Tobacco. INSTITUTION National Clearinghouse for Alcohol and Drug Information (DHHS), Rockville, MD

DOCUMENT RESUME

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AUTHOR Zuckerman, Karen, Ed. TITLE Alcohol, Tobacco, and Other Drugs Resource Guide: Tobacco. INSTITUTION National Clearinghouse for Alcohol and Drug Information (DHHS), Rockville, MD. SPONS AGENCY Substance Abuse and Mental Health Services Administration (DHHS/PHS), Rockville, MD. Center for Substance Abuse Prevention. REPORT NO DHHS-SMA-94-2069 PUB DATE Dec 93 NOTE 34p. PUB TYPE Reference Materials Bibliographies (131)

EDRS PRICE MF01/PCO2 Plus Postage. DESCRIPTORS Abstracts; Adolescents; Annotated Bibliographies; Children; Drug Education; Elementary Secondary Education; *Health; Intervention; *Prevention; Resource Materials; *Smoking; *Substance Abuse; *Tobacco IDENTIFIERS *Tobacco Industry

ABSTRACT This guide was designed to aid prevention specialists, educators, pirents, and others in addressing tobacco problems among youth. Listed here are numerous publications--each one summarized-'-on tobacco use. The guide is divided into two sections: (1) Prevention Material for Tobacco; and (2) Studies, Articles, and Reports on Tobacco. Section one includes publications on secondhand smoke, spit tobacco, non-smokers' rights, tobacco as a drug, smoking and health, and other information. Each listing includes the following information: title, organization responsible for publication, publication date, format, topic, target audience, setting, readability, inventory number, and availability, including addresses and phone numbers. Many of the materials are for children. Section two, which consists of government publications and journal articles, features more extensive summaries than those that appear in the previous section. Some of the titles here address prevention, addiction, women, tobacco advertising, peer group influence, maternal smoi _ng, Black Americans, prevention programs, health consequences, youth, passive smoking. predictors of use, gender differences. intervention, and government policy. Names, addresses, and phone numbers for groups, organizations, and programs on tobacco appear at the end of the guide. (RJM)

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U.S. DEPARTMENT OF EDUCATION ()nice of Educations! Research and Improvement EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) This document has been reproduced as received Iron, the person or organ,zation originating 4 December 1993 O Minor changes have been made to morose reproduction (lushly

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From the Acting Director of CSAP... According to the Centers for Disease Control and Prevention, roughly 419,000 people die in the United States from tobacco use every year. Teenagers make up the haw largest percentage of new cigarette smokers and studies show that ss,ti'N\ tobacco is one of the most common "gateway drugs" there is. Obvio- ' usly, the problem of tobacco use among our country's youth must 5,\ be addressed. c: CSAP recognizes the seriousness of tobacco problems and is work- ing diligently to bring hope for a healthier tomorrow. Designed to aid prevention specialists, educators, parents, and others, this resource guide includes a listing of exciting and colorful prevention materials, useful research U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES abstracts, and relevant resources Public Health Service for your use and attention. Substance Abuse and Mental Health Services Administration Prevention works. We can save lives. Vivian L. Smith, M.S.W.

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BEST COPY AVAILABLE The listing of materials or programs in this resource guide does not constitute or im- ply endorsement by the Center for Substance Abuse Prevention, the Public Health Service, or the Department of Health and Human Services. The materials have been reviewed for accuracy, appropriateness, and conformance with public health principles.

This Alcohol, Tobacco, and Other Drugs Resource Guide was compiled from a variety of publications and data bases and represents the most currentinformation to date. It is not an all-inclusive listing of materials on this topic. This guide will be updated regularly, and your comments or suggestions are welcome. To suggest information or materials that might be included in updated editions, please write to the National Clearinghouse for Alcohol and Drug Information (NCADI), P.O. Box 2345, Rockville, MD 20847-2345.

Produced by the National Clearinghouse for Alcohol and Drug Information, Karen Zuckerman, editor. For further information on alcohol, tobacco, and other drugs, call 1-800-729-6686, 301-468-2600, or TDD 1-800-487-4889.

"1-11-*Pleasefeel free to be a "copy cat," and make all the copies you want. You 11-11 have our permission! Prevention Material for Tobacco it's Time To Stop Being A Secondhand Smoke: What You Passive Victim Can Do About Secondhand Organization: Centers for Disease Control Smoke as Parents, and Prevention Decisionmakers, and Building Year: 1993 Occupants Format: Information Kit Organization: Environmental Protection Length: 20 Pages Agency (EPA) Topic: Secondhand Smoke Year: 1993 Target Audience: Parents, Employees, Format: Brochure General Public Length: 4 Pages Setting: Home., Health Care Topic: Secondhand Smoke Readability: Fairly Difficult Target Audience: Parents, Inventory Number: PHD651 Policymakers/Administrators, Employers Availability: National Clearinghouse for Setting: Home, Government, Workplace Alcohol and Drug information, P.O. 2345, Readability: Difficult Rockville, MD 20847-2345, 301-468-2600, 1-800-729-6686 Availability: EPA, Indoor Air Quality Information Clearinghouse, P.O. Box 37133, Washington, DC 20013-7133, Thisinformation kit describes second- 301-585-9020, 1-800-438-4318 hand smoke as a poison an4 states that passive smokers, especially children, Thisbrochure explains the risks of sec- are at risk for a host of physical prob- ondhand smoke and states that passive lems including lung cancer, pneumonia, smoking is estimated to cause roughly and bronchitis. Parents are pressed to 3,000 lung cancer deaths in nonsmokers keep their homes smoke-free, employ- each year. Suggestions are offered on ees are encouraged to petition for a non- how parents, employers, restaurant smoking policy in the workplace, and owners, and building occupants can all are urged to appeal for a smoke-free protect themselves and others from the atmosphere at their favorite restaurant. dangers of passive smoking. A special Fact sheets, containing action steps and message for smokers is also included, resources, are included. asking them, among other things, to re- frain from smoking around children and to encourage their employers to offer a smoking cessation program.

Tobacco 4 Page 1 The Challenge: Focus on Spit Beat the Smokeless Habit contains infor- Tobacco mation on smokeless tobacco and offers Organization: U.S. Department of Education student baseball players a nine-inning Year: 1993 game plan on how to break the habit. Professional baseball player cards are Format: Newsletter scattered throughout the booklet as are Length: 24 Pages quotes from players such as Nolan Topic; Spit Tobacco Ryan, John Franco, and Norm Charlton. Target Audience: Alcohol/Drug Prevention Professionals and Educators The booklet discusses the history of Setting: School' smokeless tobacco, contains informa- Readability: Difficult tion about the drug's health. risks, including graphic photographs of pa- Inventory Number: PFID650 Availability: National Clearinghouse for tients with smokeless tobacco-induced Alcohol and Drug Information, P.O. Box mouth cancer, and offers suggestions 2345, Rockville, MD 20847-2345, and encouragement on how to quit. 301-468-2600, 1 -800- 729 -6606

TheChallenge is a quarterly newsletter, I Mind Very Much if You Smoke produced by the Department of Educa- Organization: National Cancer Institute tion, containing lesson plans, informa- Year: 1993 tion on state-of-the-art programs, and Format: Booklet topical articles on alcohol, tobacco, and other drug use and prevention. This is- Length: 12 Pages sue focuses on spit tobacco and includes Topic: Secondhand Smoke Target Audience: Parents, Employees, a look at the history of spit tobacco, cur- General Public ricula for students in grades K-12, facts Setting: Home, Worksite and figures about spit tobacco and Readability: Fairly Difficult youth, prevention and education pro- Availability: Cancer Information Service, grams, and resources. 1-800-4CANCER

This brochurestates that secondhand Beat the Smokeless Habit smoke can cause serious adverse health Organization: National Cancer Institute complications, including lung cancer, Year: 1992 heart disease, pneumonia, and asthma. Format: Booklet It advises readers to say "no" to second- Length: 20 Pages hand smoke at home, at the worksite, Topic: Smokeless Tobacco and in public places and suggests tact- Target Audience: Student Athletes (Baseball ful ways to do so. Additional action Players), Recreation /Sports Personnel steps for nonsmokers to take are in- Setting: Recreation/Sports cluded as is a list of organizations for Readability: Average further information. Availability: Cancer Information Service, 1-800-4CANCER

Page 2 For further informalion, write to NCADI, P.O. Box 2345 Rockville, MD 20847-2345 Drugs Mean Nicotine Tool Thisbrochure explains why tobacco is Gillespie, J. so dangerous and what the chemicals inside the tobacco plant can do to the Organization: Hazelden body. Cancer, heart disease, and strokes Year: 1989 are discussed as potential conditions Format: Brochure that tobacco may cause, and special risk Length: 8 Pages populations such as pregnant women Topic: Tobacco, Alcohol, and Other Drugs, are highlighted. and Prevention Target Audience: Community Service Groups and Youth ages 5-15 Setting: Community Organization and Smokeless Tobacco! Yolanda School and Mark Talk to Teens Readability: Easy Availability: Hazelden, Pleasant Valley Stang, L. Road, P.O. Box 176, Center City, MN Organization: Network Publications 55012-0176; 800-328-9000 Year: 1990 Thispamphlet defines tobacco as "the Format: Brochure hidden drug," and states that it is one of Length: 7 Pages the most addictive drugs. Effects of Topic: Tobacco Prevention, Intervention nicotine on the body, why people begin and Treatment to smoke, and why it is so difficult to Target Audience: Jr. and Sr. High Youth stop are some of the topics addressed. Setting: Home and School Teenagers are urged to talk to a parent, ReadabilN Easy friend, or teacher about their problems Availability: ETR Associates, Network and not to "plug up your mouth with a Publications, P.O. Box 1830, Santa Cruz, cigarette and medicate your scared or CA 95061-1830: 1-800-321-4407 angry feelings with nicotine." Twoteenagers discuss the negative effects of smokeless tobacco on health About Tobacco and appearance. Facts about the addic- tiveness of snuff are included, and sug- Peterson, P.G. gestions on how to quit are listed. Organization: Network Publications Year: 1990 Format: Brochure Length: 5 Pages It's Just a Matter of Time Topic: Tobacco Prevention, Intervention Organization: Captain K.I.D. Productions and Treatment Year: 1990 Target Audience: Jr. and Sr. High Youth Format: Poster Setting: Home and School Length: 1 Page Readability: Average Topic: Tobacco Prevention, Intervention Availability: Network Publications, P.O. Box and Treatment 1830, Santa Cruz, CA 95061-1830; Target Audience: Elementary Youth and 1-800-321-4407 Preschool Setting: Home and School Readability: Low Literacy

Tobacco Page 3 Availability: Captain K.I.D. Productions, P.O. Context: Part of a Packet/Program Box 25529, Anaheim, CA 92825-5529; Topic: Tobacco, Alcohol, and Other Drugs 714-758-8.441 Prevention Target Audience: Educators and Coaches Thisposter shows an illustration of Setting: School four cigarettes with a running time Readability: Easy bomb wrapped around them. The mes- Availability: National Clearinghouse for sage, in bright red letters, reads, "It's Alcohol and Drug Information, P.O. Box just a Matter of 'Timer 2345, Rockville, MD 20847; 800-729-6686 This trifold offers assistance for coaches and teachers on how to help Everything You Need to Know their students stay away from tobacco,

About Smoking alcohol, and other drugs. Useful facts _ Keyishian, E. about tobacco and alcohol are men- Organization: The Rosen Publishing Group, tioned as are suggested topics for class- Incorporated room discussion. An extensive resource Year: 1989 list for additional information is also in- Format: Book cluded. Length: 64 Pages Topic: Tobacco Prevention, Intervention and Treatment Score: The Performance Target Audience: Elementary, Jr. High, and Magazine Sr. High Youth Organization: U.S. Department of Health Setting: Home and School and Human Services Readability: Easy Year: 1989 Availability: The Rosen Publishing Group, Format: Magazine Incorporated, 29 East 21st Street, New Length: 7 Pages York, NY 10010; 212-777-3017 Context: Part of a Packet/Program Topic: Tobacco, Alcohol, and Other Drugs Thishook provides a host of informa- Prevention tion about cigarette smoking. Chapters Target Audience: Jr. and Sr. High Youth address such topics as health risks, ciga- Setting: School rette advertisements, addiction, and Readability: Easy quitting. A glossary is included to ex- Availability: National Clearinghouse for plain new words, and a suggested read- Alcohol and Drug Information, P.O. Box ing list is offered. 2345, Rockville, MD 20847; 800-729-6686

This magazine, which makesup part The Performance Edge: A of the Performance Edge kit, explains to teenagers how drinking and smoking Guide for Coaches and hurt athletic performance and take Teachers away the "edge" regarding fitness and Organization: U.S. Department of Health sex appeal. Colorfully illustrated with and Human Services charts, brief articles, and quizzes, this Year: 1989 Format: Brochure Length: 4 Pages 7

Page 4 For further Information, write to NCADI, P.O. Box 2345 Rockville, MD 20847-2345 magazine conveys a definite no use mes- smell of smoke. After much persuasion sage, and lists resources for further in- Mr. Smith breaks his habit and the formation. whole family rejoices.

The Performance Edge Smoking & Health Organization:U.S. Department of Health Dye,C. and Human Services Format: Poster Organization: Do It Now Foundation Length: 1 Page Year: 1991 Topic: Tobacco, Alcohol, and Other Drugs Format: Brochure Prevention Length: 8 Pages Target Audience: Young Adults, Sr. High Context: Stands Alone and Part of a Youth, and Athletes Packet/Program Setting: Recreation/Sports and School Topic: Tobacco Prevention Readability: Average Target Audience: General Public and Availability: National Clearinghouse for Women Alcohol and Drug Information, P.O. Box Setting: Community Organization and Home 2345, Rockville, MD 20847; 800-729-6686 Readability: Fairly Difficult Availability: D.I.N. Publications, P.O. Box Thisposter pictures an Olympic ath- 27568, Tempe, AZ 85285; 602-491-0393 lete performing a dive. The slogan reads "Tobacco and Alcohol Don't Mix with the Performance Edge." This brochure pointsout the dangerous effects of cigarette smoking. Public policy information is given and statis- tics and charts are included that docu- Not in Here, Dad! ment recent trends and correlations. Dutton,C. Suggestions are given on ways to "un- stress" while trying to quit. Organization: Barron's Educational Series Year: 1989 Format: Book Length: 24 Pages About Smoking Topic: Tobacco Organization: Alcoholism and Drug Target Audience: Elementary Youth Addiction Research Foundation Setting: Home and School Year: 1989 Readability: Easy Format: Booklet Organization: Barron's Educational Series, Length: 4 Pages Incorporated, 250 Wireless Boulevard, Topic: Tobacco Hauppauge, NY 11788; 516-434-3311 Target Audience: Elementary, Jr. High, and Sr. High Youth Thispicture book tells the story of the Setting: Home and School Smith family and how Mr. Smith's Language: Bilingual -- French and English smoking habit disrupted their lives. Tar- Readability: Easy geted toward young children, the book Availability: Alcoholism and Drug Addiction tells how the cigarettes hurt Mr. Smith's Research Foundation, 33 Russell Street, health and caused the wholehouse to Toronto, Canada M5S 2S1; 800-661-1111

Tobacco Page 5 8 This booklet, available in both English Topic: Tobacco, Prevention, Intervention, and French versions, discusses the and Treatment' chemical make-up of tobacco and ex- Target Audience: Educators, Employers, plains how cigarettes are made. The and Sr. High Youth physical effects of nicotine on the body Setting: Home and School are stated, with references to prenatal Language: English and Spanish exposure and second-hand smoke. In- Readability: Fairly Difficult formation is presented through car- Availability: Performance Resources Press, Inc., 1863 Technology Drive, Suite 200, toons, charts, and brief paragraphs. Troy, MI 48083-4244; 313-588-7733

Thispamphlet includes information Tobacco: Habit or Addiction on the health effects of cigarette smok- Organization: Life Skills Education, Inc. ing. Smoking during pregnancy, effects Year: 1989 on the nonsmoker, smokeless tobacco, Format: Booklet and getting ready to quit are some of Length: 14 Pages the topics addressed. Topic: Tobacco Mode of Delivery: Self-Instructional and Instructor-led Smokeless Tobacco: Is It Worth Target Audience: General Public, Parents, and Sr. High Youth the Risk? Setting: Home and School Bailey, B.J. Readability: Average Organization: American Academy of Availability: Life Skills Education, Inc., 226 Otolaryngology, Head and Neck Surgery Ubbey Parkway, Weymouth, MA 02189; 617-337-7828 Year: 1989 Sponsor/Endorser: National Cancer institute Thispamphlet provides extensive in- Format: VHS Video formation on tobacco. Topics include Length: 13 Minutes why people begin to smoke, facts and Topic: Tobacco Prevention figures regarding smoking related dis- Target Audience: College Students, Sr. High eases. specific concerns for women, Youth, and Young Adults risks of second-hand smoke, and issues Setting: School surrounding quitting. A listing of re- Literacy level: Average sources for further information is also Availability: American Academy of Otolaryngology, Head and Neck Surgery, included. 1 Prince Street, Alexandria, VA 22314; 703-519-1528

Tobacco This video explores the dangers of Organization: Performance Resources Press, smokeless tobacco use. Professional Inc. baseball players convey the risks of Year: 1991 chewing tobacco and dip. Graphic pho- Format: Brochure tographs show the physical effects of Length: 1 Page mouth cancer, and doctors offer advice Context: Stands Alone and Part of a on how to quit the smokeless tobacco Packet/Program habit. 9

Page 6 For further Information, write to NCADI, P.O. Box2345 Rockville, MD 20847-2345 Tobacco: Mind-Altering Drug Inthis comic book Alpha the robot Series teaches kids to "Take pride in what you Organization: Wisconsin Clearinghouse put inside." He shows kids why smok- Year: 1991 ing cigarettes or using other tobacco Format: Booklet products is an unhealthy decision. The Length: 14 Pages influence that parents, advertising, and Context: Stands Alone and Part of a peers have on kids is discussed, and Packet/Program facts.about the physical effects of ciga- Topic: Tobacco Prevention rette smoking are mentioned. Target Audience: General Public, High-Risk Youth, and Young Adults Setting: Community Organization and Health Care Bad Mouthin: What Smokeless Readability: Fairly Difficult Tobacco Can Do to You Availability: Wisconsin Clearinghouse, P.O. Organization: Wisconsin Clearinghouse Box 1468, Madison, WI 53701-1468; Year: 1990 1-800-322-1468 Format: Comic Book Length: 6 Pages Thisbooklet provides basic informa- Topic: Smokeless Tobacco Prevention tion about the short-term and long-term Target Audience: Educators Grades 1-9, effects of tobacco use. The hazards asso- Elementary Youth, and General Public ciated with its use are described, and a Setting: Community Organization and breakdown of who uses tobacco is con- School veyed through charts and graphs. Rea- Readability: Easy sons why people use tobacco and the le- Availability: Wisconsin Clearinghouse, P.O. gal aspects of cigarette smoking and Box 1468, Madison, WI 53701; advertising are included. 1-800-322-1468 Thiscomic book uses cartoon sketches Take Pride in What's Inside to convey the dangers of ,thewing with... The Insiders: The smokeless tobacco. Young teens discuss the physical effects snuff has on the Tobacco Temptation mouth and gums, and dispel myths that Organization: Syndistar, Inc. many advertisements promote. Year: 1991 Format: Comic Book Length: 17 Pages Topic: Tobacco Prevention Kids Say Don't Smoke Target Audience: Educators-Grades 1-6 Tobias, A. and Elementary Youth Setting: Home and School Organization: Smokefree Educational Services, Inc. Readability: Low Literacy Year: 1991 Availability: Syndistar, Inc., 125 Mallard Street, St. Rose, LA 70087-9471; Format: Book 1-800-841-9532 Length: 50 Pages Topic: Prevention Target Audience: General Public Setting: Community Organization

Tobacco Page 7 Readability: Average Availability: Smokefree Educational Services, Inc., 375 South End Avenue, Suite 32F, New York, NY 10280-1085; 212-912-0960

Thisbook provides a host of reasons why kids should not start smoking. Each page also features a copy of a win- ning student's full-color poster from the first annual Smoke-Free Ad Contest. Facts, figures, and famous quotations are dispersed throughout the book, and an "Organizations of Interest" list is included.

Thank You for Not Smoking Near Me: Second Hand Smoke Is Bad for My Health Organization: Dogs Against Drugs Year: 1991 Format: T-Shirt (children's sizes only) Topic: Tobacco Prevention Target Audience: Elementary Youth Setting: Home Readability: Low Literacy Availability: Dogs Against Drugs, P.O. Box 12164, Santa Rosa, CA 95406; 707-575-8813

'Thisfour-color t-shirt shows a lit cigarette with an X through it, and the words, "Thank you for not smoking near me: Second hand smoke is bad for my health." Advertised as a walking billboard, this t-shirt, which is designed for youth, asks adults not to smoke around children.

Page 8 For further Information, write to NCADI, P.O. Box 2345 Rockville, MD 20847-2345 Studies, Articles, and Reports on Tobacco

levels of school achievement, with Government fewer skills to resist pervasive influ- Publications and ences, with friends who use tobacco, and with poorer self-images are more Journal Articles likely than their peers to use tobacco; 5) Cigarette advertising appears to increase young people's risk of smoking; Preventing Tobacco Use and 6) Community-wide efforts, which Among Young People: A include tobacco tax increases, enforce- Report of the Surgeon General ment of minors' access laws, youth- Report, Centers for Disease Control and oriented mass media campaigns, and Prevention (in press), 1994 school-based programs, are successful (Available from CDC: 1-800-CDC-1311) in reducing adolescent use of tobacco.

Oneout of three adolescents in the United States is using tobacco by age 18, adolescent users become adult users, Tobacco May Provide and few people begin using tobacco af- Gateway to Drug, Alcohol ter age 18. Preventing young people Abuse from starting to use tobacco is the key Keegen, A. to reducing the death and disease caused by tobacco use. This report NIDA Notes Summer/Fall 1991 documents that intervention, programs targeting the broad social environment Scientistsare accumulating evidence of adolescents are both effective and that tobacco and its key ingredient, nico- warranted. The report examines the tine, may provide a gateway to illicit health effects of early tobacco use, the drug use and alcohol abuse. While the reasons why young people begin using use of tobacco products is not a specific tobacco, the extent to which they use it, cause of drug and alcohol abuse, it and efforts to prevent tobacco use by clearly is one of the most powerful, pre- this population. Six major conclusions ventable risk factors preceding drug are highlighted: 1) Nearly all first to- and alcohol abuse. Three characteristics bacco use occurs before high school of tobacco that may be involved in the graduation; 2) Most adolescent smokers subsequent abuse of drugs or alcohol are addicted to nicotine and report that are outlined. First, nicotine is a potent, they want to quit; 3) Tobacco is often addicting drug. Second, cigarette smok- the first drug used by those young peo- ing is a complex learned behavior. ple who use alcohol, marijuana, and Third, nicotine is used to regulate mood other drugs; 4) Adolescents with lower and behavior; it provides relief from

Tobacco Page 9 stress and boredom. Tobacco then be- Biobehavioral Research on comes a stepping stone to other drug Nicotine Use in Women use. Other factors making a person vul- Pomerleau, C. S.; Pomerleau, 0. F.; and nerable to drug use include stress, socio- Garcia, A. W. economic status, exposure frequency, and possibly even genetic predisposi- British Journal of Addiction 86(5):527-531, tion; however, tobacco use is the most 1991 praventable risk factor to such behavior. (Available from Cynthia S. Pomerleau, University of Michigan, Department of 3 Ref. Psychiatry, Behavioral Medicine Program, Riverview Medical Building. 900 Wall Street, Ann Arbor, MI 48105.)

Predictors of Smoking MoreAmerican women are taking up Prevalence among New York smoking than men and fewer are quit- Latino Youth ting; if current trends continue, rates for Dusenbury, L.; Kerner, 1. F.; Baker, E.; women will surpass those for men by Botvin, G.; James-Ortiz, S.; and Zauber, the mid-1990s. But ironically, much of A. what is known about the biobehavioral aspects of smoking is based on research American Journal of Public Health 82(1):55-58,1992 using male subjects. The present paper (Available from Linda Dusenbury, reviews evidence suggesting that: (1) Department of Public Health, Cornell women may differ from men with re- University Medical College, 411 East 69th gard to nicotine intake and/or effects; Street, New York, NY 10021.) (2) nicotine intake and effects may be in- fluenced by menstrual cycle phase; (3) Theauthors examined prevalence oral contraceptive use and estrogen re- rates and risk factors for smoking placement therapy may affect intake among Latino adolescents, using a mul- and effects of nicotine; (4) the effects of tiethnic sample of sixth- and seventh- chronic nicotine use on female reproduc- grade students (n = 3,129) in 47 New tive endocrinology may have implica- York City public and parochial schools. tions for the reinforcement of smoking; The students completed questionnaires; and (5) pharmacological agents used to self-reported smoking data were col- treat smoking may have different effects lected by means of the "bogus pipeline" in women than in men. Guidelines and technique. The largest group of Latino suggestions are presented by future students (43 percent) was Puerto Rican; biobehavioral research in women, in- 20 percent were of Dominican back- cluding standardization of assessment ground, 7 percent were Colombian, and procedures, attention to the use of ap- 7 percent were Ecuadorian. "Current propriate controls, and use of pharma- smoking" was defined as smoking at cological probes. 40 Ref. least once per month. A series of logistic regression analyses indicated that peer influence was the strongest predictor of smoking. Family influence was Impor- tant as well. The results are discussed in terms of their implications for prevention. 13 Ref.

Page 10 For further information, write to NCADI, P.O. Box 2345 Rockville, MD 20847-2345 (Available from Susan A. McDaniel, Tobacco Advertising in Department of Sociology, University of Gender-Oriented Popular Alberta, Edmonton, Alberta T6G 21-14, Magazines Canada.) Krupka, L. R.; Vener, A. M.; and Richmond, G. Adolescents,as the fastest growing group of smokers, have been a focus Journal of Drug Education 20(1): 15-29, 1990 and concern of health educators and re- (Available from Lawrence R. Krupka, searchers. Adolescent smoking is of par- Michigan State University, Department of Natural Sciences, East Lansing, MI 48824.) ticular interest because initiation and early habits are known to have impor- number and content of tobacco ad- tant implications for lifetime smoking The or cessation. Despite the well-known vertisements were examined in 74 gen- centrality of the peer group in adoles- der-oriented popular magazines pub- cent behavior, smoking cessation pro- lished during the summer of 1988. grams have been largely directed to- More ads were present in women's than ward individuals rather than groups, men's magazines, and the messages con- with emphasis on encouraging the indi- tained in these ads were differentially vidual to say "no." In this article, smok- stressed as a function of the magazine's primary readership. The type of Sur- ing behavior and peer group patterns geon General's warning appearing in an among a sample of 1,689 eighth-grade students from southern Ontario were as- ad often was not directed toward the typical concerns of the readership of the sessed. It was found that peer groups are crucially important in the initiation magazine in which the ad appeared. of smoking among young adolescents, This survey, and a follow-up 3 months particularly girls. The patterns of indi- later, indicated that the Surgeon Gen- rect peer influence on girls is such that eral's report on nicotine addiction, pub- girls are less likely to stop smoking once lished in the Spring of 1988, had no ap- parent effect on the number of ads they have begun than are boys. placed. Advertising revenues received by publishers from conglomerates that control the manufacture of foods as well Tobacco Foes Attack Ads That as tobacco products may be partially re- Target Women, Minorities, sponsible for this finding. It was con- Teens, and the Poor cluded that effective drug education JAMA: Journal of the American Medical programs should encourage skepticism Association 264(12): 1505, 1990 when tobacco advertisements are examined. 28 Ref. Advocatesfor women, minorities, youth, and economically disadvantaged people are among the anti-smoking ac- Peer Group Influence as a tivists adopting what they see as the to- Factor in Smoking Behavior of bacco industry's own tactics: moving away from wide-angle warnings about Adolescents the long-term health hazards and focus- vanRoosmalen, E. H. ing instead on different brands, the JAMA: Journal of the American Medical smoker's self-image, and the short-term Association 264(12): 1591, 1990 social consequences, in messages tai-

Tobacco 14 Page 11 bored to these specific groups. Four sure, it was demonstrated that adoles- hundred thousand of the 2.5 million cents who experimented with cigarettes smokers the tobacco industry loses were better able to recognize advertised every year are lost because of tobacco- products than those who had not, a se- related deaths. The new smokers that lective exposure effect. Conversely, sub- act as replacements for these are chil- jects who were better at recognizing ad- dren, with an average starting use age vertised brands were more likely to of 12.5 years. A variety of activities that have experimented with cigarettes, an organizations are pursuing to end the effect due to their exposure to cigarette tobacco advertisements targeted to high- advertising. 34 Ref. risk groups are outlined.

Tobacco Use by American Cigarette Advertising and Indian Youth Adolescent Experimentation Moncher, M. S.; Schinke, S. P.; Holden, with Smoking G. W.; and Aragon, S. Klitzner, M.; Gruenewald, P. J.; and JAMA: Journal of the American Medical Bamberger, E. Association 262(11):1469,1989 British Journal of Addiction 86(3):287-298, 1991 Astudy of 1,150 female and wale (Available from Paul J. Gruenewald, American Indian youth revealed high Prevention Research Center, Pacific rates of tobacco use. Responding to 126 Institute for Research and Evaluation, 2532 Durant Avenue, Berkeley, CA items on a confidential questionnaire, 94704.) children reported their lifetime prevalence of smoked and smokeless tobacco and their use during the prior 7 days Theextent to which cigarette advertis- and 24 hours. Analysis of self-reported ing contributes to increases in smoking tobacco use focused on rates of lifetime has been debated by public health pro- prevalence, recent incidence, and peer fessionals and the tobacco industry. One use. The present findings, together with aspect of this debate has been the de- other data, suggest the need for more re- gree to which advertising influences search on the development of culturally smoking among adolescents. Previous sensitive assessment and prevention in- research suggests that there are signifi- terventions targeting tobacco use cant relationships between measures of among American Indian youths. 4 Ref. advertising and smoking. However, potential simultaneous relationships between these measures have not been addressed. Observed correlations may Maternal Smoking During arise from the effects of advertising on Pregnancy Affects Children's smoking or from smokers' selective ex- Vigilance Performance posure to advertisements. This study examined relationships between cigarette Kristjansson, E. A.; Fried, P. A.; and advertising and smoking experimenta- Watkinson, B. tion. Using environmental and psycho- Drug andAlcohol Dependence 24(1):11-19, logical measures of advertising expo- 1989 13

Page 12 For further Information, write to NCADI, P.O. Box 2345 Rockville, MD 20847-2345 (Available from Elizabeth A. Kristjansson, ing, as well as AIDS and homicide. The Carleton University, Department of death rate for liver cirrhosis, linked Psychology, Ottawa, Ontario K1S 5B6, with heavy drinking, is nearly twice as Canada.) high for Blacks as for the rest of the population. Blacks also suffer dispropor- .Aspectsof attention behavior in 4 to 7 tionately from cancer of the esophagus, year olds, as assessed by auditory and also linked to drinking and smoking. Al- visual vigilance tasks, were related to coholism rates are also higher among prenatal exposure to cigarettes. Data on Blacks. The high incidence among 76 to 79 children born to healthy, White, Blacks of disease and illness associated predominantly middle-class women with alcohol is paralleled by high rates were analyzed using multiple regres- of disease linked to the use of tobacco, sion techniques controlling for poten- including cancer, heart disease, and tially.confounding variables including stroke. postnatal second hand smoke exposure. Cigarette smoking during pregnancy was related to an increased activity level of the children during the tasks Unrealistic Optimism among and increased errors of commission in Adolescent Smokers and the auditory task and, to a lesser de- Nonsmokers gree, in the visual task. After controlling Reppucci, J. D.; Revenson, T. A.; Aber, for confounding factors, the relation- M.; andReppucci, N. D. ship between prenatal smoking and errors of omission did not retain signifi- Journal of Primary Prevention 11(3):227-236, cance. The combination of results 1991 suggest that the deficits in attention (Available from N. Dickon Reppucci, 301 may reflect impulsive responding and Gilmer Hall, Department of Psychology, University of Virginia, Charlottesville, VA increased overall activity. 25 Ref. 22903.)

Two studieswere conducted to inesti- Alcohol, Tobacco, and Black gate unrealistic optimism among adoles- Americans: Health Coalition cent cigarette smokers. In the first study, Calls for Curbs on Ethnic Ads 54 smokers and 304 nonsmokers agreed Prevention File Winter 1990, pp. 7-10 that there was a strong relationship be- (Available from Prevention File, Program on tween smoking and lung cancer. Non- Alcohol Issues, UCSD Extension, X-001, La smokers accurately predicted their Jolla, CA 92093.) chances of contracting lung cancer as be- low average. However, smokers per- Acoalition of 22 health and commu- ceived themselves as having only an av- nity groups is asking the Federal gov- erage chance of contracting lung cancer. ernment to limit the alcohol content of The second study replicated the first in malt liquora high-proof beer -- and re- both procedure and results regarding strain the advertising of the product lung cancer, but also added perceptions aimed at Blacks and Hispanics. The life of the relationship between smoking expectancy of Black Americans has de- and two other smoking-related health clined as a result of deaths from types problems, emphysema and heart at- of cancer linked to drinking and smok- tacks. The results were similar: 33 smok-

Tobacco 16 Page 13 ers rated their chances of developing smoking, by such activities as assertive- emphysema and having heart attacks as ness training through role playing. En- higher than 299 nonsmokers, but still durance sports activities would be em- viewed their chances as only about aver- phasized while learning of the effects of age. Finally, perceptions of stress were smoking on physical conditioning. The examined. Smokers perceived them- costs of such a program are estimated, selves to be under more stress than non- and classroom activities are outlined. smokers. It was concluded that self-de- 25 Ref. ception as indicated by unrealistic optimism regarding the chances of getting smoking-related diseases charac- Smokeless Tobacco Use by terized adolescent smokers. 7 Ref. Youth in the U.S. Boyd, G. M., and Glover, E. D. School-Based Smoking Journal of School Health 59(5): 189-194, 1989 (Available from National Institute on Alcohol Prevention Program for Abuse and Alcoholism, Parklawn Building, Adolescent Girls in New York Room 12-C23, 5600 Fishers Lane, City Rockville, MD 20857.) Hynes, M. M. Oralsnuff and chewing tobacco, com- Public Health Reports 104(1):83-87, 1989 monly referred to as smokeless spitting (Available from Ms. Margaret M. Hynes, tobacco, are being used by many adoles- Columbia University, School of Public cent and young adult males, and no in- Health, Division of Sociomedical dication exists that use by this group is Sciences, 600 West 168th Street, New York, NY 10032.) declining. Users are at risk for oral cancer, noncancerous oral pathology such as Jeukoplakias, and addiction. Informa- Teenagegirls comprise the largest per- tion about patterns of smokeless to- centage of new cigarette smokers in the bacco use and motivations of users may United States today. Factors contribut- help planners develop and implement ing to smoking initiation include peer interventions. Variables include the im- pressure, family and social influences, portance of peer and family influences, cigarette availability, and cigarette ad- socia ..nage, knowledge of harmful ef- vertising. Because three-quarters of fects, regional differences, use of other smokers become dependent on ciga- substances, and addiction. Due to the rettes by age 20, smoking prevention addictive nature of smokeless tobacco, programs aimed at the adolescent popu- older youth may need cessation pro- lation have great potential. The programs.Health educators are encour- posed program outlined is directed at aged to include smokeless tobacco in girls 12 to 18 years of age in New York their tobacco use prevention programs City. Among the objectives are increas- and to develop and implement compre- ing students' knowledge of the short- hensive tobacco interventions appropri- and long-term health effects of smoking ate for their youth population. 43 Ref. and awareness of the social factors that lead to smoking. Participants would be taught social skills and behaviors that could help them to resist initiating Pi

Page 14 For further information, write to NCADI, P.O. Box 2345 Rockville, MD 20847-2345 Health Consequences of Using nificant health risks of tobacco use, Smokeless Tobacco: Report of many smokers have great difficulty in the Advisory Committee to the quitting. Nicotine is the drug in tobacco that causes addiction. The phar- Surgeon General: 1986 macologies and behavioral processes Cullen, J. W.(Ed.) that determine tobacco addiction are Department of Health and Human Services, similar to those that determine addic- Surgeon General's Advisory Committee tion to drugs such as cocaine and her- on the Health Consequences of Using oin. Tobacco use is a disorder that can Smokeless Tobacco, Washington, DC, be remedied through medical attention. April 1986. 195 pp. (Available from the U.S. Department of Health and Human Services, Public Health Service, Blair Building, Room 427, Smoking among Older Adults: Bethesda, MD 20892-4200.) Problems, Consequences and Thisreport discusses the health conse- Possible Solutions quences of smokeless tobacco use. It Rimer, B. constitutes a comprehensive review by Surgeon General's Workshop: Health an advisory committee to the U.S. Sur- Promotion and Aging. Background geon General of the available scientific Papers. Washington, DC: March 20-23, literature to determine the health conse- 1989. 173 pp. quences of using smokeless tobacco. Af- (Available from Superintendent of Documents, U.S. Government Printing ter a careful examination of the relevant Office, Washington, DC 20402.) epidemiologic, experimental, and clinical data, the committee concludes that Forolder smokers, as for smokers of 11-te oral use of smokeless tobacco repre- any age, smoking is a modifiable behav- sents a significant health risk. It is not a ior with serious health consequences. safe substitute for smoking cigarettes. It Unfortunately, the body of knowledge can cause cancer and a number of non- aimed at helping older smokers quit is cancerous oral conditions and can lead limited because older smokers have to nicotine addiction and dependence. been a lower priority for research than younger populations. This state of af- fairs must change. Although the preva- Health Consequences of lence of smoking is somewhat lower in Smoking: Nicotine Addiction. the older population than in young A Report of the Surgeon groups, older adults are at least equally General interested in personal health promotion; Public Health Service, Rockville, MD: the consequences of continued smoking Centers for Disease Control, Office on are especially serious for them; and the Smoking and Health, 1988, 20 pp. benefits of their quitting are substantial. (Available from Superintendent of For example, smoking cessation can im- Documents, U.S. Government Printing prove vital capacity and reduce disabil- Office, Washington, DC 20402-9325.) ity and can reduce costs to third-party reimbursers of health care costs, includ- Thisreport examines the scientific evidence that cigarettes and other forms of tobacco are addicting. Despite the sig-

Tobacco IS Page 15 ing the Federal government. Clearly, following conclusions summarize the older Americans who smoke should be health consequences of smoking cessa- encouraged to quit smoking. tion for those who quit smoking in com- parison with those who continue to smoke: (1) Smoking cessation has major Smoking Tobacco and Health: and immediate health benefits for men and women of all ages. (2) Former A Fact Book smokers live longer than continuing Department of Health and Human Services, 1989 smokers. (3) Smoking cessation de- creases the risk of lung cancer, other can- Thisfact book addresseS the medical, cers, heart attack, stroke, and chronic social and economic aspects of cigarette lung disease. (4) Women who stop smoking. It identifies cigarette smoking smoking before pregnancy or during as the chief preventable cause of death the first 3 to 4 months of pregnancy re- in the United States. Areas covered in- duce their risk of having a low birth- dude per capita consumption data, weight baby to that of women who smoking by education level data, preva- never smoked. (5) The health benefits of lence of cigarette smoking by sociode- smoking cessation far exceed any risks mographic characteristics, survivalrate from the average 5-pound (2.3-kilo- data, relapse rate information, and risks gram) weight gain or any adverse psy- from smoking during pregnancy, chological effects that may follow quit- among many other areas. Charts, ting. graphs, and figures are used to high- light information provided in the text. Strategies to Control Tobacco Use in the United States: A Health Benefits of Smoking Blueprint for Public Health Cessation: Report of the Action in the 1990's: Smoking Surgeon General. 1990 and Control Monograph No. 1 Rockville, MD: Office on Smoking and Shopland, D. R.; Burns, D. M.; Samet, J. Health, 1990. 628 pp. M.; and Gritz, E. R. (Eds.) (Available from the U.S. Department of Health and Human Services, Centers for Bethesda, MD: National Institutes of Health, Disease Control, Center for Chronic 1991. 298 pp. Disease Prevention and Health Promotion, Office on Smoking and Health, Rockville, MD 20857.) Asummary is provided of what has been learned over the past 40 years of Morethan 38 million Americans have the public health effort against tobacco quit smoking, and almost half of all liv- smokingfrom the early trial-and-er- ing adults in the United States who ever ror health information campaigns of the smoked have quit. Nevertheless, more 1960s to the National Cancer Institute's than 50 million Americans continue to (NCI's) science-based ASSIST project smoke. This report reviews in detail the (the American Stop Smoking Interven- health consequences of smoking cessation Study for Cancer Prevention), tion for those who have quit and for which began in the fall of 1991. An his- those who will quit in the future. The torical accounting of these efforts is pre-

Page 16 For further information, write to NCADI, P.O. Box 2345 Rockville, MD 20847-2345 sented, as well as the reasons why com- of tobacco to minors, their failure to en- prehensive smoking control strategies force their laws would place them out are now needed to address the smoker's of compliance with the new Federal total environment and reduce smoking law. The survey reports the following prevalence significantly over the next findings: (1) All but three States ban the decade. While the data clearly show sale of tobacco to minors under the age that only White male smokers reacted of 18; (2) Only two States are enforcing to the first wave of public information laws restricting the sale of minors state- in the 1950s, the counteradvertising wide; (3) A few States are funding local campaigns of the late 1960s produced a initiatives to reduce youth access; (4) greater level of smoking cessation Low priority by police and lack of a des- across all major demographic groups. ignated enforcer are seen as obstacles to The current state of the art in combat- enforcement; (5) Despite lack of State ef- ting tobacco use combines multiple en- forts, some localities are demonstrating vironmental changes with multiple pro- enforcement is possible; and (6) Vend- grams directed to individuals in ing machine restrictions are the most different stages of the smoking initia- common initiative. tion and cessation process. This strat- egy recognizes that no single approach is best for all individuals, that no one in- Spit Tobacco and Youth tervention channel is capable of effec- Department of Health and Human Services, tively reaching all smokers, and that no Office of the Inspector General, single time is best for individual smok- December, 1992 ers to make an attempt to quit. The AS- SIST framework incorporates a three- This study describes thepresent status axis model, consisting of target of youth use of spit tobacco 'in six areas: populatioits, intervention channels, and prevalence and patterns of use, health interventions. More than 90 million effects, environmental influences on . Americans will be directly affected by use, product promotion and sales, regu- ASSIST over the life of the project. lation and enforcement, and educational efforts. The following findings were reported: (1) Under-age spit tobacco use is high, wide-spread and be- Youth Access to Tobacco gun early; (2) Often addicted to spit to- Office of the Inspector General/DHHS, bacco, under-age users are seriously December, 1992 endangering their health; (3) Family and friends and other incentives strong- InJuly 1992, the President signed the ly contribute to under-age use; (4) Exten- ADAMHA Reorganization Act, which sive and successful promotion of spit to- requires States to ban the sale and distri- bacco victimizes susceptible youth; (5) bution of tobacco products to anyone Spit tobacco laws and their enforcement under the age of 18 by October 1, 1994. are weak and ineffective; and (6) Under- This report examines the current accessi- age spit tobacco use is a community bility of tobacco to minors, and dis- problem, requiring broad intervention. cusses State and Federal options to reduce the accessibility problem. Although most States prohibit the sale

Tobacco Page 17 0 Model Sale of Tobacco Thisreport examines the fundamental Products to Minors Control Act developments over the past quarter cen- Department of Health and Human Services, tury in smoking prevalence and in mor- May 24, 1990 tality caused by smoking. It highlights important gains in preventing smoking and smoking-related disease, reviews Accessof minors to tobacco is a major changes in programs and policies de- problem in every State of the Nation. signed to reduce smoking, and empha- This document contains a model law sizes sources of continuing concern and recommended for adoption by States or remaining challenges. Five major con- localities to prevent the sale of tobacco clusions are drawn from this report. products to minors. The law would do They are: (1) The prevalence of smoking the following: (1) Create a licensing sys- among adults decreased from 40 per- tem, similar to that used to control the cent in 1965 to 29 percent in 1987; (2) Be- sale of alcoholic beverages, under tween 1964 and 1985, approximately which a store may sell tobacco to adults 750,000 smoking-related deaths were only if it avoids making sales to minors. avoided or postponed as a result of deci- Signs stating that sales to minors are ille- sions to quit smoking or not to start; (3) gal would be required; (2) Set forth a The prevalence of smoking remains graduated schedule of penalties--mone- higher among Blacks, blue-collar work- tary fines and license suspensions--for il- ers, and less educated persons than legal sales so that owners and employ- among the overall population. The de- ees face punishment proportionate to dine in smoking has been substantially their violation of the law; (3) Provide slower among women than among separate penalties for failure to post a men; (4) Smoking begins primarily dur- sign, and higher penalties for sales with- ing childhood and adolescence; and (5) out a license; (4) Place primary, but not Smoking is responsible for more than exclusive, responsibility for investiga- one of every six deaths in the United tion and enforcement in a designated States. State agency; (5) Rely primarily on State- administered civil penalties to avoid the time delays and costs of the court sys- tem, but allow use of local courts to as- Smoking and Health: A sess fines, similar to traffic enforcement; National Status Report. A (6) Set the age of legal purchase at 19; Report to Congress, Second (7) Ban the use of vending machines; Edition and (8) Contain a number of features to Department of Health and Human Services, minimize burdens on retail outlets. February, 1990 Cigarette smoking is the chief preventable cause of death in our society. This Reducing the Health report presents health and cost conse- Consequences of Smoking: 25 quences of tobacco use to Congress and Years of Progress. A Report of the American people, broken down by the Surgeon General each of the 50 States. The report shows Atlanta, Georgia: Centers for Disease that smoking is a particularly important Control and Prevention, 1939 problem for young Americans -- nearly

2 1

Page 18 For further information, write to NCADI, P.O. Box 2345 Rockville, MD 20847-2345 all smokers now start smoking regu- Smokelesstobacco use is increasing larly in their teenage years. In addition, throughout the United States, especially data show that cigarette smoking is be- among children. With more than 30,000 coming increasingly concentrated new cases of oral cancer reported in among Americans with lower incomes 1991 for the United States alone, it is and less education. time that use of smokeless tobacco take its rightful place next to cigarette smoking, in national and world conscious- ness, as a serious health risk that must Clinical Interventions to be stopped. This monograph, which in- Prevent Tobacco Use by cludes a keynote address from HISS Sec- Children and Adolescents retary Louis W. Sullivan, M.D., and a Epps, R.P., and Manley, M.W. forward from U.S. Surgeon General tonia Novello, M.D., discusses the is- National Institutes of Health /National sues and implications surrounding Cancer Institute/American Academy of smoking tobacco use, and offers recom- Pediatrics, (1991) mendations on prevention, cessation, and policy. Eachday more than 3,000 children in the United States begin to use tobacco. Physicians who treat children have the Other Publications opportunity to play a major role in fos- tering the prevention and cessation of smoking. This guide provides physi- Gateway Theory Revisited: cians with general recommendations on Alcohol, Cigarette, and how to help prevent, delay, or minimize Marijuana Use Patterns of the use of tobacco among children and Young Adults adolescents. Physicians are asked to: (1) Yu, J., and Williford, W. R. Anticipate the risk for tobacco use at each developmental stage; (2) Ask Report, New York State Division of about exposure to tobacco smoke and Alcoholism and Alcohol Abuse, Albany, NY, 1990 tobacco use at each visit; (3) Advise all (Available from Jiang Yu, Ph.D., New York smoking parents to stop and all chil- State Division of Alcoholism and Alcohol dren not to use tobacco products; (4)As- Abuse, 194 Washington Avenue, Albany, sistchildren in resisting tobacco use, NY 12210.) and assist tobacco users in quitting; and (5) Arrange followup visits as required. Usingthe data from the New York Specific suggestions are broken down State Youth Alcohol Survey (1986), the according to three developmental ages. authors re-examined the gateway the- 17 Ref. ory. Logit analysis is employed to esti- mate the causal effect of using one type of drug on the subsequent use of other drugs. Comparisons are made between Smokeless Tobacco or Health: male and female alcohol and other drug An International Perspective use patterns. The data suggest that alco- National Cancer Institute, Smoking and hol use tends to increase the chance of Tobacco Control, Monograph 2,1992 using cigarettes, and the chance of mari-

Tobacco 22 Page 19 juana use is increased by the use of alco- (Available from University of Southern California School of Medicine, hol and cigarettes. The onset age of alco- Department of Preventive Medicine, 35 hol use is found to influence the current North Lake Avenue, Suite 200, Pasadena, pattern of alcohol and other drug use; CA 91101.) most young adult current alcohol and other drug users started drinking in the Thepurpose of this study was to com- critical onset age period between 13 and pare longitudinal smoking prevention 16. 21 Ref. program effects estimated on a population-based cohort sample of sixth-grade students (average n per year = 4,664) using different schools as units of analysis Adolescent Smoking: A (middle/junior high school as the Review of Prevalence and school of origin or high school of inter- Prevention vention). Fifty schools in 15 school dis- Miller, S. K., and Slap, G. B. tricts were demographically matched Journal of Adolescent Health Care and assigned to either a school and com- 10(2): 129-135,1989 munity-based program for prevention (Available from Dr. Gail B. Slap, Section of of cigarette, alcohol, and marijuana use, Adolescent Medicine, Children's Hospital or a health education as usualcontrol of Philadelphia, 34th Street and Civic group. Smoking was measured by ques- Center Boulevard, Philadelphia, PA tionnaires administered to the students. 19104.) An expired air (CO) measure of smoking was also administered to increase ac- This review critically evaluates the ex- curacy of self-reports. Program effects tensive literature on the epidemiology were estimated with regression analy- and prevention of adolescent smoking. ses, controlling for school-level socioeco- Trends in adolescent smoking attitudes nomic status, racial/ethnic make-up, ur- and behavior as well as the immediate banicity, and grade. Using school of and long-term health consequences of origin as the unit of analysis, program adolescent smoking are discussed. The effects showed 1-year net reductions of - factors associated with adolescent smok- 8, -6, and -5 percent in prevalence rates ing and several smoking interventions of smoking in the last month, last week, are analyzed. Suggestions are madefor and last 24 hours; 2-year program ef- improving the ?valuation of future pro- fects showed similar net reductions of - grams designed to prevent adolescent 6, -5, and -3 percent (P's-0.001). Analy- smoking. 79 Ref. ses with endpoint school as theunit showed slightly weaker effects at the 2- year follow-up, the year duringwhich Longitudinal Effects of the 64 percent of students had moved to a Midwestern Prevention Project junior high or high school. The findings are discussed in terms of thepotential on Regular and Experimental contamination of experimental groups Smoking in Adolescents in longitudinal studies from school con- Pentz, M. A.; MacKinnon, D. P.; Dwyer, solidations, family mobility, and feeder J. H.; Wang, Y. I.; Hansen, W. B.; Flay, patterns to high schools, and the differ- B. R.; and Johnson, C. A. Preventive Medicine 18(2):304-321, 1989 23

Page 20 For further information, write io NCADI, P.O. Box 2345 Rockville, MD 20847-2345 ent smoking environments represented Passive Smoking on by middle, junior high, and high Commercial Airline Flights schools. 35 Ref. Mattson, G. E.; Boyd, G.; Byar, D.; Brown, C.; Callahan, J. F.; Cone, D.; Cullen, J. W.; Greenblatt, J.; Haley, N. J.; Hammond, S. K.; Lewtas, J.; and Reeves, Effects of Alcohol and Tobacco W. Advertising on Adolescents Orlandi, M. A.; Lieberman, L. R.; and Brown University Digest of Addiction Theory and Application 8(7):7-8,1989 Schinke, S. P. In Perspectives on Adolescent Drug Use, B. Thisstudy measured the effect of am- Segal, Ed., pp. 77-97. Binghamton, NY: bient tobacco smoke on nonsmokers fly- Haworth Press, Inc., 1989 ing on typical commercial flights. Nine (Available from Haworth Press, Inc., 10 Alice nonsmoking subjects (four flight atten- Street, Binghamton, NY 13904-1580.) dants and five passengers) participated on each of four flights. The attendants Alcoholand tobacco consumption were rotated between smoking and non- have been identified as leading causes smoking sections while the passengers of morbidity and mortality in the were seated in or near smoking sec- United States.Despitethis fact, these tions. All the subjects on all flights were drugs are sold legally and advertising is exposed to measurable levels of smoke. generally permitted. A variety of restric- In addition, many perceived a smoky tions have, nonetheless, been imposed environment and experienced eye and on both the sales and the advertising of nose irritation. Cotinine (a nicotine me- these products and still others have tabolite) levels in urine returned to pre- been proposed, though this has become flight levels 72 hours postflight. The a highly controversial issue and the authors concluded that even with the source of considerable debate. The as- segregation of smoking and nonsmok- pect of this debate, which centers on ing sections, passive tobacco smoking in children and adolescents, is the topic of closed environments posed a health this article. Public health advocates risk. 5 Ref. claim that recent alarming trends in the prevalence of alcohol and tobacco use among minors are due, at least in part, Predictors of Chewing Tobacco to the extensive advertising campaigns and Cigarette Use in a in which these industries engage. Indus- Multiethnic Public School try representatives retort that, since no scientific research study has proven that Population their ads cause consumption among Elder, J. P.; Molgaard, C. A.; and this age group, these claims are un- Gresham, L. founded. The purpose of this article is In Forum on Alcohol and Other Drug to analyze what have, to date, been Concerns among California Asians and Pacific Islanders. Sacramento, CA: sources of considerable confusion in February 4 - 5, 1990 this area and to suggest an alternative (Available from John P. Elder, San Diego framework for future discussions. 69 State University, Graduate School of Ref. Public Health, San Diego, CA 92182.)

Tobacco 24 Page 21 Smoking and tobacco-chewing habits and those with heart disease, as well as of sixth and seventh graders were inves- mitochondrial respiration. The polycy- tigated. Four hundred thirty-three clic aromatic hydrocarbons in ETS accel- White, Black, Mexican-American, and erate the development of atherosclerotic Oriental students in San Diego public plaque. ETS causes heart disease and is schools self-reported their tobacco use the third leading preventable cause of as well as perceptions of use among death, after active smoking and alcohol. their peers and friends, parental socio- 71 Ref. economic status, and other variables. One-third of the respondents had used some form of tobacco at least once, with Smokeless Tobacco Addictive, cigarette smoking more common than and a Gateway Drug chewing. Norm perceptions and best friend's habits predicted both smoking Henningfield, J. and chewing experimentation and Tobacco and Youth Report Autumn 1990 prevalence.White males were more frequent "chewers," while Blacks and Thedanger of smokeless tobacco, as a Mexican-Americans were more frequent gateway to using illicit drugs and as a smokers. Significant associations be- relatively difficult drug to quit using, is tween the two types of tobacco use described in this article. Marketing were also found. strategies that appeal to youth are described, including starter products that taste like candy and are often given as samples. The article cites research that Passive Smoking and Heart indicates that use of smokeless tobacco Disease: Epidemiology, escalates at a rate four times that of ciga- Physiology, and Biochemistry rettes. The marketing and the addiction Glantz, S. A., and Parmley, W. W. rate is implicated in a six-fold increase in the number of males age 17 to 19 Conference Paper. Perth, Australia: April 1 - 5, 1990, 29 pp. who regularly use smokeless tobacco. Research is reported to support the con- (Available from Stanton A. Glantz, Division of Cardiology, Box 0124, M1186, University tention that smokeless tobacco is a gate- of California, San Francisco, CA way drug. 94143-0124)

Theevidence that environmental to- Gender Differences in bacco smoke (ETS) increases risk of Psychosocial Determinants of death from heart disease is similar to Adolescent Smoking that available when the Surgeon Gen- eral concluded that ETS caused lung Clayton, S. cancer in healthy nonsmokers. ETS in- Journal of School Health 61(3):115-120, 1991 creases risk of death from heart disease (Available from Serena Clayton, University by 30 percent among nonsmokers living of California - Los Angeles, Division of with smokers. ETS adversely affects Behavioral Sciences and Health platelet function and damages arterial Education, Los Angeles, CA 90024.) endothelium. ETS significantly reduces exercise capability of healthy people 2;)

Page 22 For further Information, write to NCADI, P.O. Box 2345 Rockville, MD 20847-2345 Becauseof the social meaning smok- tional attainment are at particularly ing has acquired and because of differ- high risk for smoking initiation and con- ent trends in male and female initiation tinuation. Advances in gender-specific rates, it is reasonable to suspect that dif- knowledge regarding the processes on ferent psychosocial factors predict smok- initiation, cessation, and relapse pro- ing in teenage boys and girls. A litera- vide more specific opportunities for tar- ture review revealed external pressures geted intervention. Strategies for such as peer and parental smoking are change involve media, clinical ap- important for both boys and girls proaches, and public health efforts. Em- though their influence may be moder- phasis needs to be placed on tailoring ated differentially by age and type of the message and on using innovative smoking assessed. Some data support channels through which women can be the hypothesis that female smoking is effectively reached. Advocacy groups associated with self-confidence, social are targeting public policies affecting experience, and rebellion, whereas male women. Ongoing gender-specific re- smoking is associated with social insecu- search is needed in the next decade. 136 rity. Overall, group differences such as Ref. gender and socioeconomic status are well-documented in terms of smoking prevalence but underexplored in the area of psychosocial predictors. In this Teen Smoking Boosts Risk for review, gender differences have been Later Pot Use documented with sufficient frequency The Bottom Line1991 to warrant further attention to develop gender specific components of smoking Accordingto a recent analysis of Fed- prevention programs. 28 Ref. eral surveys, adolescent cigarette smokers are 100 times more likely to smoke pot than are teenage non-smokers. Many believe that tobacco addiction Women and Smoking: Current serves as a major gateway to other Trends and Issues for the 1990s forms of drug addiction. Not only does Berman, B. A., and Gritz, E. R. smoking tobacco predict later use of marijuana, but increasing levels of to- Journol of Substance Abuse 3(2):221-238, 1991 bacco use also are associated with fu- (Available from Barbara A. Berman, Division ture episodes with other illicit drugs of Cancer Control, Jonsson such as cocaine and heroin. Tobacco is Comprehensive Cancer Center, one of the most important preventable University of CaliforniaLos Angeles, 1100 risk factors for the development of Glendon Avenue, Suite 711, Los Angeles, other drug addictions. Other survey re- CA 90024.) sults conclude that tobacco appears to be more addictive than alcohol or other Despitesignificant change in smoking drugs, 40 percent of those teenagers patterns among women during the who smoke daily had been drunk in the 1980s, the toll in tobacco-related morbid- last 30 days, users of smokeless tobacco ity and mortality remains high and will were more likely to use cigarettes, mari- continue to rise for some diseases (e.g., juana, or alcohol tl an non-users, and lung cancer). Women with lower educa- use of other drugs such as heroin, co-

Tobacco 26 Page 23 caine, amphetamines, and sedatives is proval of smoking during pregnancy, associated with increased levels of nico- friends' cigarette use, and race play a tine dependence. It is believed that particularly important role in this be- studying tobacco use can serve as a havior. The implications of these find- model to investigate the biological ings for preventive programs are dis- mechanisms of those other drug de- cussed. 36 Ref. pendencies, and that more effective efforts to prevent smoking might help cur- tail the spread of illicit drug use. Ethnicity and Psychosocial Factors in Alcohol and Tobacco Use in Adolescence Factors Related to Cigarette Bettes, B.A.; Dusenbury, L.; Kerner, J.; Smoking During Adolescent James-Ortiz, S.; and Botvin, Pregnancy Child Development 61(2):557- 565,.1990 Hussey, J. M.; Gilchrist, L. D.; Gillmore, M. R.; and Lohr, M. J. The relationship between ethnicity and psychosocial factors and alcohol Journal of Youth and Adolescence .21(4):409-420,1992 and/or tobacco use during adolescence (Available from Jon M. Hussey, School of was evaluated. The studysample in- Social Work JH-30, University of cluded 2,125 seventh grade students in Washington, Seattle, WA 98195.) 47 public and parochial schools in New York City that contained at least 25 per- Previous research suggests that mater- cent Hispanic students. The study nal smoking during pregnancy remains evaluated the differences between prevalent, particularly among adoles- Black, Anglo, Puerto Rican, and Domini- cents. However, little is known about can adolescents in cigarettesmoking, al- the factors related to smoking during cohol consumption, and psychosocial adolescent pregnancy. The goal of the functioning. The study results revealed present study is to identify intraper- the following: (1) Public school students sonal, familial, and peer factors that are reported less use of alcohol but similar related to smoking during adolescent use of tobacco when compared to paro- pregnancy, and to determine the rela- chial school students; (2) Dominican stu- tive degree to which they affect this be- dents reported more use of alcohol than havior. Interviews were conducted Black and Puerto Ricans, while Puerto with 241 unmarried pregnant adoles- Ricans reported more use than Blacks; cents who planned to carry their preg- and (3) There was no significant differ- nancies to term. Consistent with pre- ence in tobacco use between thethree vious studies, 27 percent of the ethnic groups. In addition, the data in- respondents reported daily smoking dicate that psychosocial functioning af- during pregnancy, and Whites reported fects substance use differently in the higher rates of use than members of groups and that the use ofalcohol may other racial groups. Smoking during be more compatible with Dominican adolescent pregnancy was related to in- culture than the others. However, it is trapersonal, familial, and peer factors. The results of a regression analysis suggest that perceived parental disap- 2?

Page 24 For further Information, write to NCADI, P.O. Box 2345 Rockville, MD 20847-2345 not clear whether these constructs will Selling Smoke: Cigarette predict increased drug use by adoles- Advertising and Public Health cents or not. 33 Ref. Warner, K. E. Washington, DC: American Public Health Association, 1986. 112 p. Psychosocial Approaches to (Available from the American Public Health Smoking Prevention: Review of Association, 1015 15th Street, NW, Findings Washington, DC 20005.) Flay, B. R. Thismonograph explores the relation- Health Psychology63 p.(1985) ship of cigarette advertising to public (Available from Brian R. Flay, Health health. It comes in the wake of propos- Behavior Research Institute, 1985 Zonal Avenue, Los Angeles, CA 90033.) als by major health and medical organizations that promotion of tobacco prod- Twenty-sixschool-based studies of ucts be banned. The monograph psychosocial approaches to smoking describes the nature and magnitude of prevention are reviewed. Two major ap- promotional expenditures on cigarettes; proaches are represented: the "social in- identifies the diverse functions that ad- fluences" approach, and the broader vertising and promotion are alleged to "life/social skills" approaches. The re- serve; reviews the evidence on the rela- search studies are considered in four tionship between advertising and ciga- "generations": (1) The seminal work by rette consumption; examines the issues Richard Evans and colleagues at the involved in the ad ban proposal; and of- University of Houston; (2) Seven "pilot" fers an assessment of whether the ban studies of improved programs at Stan- should be implemented. ford, Minnesota, New York and Wash- ington, with one school or classroom per experimental condition; (3) Eleven Every C' dud Has a Silver Lining, improved "prototype" studies by these Even with Airline Smoking Ban four groups and others, with two or BottomLine 9(4):48-50, 1990 three units randomly assigned to conditions; and (4) Six studies where maxi- Nowthat the airlines have banned in- mizing internal validity was of prime flight smoking, some smokers have concern. None of the pilot or prototype found that chewing gum, taking deep studies considered alone provided inter- breaths, and eating tend to calm the pretable results; however, reported re- urge to light up. Coffee and alcohol of- sults were fairly consistent, with each fer no relief at all in easing the pain tested program seeming to reduce smok- from nicotine withdrawal. The biggest ing onset by about 50 percent. The ma- help for cigarette-addicted flyers is jor contribution of the pilot and proto- CigArrest Gum, advertised as "The type studies was improved programs Traveler's Smoking Alternative." It be- and methods. came air travelers' only alternative to lighting up, and includes a stop-smoking kit, tablets, and the new gum. More competition is on the way, principally from makers of nicotine patches that

Tobacco 2s Page 25 slowly release nicotine into the wearer's this research over the past two decades. skin to ease withdrawal symptoms. It is these organizations which, once the Leading marketers say the airline smok- most effective interventions are identi- ing ban may encourage other manufac- fied, are capable of supporting the cen- turers to end CigArrest's dominance in trally planned, consensus-driven, com- the growing market for "smoking cessa- prehensive approaches to tobacco use tion" products. The CigArrest products control which will be necessary to con- are an important option for peoplewho tinued success in reducing tobacco-re- won't spend $500 to $1000 to go to a lated mortality in the industrialized smoking cessation clinic or who don't world and to begin addressing the have the time. More important, they are growing problems of tobacco use in the affordable, readily accessible and avail- developing world. able when motivation is high.

Marketing Disease to Comprehensive Approaches to Hispanics: The Selling of Tobacco Use Control Alcohol, Tobacco, and Junk Glynn, T. J. Foods Maxwell, B., and Jc...obson, M. British Journal of Addiction 86(5):631-635, 1991 Washington, DC: Center for Science in the (Available from Thomas J. Glynn, National Public Interest, 1989. 100 pp. Cancer institute, Smoking, Tobacco, and Cancer Program, Executive Plaza North, #320, 9000 Rockville Pike, Bethesda, MD The marketing of alcohol, cigarettes, 20892.) and junk foods, targeted at the Hispanic population is discussed. It is noted that Thisessay suggests approaches to two these are products that result in drink- issues of importance to the future of to- ing and driving, cancer, heart disease, bacco use control research. First, there is and obesity. Chapter headings within need to identify those areas of tobacco this book include: (1) Marketers dis- use prevention and cessation research cover Hispanics; (2) Hispanic health that have evolved to the point where ad- risks; (3) Targeting Hispanics; (4) Event ditional investigation would only bring marketing; ai,d (5) Contributions to His- incremental gains. The reduction poten- panic organizations. Tables include: (1) tial of this research should then be con- Hispanic ad dollars spent by category; solidated by applying existing, effective (2) Percentage of men suffering from al- interventions widely and systematically. cohol problems; (3) Smoking rates of Conversely, there is need to identify Hispanics, Blacks, and Whites; (4) Lung those areas in which additional research cancer rates for Hispanics and Whites; is necessary. Second, the most logical (5) Mortality rates for smoking-related way to reach agreement on those areas diseases; (6) Cancer rates among His- which are ready to move from research panics and Whites; (7) Cigarette use by to application-of-research is, with the co- Hispanic and White children ages 10 to operation and advice of the research 15; (8) Obesity among women ages 18 community, through the large funding and over; and (9) Top advertisers in the organizations which have supported Hispanic market, 1988. 258 Ref.

2 ;1

Page 26 For further Information, write to NCADI, P.O. Box 2345 Rockville, MD 20847-2345 Selling the Smokeless Society Tobacco Money, Tobacco Flay, B. R. People, Tobacco Policies: How American Public Health Association, Millions of Tobacco Dollars and Washington, DC, 1987 Tobacco People in High Places (Available from the American Public Health Drive White House Pro-Tobacco Association, 1015 15th Street, NW, Washington, DC 20005.) Industry Policies Samuels, B.; Douglas, C.; Wolfe, S.; and Thismonograph reviews and synthe- Wilbur, P. sizes evaluations of 56 mass media pro- Public Citizen's Health Research Group, grams and campaigns designed to re- Advocacy Institute, August 1992 duce cigarette smoking. Programs are divided into three groups according to Betweenthe 1988 Presidential election format and objectives: (1) Programs and and August 1992, roughly $3.11 million campaigns designed to inform smokers in tobacco soft money was given to Re- about the consequences of smoking and publicans and Democrats. This report to motivate smokers to want to quit; (2) analyzes the role this tobacco money Programs and campaigns designed to plays in enacting White House policies, promote some specific action prepara- and asserts that many anti-tobacco ef- tory to smoking cessation; and (3) Tele- forts have been squelched due to the to- vised self-help cessation clinics. The programs and campaigns providing in- bacco industry's strong influence on the formation and/or motivation generally executive branch. The report is divided produced significant changes in aware- into four parts: Part one, entitled, The ness, knowledge, and attitudes; how- Money, charts the extent which tobacco ever, only extensive national campaigns donations are made to political figures, also produced meaningful behavior citing that through June 30, 1992, the to- change. Programs and campaigns pro- bacco industry gave over $2 million for moting specific actions produced mixed the 1992 election; The People, part two, results, depending in large part on the lists and describes 45 people in the type of promotion involved. Televised Bush, Clinton, Reagan, and previous ad- self-help clinics were generally effec- ministrations or campaigns with strong tive. Viewing alone was as effective as ties to or presence in the tobacco indus- using an effective self-help manual, try; Part three, The Policies, explains while requesting a manual to accom- that recent presidential policies have pany a self-help clinic almost doubled been to oppose legislation to place more the effectiveness of television alone. controls over tobacco use and to simul- taneously force American tobacco into foreign markets via the U.S. Trade Rep- resentative; and Part four, Recommenda- tions, offers three suggestions: (1) Presi- dential candidates should refuse to accept any contribution from the tobacco industry; (2) No tobacco industry officials should be in key administration or campaign posts; and (3) The new president should push for legislation to

Tobacco Page 27 ban all tobacco advertising and to sub- dates for Congress not accept any contri- stantially increase Federal excise tax butions from tobacco companies or cigarettes as Canada has done. 122 Ref. their representatives, and that members of Congress start to represent the wishes a! their real constituents, as op- posed to those of the tobacco lobby, by The Congressional Addiction to enacting strong public health policies to Tobacco: How the Tobacco combat the devastating health and eco- Lobby Suffocates Federal nomic problems wrought by tobacco. 93 Health Policy Ref. Wolfe, S.; Douglas, C.;Wilbur, P.; Kirshenbaum, M.; McCarthy, P.; Bame, A.; and Mc Knew,D. Public Citizen's Health Research Group Advocacy Institute, October 1992

Despite the fact that tobacco is the leading preventable cause of death and disease in the United States and around the world, Congress has done very little to combat the tobacco epidemic. This is the most comprehensive report to date regarding the tobacco industry's successful attempt to buy Congress and the deadly pro-tobacco legislative gridlock that continues to afflict our Federal leg- islators. There are four sections of this report. In the first section, The Death Money, the authors focus on the money the industry has contributed to congressional campaigns, and also examine the additional personal contributions made by tobacco industry executives and lob- byists, and those individuals who support the tobacco political action commit- tees (PACs). The second section of the report, The Policies, looks at the impact of the tobacco industry money and influence on the business of Congress, that is the making of public policy. Sec- tion three, Public Opinion, examines the desires of the majority of the American people, and determines that congressional inaction is not what the majority favors. In section four, Recommenda- Hops, the authors suggest that candi- 31

Page28 For further information, write to NCADI, P.O. Box 2345 Rockville, MD 20847-2345 Groups, Organizations, & Programson Tobacco

Action on Smoking and Health Local American Lung Association 2013 H Street, NW (Consult your telephone directory) Washington, DC 20006 Lung Line 202-659-4310 National Asthma Center 1-800-222-5864 Advocacy Institute 1730 Rhode Island Avenue, NW National Clearinghouse for Alcohol and Suite 600 Drug Information Washington, DC 20036 P.O. Box 2345 202-659-8475 Rockville, MD 20847 301-468-2600, 1-800-729-6686 American Cancer Society 1599 Clifton Road, NE National Heart Lung and Blood Institute Atlanta, GA 30329 Information Center 1-800-ACS-2345 P.O. Box 30105 Bethesda, MD 20824-0105 American Heart Association 301-951-3260 7272 Greenville Avenue Dallas, TX 75231 Office on Smoking and Health 214-373-6300 4770 Buford Highway, NW Mail Stop K-50 Americans for Non Smokers' Rights Atlanta, GA 30341 2530 San Pablo Avenue, Suite J 404-488-5705 Berkeley, CA 94702 510-841-3032 Pan-American Health Organization 525 23rd Street, NW Cancer Information Service Washington, DC 20037 1-800-4-CANCER Fax: 202-861-8466

Coalition on Smoking OR Health (CSH) Smokefree Educational Services, Inc. (legislative information only) 375 South End Avenue, #32F 1150 Connecticut Avenue, NW New York, NY 10280 Suite 820 212-912-0960 Washington, DC 20036 202-452-1184 St. Helena Hospital and Health Center P.O. Box 250 ilazelden Educational Materials Deer Park, CA 94576 P.O. Box 176 1-800-862-7575 (in CA) Center City, MN 55012-0176 1-800-328-9000 Stop Teenage Addiction to Tobacco (STAT) Johnson Institute 121 Lyman Street, #210 7205 Ohms Lane Springfield, MA 01103 Minneapolis, MN 55439-2159 413-732-7828 OR 1-800-998-7828 1-800-231-5165 1-800-358-9195

Tobacco * U.S. GOVERNMENT PRINTING OFFICE:1994 - 3 0 1- 0 4 91 3 6 3 5 Page 29 32 NCADI National Clearinghouse for Pub!!tios Alcohol and Drug Information 40. 1-800-729-6686or301-468-2600 .4111111010111071MISIIIIIIIIIMMINININININA TDD 1-800-487-4889

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