School-based programs are unable to decrease the long-term smoking prevalence among adolescents

Slapping a $1-a-pack tax on cigarettes and putting the money into antismoking campaigns could cut the number of young smokers by 26 percent and avoid more than 108,000 smoking-related deaths by the time their generation reaches age 85, new research suggests.

“The number of lives that potentially could be saved due to smoking-prevention initiatives overshadows nearly all other public health measures,” says Frederick P. Rivara, M.D., M.P.H., of the University of Washington in Seattle.

The analysis appears in the August issue of the American Journal of Preventive Medicine.

There were about 4 million 18-year-old Americans in the year 2000, Rivara and colleagues report. About 27 percent of the men and 23 percent of the women were smokers at that age. By the time this group turns 85, Rivara estimates, more than 412,000 will die of smoking-related diseases. That translates to an estimated 6 million years of life lost.

“This would be repeated each year, as each successive cohort of individuals ages,” he says. Aggressive anti-smoking campaigns could save thousands of lives, he adds, but current anti-smoking efforts have produced only mixed results.

“School-based programs are unable to decrease the long-term smoking prevalence among adolescents,” Rivara says. Smoking bans and restricting sales to minors haven’t helped either.

However, previous research shows that raising cigarette prices and disseminating multimedia antismoking campaigns do reduce adolescent smoking.

“A 10 percent increase in price would result in a 6 percent decrease in smoking prevalence,” Rivara says. Large, statewide multimedia campaigns in Massachusetts and California cut smoking rates by 6 percent to 12 percent.

Combining these two approaches could sharply cut smoking and the ensuing illness and death. There would be 26 percent fewer smokers by age 18 and a similar decline in current and former smokers at age 35, he says.

“In the population of people aged 18 years in 2000, 108,466 lives and 1.6 million years of potential life lost would be saved by preventing 26 percent of smoking-attributable mortality,” Rivara says.

This double-barreled approach would pay for itself, he says: “The increased revenue generated from higher excise taxes on tobacco would fund the large-scale multimedia campaign.”

The antismoking campaign would still have to compete with tobacco company marketing muscle, he adds. The companies might cut cigarette prices or use special promotions to get around the tax increases, diminishing their effect.

Reducing adolescent smoking won’t cut smoking-related death rates for decades, but the size of the effect is great enough to make the attempt, he says.

The study was supported by a grant from the Robert Wood Johnson Foundation.

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