tax initiative, was suppose to significantly reduce youth tobacco use and maintain that trend over time. But a recent evaluation of the program by health researchers at UC San Diego shows that teen smoking did not decline from 1989-93, and actually increased by 26.3% after1993 to a current statewide youth tobacco use rate of 12%. Since 1993, all measures of teen smoking behavior indicate that more California adolescents are currently smoking and more will smoke in the future. The state program did have some initial success in reducing adult smoking, but since 1993 this initial effect did not continue. The results of the tobacco control program evaluation were published in the September 9th issue of the Journal of the American Medical Association.
Like the dutiful messenger delivering bad news to the king, UC San Diego researcher Dr. John Pierce and his colleagues were punished for reporting their unflattering findings and pointed opinions to the California Department of Health Services (CDHS). Not only was Pierce's tobacco research program grant defunded by CDHS, state health officials also publicly made disparaging professional and personnel remarks about Pierce in the media. CDHS also tried to bury the evaluation report and cover-up its critical findings and conclusions.
The grant defunding, derogatory remarks and cover-up appear to be retaliatory and politically-motivated. In reporting the details showing the lack of the tobacco program's effectiveness on youth, and adults since 1993, Pierce cites four reasons for this ineffectiveness: 1) the illegal tobacco control program budget cuts or "diversions" by Governor Wilson and the state legislature; 2) the dramatic growth in youth-oriented tobacco advertising and promotional activities; 3) cigarette price manipulations and reductions through aggressive sales promotions and discounts; and 4) the documented increase in the political lobbying activities and political campaign contributions of the tobacco industry and its allies and surrogates in the state legislature and in city and county government.
On the good news front, the program evaluation did find significant reductions in children's exposure to environmental tobacco smoke in the home and family vehicles, and the California youth smoking rate is one of the lowest in the country. But the bad news is that there were significant increases in children and adolescent susceptibility to start smoking, in early and advanced smoking experimentation by teens, in underage nicotine addiction, as well as in overall youth smoking use rates.
To make matters worse, since 1993 receptivity to tobacco advertising and promotional activities increased among California teens, with 34% of adolescent experimentation with cigarettes directly attributed to tobacco marketing. Reports >from the Federal Trade Commission show retail tobacco advertising and promotion in stores is the most widespread and persuasive form of tobacco marketing, with over 65% of total tobacco industry spending on marketing each year going into retail advertising. The state program's widely-known anti-tobacco media campaign, which was suppose to counter the effect of this industry marketing, appeared ineffective in changing the beliefs or smoking behavior of California adolescents.
While efforts to reduce youth access to tobacco and illegal tobacco sales to minors have been successful, especially in certain parts of the state, teens believed cigarettes were as easy to get in 1996 as they believed in 1990. While there appears to be reductions in youth access to commercial sources of tobacco such as illegal sales from stores and vending machines, teens still believe they have very easy access to social sources of tobacco such as friends, peers, parents, other family members and second-party sales (adults buying for minors).
The state tobacco program's school-based classroom efforts failed to educate students about the health hazards of smoking. In 1996, 48% of all teens believed it is safe to experiment with cigarettes, more than the 43% who held the belief in 1990. Between 1990-96, fewer and fewer students reported teen smokers adhered to smokefree school policies, and 57% of students in 1996 did not think that current health education/tobacco prevention classes are effective in dissuading adolescents from smoking.
While Pierce and his colleagues stated some reasons for the tobacco control program's ineffectiveness, my nine years involvement in the tobacco program on the local and state levels discovered additional reasons. One is the state program's over-emphasis on addressing adult smoking issues, such as smokefree bars, adult cigar smoking and private cigar clubs, rather than focusing more effectively on proven and promising youth tobacco prevention and cessation approaches.
Another reason is the controlling and autocratic state government bureaucracy running the tobacco program creating stifling and needless paperwork and thwarting creativity, initiative and independence among local tobacco program operators. While there are many competent local and regional program operators, many timid county health departments are afraid to challenge the status quo of pro-tobacco influences in their communities, and some nonprofits and community agencies lack sufficient organizational and staff resources, capabilities and expertise in tobacco control. Finally, the 1996 state law that criminalizes and punishes children and teens for smoking in public probably promotes more teen smoking and exacerbates the problem, as well as shifting the burden and responsibilities >from tobacco companies and retailers to minors, in effect blaming and punishing the victim.
The California Tobacco Control Program needs to be re-organized, re-designed and revamped. It needs to refocus its resources and energy on addressing the numerous and complex causes of teen smoking with multi-level, comprehensive prevention and cessation programs delivered through a flexible, decentralized statewide system. Otherwise, we will continue to lose more of our children to tobacco addiction and the tobacco industry.
Rick Kropp is a youth tobacco prevention and policy consultant living in Santa Rosa and former director of STAMP (Stop Tobacco Access for Minors Project), the recipient of the 1993 C. Everett Koop National Health Award.
Copyright Rick Kropp, 1998
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