Adolescent smoking: Are we ready to take up the challenge?

Many adolescents smoke. According to the Addiction Research Foundation's 1999 Ontario Student Drug Use Survey (1), 29.2% of high school students smoked cigarettes during the previous year. Children who are eight and nine years of age, and younger are also trying cigarettes. Clearly, current prevention programs and programs that are aimed at helping adolescent smokers to quit are not working. A recent US$15 million longitudinal study, which was funded by the United States National Cancer Institute, evaluated a comprehensive smoking prevention program and found no difference in smoking rates among students who participated in the program and those students who did not participate (2). To date, increasing tobacco taxes has been the most effective way of decreasing tobacco consumption among youth. The challenge is to identify additional strategies that are equally effective. Bill S-20, the Tobacco Youth Protection Act, is a private member's bill that was introduced in the Senate in 2000. The bill would place a levy on tobacco products; the monies accumulated would be used to fund programs that are aimed at the prevention of tobacco use by youth. The levy would not significantly affect the price of a pack of cigarettes; therefore, most likely, it would not act as a deterrent, as increased tobacco taxes do, to youth who purchase cigarettes. A newspaper article reported that the majority of Canadians would support such a bill (2). Major tobacco companies have also shown great support for Bill S-20. One wonders why they are doing so? The support of the tobacco industry is of concern. Physicians for a Smoke-Free Canada and the Advocacy Committee of the Canadian Association for Adolescent Health (CAAH) have reviewed Bill S-20. Canadians should be informed about important aspects of this bill. Bill S-20 states that the Canadian tobacco industry has an objective of preventing the use of tobacco products by young persons in Canada. However, the vast majority of adult smokers begin smoking as adolescents. If youth are ‘prevented’ from becoming smokers, there will be no new ‘consumers’ to take the place of those who quit or die. Why would the tobacco industry support an objective that, ultimately, appears to reduce its profits? If Bill S-20 passes, less support and emphasis may be placed on measures such as the reintroduction of higher tobacco taxes, which is a proven method of decreasing consumption of tobacco products by young people. It is crucial for Canada to have a comprehensive strategy aimed at the prevention of youth smoking that would include higher taxes and stronger consequences for selling tobacco to minors. The bill outlines tobacco ‘industry benefits’, which include “access to the information gathered by the foundation regarding the use of tobacco products by young persons”. Why would the tobacco industry require this information? Benefits also include “the improvement in the business climate for the industry”. What does an improved ‘business climate’ (for the tobacco industry) have to do with the health of Canadian youth? A huge amount of money will be generated annually by the proposed levy. How will decisions be made about the way in which funds will be allocated? Given that there are few, if any, programs that have demonstrated effectiveness, on what basis will decisions be made to fund existing programs? Who will make these decisions? Who should make these decisions? Many aspects of the bill are positive. Money is needed for research into effective strategies. Youth will be involved in the process. Representatives from health and youth-serving organizations will also be involved. Physicians for a Smoke-Free Canada has reviewed the bill in detail and suggested a number of revisions. The CAAH supports the bill with the suggested revisions. The revised bill would ensure that the focus is on the health of our youth instead of the health of the tobacco industry. A final point is that we must continue to push for the government to raise tobacco taxes. Increasing tobacco taxes is still the only strategy that has been demonstrated to have a significant effect on tobacco use by youth. Increased tobacco taxes must be implemented in addition to other initiatives such as Bill S-20. Organizations, such as the Canadian Paediatric Society and the CAAH, can and should play a major role in lobbying the government to increase tobacco taxes. Adolescence is a time of change, experimentation and risk taking. Therefore, a certain percentage of youth will always try smoking. Sadly, many of these same young people will go on to be life-long smokers. The challenge is to prevent as many young people as possible from initiating tobacco use, and to find effective ways to encourage and assist those youths who have become regular smokers to quit. Are we ready to take up the challenge?

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