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Progress in preventing smoking tracks the spending on programs.
Published Jul. 12, 2010

Efforts to extinguish teen smoking are stalling, new federal data showed this week, reflecting a troubling trend also apparent among Florida high school students.

A national survey released this week by the U.S. Centers for Disease Control and Prevention found that smoking rates among high school students slowed only a little between 2003 and 2009, compared with previous years of celebrated declines.

This has health experts worried, because studies have shown that most smokers pick up this famously tough-to-break habit in their youth. National declines in tobacco use are considered the main reason that deaths from cancer are decreasing.

But far too many kids are taking up cigarettes. According to the Campaign for Tobacco-Free Kids, 369,000 Florida kids now under age 18 will ultimately die prematurely from smoking. And cigarettes, a local judge says, are for many kids just the first indication of future trouble with drugs and discipline.

In 2009, 39.7 percent of state high school students reported ever trying cigarettes, up slightly from the previous year, the Florida Youth Tobacco Survey found. About 14 percent are current smokers, a figure that has held steady, the Florida report shows.

What's most worrisome is that the successes of the anti-tobacco movement in the late 1990s and early 2000s have stagnated.

"We feel like we do need to do more as a country and within states to again get back on track," said Ann Malarcher, a senior scientific adviser in the CDC's office of smoking and health.

"Tobacco control programs in states have been really grossly underfunded," she added. "With the economy now in the recession, there have been even more cutbacks to state health department budgets so they cannot field the strategies that we know are effective in prevent youth from starting smoking."

Efforts weakened

Florida, in particular, has seen attacks on its funding for youth anti-smoking programs. The state's "Truth" campaign, piloted in the late 1990s, was hailed as a national model before its budget - funded by litigation against the tobacco industry - was diverted by legislators for other needs.

Resources to fight smoking have stabilized since voters approved a 2006 constitutional amendment requiring dedicated funding. Still, the $67.7 million in state and federal funds that Florida is spending this year on tobacco prevention is a third of what the CDC recommends, according to the Campaign for Tobacco-Free Kids.

The restored funding is helping, said Florida Deputy Health Secretary Kim Berfield. She pointed to survey data showing regained momentum in reducing teenage smoking immediately after voters ensured funding for the anti-tobacco programs.

In 2003, for example, 50.4 percent of Florida high school students said they had ever tried cigarettes, compared with last year's 39.7 percent.

But for the past three years, smoking rates have been mostly flat or slightly up among Florida's high school students, and middle school declines have slowed.

One example of a more recent anti-smoking program unfolds once a month in the courtroom of Hillsborough County Judge Nick Nazaretian. For the past 18 months, he has been holding court for minors cited for possessing tobacco and failing to attend a mandatory class and/or pay a fine.

He keeps a jar with an unappealing sample of a smoker's lung in it to illustrate health impacts, but he doesn't just lecture the young smokers. He also questions them to find out what other kind of trouble they might be up to.

"It just seems like a lot of these kids have a lot of other problems," including discipline, academic and drug issues, he said. "I'd say about one of three kids, once you get to talking to them, admit to using marijuana, taking pills, and now the latest thing, using cough syrup (to get high). Smoking can be just the beginning of antisocial behavior."

Parents, he said, appreciate the fact that their kids are getting a stern talking-to from the black-robed judge. But he talks to parents, too, and discovers many of them are smokers. "You have to lead by example," says Nazaretian, who is a nonsmoker.

Smoker demographics

In Florida and nationally, white high schoolers were the most likely to be "current smokers" - having smoked at least once in the past 30 days.

Seniors were almost twice as likely to have smoked in the past month than freshmen, with one in four nationally admitting they smoke.

The one group that continued to see steady declines in smoking is black girls. In 2009, just 8.4 percent of black girls were current smokers, compared with 22.8 percent of white girls.

What's to be done?

"The thing that Florida could learn from this is if they want to not stall out on youth smoking rates you probably want to look at increasing funding for the programs - and more importantly, increasing cigarette taxes," said Kevin O'Flaherty, the regional advocacy director for the Campaign for Tobacco-Free Kids who works with Florida.

On that front, experts hope recent increases in state and federal cigarette taxes will stop more kids from lighting up.

Research shows young smokers are especially sensitive to cigarette price increases, since they don't have much money. O'Flaherty noted that Florida's $1.34-per-pack tax is around the national average, but well below more aggressive states.

Public health officials also hope the 2009 law giving the Food and Drug Administration authority to regulate the manufacture, marketing and sale of tobacco will help reduce teen use by restricting marketing practices aimed at young people.

FDA authority also should help control products such as smokeless, candy-flavored tobacco that has special appeal for kids, said Laurie Ellston, tobacco prevention program director with Hillsborough's Anti-Drug Alliance.

Both Ellston and Nazaretian said they think that in addition to anti-smoking programs, smokeless tobacco might help explain why the smoking trends aren't higher.

"While the smoking numbers may stay the same, there are alternatives that aren't being measured," Nazaretian said. "It's gone to a hidden scenario."

Letitia Stein can be reached at or (813) 226-3322. For more health news, visit