It was almost two years ago that Joe Califano (then secretary of then HEW) publicly hailed preliminary survey results that seemed to indicate a drop in smoking among adolescent boys.
It appeared that at last the concerted anti-smoking efforts of doctors, psychologists and health educators had begun to take hold, at least with boys.
But alas, researchers and adolescent health experts have since discovered that it may be that teens were not smoking less at all. They simply may have been lying about it more.
Dr. Richard Evans, director of the University of Houston Department of Psychology and head of its Social, Psychological and Behavioral Medical Research Training Group, has been on the front lines of the effort to prevent and control smoking for years. (He was one of the principal authors of the chapter on "Smoking and Youth" in the Surgeon General's updated 1979 Report on Smoking and Health.)
At a recent symposium on health problems of adolescents at Johns Hopkins University, Dr. Evans and other specialists noted that survey results change significantly when teenagers are told that their self-reports on smoking will be checked by nicotine-saliva tests.
"Kind of like the threat of an income-tax audit," said Evans.
What happened, speculate the experts, is that all the anti-smoking emphasis, publicity and programs have convinced youngsters that the country's nonsmoking majority -- about two-thirds of the population -- doesn't like smoking. This creates in the mind of the teen-ager what the experts call a "reporting bias."
It's "better" to say you're not smoking, even when you are.
Nevertheless, it may be that the experts on those years between 12 and 20 -- the years that parents often consider to be a form of temporary insanity -- are beginning to get a handle on the age group. And are starting to devise strategies that can lead the teens away from the kinds of self-destructive behavior that seem to get an unbreakable toehold during those vulnerable years.
Since the first hints connecting cigarette smoking with lung cancer -- and subsequently linking smoking to heart, lung, circulatory and such disorders as early menopause and ill effects on fetuses -- educators have tried to head off potential smokers. Especially because, as any reformed smoker can tell you, it is harder to stop smoking than almost anything you can name.
So first there was stark fear arousal. That worked wonderfully with the 7-, 8- and 9-year-olds who often warned smoking parents, "You're gonna die!" But by the time the kids got to be about 14, fear had basically lost its deterrent effect. Nor did the threat of such instant smoking ills as yellow teeth, yellow nails, bad breath or acne have much effect.
Finally, the Houston behaviorists, under Dr. Evans, began a program in conjunction with the National Heart, Lung and Blood Institute. After a three-year trial, it is offering hope of an effective approach. Their own surveys -- backed carefully with the corroborating saliva tests -- indicate a drop of about 6 percent in new smokers in the schools in which the programs operated. It is regarded as a landmark breakthrough and is being used, along with other techniques, in major experimental anti-smoking centers in this country.
The Evans recipe is imaginative, but not complex. It uses both the strong peer-group orientation of the teen-ager and the Madison Avenue techniques which orginally lent the aura of glamor or manliness to the smoker.
The subtle message and good film-making, rock-music background, no preaching, bright colors, genuine teen situations (from disco to girls room) and genuine teen actors give the films verisimilitude and effectiveness. And with enough different films to avoid the "nag-effect" or the pure boredom of most of the hundreds of thousands of pieces of "educational material" hitherto available, the Evans films are good box office in Houston schools, and have become the underpinnings of a number of other imaginative programs in other centers. They are popular with teachers because they are easily deliverable. In fact, Evans hopes they soon will be made available to schools and other groups nationwide. Inquiries may be sent to Dr. Evans at the University of Houston, Houston, Tex. 77004.
Among specific strategies, teens can learn:
Techniques for saying "no" to pro-smoking peer pressure, as in "My coach won't let me on the team," or "I thought you were my friend; why do you want me to smoke?" or "I'm allergic."
Techniques for psyching-out ads: Noticing how the surgeon general's warning is made inconspicuous by placement, shadowing, coloring.
The hard health facts from peer opinion leaders.
Another program, described by Dr. Gilbert Botvin of Cornell University, also tries to identify and utilize behavioral factors which tend to lead to smoking, for example, as an effort to improve self-esteem or as a reflection of impatience to grow up. He points out, too, that smoking is only one of the self-destructive behaviors to which adolescents are prone -- alcohol and drugs being others -- so that "smoking education must, in fact, become health education . . . some effort should be made to integrate smoking prevention into substance-abuse prevention."
Evans agrees. "You have to remember that by the ninth grade, youngsters have been exposed to enormously sophisticated communication techniques on TV. They simply will not accept the old-fashioned instructional film.
"What we may be heading for is a real breakthrough in considering how psychological stratgies and communications theory can be more effectively used in health education."