NOVEMBER2002

Q: Is tobacco considered to be as dangerous and addictive as other drugs, such as cocaine and crack cocaine? Should we be concerned about our children starting to use tobacco?

Although tobacco products such as cigarettes, cigars, and chewing tobacco are not illegal in the United States, they are some of the most dangerous and addictive drugs available. We must all be concerned about children and adolescents using tobacco even on an experimental basis. Although tobacco is the single greatest cause of avoidable disease and premature death in adults in the United States, most adults initiate smoking during adolescence, thus making the prevention of tobacco addiction a challenge for parents and caregivers, health professionals, teachers, and all others who work with children. In the United States, every day 6,000 adolescents and young adults start smoking. This is a 50% increase from 1988. Approximately half of these young people will become daily smokers. The "Youth Risk Behavior Surveillance for 1999" (YRBS) cites the following: 70.4% of students had tried cigarettes, 34.8% of students had smoked cigarettes on more than 1 of the preceding 30 days, and 16.8% of students had smoked on 20 or more of the 30 preceding days.

In the National Youth Tobacco Survey, Centers for Disease Control and Prevention (CDC) cited differences in tobacco use rates for different ethnic and racial groups. Middle school white students (33.8%), African-American students (44.0%), and Latino students (40.0%) were significantly more likely to have smoked than adolescents of Asian origin. In high school, white students (63.3%), African-American students (62.4%), and Latino students (66.4%) were significantly more likely than Asian students (52.4%) to have ever smoked cigarettes. Early tobacco use of individuals who become regular smokers (90%) started before age 19; dependence is common after smoking as few as 100 cigarettes. Risk factors associated with smoking during the adolescent years include low self-esteem, poor school performance, increased risk-taking behaviors, alcohol and other drug abuse, depression and anxiety, and other psychiatric disorders. Nicotine is frequently the gateway substance, and smokers are 15 times more likely to progress to other drug use than those who have never smoked.

One of the major factors that increase the risk of a child or adolescent initiating smoking or using other tobacco products is whether the parent or caretaker uses tobacco. Protective factors that guard against the initiation of tobacco use include close communication between the parent and adolescent, building high self-esteem, social competence, assertiveness, and a strong sense of right and wrong.

Finally, the effects of tobacco use are both short and long term. In the short term, during childhood and adolescence, tobacco use can contribute to such diseases as asthma, ear infections, and allergies. It can slow or stunt the growth of bones and lungs, decrease the ability to exercise, among other health problems. Long-term effects are well-known, and they include heart disease, lung cancer, emphysema, and osteoporosis.