The Surgeon General of the United States officially declared tobacco as harmful to human health in 1964, and despite declines in tobacco use among Americans in the decades since, there are still approximately 1,300 tobacco-related deaths each day in the United States. In Kentucky, smoking rates remain stubbornly high at around 25 percent compared with 15 percent in the nation overall.
For many health officials, the best approach to reducing these rates starts with educating children about the dangers of tobacco use. In the documentary Tobacco-Free Kentucky Kids, leaders in Kentucky’s teen smoking prevention field discuss successful public awareness campaigns that are ongoing around the commonwealth.
The program also examines teenagers’ use of smokeless tobacco and e-cigarettes, and interviews high school students who are using the TATU (Teens Against Tobacco Use) platform to educate both younger students and adults about smoke-free policies and tobacco cessation. This program is funded in part by a grant from the Foundation for a Healthy Kentucky.
“We know that 90 percent of people who start smoking, start before the age of 18, before they’re really even legally able to buy cigarettes” says Audrey Darville, PhD, APRN, a tobacco treatment specialist with University of Kentucky HealthCare. “And, by the age of 25 or 26, nearly everyone has either decided not to smoke, and will not smoke going forward in their life, or become tobacco users.”
Kentucky ranks second behind West Virginia in the teenage smoking rate. Tobacco was one of Kentucky’s primary agricultural crops during the 19th and 20th centuries, and in many parts of the state the plant still exerts a hold on the economy and culture.
But more than ever before, younger generations of Kentuckians are turning away from tobacco use due to their understanding of the myriad health problems associated with smoking and chewing or dipping. The efforts to spread awareness of tobacco’s harmful effects are being led by both medical professionals and motivated teen advocates who have seen their elder relatives suffer from debilitating diseases after decades of using tobacco.
Teen Advocates Making a Difference
“My grandma has smoked my whole life,” says Katelyn McWhorter, a senior at Lincoln Co. High School. “So, I’ve seen the effects of smoking and how bad it can be and the effects it can cause. And so, I just really want to prevent other people from putting that upon their families and upon themselves, because I’ve seen how bad it can get.”
McWhorter and some of her fellow high school students in Lincoln County are members of a program called Teens Against Tobacco Use (TATU). The program was developed by the American Lung Association, the American Cancer Society, and the American Heart Association. TATU enlists local health department officials to first educate teens about tobacco addiction, and then supervise them as they lead meetings with students in middle and elementary schools.
The TATU model turns high school students into mentors for younger kids, and instructs the teens on the basics of tobacco use and how nicotine addiction works. TATU organizers in Lincoln County and other school districts feel that anti-tobacco messages to young children are more effective coming from their high school peers, who are often seen as role models.
“It’s so important to teach them at a younger age,” says youth services coordinator at the school, Mindy Stevens. She notes that in the current media-saturated culture, children are being exposed to tobacco products at an early age compared with previous generations. “So we’re trying to reach them now at even kindergarten levels, before they make those decisions, because if we wait until they are in high school, it’s too late, they’ve already made those choices.”
In addition to the TATU counseling groups, high school students around the commonwealth are engaging in public relations campaigns targeted at their own peers and even at adults. The Casey Youth Coalition is one example. Motivated by persistent smoking in the high school bathrooms, the students at Casey County High School created a campaign called Photo Voice. For Photo Voice, the students took photographs of smoking’s toll on their high school campus and community, added captions, and then displayed their collection and also posted it online. The campaign has been well-received, and other school groups in Kentucky and from out of state have inquired about copying the format.
Jacob Steward, a sophomore at Bourbon County High School, recently gave a speech at the launch of Smoke-Free Tomorrow, an advocacy group featuring some of Kentucky’s prominent health care organizations. Steward is a member of a group called Students Making a Community Change (SMACC), and his speech in Frankfort drew rave reviews from health officials and politicians alike.
“This is as much an educational opportunity as it is really a volunteer or service opportunity, in my opinion,” Steward says, “in improving the lives of Kentuckians as well as learning about the dangers and effects of tobacco and the risks that Big Tobacco poses to teenagers.”
Changing Kentucky’s Tobacco Culture for the Next Generation
Recent national television and online public service campaigns such as the “Real Cost” campaign from the Food and Drug Administration and the “Finish It” series of PSAs from the Truth Initiative have inspired health officials and teen groups to produce their own media spots. In western Kentucky, officials with the Barren River District Health Department started a Facebook campaign that promotes Kentucky’s Quit Line (1-800-QUIT-NOW, www.quitnowkentucky.org). Meanwhile, tech-savvy teens in the same area have created their own PSAs for local television. Their message: “We don’t have time for tobacco!”
Increasingly, advocates are directing their efforts to curb usage rates for both smokeless tobacco and the relatively new product of electronic cigarettes. Kentucky’s rate of teenage chewing tobacco use is 17 percent, compared with the national average of 8 percent. The habit is one that is often passed down through generations in the commonwealth.
“Smokeless tobacco use invariably leads to what we call ‘poly-tobacco use,’ which is using more than one tobacco product,” says Donald Helme, PhD, associate professor in the Department of Communications at the University of Kentucky. Helme has recently conducted research into what “is a primary rural phenomenon.”
Smokeless tobacco users are overwhelmingly male, Helme says, and from his many interviews he’s gained an understanding about how ingrained tobacco chewing is within communities. “These young men would be out working on the farm with their father or their grandfather, and he would offer a piece of chew. And they all described [the offer] as an honor.”
Electronic cigarettes have become popular among teenagers during this decade, and studies into their health effects are just starting to be published. But according to Elizabeth Hoagland, policy analyst with the tobacco prevention program at the Kentucky Department of Public Health, officials already know enough about “vaping” to be very concerned about how it is being marketed to teenagers.
“E-cigarettes do contain nicotine, which is an addictive product,” she says. “We know that teenagers who start using e-cigarettes are about 30 percent more likely to start smoking conventional cigarettes, so they could be an initiation product, they could be a starter product.”
In November, the new 2017 Kentucky Youth Behavior Risk Survey was released, and its data offers fresh, new evidence that the persistent and dedicated efforts by anti-tobacco advocates are working. The survey showed that among high school students in the commonwealth, cigarette and cigar use decreased from 23.4 percent in 2015 to 18.2 percent in 2017. Cigarette use among middle school students dropped from 22.5 percent in 2015 to 12.1 percent in 2017, and e-cigarette use among middle schoolers dropped from 12.1 to 3.9 percent.
“Really, we are very encouraged,” Hoagland says. “I think what the numbers show is that tobacco control efforts really do work. I think these new lower tobacco use numbers really do reflect the impact of youth efforts in this state. We see time and again that youth are able to move policy and we know that these policies like smoke-free schools, smoke-free communities, they really do reduce youth tobacco use.
“If we are able to really double down on these efforts, then we can envision a future that is tobacco-free.”