Date: Sept. 13, 1994
Contacts: Barbara Rice, Media Relations Associate
Richard Julian, Media Relations Assistant
(202) 334-2138; Internet <news@nas.edu>


EMBARGOED: NOT FOR PUBLIC RELEASE BEFORE NOON EDT TUESDAY, SEPT. 13


MORE AGGRESSIVE MEASURES NEEDED TO LOWER
TOBACCO USE AMONG NATION'S YOUTHS, STUDY SAYS


WASHINGTON -- More aggressive measures are needed to counteract the social forces that continue to induce a quarter of the nation's young people to use tobacco products, a committee of the Institute of Medicine (IOM) has concluded. Its new report* recommends a youth-centered tobacco control strategy that leans strongly toward legislative and regulatory action.

The committee called on Congress to enact legislation allowing the Public Health Service to regulate the packaging and makeup of all tobacco products and to prescribe ceilings on tar and nicotine content. A large increase in the federal excise tax on tobacco products and tougher regulation of tobacco advertising, sales, and promotion also are among the report's recommendations.

"The question is not if society should try to prevent tobacco use by children and youths, but rather how this objective should be achieved," said committee chair Paul R. Torrens, professor of health services administration, University of California, Los Angeles. "Each year, more than 1 million youths become regular smokers. They're taking an average of 15 years off their lives and committing our health care system to at least $8.2 billion in extra medical costs over their lifetimes."

DETERRING TOBACCO USE

The committee recommended a $2 increase in the federal excise tax on cigarettes, and proportional increases for smokeless tobacco products such as chewing tobacco and snuff. Sizable price increases on tobacco products would be an important deterrent to teenage tobacco use, the committee said. This conclusion was confirmed in focus groups, conducted under the auspices of the IOM committee.

"A $2 increase in the price would definitely stop a lot of teens from smoking," said one teen, quoted in the IOM report. "Kids have better ways to spend $5 than on cigarettes. A 50-cent increase wouldn't make any difference." The number of cigarettes consumed annually by about 3 million minors in the United States has been estimated conservatively at 516 million packs, the report notes. At least half of those are illegally sold to minors.

Most smokers begin smoking during childhood and adolescence; nicotine addiction begins during the first few years of tobacco use. Decades of research show that if people do not begin to use tobacco as youngsters, they are highly unlikely to initiate use as adults. For adults who smoke daily, 89 percent began using cigarettes and 71 percent began smoking daily by age 18.

"In short, decisions by youths about whether to use tobacco have lifelong consequences," said the committee. "On the one hand, if a person reaches the age of 18 without being a user of tobacco products, he or she is highly unlikely to become a tobacco user during adulthood. On the other hand, most children and youths who initiate regular tobacco use become addicted and their addiction persists for many years thereafter, perhaps throughout their lives. This is why a youth-centered prevention policy is an essential part of any coherent strategy for eliminating tobacco-related deaths and disease."

CURBING ACCESS

Curbing access to tobacco products by youths is another key part of the committee's blueprint. The committee recommended:

> banning tobacco vending machines and self-service displays;

> banning the distribution of free tobacco products in public places or through the mail;

> requiring merchants to obtain a state license to sell tobacco products. The license could be suspended or revoked if the merchant sells tobacco to minors or violates other state and local laws designed to reduce access.

"Given that nearly one in five deaths in the United States is attributable to tobacco, reducing smoking would arguably have more impact on the nation's health than any other public health initiative," said the committee. Cigarette smoking is the leading cause of avoidable death in the United States. More than 400,000 people die prematurely each year from diseases attributable to tobacco use. Smoking caused 87 percent of deaths from lung cancer and 82 percent of deaths from pulmonary diseases. An estimate from the congressional Office of Technology Assessment put the social costs of smoking at $68 billion in 1990.

Since 1964, when the surgeon general called the nation's attention to smoking's health hazards, the prevalence of smoking among adults has declined substantially -- from 40.4 percent in 1965 to 25.7 percent in 1991. But the momentum toward the goal of reducing tobacco use has stalled, the committee said, in part because the tobacco-using population is being replenished with new recruits.

SMOKING AS A LEARNED BEHAVIOR

Youths believe erroneously that the large majority of adults and their peers use tobacco, and research shows that overestimating smoking prevalence is one of the strongest predictors of smoking initiation. "Tobacco use is a learned and socially mediated behavior," the committee said. "Experimenting with tobacco is attractive to children and youths because of associations they learn to make between tobacco use and the kind of social identity they wish to establish."

Youths are led to believe that tobacco consumption is widespread among adults and is a social norm among "attractive, vital, successful people who seek to express their individuality, who enjoy life, and who are socially secure." This message is driven home to children and youths, the committee contends, by their near-constant exposure to pro-tobacco messages and images.

The committee identified numerous examples to support its premise. Neighborhood billboards promote tobacco products, for instance, and children and youths eat in restaurants and frequent shopping malls where tobacco use is permitted. They also attend cultural and sporting events either sponsored by the tobacco industry or where tobacco logos are prominently displayed.

PROMOTING A TOBACCO-FREE SOCIAL NORM

Promotion of a tobacco-free social norm, the committee found, is critical to discouraging youths from using tobacco, but pro-tobacco messages are particularly difficult to combat among children and youths. Even children ages 6 to 10 can identify the images and slogans of popular brands of cigarettes, the committee added. "The symbols of the most popular cigarettes among youths -- a cowboy and a camel cartoon character -- are more likely to appeal to children than to adults."

After studying a variety of social factors that influence youths who experiment with tobacco, the committee spelled out actions that can be taken to foster a tobacco-free social norm throughout U.S. society:

> Congress should repeal the federal law that precludes state and local governments from regulating tobacco promotion and advertising within state borders.

> Congress and state legislatures should eliminate all features of advertising and promotion of tobacco products that tend to encourage initiation of tobacco use among the young.

> Mass media campaigns, including paid anti-tobacco advertisements, should be intensified to reverse the image appeal of pro-tobacco messages, particularly those that appeal to children and youths.

> Tobacco-free policies should be adopted and enforced in all public locations, especially those that cater to or are frequented by children and youths, including all educational institutions, sports arenas, cultural facilities, shopping malls, fast-food restaurants, and transit systems.

> Parents should "clearly and unequivocally" express disapproval of tobacco use by their children, and, if smokers themselves, should quit smoking. Although the degree of parental influence on tobacco use by youths is not clear, the lack of parents' general concern about their children seems to increase a child's risk of using tobacco.

The federal government should play a strong leadership and coordination role to foster a tobacco-free norm, but, the committee noted, this does not mean that the nation needs a "czar" of tobacco control. Many organizations, coalitions, and federal agencies are already promoting a tobacco-free norm.

The committee suggested that a tobacco-free norm may already be taking root among African-American youths, whose daily smoking has declined dramatically from 16 percent in 1980 to 4.4 percent in 1993, according to surveys of high school seniors. Reasons for this decline are unclear, but the committee called it "a bright spot in an otherwise dim picture."

Daily smoking has remained stubbornly high among non-Hispanic white youths (22 percent in 1980 and 23 percent in 1993). Information on long-term smoking trends among Hispanic and Asian youths is sparse. In 1991, 12 percent of seniors who were Hispanic smoked daily. Small increases and decreases have occurred in rates among all teens as a group over the years, but a statistically significant increase of 1.8 percent in daily smoking from 1992 to 1993 has concerned public health officials.

RESEARCH NEEDS

Several research needs were also identified by the committee. For example, smoking trends and differences among ethnic groups should be studied more closely. Responses by children and youths to tobacco advertising should also be examined. And the effectiveness of different public policies should be assessed as well as compared across all levels of government.

The study was funded by the Robert Wood Johnson Foundation, Metropolitan Life, American Heart Association, Tobacco-Related Disease Research Program of California, Centers for Disease Control and Prevention, National Institute on Drug Abuse, National Cancer Institute, Maternal and Child Health Bureau of the Health Resources and Services Administration, Indian Health Service, W.K. Kellogg Foundation, Center for Substance Abuse Prevention, and Agency for Health Care and Policy Research.

The Institute of Medicine is a private, non-profit organization that provides health policy advice under a congressional charter granted to the National Academy of Sciences. A committee roster is overleaf.


*The report, Growing Up Tobacco Free: Preventing Nicotine Addiction in Children and Youths, is available from the National Academy Press at the mailing address in the letterhead; tel. (202) 334-3313 or 1-800-624-6242. The cost of the report is $24.95 (prepaid) plus shipping charges of $4.00 for the first copy and $.50 for each additional copy. Reporters may obtain copies from the Office of News and Public Information at the letterhead address (contacts listed above).




INSTITUTE OF MEDICINE
Division of Biobehavioral Sciences and Mental Disorders

Committee on Preventing Nicotine Addiction in Children and Youths

Paul R. Torrens, M.D., M.P.H. (chair)
Professor of Health Services Administration
Department of Health Services
School of Public Health
University of California
Los Angeles

Albert Bandura, Ph.D. (1)
David Starr Jordan Professor of Social Science in Psychology
Department of Psychology
Stanford University
Stanford, Calif.

Neal L. Benowitz, M.D.
Professor and Chief
Division of Clinical Pharmacology
Departments of Medicine, Pharmacy, and Psychiatry
School of Medicine
University of California
San Francisco

Richard J. Bonnie, LL.B. (1)
John S. Battle Professor of Law and Director
Institute of Law, Psychiatry, and Public Policy
University of Virginia School of Law
Charlottesville

K. Michael Cummings, Ph.D., M.P.H.
Director, Smoking Control Program
Department of Cancer Control and Epidemiology
Roswell Park Cancer Institute
Buffalo, N.Y.

Donald R. Dexter Jr., D.M.D.
Executive Director
Klamath Tribal Health and Family Services
Klamath Falls, Ore.

Ellen R. Gritz, Ph.D.
Professor and Chair
Department of Behavioral Science
M.D. Anderson Cancer Center
University of Texas
Houston

Gerardo Marín, Ph.D.
Professor of Psychology and Associate Dean
College of Arts and Sciences
University of San Francisco

Mark Nichter, Ph.D., M.P.H.
Professor
Department of Anthropology
University of Arizona
Tucson

Peggy O'Hara, Ph.D.
Associate Professor and Director of Graduate Programs in Public Health
Department of Epidemiology and Public Health
University of Miami School of Medicine

Cheryl L. Perry, Ph.D.
Professor
Division of Epidemiology
School of Public Health
University of Minnesota
Minneapolis

Thomas C. Schelling, Ph.D. (1,2)
Distinguished Professor of Economics and Public Affairs
School of Public Affairs
University of Maryland
College Park

Herbert Severson, Ph.D.
Research Scientist
Oregon Research Institute, and
Associate Professor
School of Psychology
University of Oregon
Eugene

Sarah Moody Thomas, Ph.D.
Associate Director for Community Education and Applications
Stanley S. Scott Cancer Center
Louisiana State University Medical Center
New Orleans

IOM STAFF

Barbara S. Lynch, Ph.D.
Study Director

Robert Cook-Deegan, M.D.
Division Director

^{___________________________________}
1 Member, Institute of Medicine
2 Member, National Academy of Sciences