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Published in CenterView on March 26, 2012

Youth smoking concerns UMMC cessation experts

By Matt Westerfield

According to the Centers for Disease Control and Prevention, 19.5 percent of high school and middle school-aged Mississippians are smokers, compared to the national average of 19.3 percent for adult smokers.

And while the smoking rate among young adults was tumbling a decade ago, new evidence indicates that progress has ground to a halt.

Experts at the University of Mississippi Medical Center's ACT Center for Tobacco Treatment, Education and Research say it requires a sustained, comprehensive approach to reverse this trend, an approach in which health-care providers can play a key role.

A report released earlier this month by the U.S. Surgeon General on tobacco use by young people found that more than 600,000 middle school students and 3 million high school students smoke cigarettes. "Preventing Tobacco Use Among Youth and Young Adults" also showed that rates of decline among young adults who smoke has slowed since 2003, and the rates of decline for those using smokeless tobacco have stalled completely and use is actually on the rise in some groups.

This marked slowdown comes on the heels of steep gains in both preventing tobacco use and quit rates beginning in the late '90s, which were prompted by a public health campaign following the last surgeon general report on smoking in 1994.

Two people start smoking for every one who dies from this addiction each year, Surgeon General Regina Benjamin warned in the report. And 88 percent of those "replacement smokers" try tobacco for the first time before turning 18.

"Prevention efforts have reduced the number of children and young adults who start using tobacco, but those efforts may have hit their peaks, given the current level of funding," said Dr. Thomas Payne, director of research and associate director of the ACT Center. "There are comparable trends for adults with regard to cessation. We've seen a big drop in the prevalence rate, but in the last five years, quit rates have flattened."

Part of the reason for this can be attributed to the genetic risk for developing nicotine dependence, Payne said. With many substances that can be abused, a certain percentage of the population is at elevated risk because it possesses a higher predisposition to become addicted.

"Available evidence suggests those more likely to quit are less strongly addicted to tobacco," he said. "They are less likely to become regular users. If they do become regular users, they can give it up more easily."

Further complicating matters, the report also noted that the younger people are when they first try tobacco, the more likely they will become addicted. Addiction to nicotine is a critical component, the report states, because that's what can lead to long-term tobacco use, resulting in immediate and long-lasting health effects for young people whose lungs are still developing.

Nicotine increases the dopamine flow in the brain. Part of the reason it's so addictive is that it enters the bloodstream and reaches the brain rapidly, Payne said. Then it leaves the body quickly as well, so a smoker feels the effects of nicotine almost immediately and then feels the urge to smoke again relatively soon.

Dr. Karen Crews, director of the ACT Center, said the down economy is another important factor in declining quit rates, simply because there has been less funding available for public awareness and prevention programs.

"Based on the funding we receive, we can initiate treatment with about 4,000 new patients each year," Payne said. "That's a good number of people, but there are about half a million smokers in the state of Mississippi. Targeting 4,000 or 5,000 a year, it's going to take many years to get there.

"The Quitline and other health care-based activities contribute to this effort as well, but the total number of users reached each year remains too low."

Crews said really making an impact means also changing the culture for children by raising taxes on cigarettes, instituting statewide smoke-free policies, training health-care providers to discuss the risks of smoking and providing evidence-based treatment options for patients.

Children who live in homes where one parent smokes are twice as likely to start smoking, Crews said. If both parents smoke, the risk is even greater.

"In addition to working directly with youth, one effective way to prevent children from using tobacco or to help them quit is to assist tobacco-using parents to quit," she said. "Again, these efforts are most effective when implemented within a comprehensive approach."

In its annual State of Tobacco Control Report Card released in January, the American Lung Association gave Mississippi and many other states mostly Fs for tobacco-control efforts aimed at protecting children and curbing tobacco-related diseases.

The ACT Center, which offers free services for quitting tobacco to any Mississippi resident, generally treats adults 18 and older and is not specifically geared toward prevention. Information is available at www.act2quit.org, or by calling (601) 815-1180. The Quitline can be reached at 1-800-QUIT NOW.

"The bottom line is, we need both prevention and cessation efforts," Payne said. "Prevention stops the revolving door of children becoming replacements for adult tobacco users who die. Treating existing tobacco users saves lives, reduces suffering and is the most cost-effective approach to reducing the $200 billion annual burden on our health-care system."