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There is no doubt that smoking cigarettes is dangerous and has serious negative health effects. This has been known with certainty for over a decade, and legislation regarding smoking and tobacco use has reflected this knowledge. Current adolescents and young adults have grown up knowing that smoking is bad for health, and in most of the US the purchase of tobacco is restricted to those who are over 18. Despite this, in the US more than 3200 people every day under the age of 18 try their first cigarette. Even if this is “only” occasional cigarette use to begin with, 2100 adolescents and young adults who were occasional smokers become regular smokers each day. Over 90% of current smokers tried their first cigarette under the age of 18, and 99% tried their first cigarette under the age of 26 (see the CDC fact sheet for more info). What is important to recognize is that of those 3200 people under 18 who are trying their first cigarette almost all are aware of the harmful effects of smoking.

I am not saying that the stop smoking campaigns haven’t worked; smoking is on the decline and that is certainly partially a result of the educational awareness campaigns in addition to the stricter tobacco laws and the dramatic increase in prices. However, there is a significant subset of youth who are still initiating tobacco use despite the warnings, the price, and the inability of those under 18 to legally purchase cigarettes. These facts are indicative of a need to change the approach to smoking campaigns.

Current stop smoking campaigns focus on two areas: quitting and education about the risks. However, I think there needs to be a significant shift in the approach. Everyone can agree that nicotine is addictive, and possibly one of the more addictive substances to which we can be exposed. It would be much easier to focus our efforts on reducing the amount of people who start smoking than to try and help them quit once they are hooked. The problem is that the current campaigns aimed at reducing smoking initiation are no longer relevant. I would put money of the fact that few to none of the 3200 children and adolescents who try a cigarette each day are unaware of the dangers. Most of use can recite the potential effects of cigarette smoking in our sleep!

Public health officials and policy makers are somewhat aware of this problem and their solution is to push to raise the legal age of purchasing tobacco products and raise prices. Sure, this may decrease a few of those who are trying tobacco products, but we can see that many people trying cigarettes are already underage, so how will raising the age limit help?

We need to change our focus. We need to examine the why. In most circles smoking is no longer seen as cool and fashionable — kids are probably far more likely to be pressured into trying marijuana than cigarettes — so why are they still starting to smoke? When I was in high school I remember three main reasons that people smoked: to feel the “buzz”, to help them calm down, and to lose weight. In college and immediately thereafter I noticed that many people also smoked due to their jobs. For example, individuals working in the service industry only received a break to smoke; if you did not smoke you did not get a break. As counterintuitive as it sounds, many people will start smoking “casually” in order to take a 5 minute break outside from a hectic job.

None of these issues are addressed in current smoking campaigns. We need to change the approach to smoking entirely. We need to stop telling kids not to smoke because it’s bad, and instead understand why they are thinking about trying cigarettes. Sure, there will always be those that are curious, but I think that by changing the message and approaching alternative ways that adolescents and young adults can deal with the issues that make them start smoking, we can make a significant dent in the number of people who do start.

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