This is an important publichealth question, because if we knew the answer, it might be possible to figure out strategies to prevent adolescents from starting. Getting teenagers not to smoke might not have as big an impact on mortality rates as have immunization, adequate food, and clean drinking water, but it would be an important step.
There is evidence that if one is not addicted to tobacco by age 20, it is less likely that addiction will start later. Thus, teens and preteens should be key groups for whom antismoking programs should be designed.
But what kinds of programs? Does raising the price of cigarettes work? What about pictures of cancer on the package?
There have been studies assessing whether schoolbased antismoking programs work. They may work for short periods, in some communities, for some children. I suspect that if these interventions had a longterm impact, they would have been implemented by public health officials throughout the developed world. Certainly there is evidence that children whose parents smoke are more likely to become addicted to tobacco. There have been recent studies showing that females who smoke are more genetically predisposed to develop lung cancer than males. Even these studies are unlikely to have much of an impact on girls' smoking habits, and may actually convince boys that smoking is safe.
My own hunch is that teenagers start smoking because it's "cool" to smoke. And it's "cool" to smoke because the idols of many teenagers, movie actors and actresses, smoke on screen.
The Globe and Mail of January 11, 2021 had a short article on a study done by the organization Tobacco Control. Actors and actresses surveyed felt that some of the characteristics that cigarettes were seen to portray were sexiness and sophistication, toughness, coolness, and rebelliousness.
It's just a hunch, but I think movies and television may have a significant role to play in this publichealth problem. Studies should be done to answer the question as to why teenagers smoke. Before governments implement strategies, they should have evidence from good research that these strategies will work.
To the Editor:
After reading the editorial in the March 2000 Annals, I wonder why we do not see the answer to the question "why do teenagers smoke?" Is the smoke blurring our vision?
Nicotine is an addictive substance. It causes tolerance, physiological dependence, and withdrawal symptoms. Addiction is a brain disorder (DSM IV), not a purely behavioural disorder as was previously thought. Nicotine causes selfreinforcing behaviours, and is highly rewarding. In the brain, it produces the neurobiologic hallmark of addictive substances a surge of dopamine in the nucleus accumbens.
The cigarette is an effective and available delivery system. Thus, tobacco companies are legalized "drug pushers."
Do all teens who smoke become addicted to nicotine? No. But teens may continue smoking because they find it helps them to "cool off"