As the federal government and the states gear up to combat teen smoking, California - the state with the longest-running antitobacco effort - may offer a startling lesson: Focusing ad campaigns on teens alone doesn't work. And nobody seems to know what kind of approach does work.
Nationwide, an estimated 3,000 teenagers pick up the smoking habit every day, swelling the ranks of the 45 million smokers in the United States, according to national health groups.
Lessons from the Golden State are taking on fresh relevance as Congress considers a $368 billion national tobacco settlement (and individual states cut deals) that could pump hundreds of millions of dollars into teen antismoking campaigns.
Over the past decade, California has spent large sums on campaigns to reduce smoking among its citizens - particularly youngsters. And it has cut adult cigarette use by some 40 percent.
California's effort began in 1988, when voters passed Proposition 99, setting aside funds from higher cigarette taxes to pay for a state program. In its early years, with spending at $95 million a year, the program succeeded in cutting smoking rates.
Today, 18 percent of Californians smoke, compared with a 25 percent nationwide average. But despite the effort, since 1993 the rate among teens has climbed from 9 percent to 11.6 percent.
Officials attribute the increase to funding cuts, which reduced yearly antismoking outlays to as low as $36 million before a lawsuit forced the state to restore funding to $102 million this year.
But critics like Stanton Glantz, a researcher at the University of California at San Francisco, blame the increase on the youth focus of prevention campaigns, because "kids are looking at young adults."
Other experts agree with Dr. Glantz's analysis.
"It's going to backfire if you're not doing anything about adult smoking," agrees John Pierce, a cancer researcher at the University of California at San Diego. "You'll miss the audience because kids are trying to be like adults."
But Dr. Pierce also faults the tobacco industry, calling the money spent on cigarette promotion and its effects "amazing."
"They're able to wipe out the efforts of the public-health promotions with kids," he says.
California - with its new, graphic anti-industry ads - has a media budget of $33 million a year, Pierce says, a pittance compared with industry spending that totals 10 times that amount.
"We don't have any messages that are powerful with kids, compared to their messages," Pierce says. "We have by the age of 9 an effective school program. But by 14, we've lost it. We are getting blown away. Marlboro has really won the battle. It took them 15 years to come up with Joe Camel and the Marlboro man."
STATE health officials readily admit their departments are outspent on advertising by the tobacco companies. But they insist that California's success also depends on other programs. One-third of its funding goes to media campaigns, another third to local health departments, and the final third to outreach efforts like the Cougars of San Francisco.
On a recent Sunday afternoon, a "patrol" of teens - dubbed the Smokefree Cougars - stalks the tobacco shops here.
Minors are barred from smoke shops, state law says, but the window displays hint otherwise. That's why the group of teens sponsored by the state-funded local Tobacco-Free Project stood at a downtown shop.
Mike Yuong, 14, counted 41 cigarette ads plastered on the windows. He pointed to cartoonish chess pieces modeled after "The Simpsons" sitcom, model cars, and candy displayed around the posters. "Kids would like this," Mike says. Behind him, the Marlboro man glimmered. "They make you want to go inside. Then you walk into a tobacco store and you don't even know it. Kids think, 'Maybe I should try it.' "
The Cougars know their public stand is rare among kids. Their friends who smoke aren't about to quit. And they say the most powerful influence on kids are parents and friends. Some kids, they say, just laugh at the state's new advertising campaign: a TV spot with a gravel-voiced woman who says she began smoking at 13.
But the Cougars feel they may be making a small difference.
California is also adding laws to prevent more teens from smoking. Beginning on Jan. 1, it will become the first state in the country to ban smoking in all bars and restaurants.
"Our idea is to make California a hostile environment for smoking," says James Stratton, the state's deputy director for prevention services. "We want to denormalize and deglamorize tobacco."