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'Tough Puff' Deters Teen Smokers

Threat of legal enforcement helps discourages the habit, new research suggests

FRIDAY, Nov. 16, 2001 (HealthDayNews) -- Threatening a kid with fines or losing his driver's license is at least part of a good plan to keep teens from smoking, suggests a new survey.

The study of students in Florida, where underage possession of cigarettes can lead to a citation, says that young smokers are more likely to change their smoking habits if they know they could face a fine or loss of their license.

But experts on youth anti-smoking campaigns differ on whether penalties are the best approach.

The American Lung Association estimates that smoking-related diseases, including lung cancer and emphysema, claim more than 430,000 American lives every year.

"Up until the late '90s, the epidemic of tobacco use among kids was basically out of control," says lead author William Livingood, the director of health, policy and evaluation research at the Duval County Health Department in Jacksonville, Fla.

Using money from the state's 1997 settlement between the tobacco industry and the U.S. attorneys-general offices, he says, "Florida was one of the first states to adopt a very comprehensive tobacco prevention program."

Since the settlement, tobacco use among children has declined significantly in Florida. The program involves advertising, education programs, youth and community partnerships, research and law enforcement. In particular, enforcement officials targeted areas like schools and malls where youths gather.

In Florida, underage smokers face a $25 fine or 16 hours of community service if they're caught buying, possessing or using tobacco products. A second citation within 12 weeks of the first means another $25 fine. A third citation within the same 12 weeks means that a youth's driver's license will be withheld or revoked.

The survey, which will appear in December issue of journal Health Education and Behavior, looked at the results of surveys given to more than 2,000 students, 1,140 of whom lived in high-enforcement counties in Florida and 948 who lived in low-enforcement counties.

Led by Livingood, a group of researchers looked at the students' awareness of enforcement activities and penalties and whether the kids thought the penalties influenced their willingness to smoke.

The researchers found that youths in the high-enforcement areas, unlike the low-enforcement area students, said that the penalties for buying, possessing or smoking cigarettes made them less willing to smoke near schools.

Being older and smoking more heavily made a difference, however. High school students were less likely than middle school students to say that the penalties mattered. Students who smoked no more than one cigarette a day said the penalties were a bigger factor in the decisions, while those students who smoked more often were more likely to say that the penalties did not matter.

The study also found that in the 30 days prior to the survey, smoking rates among youths were lower (up to 26.6 percent) in high-enforcement counties than in low-enforcement counties (up to 29.2 percent).

Livingood says that compared to the public health effect of helping to reduce youth smoking, the penalties amount to a very small "discomfort."

But he stresses that enforcement is only one part of a program. "There's no doubt that increases in price are also having an impact," he says. "Programs that address the attitudes of kids also are very important."

"Clearly, their attitudes were still the strongest predictor of whether they were going to use tobacco or not," says Livingood.

But Douglas Luke, an associate professor of community health at St. Louis University in St. Louis, says that penalties for possessing tobacco don't work.

"They turn out to be pretty unpopular," says Luke. "A lot of teen-agers work, and a lot of families depend on their teen-agers being able to drive. Regardless of whether parents believe that their teen-agers should be smoking, I think there's a lot of people who'd say that the punishment doesn't fit the crime."

"Criminalizing smoking is not shown to be effective," says Luke. "We have a long history in this country of when we try to criminalize behavior, it doesn't always work -- look at Prohibition."

He adds that communities that use legal restrictions often don't have the resources or the will to enforce the laws. "In a lot of communities, people say that police have a lot more important things to do," says Luke.

But Livingood says that community leaders in Florida strongly support programs that target sales of tobacco to minors. "They're overwhelmingly still supportive of even possession enforcement," he says.

Dr. Joseph DiFranza, a professor of family medicine at the University of Massachusetts in Worcester, Mass., says that penalties run the risk of placing the blame on the youths rather than on those who promote smoking.

"In some cases, these laws have actually been counterproductive, because they've been written in a way that makes it very difficult or impossible for law enforcement authorities to enforce the ban on selling tobacco to kids," says DiFranza.

But DiFranza says that enforcement can prevent youths who smoke from congregating in front of schools, where they might serve as role models to younger children.

What To Do

Find out more about Florida's enforcement program at the Online Tobacco Education Resources.

You can also check out this statement on penalties from the Campaign For Tobacco Free Kids. (You'll need Adobe Acrobat Reader to read this page.)

SOURCES: Interviews with William C. Livingood, Ph.D., director, Health, Policy and Evaluation Research, Duval County Health Department, Jacksonville, Fla.; Joseph R. DiFranza, M.D., professor, Department of Department of Family Medicine and Community Health, University of Massachusetts, Worcester, Mass.; Douglas A. Luke, Ph.D., associate professor of community health, School of Public Health, St. Louis University, St. Louis, Mo.; December 2001 Health Education and Behavior
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