Antismoking Efforts Need More Than Money

As an eight-year veteran of California's Proposition 99-funded, statewide tobacco- control program, I wholeheartedly agree with the premise of "Wind Shift in California's Battle Against Teen Smoking" (Nov. 28).

California's well-funded program to reduce teen smoking has not been effective, especially its multimillion-dollar antitobacco media campaign. And after all these years, state and local health officials still don't know what really works to reduce and prevent youth tobacco use. Throwing money at this critical public-health problem does not appear to be the answer.

However, this lack of success in curbing teen smoking is not necessarily due to reasons cited in the article. For example, attributing the rise in teen smoking to funding cuts in the tobacco-control program that is ludicrous. Groups make this claim use it for political purposes to regain illegally diverted funds. These groups seem more interested in getting all the funds than reducing youth tobacco use.

In addition, I respectfully disagree with my colleague Dr. Stan Glantz at the University of California at San Francisco: The California tobacco-control program has always had an adult focus, especially in the early 1990s when the emphasis was on smoke-free workplaces and restaurants and curbing adult smoking through cessation services. This adult focus continues today with, for example, our new smoke-free bars law going into effect Jan. 1.

The adult focus and youth focus of the California program is a balanced, comprehensive, and integrated approach to achieving a smoke-free society. Dr. John Pierce, of the University of California at San Diego, is right on the mark in faulting the tobacco industry's insidious recruitment and marketing activities targeting young people. But while tobacco advertising and promotion is a significant contributing factor in youth tobacco initiation, experimentation, and use, as Dr. Pierce's research clearly shows, tobacco marketing is only part of the problem.

Groups and individuals pushing unilateral, simplistic solutions are looking for a quick and easy answer to teen smoking. For example, the tobacco, retail, and advertising industries cite peer pressure as the main cause of teen tobacco use, while attacking proposed restrictions on tobacco advertising and promotion that target youths, despite the increasing body of research linking tobacco marketing with youth tobacco use. These industries want children and adolescents criminalized and punished for smoking.

What we must understand is that youth tobacco use is a problem requiring a multifaceted, concerted, and long-term set of solutions. Tobacco use among children and teenagers is increasing for environmental, sociodemographic, behavioral, and personal reasons.

Environmental factors include tobacco advertising; parental, family, and peer influences; negative role models; continued social support and acceptance of tobacco use; and easy access to tobacco from commercial and social sources.

Another set of factors contributing to the problem are sociodemographic, such as socioeconomic status, and the developmental stage and gender of the teen. Young people from poor families have higher smoking rates than other teens. And most young smokers are girls.

Behavioral factors also play a prominent role in teen smoking - including risk-taking, problem behavior, poor academic achievement, and rebelliousness.

Finally, personal factors such as self-esteem, self-image, psychological makeup, and personality traits are contributing factors in teen tobacco use.

Because there are so many reasons children and adolescents use tobacco products, there is no silver bullet or magic solution to the problem. No one approach or program by itself can significantly reduce teen smoking.

Rick Kropp

Santa Rosa, Calif.

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