PREVENTIVE MEDICINE 27, A1–A2 (1998)ARTICLE NO. PM980421

INTRODUCTION

Tobacco-Use Cessation in the ‘90s—Not ‘‘Adults Only’’ AnymoreThomas Houston, M.D.,*,1 Lloyd J. Kolbe, Ph.D.,†,‡ and Michael P. Eriksen, Sc.D.‡

*Department of Preventive Medicine and Environmental Health, American Medical Association, Chicago, Illinois 60610; and†Division of Adolescent and School Health and ‡Office on Smoking and Health, National Center for Chronic Disease Prevention

and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341

Tobacco use is the leading cause of death in the United To help improve our understanding about youngStates, accounting for more than 420,000 deaths annu- people and tobacco cessation, the Centers for Diseaseally [1]. Indeed smokers who do not quit by age 35 have Control and Prevention’s (CDC’s) Division of Adoles-about a 50% chance of dying from a tobacco-related cent and School Health and Office on Smoking anddisease [2]. This pandemic has its roots in adolescence; Health have worked with the American Medical Asso-each day, 3,000 young people are added to the rolls of ciation’s (AMA’s) Department of Adolescent Health onregular smokers [3]. In fact, almost 90% of today’s adult a pilot project that has begun examining this issuesmokers began as teens [4]. Unfortunately, the numbers in a systematic way. The papers in this special issueare not getting better; tobacco use among young people reflect the work of special consultants to the AMAcontinues to increase. project and pose some important questions: What do

Nicotine dependence is the key to regular tobacco young people think about tobacco cessation? Does theuse. Just like adults who smoke cigarettes and use spit Prochaska ‘‘stages of change’’ model apply to tobaccotobacco, young people who use tobacco report similar cessation among young people? What are some of thecravings and symptoms of withdrawal when addicted predictors of different levels of cigarette and smokelessto nicotine. Unfortunately, young people often express tobacco use among young people? What predicts theirlittle concern about the consequences of taking up to- interest in quitting? Can the brief office-visit modelbacco products. Most occasional adolescent smokers say used by health professionals to help adults quit alsothat they will not still be smoking 5 years after high be used effectively with youth? Are there particularschool graduation, but in fact only about half of those techniques that might be effective in discussing riskyquit by that time. Furthermore, of those who smoke a behaviors with adolescents?pack per day as seniors, most still smoke as intensely Recently there have been some encouraging activi-5 years later [5]. ties. The National Cancer Institute has announced the

Many adolescent smokers have seriously considered availability of funds for research on young people andquitting, and over half of high school users have actu- tobacco-use cessation [7], and both the Institute of Med-ally tried to quite [6]. Sadly, tobacco-use cessation for icine [8] and the Advisory Committee on Tobacco Policyyoung people has not been given the same priority—in and Public Health [9] (which is chaired by former Sur-either research or practice—as that for adults. Fur- geon General C. Everett Koop and former FDA Commis-thermore, most of the tobacco cessation interventions sioner David Kessler) have called for more research andfor young people have been transferred from the adult treatment options for young people who use tobacco. Inworld; most such programs in use today have not had addition, a meeting of leading scientists and health-rigorous evaluation, and little primary research has related agencies and organizations was convened bybeen done on tobacco-use cessation among youth. Tra- the CDC in 1997 to explore ways in which the scienceditionally, the health community has concentrated al- and application of youth cessation programs could bemost exclusively on convincing young people not to advanced [10]. We hope that the articles in this volumestart using tobacco, instead of also helping them to stimulate discussion and interest about tobacco-use ces-quit. sation for young people among health professionals,

tobacco-use prevention advocates, organizations that1 To whom reprint requests should be addressed. serve youth, researchers, and funding agencies. Given

A1 0091-7435/98 $25.00Copyright q 1998 by American Medical Association

All rights reserved.

A2 HOUSTON, KOLBE, AND ERIKSEN

5. Johnston LD et al. National survey results on drug use fromthe large, and unfortunately increasing, number ofthe Monitoring the Future Study, 1975–1994. Washington: U.S.young people who are addicted to tobacco, we must doDepartment of Health and Human Services, Public Health Ser-more to help them quit. vice National Institutes of Health, National Institute on DrugAbuse, 1996. [NIH Publication No. 96-4027]

REFERENCES6. Centers for Disease Control and Prevention. MMWR 1998;47(19).

1. Centers for Disease Control and Prevention. Cigarette smoking- 7. National Cancer Institute. Prevention and cessation of tobaccoattributable mortality and years of potential life last—United use by children and youth in the U.S. National Institutes ofStates, 1990. MMWR 1993;42:645–649. Health guide 1997 Dec 19;26(40). [RFA: CA-98-002]

2. Doll R, Wheatley K, Gray R, Sutherland I. Mortality in relation8. Lynch BS, Bonnie RJ, editors. Growing up tobacco free: pre-to smoking: 40 years obervations on male British doctors. BMJ

venting nicotine addiction in children and youths. Washington:1994;309:901–11.Institute of Medicine, National Academy Press, 1994.

3. Substance buse and Mental Health Services Administration. Un-9. Koop CE, Kessler DA. Final report of the Advisory Committeepublished, 1994.

on Tobacco Policy and Public Health. Washington: U.S. Govt.4. U.S. Department of Health and Human Services. PreventingPrinting Office.tobacco use among young people: a report of the Surgeon General.

Atlanta: U.S. Department of Health and Human Services, Public 10. Centers for Disease Control and Prevention. Atlanta: NationalCenter for Chronic Disease Prevention and Health Promotion,Health Service, Centers for Disease Control and Prevention, Na-

tional Center for Chronic Disease Prevention and Health Promo- Office on Smoking and Health and Division of Adolescent andSchool Health. Monograph in press.tion, Office on Smoking and Health, 1994.