15. CONCLUSIONS

Survey data and qualitative research demonstrate that smoking is a serious health hazard to the teenagers of the province. The research reviewed here has identified three major concerns that any smoking prevention program needs to address:

Smoking is highly concentrated in the most vulnerable subgroups of the teen and preteen population. The problem is particularly severe among the less advantaged segments of the population, such as low income households or Aboriginal teens. Smoking is an even more dangerous behaviour for these groups because of the potential for interactions with other addictions that tend to be more prevalent among disadvantaged population segments. These groups may require special smoking prevention programs that complement other health campaigns which focus on their urgent needs.

Smoking retains much of its longstanding appeal as a symbol of adolescent rebellion or rite of passage into adulthood. Prevalence rates among older adolescents and young adults are among the highest of any population group. While previous age cohorts have given up smoking as they age, there is no assurance that this pattern will continue with the current adolescent age cohort or within some adolescent subcultures. Consequently, programs aimed at teens need to recognize this diversity and the potential for new cohorts or subcultures to move in a different direction from the preceding generation. A message that impacted one cohort may be dismissed out of hand by a subsequent cohort that is drawn in a different lifestyle direction. Smoking in its current incarnation as a stigmatized behaviour easily complements extreme fashions and experimentation with substance abuse as one of the core elements of a disaffected youth subculture. While this may deter smoking experimentation among some teens or prompt others to quit at an early stage of their smoking careers, this redefinition of smoking may have enhanced its appeal among the most disaffected segment of youth. Perversely, every attempt to stigmatize smoking only enhances its appeal as a way to engage in self destructive or rebellious behaviour with few immediate consequences.

Complicating the situation is the fact that smoking teens are often surrounded by other teens and adults who smoke. Regardless of whether or not these people represent positive role models, their presence lends a degree of social acceptance and inevitability to the process of becoming a smoker. The rebellious posture associated with smoking exerts its own appeal, especially among more marginal youth who see the bleakest future ahead of them. Smoking is positioned to become part of a self reinforcing cycle of low self esteem and feelings of failure and helplessness characteristic of other forms of substance abuse.

Prevention and cessation efforts need to diversify over several fronts. Communication efforts need to target preteens who have not yet begun to smoke, insofar as the smoking initiation process begins at an early stage of adolescence or before. Since the proportion of teen smokers increases with age, it is just as important to have effective cessation programs for teens who smoke. In fact, teen smokers are trying to quit but are largely unsuccessful and unaware of programs available to them perhaps because there is a dearth of teen cessation programs. Communications aimed at teens who are already smoking or thinking about starting should consider a variety of strategies that can tap the diverse and contradictory attitudes about smoking that have been identified among teens. Hammering away at the health risks inherent in smoking may be important over the long term, but will probably have little immediate effect since teens find the prospect of health problems in adulthood as too distant and remote to motivate much immediate behavioural change. Reminders of the potential health consequences of smoking for others (especially younger siblings, children or non-smoking friends) may be more effective than emphasis on the direct consequences for the smoker.

At the same time, stricter enforcement of existing laws that prohibit sales of tobacco products to minors could help counteract some of the other forces that promote smoking experimentation. The goal would not be shutting off the supply of cigarettes to teenagers - older peers, parents or petty theft would continue to provide a ready supply. Rather, more consistent enforcement would send the message that the adult world was serious about its commitment to discouraging underage smoking.