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May 5, 1989
"Classes and Taxes: Stub Out Teen Smoking"
San Jose Mercury News
By Timothy Taylor
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THREE weeks ago, Michael Doonesbury's boss at the advertising agency asked him to design a campaign to encourage young people to take up smoking. Thanks to the pleasantly demented vision of cartoonist Garry Trudeau, Mike has nightmares about the ads he could design ("Hey, teens! Mr. Butts here! Getting hooked on cigarettes is fun -- and surprisingly easy! For just a few dollars a day, you'll have a glamorous new habit for life!") and qualms about what his principles are worth ("I wonder if $500 to the Cancer Society would cover it?"), before he decides to turn down the assignment.

The recent report of the surgeon general provides evidence that Doonesbury was taking some swings at a serious social problem, but whiffed on the most sensible solutions. This report is a special one: It appears on the 25th anniversary of the first surgeon general's report to warn that smoking can be hazardous to your health.

This country can whirl into a frenzy over trace amounts of pesticides on farm produce, but it seems nearly oblivious to the fact that almost 400,000 people die every year as a result of smoking. One death in six in this country is caused by smoking.

Thomas Schelling, director of the Institute for the Study of Smoking Behavior and Policy at Harvard University, pointed out in a recent essay that the number of people dependent on tobacco for a living is smaller than the number who die every year because of smoking.

One can make a somewhat convincing libertarian case that adults should be free to do whatever they want to their bodies, as long as they do it in private. Even if 400,000 of them die every year from the behavior. Even if the rest of us end up paying for it in higher public and private insurance premiums.

But the argument that adults should have total freedom does not apply too well when smoking is recognized as a problem of addicted children. The surgeon general's report documents that four-fifths of smokers started before the age of 21, and the age at which smokers start has been falling. Although the percentage of teen-agers who smoke declined during the 1970s, it has stopped falling during the 1980s.

After being caught young, 80 percent of smokers say they would like to quit, and two-thirds have made at least one serious attempt to quit, according to Surgeon General C. Everett Koop.

Reasonable people can differ over whether the government should discourage adults from smoking, or if it should just set limits on when smokers can infringe on the clear air of others. But surely children should be able to postpone choosing nicotine addiction until they are adults.

Strangely enough, the tobacco advertising that was bothering Mike Doonesbury doesn't seem to be a major part of the problem. In these times of tight government budgets, restrictions on tobacco advertising have the attraction of a cheap and visible policy, but it's not clear what such restrictions would accomplish. The surgeon general's report says "it is more likely than not" that advertising increases cigarette consumption, but only after specifying that "no scientifically rigorous study" has answered the question, and that no one knows how large such an effect might be.

In fact, the ban on television and radio cigarette advertising that was enacted in 1971 may have actually provided a boost to smoking. Before the ban, federal law required tobacco companies to donate funds for one anti-smoking public service announcement for every three cigarette ads that aired. These anti-smoking spots were so powerful and effective that tobacco companies barely lobbied at all against the bill to ban their ads from TV and radio. When their TV ads disappeared, so did the anti-smoking public service spots.

But the surgeon general's report does provide a number of policies that would help to reduce smoking among young people. Here are my three favorites.

  • Make prevention of tobacco use a part of the high school curriculum. Such a curriculum is mandated in 20 states, but California is not one of them. California provides only more general education about all alcohol and drugs.
  • Raise the tax on cigarettes. Dozens of economic studies have demonstrated that a higher price reduces consumption of cigarettes. A safe estimate would be that a 10 percent higher price causes a 5 percent decline in use. As one might expect, price changes have a lesser effect on older smokers who are already hooked, and a greater effect on young people. One estimate is that a 10 percent increase in the price might cut smoking among young teen-agers by 14 percent, with most of that change coming from kids who decide not to smoke.

    Raising the federal cigarette tax from 16 cents a pack to 32 cents a pack would raise prices enough to cut cigarette use among those under 18 by 21 percent, while cutting overall use by about 6 percent.
  • Enforce the laws that prohibit the sale of tobacco products to minors. Most teens obtain cigarettes by buying them: In one Massachusetts study, an 11-year-old girl was able to buy cigarettes at 75 of 100 places she tried.

These steps are intended only to load the dice against smoking; of course, any teen-ager who wants to smoke badly enough will be able to. But there are 70 million children in the United States. If they follow the example of adults, the surgeon general reports, 29 percent of them will become smokers, and 5 million of them will die of smoking-related diseases.

Facing grim numbers like that, even partial success would be welcome.

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