BOSTON — When an antismoking advertisement appears on TV, Lori Rupolo talks to her eight-year-old son, Michael, about it.
"You're not going to do that," she will say, "Do you know why?"
He's got all the answers down pat. Still, she worries. "He can tell me he's never going to [smoke], but when he turns 15 or 16, there are going to be other kids who do."
Mrs. Rupolo's concern is not uncommon. Parents often assume that peer pressure is an influence they can't fight. But a growing number of researchers say that parents, relatives, and mentors can play a significant role in a child's decision to smoke - or not.
"Kids tell us very clearly that the place they get scripting from is parents," says Pamela Clark, a longtime researcher on teen smoking. That script "needs to be strong and unambiguous. 'You will not use tobacco. Period.' "
When children don't have a strong script to draw from they will pull from elsewhere. Friends. Other relatives. Media messages, including those at tobacco-sponsored sporting events and parties (see story below). And Hollywood (remember Leonardo DiCaprio's character in "Titanic"?).
"My parents know, but they don't say anything," says Benoit, a French youth visiting Boston who smokes "at parties and on vacation."
In many countries, including the United States, Brazil, Singapore, and India, there are government efforts to provide an antismoking script. "Parents need to communicate a very strong message, but community and society need to back up parents in a big way," says Jean Forster, professor of epidemiology at the University of Minnesota.
President Clinton and some members of Congress are still working on a tobacco industry deal that would raise the tax on cigarettes, end marketing to children, and fund smoking-cessation programs. Many states are spending millions of dollars on antismoking programs in schools, on television, in concerts, and are mounting sting operations against shopkeepers who sell cigarettes to children.
Behind such efforts are sobering statistics. By age 18, 2 out of every 3 young Americans have tried smoking, according to the Centers for Disease Control and Prevention (CDC) in Atlanta. About half of the adolescents who tried it went on to smoke daily. White high-schoolers are almost twice as likely to become daily smokers as Hispanics, according to a 1997 CDC survey. And it's not a guy thing any longer. As many white and Hispanic girls now smoke as boys. Black students have the lowest smoking rate.
Enhancing self-image is a prime motivator among smokers. "It ties in with how they perceive themselves," says Mary Halbach, director of community health in Barberton, Ohio, who works with middle-school students. "Where do I fit in?" they will ask. If I'm not an athlete, not in the smart group or band, I'll be a risk-taker smoker.
Peer pressure often prompts the first puff. "Every kid has their first cigarette with friends; I never smoked by myself," says Stephanie, a Boston teen who says she used to smoke.
But teens, like the experts, are divided over the ultimate power of peers."The peer pressure argument is a crock," says Brian, a Cincinnati teenager, who smokes occasionally.
"There is no penalty in saying 'no' or going against the group," says Dr. Clark at Northeastern Ohio Universities College of Medicine, who has been studying teens and smoking for five years. Many teens interviewed by the Monitor agreed.
Parents might also point out the social consequences of smoking, says Lloyd Johnston at the University of Michigan's Institute for Social Research, which did a landmark study of drug use among 8th-, 10th-, and 12th-graders. He notes that a substantial number of adults say they would rule out a smoker as a potential marriage partner.
Nonsmoking teens express disgust over the smell and the taste. Many also cite athletic performance as a reason to not smoke. "If you smoke, you can't skate," says Wallace, a Boston teen who is a serious in-line skater.
Correcting false views is another step parents can take. A CDC report concludes that "adolescents consistently overestimate the number of young people and adults who smoke. Those with the highest overestimates are more likely to become smokers than are those with more accurate perceptions."
Therefore, denormalizing smoking is an effective part of prevention.
"Fewer than 25 percent of adults smoke," says Gregory Connolly, director of the Massachusetts Tobacco Control Program. He suggests that parents emphasize that smoking is not normal behavior and the best way to do that is to not smoke, themselves. In addition, they should talk about the addictive nature of nicotine (similar to heroin), teach refusal skills, teach media-literacy (dissect a tobacco ad and how it intends to influence), and not treat smoking like a forbidden fruit.
Exposing the tobacco industry gives young people the chance to redirect their rebellion, Mr. Connolly says. "Teens hate manipulation, judgmentalism, and hypocrisy," Clark says. Ask them, "Are you being manipulated by media?"
In focus groups, when teen smokers find out some of the ingredients in cigarettes, including chemicals found in nail-polish remover and batteries, they feel betrayed and angry, Forster says. When they think about their smoke harming children and pregnant women, they also get upset.
Researchers disagree on how effective harping on health consequences is with teens. Young smokers can often list the health consequences but few see themselves at risk. "Most kids don't believe they will get addicted," says Dori, a Boston high school senior, who says she thinks her once-occasional habit has become an addiction.
Researchers say probably the worst thing parents can do is remain silent, but plenty do, especially if they smoke. "Kids are looking for guidelines," reiterates Clark. But some parents fear the response, the back talk, and want to avoid conflict. "Children are looking for limits and too often we offer them friendship," she says.
Nonsmoking teens will explain why they don't smoke in hyperbole. "My parents are totally against it. If I ever got caught, I'd be grounded forever," says Patrick, a young Cincinnati nonsmoker. That kind of comment, says Clark, translates into "I have too much respect for my parents."
Dr. Forster, at the University of Minnesota, has had similar findings. "What seems to influence them is disappointing people they respect." Some will mention grandparents.
Research indicates that if a child has a parent who smokes, he or she is more likely to try tobacco. But such parents can set aside their own feelings of guilt, Clark says, "and tell their teen how profoundly disappointed they would be if their child started." The script should be, she says, "I'm a smoker, but you're not going to be." That approach has worked with Sheri, a Nashville, Tenn. seventh grader. Her mother smokes but she doesn't. "She tells me all the down sides, because she knows from experience."
A gateway drug
Parents sometimes rationalize that "oh, it's only smoking, not something worse." But tobacco is a gateway drug, often leading to marijuana or other drugs, says Ms. Halbach.
As a parent, you need to follow through with penalty when you catch them, says Clark. Take away privileges or if they're younger, take away their allowance. If a child says "my friends made me," dissect every action in in minute tedium. "Who took off the wrapper? Who put it in your mouth? Who lit it? Who smoked it?" Ask "At what point did your friend stop and you take over? What kind of image do you think you're portraying to others about yourself?" says Clark.
If they're already addicted they need to get professional help. Halbach suggests a cessation program that is nonjudgmental in tone.
Finally, communities need to back up parents. If you see a clerk selling cigarettes to a 12- year-old, say something, Clark says. If you see someone else's youngster smoking, make the call to his parent. "We all have to speak out to protect children,"she says.
TIPS FOR RAISING A SMOKE-FREE FAMILY
* Let children know how you feel about tobacco use. Kids want to know the boundaries, and they can't know the rules unless you tell them. Be clear about the rules, with no mixed messages.
* Children do listen. They may rebel at first, but when it comes to making decisions about risky behaviors, they value and use clear messages they have been given by their parents.
* Don't assume children will learn to be smoke-free at school. They may hear about the health risks, but often believe that they are personally invincible.
* Make an emotional appeal. Telling a child how hurt or disappointed you would be if they decided to smoke has more impact than reasoning with them about the health dangers.
* Peer pressure is often used as an excuse. Take the issue seriously, but help your child understand that they are responsible for their own actions.
* Be a good role model. If you smoke, set aside your own feelings about it, and make it clear that you expect your child to not use tobacco.
* If relatives smoke, instruct them not to provide tobacco to your child.
* Don't believe that tobacco use is less dangerous than other risky behavior. Many studies link tobacco use with immediate health and social consequences, and teen smoking produces, on average, 20 years of addiction.
* Help clean up tobacco in your child's environment. Insist on tobacco-free school zones, and protest if neighborhood stores sell tobacco to children.
* It is never too early or too late to intervene. Some children take their first puffs at ages 7 to 9. Even those who have been smoking for several years can be helped to quit.
- Pamela Clark, a researcher on youth smoking and a professor at the Northeastern Ohio Universities College of Medicine in Rootstown.
ANTI-SMOKING WEB SITES