Drive cuts teens' smoking in N.C.

Rates drop to all-time low

Where Big Tobacco once called the political shots, state programs are cutting into the cigarette companies' future customer base.

North Carolina's anti-smoking programs have cut teenage smoking to record low levels, according to a new study by researchers at UNC-Chapel Hill's medical school.

The percentage of middle-school students who smoke dropped from 5.8 percent in 2005 to 4.5 percent in 2007; the share of high school students who smoke fell from 20.3 percent to 19 percent, according to what's billed as the first comprehensive independent evaluation of the state Health and Wellness Trust Fund's anti-smoking efforts. Smoking among students in ninth through 12th grades has declined nationally from a peak of 36.4 percent in 1997. That drop flattened in 2003, a trend bucked by the recent declines here.

The trust fund gets a quarter of the state's payments from the 1998 national settlement with tobacco companies, and the fund has spent $125 million trying to persuade people to quit smoking or not to start in the first place. Its budget for anti-smoking programs this year is $17.1 million.

Gov.-elect Beverly Perdue, chairwoman of the trust fund since its creation in 2001, called the study results gratifying and a "tremendous sign of progress" for an initiative that has sometimes had to buck North Carolina's fading but still influential pro-tobacco forces.

"We're beginning to create generations of healthier North Carolinians and a stronger work force," she said in an interview.

Reductions in teen smoking eventually should affect adult smoking rates; studies suggest that 80 to 90 percent of current adult smokers took up the habit before they turned 18.

But the number of teens still smoking and the lingering attraction of tobacco make it clear the trust fund's task remains difficult. Critics point out that the fund is spending less than a fifth the amount the U.S. Centers for Disease Control and Prevention recommends.

Eroding 'cool' factor

The fund's three-pronged efforts attack the image of smoking and smokers, trying to erode the cool factor in lighting up. For the initiative targeting teens, it pairs advertising campaigns -- some with graphic examples of the health risks -- with community-based anti-smoking programs, some led by teenagers. Nearly 85 percent of middle school students and 89 percent of high school students said they had seen television ads that were part of the campaign.

"Everybody thinks it's disgusting now," said Chris McIntosh, 16, a junior at Enloe High School in Raleigh. "And you see those commercials. I don't want a hole in my neck, I don't know about you."

There was little doubt the trust fund's programs triggered most if not all of the declines in smoking, said Dr. Adam Goldstein, director of Tobacco Prevention and Evaluation Program at UNC. The methods have been proven in studies around the country, Goldstein said.

Further evidence, he said, is that there has been little change during the same period in tobacco use the state programs did not target, such as smokeless tobacco and smoking by older adults.

Also, the percentage of high school students nationwide who smoke was unchanged from 2003 to 2007, according to the CDC.

The state program marks a big change from a time when state and local leaders wouldn't even consider any regulation seen as harmful to tobacco growers or cigarette companies. North Carolina was the last state in the nation to approve a cigarette tax, for example; its tax is still among the lowest.

Kurt Ribisl, an associate professor at the UNC School of Public Health who studies tobacco issues, said the trust fund's efforts were impressive given the political courage they have taken.