AFTER spending $100 million a year on anti-smoking advertising and research, the state of California can proudly point to a 17 percent reduction in cigarette smoking among adults. In Massachusetts, which has spent $70 million over the past two years, cigarette sales are down 15 percent.
But neither campaign has been able to make inroads among teenagers who continue to get hooked on tobacco.
Now, President Clinton wants the federal government to try to prevent children from smoking. ''I think that smoking among youth should be diminished and the government has responsibility here,'' Mr. Clinton said last week.
FDA attack planned
This week, Clinton and the Food & Drug Administration are expected to unveil their attack on the youthful use of cigarettes. Among the areas pro-health advocates expect the government to focus on are advertising that attracts children, restrictions on teenage access to vending machines, and stricter enforcement of proof-of-age in the sale of cigarettes.
Spurring the government's effort are signs that cigarette usage among teenagers is rising. Last month, the University of Michigan Survey Research Center reported that 18.6 percent of eighth graders, who are 13 and 14 years old, smoke, an increase of 30 percent between 1991 and 1994. Nine percent of the eighth graders say they smoke every day compared with 7 percent in 1991.
Michael Eriksen, director of the Office on Smoking and Health at the Center for Disease Control in Atlanta, says teens smoke because of the way tobacco is marketed and because smoking is part of a ''youthful rebellion.'' But he says there is little the government can do to influence teenage anti-establishment behavior.
In advertising cigarettes, tobacco companies emphasize glamour, good looks, friendship, and independence. ''The very thing that teens aspire towards,'' says Dr. Eriksen. He sees the government's role as ''leveling the playing field about the truth of the product.''
In Washington, however, there is an active debate over what the government should or shouldn't do. Matt Myers, counsel to the Coalition on Smoking OR Health, asserts the government must restrict sales to children, combined with the elimination of the advertising tools the industry uses to create demand. ''To do one without the other is to doom a solution to failure,'' argues Mr. Myers.
Tobacco industry self-policing
Walker Merryman, a vice president for the Tobacco Institute counters, however, that the industry has for decades ''carried through a variety of voluntary programs to restrict access, restrict its own marketing and advertising and educate the retail community on their own legal responsibilities.'' If the FDA is involved in any program, Mr. Merryman says ''that would be a deal breaker.''
The most contentious issue for the tobacco industry is any attempt to restrict advertising. ''That would be a sticky point because of the thorny constitutional issues involved, such as the possibility of infringement on commercial free speech,'' Merryman says.
There is no question that cigarette advertising has soared. In 1980, the industry spent $1.2 billion on advertising and marketing. By 1993, it was spending $6 billion. ''It's not surprising but the kids smoke the most advertised brands,'' says Gregory Connolly, who runs the Massachusetts Tobacco Control Program.
The type of expenditure has changed, however. Because of increasing restrictions, the industry now spends more money on promotions, such as T-shirts and caps, and coupons and cash rebates. One of the most popular brands among teenagers is Marlboro, which exchanges clothing for coupons.
Dr. Connolly reports that 22 percent of teens who smoke claim to have a cigarette company promotional item. ''If they had it, they smoked four times as much as if they had not had it,'' says Connolly.
So far, only Massachusetts has an active anti-tobacco program geared towards teenagers. Last year, the state went to 14 malls where 200 retailers agreed to give discounts to teenagers who agreed to be part of a ''smoke-free'' campaign. Connolly has been running ads ridiculing brand imagery, such as the ''Joe Camel,'' campaign that appeals to teenagers.
Connolly is also trying to find ways to alert teenagers that they will find it difficult to stop smoking once they begin. In polls, only 25 percent of teens think they will still be smoking after high school. In reality, 75 percent still smoke eight years after high school.
The Bay State has made strides in preventing teenage access to cigarettes. In a survey last summer, Dr. Joseph DiFranza, a vice president of Stop Teenage Addiction to Tobacco, found teens had only a 30 percent success rate at buying cigarettes in the state. Nationally, children have a 75 percent success rate at buying cigarettes. All states have laws against selling to underage smokers.
Some pro-health advocates believe it is a waste of time to focus on access to vending machines. ''It's way down on the list of things to do,'' says Dr. Stan Glantz, a professor of medicine at the University of California, San Francisco. Instead, he says, ''we must keep kids from wanting cigarettes.''