When it comes to smoking, some teens want to
kick the habit as much as adults do -- But finding a program for them isn't easy.

By Karen Blum, Special to the BALTIMORE Sun, Originally published March 31, 2006

David Owens wants to kick butts this spring. Cigarette butts, that is.

The 18-year-old Carroll Island resident, a junior at Chesapeake High School in Essex, tried his first cigarette at age 13. Now he smokes a pack a day.

"I do want to quit," he says, "but it's hard. I've tried many times."

Owens' mother, father, aunts and uncles smoke cigarettes, as do many of his friends at school. He wants to stop so badly that he voluntarily attended a punitive tobacco education class for students caught smoking at school.

In February, when the high school started its first voluntary smoking cessation class, Owens was one of the first to enroll.

"There's a definite trend in that more and more youth are thinking about quitting," says Jan Kilby, a nurse and education specialist at Franklin Square Hospital Center who teaches the class. "Almost everyone who has gotten caught [possessing cigarettes] has tried to quit."

But local teens who want to break the habit may have to look hard for help -- there are relatively few smoking cessation programs for those younger than 18. And most teens who try them don't succeed in quitting.

Dr. Eric Moolchan, director of the National Institute on Drug Abuse's Teen Tobacco Addiction Treatment Research Clinic in Baltimore, says that's partly because the treatment of nicotine addiction is so complex.

"It's a chronic and relapsing condition, and the success rates are low," he said.

Dr. Kevin Ferentz, an associate professor of family medicine at the University of Maryland School of Medicine, says sociological factors also contribute to the dearth of programs.

"Adolescents [feel] immortal and they don't have the same health issues that start to affect adults," says Ferentz, who directed smoking cessation programs at local high schools from 1998 to 2003, when funding from the Maryland Academy of Family Physicians ran out. "Also, smoking is still considered cool in our society."

Since teens have just started smoking, he said, they may not have seen any negative health effects yet, and they may not be interested in quitting.

Finally, while parents may give their children a hard time about smoking, they're the biggest providers of cigarettes, Ferentz says.

In Maryland, 19.3 percent of high school students smoke (about the same as the adult rate), and 12,800 youths become daily smokers every year, according to the Campaign for Tobacco-Free Kids.

Nationally, about 22 percent of high school students smoke today, down from a high of 36.4 percent in 1997.

Even though there has been an overall decline, "in talking to youth, they think everybody's smoking," Kilby says. "Smokers tend to cluster together, or have family members who smoke."

By age 17, two-thirds of all teenage smokers have tried to quit and failed at least once, Moolchan says. In most cases, the teens have tried a "cold turkey" approach, going from smoking their regular number of cigarettes to complete abstinence, without supervision.

"It shows that we really need [cessation] programs," Moolchan says

Under Maryland law, it's illegal for persons younger than 18 to possess tobacco products. Local schools and police departments have taken different tactics to enforce the rules.

In Howard County, public middle and high school students caught smoking at school are required to attend a Saturday anti-tobacco lesson led by a teacher. On the second or third offense, they can attend a two-evening smoking education course as an alternative to suspension.

Run by a school health educator or nurse, the program discusses methods of quitting and the "tobacco industry's manipulation" of teenagers, says Allison Sneller, the school system's tobacco use prevention and cessation project consultant.

"We would love it if they quit," Sneller says. "But this is not a cessation program. It provides coping skills to make it through the school day without smoking."

In Baltimore County, teens caught in possession of tobacco by local police receive a civil citation, a copy of which is forwarded to the Maryland Department of Juvenile Services.

The agency then contacts the family by mail, informing them that the teen has a choice -- appear in juvenile court or pay a $25 fee to St. Joseph Medical Center in Towson and attend a smoking cessation class there with a parent. Thirty teenagers were referred to the program in 2005.

Seventeen-year-old Jessica Weiss, a senior at Towson High School, was one of them. She was driving with friends in Timonium when a police officer pulled her over and searched her car, then cited her for tobacco possession. She and her mother, Mary, chose the class over the court appearance.

"I was relieved [to get the letter] because I'd known [Jessica] had been smoking for a while," Mary Weiss says. "It was helpful for somebody else to say, 'Hey, this isn't good for you, and there are repercussions for breaking the law.'"

During the three-session program, offered once a month, instructor Christine Schutzman tests the students' carbon monoxide levels, surveys their knowledge about tobacco and asks the students to come up with 10 reasons why smoking is right or fair.

"It shows them that their motivations are pretty lame," she says.

>From there, she reviews various methods of quitting and instructs students to negotiate with their parents a contract detailing how they will try to quit and what rewards they may receive if they meet their goals. The Weisses agreed on a later curfew for Jessica, and help making a down payment on a car.

"A lot of the parents didn't like that," Mary Weiss says. "They felt like the reward is living a longer life."

Schutzman says, "Parents need to be more aware of their children's smoking, but they often don't want to be or turn a blind eye to the situation. Even though the parents tend to think of [the class] as punitive, by the end I feel that most of them are really glad they came."

Jessica Weiss says she found the class environment supportive: "I was trying to quit anyway, but it was helpful to have the additional motivation."

Like many smoking stories, this one did not have a completely happy ending. After completing the program, Jessica quit smoking for a couple of weeks. But when things got stressful, she started again.

"I do have the ability to stop, and it's nice to know I have that in me and smoking doesn't rule my life," she says.

Most of these programs don't track success rates, but overall, when it comes to quitting smoking, "nothing works beyond 20 to 25 percent," Ferentz says.

But some cessation programs do better than others, according to recent research. A study of 120 teenagers published last year by Moolchan and colleagues in the journal Pediatrics showed that nicotine patches combined with therapy sessions were more effective than nicotine gum or a placebo patch.

Eighteen percent of those who received the patch and intervention stopped smoking for at least three months, compared with 6.5 percent of those who tried the gum and 2.5 percent of those who received a placebo. The study also demonstrated that both types of nicotine replacement were safe for teens.

An earlier study of a high school-based smoking cessation program, published in 2001 by researchers at Johns Hopkins Children's Center, showed that students participating in the class were more likely to quit smoking or at least try than those who received only an informational pamphlet.

Four weeks after the class ended, 52 percent of participants remained smoke-free, compared with 20 percent of those who only had the pamphlet.

The No. 1 reason teens continue to smoke is stress, Kilby says. "They don't have the same coping mechanisms as adults."

Regarding the Chesapeake class, Kilby says, "I really want to offer them the hope of quitting." However, she notes that, "with any addiction, you're always in recovery."

Owens says the class is helping him smoke fewer cigarettes.

"Even if I have the money, I try not to let myself buy them," he says. "I used to sneak outside every lunch period and smoke. Now I sit in the nurse's office the whole lunch period, and I won't bring cigarettes to school."

Jessica Weiss says she, too, is gradually reducing the number of cigarettes she smokes each day.

"I do eventually want to quit or at least have more control," she says. "I don't want to be old and dying of lung cancer. If the [cessation] program was something that was offered once a month, I would definitely go."

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