Why Focus on Tobacco Use Among Youth?

CSAP decided to focus the first PEPS guideline on reduction of tobacco use by youth for three primary reasons. The first was the belief that effective prevention intervention in this area can have major health and economic benefits. The second was the existence of a substantial knowledge base that could be synthesized and presented to practitioners. Finally, such a document was considered a timely and essential complement to the States' efforts to reduce tobacco use among youth as required by Public Law 102-321, popularly known as the Synar Amendment to the Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act of 1992.

Prevention experts believe that tobacco control efforts directed at adult smokers have little chance to progress beyond the current level of success. If additional progress is to be made to prevent individuals from smoking, tobacco control efforts need to be focused on youth. Studies show that few take up tobacco after the age of 18; most smokers who become addicted to nicotine do so as adolescents. It is here that prevention efforts offer the greatest potential for success.

Federal activity in this area is gaining momentum:

• Healthy People 2000: National Health Promotion and Disease Prevention Objectives places emphasis on programs for underage smokers and users of smokeless tobacco (U.S. Department of Health and Human Services 1990).

• The Surgeon General's 1994 report, Preventing Tobacco Use Among Young People, underscores the need for programs that target adolescents (U.S. Department of Health and Human Services 1994).

• The Institute of Medicine's 1994 report, Growing Up Tobacco Free, stresses the importance of policy and program planning (Institute of Medicine 1994).

• The Synar Amendment to the 1992 Alcohol, Drug Abuse, and Mental Health Administration Reorganization Act requires all States to exhibit good-faith efforts to inhibit access by youth to tobacco products.

• In February of 1996, the FDA issued the final rule regarding the sale, distribution, advertising, and promotion of cigarettes.

In 1994, the Center for Substance Abuse Prevention (CSAP) announced its intent to fill two significant gaps:

• The States must be urged to focus on reducing tobacco use by youth.

• Through the PEPS program, specific recommendations must be developed for practice based on tobacco use prevention approaches of demonstrated effectiveness.

To fill these gaps, PEPS staff surveyed all published and unpublished prevention research as well as programs nominated by State substance abuse agencies and others. Although programs are operating in almost every State, only those that offered sufficient documentation are included in the PEPS guideline.

Reducing Tobacco Use Among Youth: Community-Based Approaches, the book-length guideline, is the first document developed using the PEPS process. It includes discussions of tobacco use among youth, community-based prevention approaches, and implementing action plans, as well as analysis of the six prevention approaches, the research and practice evidence reviewed, the findings, recommendations for practice, and suggestions for future research.

This practitioner's guide summarizes that document. Although useful because of its brevity, this guide is not a substitute for the comprehensive guideline. Readers are encouraged to review the guideline in its entirety for a complete presentation.