Prevention and Treatment of Tobacco Dependence 155such as age (Chaloupka & Pacula, 1999; Gruber & Zinman,
2000), ethnicity (Chaloupka & Pacula, 1999), and stage of
adoption of tobacco use (Emery, White, & Pierce, 2001). It
was determined in these studies that higher cigarette prices
differentially affect older adolescents (Gruber & Zinman,
2000), young males (as opposed to young women; Chaloupka
& Pacula, 1999) and young Black men (compared to young
White men; Chaloupka & Pacula, 1999). In addition, in-
creased prices may deter rate of adoption of regular smoking
among current smokers (Emery et al., 2001). Conversely, cig-
arette pricing is unrelated to experimentation for adolescents
of all ages, probably because this stage is characterized by
very low consumption, and cigarettes often are obtained from
friends (Emery et al., 2001). Thus, it appears as though •ciga-
rette prices are a critically important policy tool in reducing
adolescent smoking beyond experimentationŽ (Emery et al.,
2001, p. 269).
Youth Access to Tobacco
It has been estimated that more than 947 million packages
of cigarettes and 26 million cans of chewing tobacco are
purchased each year by American youth (USDHHS, 1994).
Although laws exist to limit youth access to tobacco, research
has shown that the laws are not heavily enforced (DiFranza,
Norwood, Garner, & Tye, 1987; Forster & Wolfson, 1998;
Jacobson, Wasserman, & Anderson, 1997). Johnston et al.
(1999) reported that in a survey conducted in 1998, approxi-
mately 90% of adolescents aged 15 to 16 described obtaining
cigarettes as •fairly easyŽ or •very easy.Ž In a survey con-
ducted in 1997 (Centers for Disease Control and Prevention,
1998), 30% of high school smokers reported having pur-
chased cigarettes in the previous month; of these, fewer than
one-third were asked to provide proof of age.
In a comprehensive review of the literature, Stead and
Lancaster (2000) summarized the effects of interventions for
preventing tobacco sales to minors. Minimal interventions
such as providing retailers with information about the law
have been shown to be largely ineffective. Retailer participa-
tion in voluntary compliance programs, in general, is low
(DiFranza & Brown, 1992; DiFranza, Savageau, & Aisquith,
1996), and while there is evidence that interventions to
educate retailers can improve compliance, more effective
interventions require application of multiple strategies simul-
taneously, such as personal visits to retailers and education
of the community (Altman, Wheelis, McFarlane, Lee, &
Fortmann, 1999). High levels of commercial retailer compli-
ance, combined with community participation, may be neces-
sary if adolescent smoking is to be reduced.
PREVENTION AND TREATMENT
OF TOBACCO DEPENDENCEAlthough smoking rates among adolescents rose during most
of the 1990s (Johnston, O•Malley, & Bachman, 1999), results
of the 2000 Monitoring the Future Study suggest that there
has been a modest decline, particularly among twelfth
graders, who evidenced a 3.2 percentage-point drop in 2000
(Lantz et al., 2000). Despite this decline, smoking persists as
a signi“cant public health problem, particularly among
school absentees, dropouts, and other high-risk youth for
whom smoking rates are appreciably higher (de Moor et al.,
1994; Glynn, Anderson, & Schwarz, 1991; Grunbaum &
Basen-Engquist, 1993; Karle et al., 1994).
Because 89% of adult current smokers began smoking
before their nineteenth birthday, and a substantial proportion
of adolescents experiment with smoking before entering
high school (USDHHS, 1994), tobacco prevention efforts
generally have been concentrated on elementary and middle
school years. However, if early smoking prevention lessons
are not reinforced and repeated in high school, smoking
rates return to levels comparable to those seen in the general
high school population (Bell, Ellickson, & Harrison, 1993;
Ellickson, Bell, & McGuigan, 1993; Flay, 1985). The
United States has evidenced an alarming rise in smoking
prevalence among college students. Although this trend is
thought to re”ect the increase in smoking initiation from
the early 1990s (Wechsler, Rigotti, Gledhill-Hoyt, & Lee,
1998), initiation among young adults may be playing a role
(Lantz et al., 2000). As smoking in younger cohorts (youth,
young adults) continues to rise, heightened prevention ef-
forts are needed. Promising prevention strategies include
aggressive antitobacco media campaigns, increased cigarette
prices, school and community interventions, and environ-
mental changes, such as increased emphasis on reducing
adult smoking (thereby reducing the number of smoking
adult role models), expanded clean indoor air laws, and en-
forcement of laws against sales of tobacco to minors (Lantz
et al., 2000).Cessation MethodsPharmaceutical Aids for CessationSince 1984, “ve pharmaceutical products (nicotine gum,
patch, spray, inhaler, and sustained release [SR] bupropion)
have been approved by the U.S. Food and Drug
Administration (FDA) as aids for smoking cessation, and re-
search has demonstrated that use of these agents signi“cantly