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On the Teen Scene:
Young People Talk with FDA Commissioner About Smoking

The Clinton Administration has proposed measures to significantly reduce the number of children and teenagers who become addicted to cigarettes and smokeless tobacco. FDA published a proposed regulation for those measures in the Federal Register of Aug. 11, 1995.

The measures include: reducing children's easy access to cigarettes by requiring age verification and face-to-face sale; eliminating mail-order sales, free samples, self-service displays, and sale of single cigarettes and packages with fewer than 20 cigarettes; banning outdoor advertising within 1,000 feet of schools and playgrounds; permitting black-and-white text-only advertising in publications with significant numbers of readers under 18; prohibiting sale or giveaway of products, like caps, that carry cigarette or smokeless tobacco brand names or logos; prohibiting brand-name sponsorship of sporting or entertainment events; and requiring industry to fund a public education program to prevent children from smoking.

On Aug. 28, 1995, FDA Commissioner David A. Kessler, M.D., was a guest on National Public Radio's "Talk of the Nation" to discuss smoking with several teenagers. Here are excerpts from that broadcast, hosted by Ray Suarez.)

David A. Kessler, M.D.: Ray, one in five Americans will die from a smoking-related illness. Each day, 3,000 kids begin to smoke, and of those 3,000 about 1,000 will go on to die from a smoking-related illness. This is, without a doubt, the most important public health problem facing us. It's also the most preventable.
Despite what the tobacco executives say, smoking is very addictive. And it's this window of addiction during the teenage years that's very important to understand, because what the president has done is to try to take steps to close that window. Most kids who smoke, seven out of ten when you ask them, say they regret ever having started.

Suarez: What do the studies say about which kinds of teens are most at risk to make this a lifelong habit?

Kessler: There is a study called "Youth Targets, 1987" and it was prepared for the sister company of R.J. Reynolds in Canada, and this is how that document, prepared by certain consultants for the tobacco industry, views teenage smoking:
They divided teenagers into different categories: tomorrow's leaders, big city independents, quiet conformers, the TGIF group, insecure moralists, and small town traditionalists. Those were just some of the terms they used. And their own research found that it was the TGIF group that had the highest incidence of smoking. This is almost one-third of youth. It says males predominate. Achievement in leadership is not a goal for this group compared with others. Typical of their attitudes and values are, "I would not rather read a book than go out. I do not think my life is a success." Now, that doesn't mean that everybody who starts to smoke is in that group. But they have the information on where smoking is more common.

Suarez: Well, our studio guests spend a lot more time in high schools than either you and I do. And I'd love to hear what some of them have to say about who smokes in your school, in your neighborhood, among your friends and peers. Who wants to get us started?

[Laughter]

Regiana: I'm 14. I think that the people that try to be cool with the people--that's usually how it starts, with peer pressure.

Suarez: And you are not a smoker.

Regiana: No, I'm not a smoker.

Suarez: When Dr. Kessler was describing the TGIF crowd, did any of you recognize people you know from school in that description?

Brian: I'm 18. I went to high school in Los Angeles, and attitudes over there are very different about smoking. The people in my high school who started smoking typically came from a broken home, and to them, their peer group was more important than just about anything, and smoking to them was part of their peer group. And they did it because it was cool, because it was hip, because they saw people in magazines smoking. These are more the Bohemian kids, kind of the beatnik kids, and to them it was kind of a group identification.

Leah: I'm 16. I've been smoking for quite some time, and I know when I first started, because I started so young it was a peer thing, and it was because I wanted to hang out with the older crowd, and the older crowd was smoking at the time.
But I smoke now and it's strictly my choice. And I think I have pretty high goals for myself. I'd like to be a pretty big leader in what I do.

Kessler: How old were you when you started to smoke?

Leah: About 8 or 9.

Kessler: Do you know about the health risks at all?

Leah: When I had my first cigarette, no, I had never heard anything about it. I have a lot of people in my family who smoke and, of course, at the time that they were smoking and I had started, none of them were dying of it yet.

Kessler: Do you believe you would ever have a risk, a chance of getting sick from smoking?

Leah: Oh yeah. My family is now dying of it. A lot of my family members have died from cancer and smoking-related [causes].

Kessler: Why do you continue to smoke?

Leah: It's a habit now.

Kessler: Tell me a little about the habit.

Leah: It's very addictive, like they say. It's a very addictive drug.

Kessler: When you started at 8 or 9, did you think you would get hooked?

Leah: No. When I first started I figured, okay, one cigarette is not going to hurt me. And then, you know, one cigarette a day isn't going to hurt me. Two cigarettes a day isn't going to hurt me.

Kessler: Did you think you would be able to quit?

Leah: Yeah.

Kessler: Have you tried to quit?

Leah: Many times.

Kessler: And you failed?

Leah: Miserably.

Kessler: The tobacco industry has known about teenagers who smoke, and their consultants did studies called "Project 16" [and] "Project Plus/Minus." [They reported] that around the ages of 11 to 13 there is peer pressure exerted by smokers on nonsmokers, that serious smoking really starts about 14, 15 years of age, that starters no longer disbelieve the dangers of smoking, but they almost universally assume that these risks will not apply to themselves because they themselves will not become addicted. But addicted they do indeed become. And once there is acceptance that addiction is taking place, thoughts of quitting most often follow.
They continue to write that the desire to quit seems to come earlier now than before, even prior to the end of high school. In fact, it often seems to take hold as soon as the recent starter begins to see that he is hooked on smoking. However, the desire to quit and actually carrying it out are two quite different things. Once you sense you're hooked, only then do you have some desire to really quit. And then the problem is, it's too late. Does that seem to be correct?

Leah: Yeah. In a sense. I think it depends, like everybody has been saying, on the group you hang out with, the group you want to hang out with.

Suarez: We have some people in our audience who quit. Let's hear from them.

Tyler: I'm 16 years old. I started smoking maybe about two years ago in my freshman year of high school, and I did it mainly because it was my choice. Some of my friends smoked and some of them didn't. I didn't do it to hang out with anyone, but I think maybe I did it to tick my parents off or my way of rebelling, maybe. I only smoked for about three months, and during those three months, I think I became quite addicted.
But stopping: My parents watched me and I was not allowed to go anywhere or do basically anything until I had proven to them that I had quit. So they kind of cut off my supply of getting any cigarettes. And after about six months after that, I hadn't had a cigarette because I had almost no way of getting to one.

Kessler: Is it really a choice issue? That's what the tobacco industries want you to believe. And I think you can argue that the decision to smoke your first cigarette is a matter of choice. But this is a product that addicts its users. It's a marketplace that's sustained by addiction. What choice is there once you've really become addicted? Isn't it much harder to quit? When you picked up your first cigarette, did you say, "I'm going to smoke this one and 10,000 or 20,000 or 100,000 more?"

Leah: No. It was my choice at first. That very first cigarette was my choice, and maybe even the second one. But now I've been smoking so long and I've smoked so much. I can try to quit, you know. That's a choice I can make. But, you know, the wanting and the needing of the cigarette isn't a choice anymore.

Kessler: We talked a little about peer pressure. What's behind that peer pressure? Do you think advertising plays any role?

Leah: I don't think it's such a large factor.

Kessler: What brands of cigarettes do the smokers in the room smoke?

Katie: I personally smoke Marlboro Lights.

Jocko: Marlboro regs.

Kessler: Any other smokers with brands?

Unidentified panelist: I smoke Marlboro regs also.

Kessler: Three Marlboros. Any other brands?

Third Panelist: I sometimes smoke Camels.

Kessler: Camels, Marlboros. What are the three most heavily advertised brands of cigarettes? What's your guess?

Panelists: Marlboros.

Kessler: Marlboro.

Panelists: Camels.

Kessler: Camel.

Panelists: And Newport.

Kessler: And Newports. What's the three most common brands among teenagers?

Panelists: Marlboros and Newport.

Kessler: [And] Camel. Do you think that's by accident? What's the most common brands among adults? The generic brands. Adults want to buy the cheapest cigarette. Here's a picture of Joe Camel. What kind of message do you think the tobacco industry is trying to send?

Anandas: I'm 18 years old. And I think it's part of the image that they're trying to portray. I think, whether or not to be cool, a way of feeling they belong in that crowd.

Kessler: The tobacco industry spends $6.2 billion a year promoting their product. Why do you think they do that?

Robert: I'm 13. I think they do it so they can attract young smokers, and they know if they smoke when they're young, they're more likely to keep smoking until they're older.

Suarez: To join the conversation, give us a call. We're joined now by Heather, who's in Tallahassee, Florida.

Heather: I'm 25.

Suarez: Are you a smoker?

Heather: Yes, I am, and I wish that I had never started. And I wanted to tell the kids in your audience that have started smoking to quit now, no matter how bad it makes them feel, because the longer you go on, the harder it gets.

Kessler: How old were you when you started?

Heather: Thirteen.

Kessler: What was it like when you started?

Heather: I did it because I was kind of a goody-goody and that was one way for me to rebel without having to cause my parents all kinds of heartache, although it's done that too.

Kessler: Did you ever try to quit when you were a teenager?

Heather: I tried to quit several times in college, and it's very difficult, very difficult. Most of my friends are smokers now. I've got that constant smoking around me.

Kessler: When you hear the tobacco executives say that nicotine is not addictive, what do you think about that?

Heather: I think they're full of crap. And it's that combination of peer pressure, the advertisements that get into your subconscious so you're totally not even aware that they are advertising to you, and, you know, that need for teenagers to feel that they belong. And there you go, you've got a whole new smoking population.

Kessler: What do you think we can do to help reduce teenagers from ever starting?

Heather: Get rid of the vending machines, for one thing, because that is the A-number one way for kids to get cigarettes. And induce penalties on people for selling them. Right now, they don't penalize store owners, they only penalize the individuals, at least in the state of Florida. And that doesn't work, because they'll just fire the individual that sold the cigarettes to the minor and hire somebody new and start the cycle over again. They need to penalize the store owners.

Kessler: Well, when you were 13 and 14 and starting to smoke, where did you get your cigarettes?

Heather: Vending machines and clerks at your local gas station down on the corner.

Suarez: Now, it's interesting. Heather, thanks for joining us.
Heather identified advertising as an important factor. And we have a couple of black teenagers in our panel here in the studio. They are getting the same advertising messages that everybody else is getting and, in some arguments, even more in the billboards in their area.

Kessler: Twenty years ago, both white and black high school seniors, about 25 percent, smoked. Today, only 5 percent of African American high school seniors smoke cigarettes compared to 25 percent [of white high school seniors].

Suarez: Well, let's hear from some of you.

William: I'm 14. And most of the kids in my school, the ones that smoked, were those who weren't involved in a lot of activities; they weren't involved in sports or anything, and they were bored a lot of the time, and those were basically the ones that smoked.

Kessler: Can you play sports and smoke?

Ashley: I play sports. And most of the people in my school who play sports do not smoke. They'll smoke over the summer. I have a lot of friends, and they'll say, "Well, I'll smoke over the summer and then I'll quit for the school year so I can start my sports again." But basketball and football [players], most of them don't smoke. But I've noticed a lot of soccer players do smoke.

Erin: I'm 15. I'm a very serious athlete. I play lacrosse and soccer. And in my school if they find out that you do smoke, you're off the team. It's just like that with drugs and alcohol. They sort of group it altogether. It doesn't stop most people.
But like there's this girl in our school and she used to run track. She was a state champion, and she started smoking when she was a sophomore, and now she doesn't do anything. She's like a total bum mentally. I mean, she had really bad asthma, and it totally tore up her lungs.

Suarez: Let's go back to the phones in Emeryville, California. Jason, you've been patient.

Jason: I'd like to say to David Kessler that I think he's probably one of the only people in government that I respect right now. He's really decided what he's going to do and is doing it.
And I'd also like to say that I started smoking when I was about 9, I think, 'cause my sister's friends gave me a cigarette to smoke as a joke, and I started. I probably didn't smoke again until I was about 11. But then I started smoking Marlboros, and I smoked Newports for awhile, but then I switched to Camels, so that was a cross, all of them.
I'm 22. I quit about 12 months ago when my girlfriend was pregnant and we decided to have a baby. She was quitting, so I decided I should quit too. At first, it was pretty tough; then it got easier. But it's still--it's still there.

Suarez: How long has it been now, Jason?

Jason: It's been about a year now. My daughter is 2 months, so it's been little less than a year.

Suarez: We've got about a minute left, Dr. Kessler, and I'm wondering whether you see much hope now that cigarette use is starting to go up among teens. It isn't a matter anymore of telling them that it's going to be bad for them, because they are told that, and they're starting to smoke anyway. What is the answer? Is it more on the preventive side then? The enforcement side?

Kessler: The president spelled out what I think most Americans view as reasonable steps aimed at teenagers. It's not going to eliminate it entirely, but it would reduce easy access to cigarettes, and also to reduce that appeal, the glamour, the fun, the independence, the messages that we're constantly bombarded with. During the teenage years, if we can get young people through that window [period] without having them start, we really can save lives.

(FDA Consumer thanks NPR for permission to excerpt portions of this show for publication.)