The New York Times
Politics of Youth Smoking Fueled by
Unproven Data Legislation's Desired Effects Dress Up as Facts
By BARRY MEIER
It is the mantra of the nation's opponents of smoking:
that sweeping changes in the way cigarettes are marketed and sold over the next
decade will stop thousands of teen-agers each day from starting the habit and
spare a million youngsters from untimely deaths.
President Clinton recently warned, for example, that one
million people would die prematurely if Congress did not pass tobacco
legislation this year. Sen. John McCain, R-Ariz., and the author of a $516
billion tobacco bill, has urged lawmakers to stop "3,000 kids a day from
starting this life-threatening addiction."
But with the Senate beginning debate on Monday on tobacco
legislation, many experts warn that such predictions are little more than wild
estimates that are raising what may be unreasonable expectations for change in
youth smoking rates.
The assertion that one million lives would be saved, for
example, comes from a statement by the American Cancer Society last year that a
60 percent decrease in youth smoking in coming years could reduce early deaths
from diseases like lung cancer by a million. But critics say the 60 percent
figure was merely a target of anti-smoking advocates, with no analysis to back
Social issues often spark unfounded claims cloaked in the
reason of science. But the debate over smoking, politically packaged around the
emotional subject of the health of children, is charged with hyperbole, some
experts say. Politicians and policy makers have tossed out dozens of estimates
about the impact of various strategies on youth smoking rates, figures that
turn out to be based on projections rather than fact.
"I think this whole business of trying to prevent kids
from smoking being the impetus behind legislation is great politics," said
Richard Kluger, the author of "Ashes to Ashes" (Knopf, 1996), a history of
America's battle over smoking and health. "But it is nonsense in terms of
anything that you can put numbers next to."
Everyone in the tobacco debate agrees that reducing youth
smoking would have major benefits because nearly all long-term smokers start as
teen-agers. But only a few studies have tried to analyze how steps like price
increases and bans on advertising affect youth smoking. And those have often
produced contradictory results.
Consider the issue of cigarette pricing. In recent
congressional testimony, Lawrence Summers, the deputy Treasury secretary, cited
studies saying that every 10 percent increase in the price of a pack of
cigarettes would produce up to a 7 percent reduction in the number of children
who smoke. Those studies argue that such a drop would occur because children
are far more sensitive to price increases than adults.
"The best way to combat youth smoking is to raise the
price," Summers said. But a recent study by researchers at Cornell University
came to a far different conclusion, including a finding that the types of
studies cited by Summers may be based on a faulty assumption.
Donald Kenkel, an associate professor of policy analysis
and management at Cornell, said that earlier studies tried to draw national
patterns by correlating youth smoking rates and cigarette prices in various
states at a given time.
But in the Cornell study, which looked at youth smoking
rates and cigarette prices over a period of years, researchers found that price
had little effect. For example, the study found that states that increased
tobacco taxes did not have significantly fewer children who started smoking
compared with states that raised taxes at a slower rate or not at all.
Kenkel added that he had no idea how the price increase
being considered by Congress -- $1.10 per pack or more -- would affect youth
smoking rates because the price of cigarettes, now an average of $2 a pack, has
never jumped so much in the United States. And he added that there were so few
studies on youth smoking rates and price that any estimate was a guess.
"It is very difficult to do good policy analysis when the
research basis is as thin and variable as this," Kenkel said.
Jonathan Gruber, a Treasury Department official, said
that the Cornell study had its own methodological flaws and that the earlier
findings about prices supported the department's position. He also pointed out
that Canada doubled cigarette prices from 1981 to 1991 and saw youth smoking
rates fall by half.
Under the tobacco legislation being considered in the
United States, cigarette prices would increase by about 50 percent. And while
advocates of the legislation say that the increase would reduce youth smoking
by 30 percent over the next decade, they say that an additional 30 percent
reduction would come through companion measures like advertising restrictions
and increased penalties for store owners who sold cigarettes to underage
smokers and for youngsters who bought them.
The claim that comprehensive tobacco legislation would
reduce youth smoking by 60 percent over the next decade is perhaps the most
frequently cited number by advocates of such bills. But that figure first
emerged last year in a different context and quickly came under attack.
The American Cancer Society, soon after the settlement
plan was reached in June between the tobacco industry and 40 state attorneys
general, said that one goal of that agreement -- a 60 percent decline in youth
smoking rates over the next decade -- would spare one million children from
early deaths from smoking-related diseases. The plan, which recently collapsed,
would have raised cigarette prices by about 62 cents over a decade and banned
certain types of tobacco advertising and promotional campaigns.
But some tobacco opponents soon found fault with the
cancer society's estimates. For one, those critics pointed out that the 60
percent figure represented only a target, and that penalties would be imposed
on tobacco companies if it were not reached. And the cancer society, they
added, had not performed any analysis of the June deal to determine whether it
could produce a 60 percent decline in youth smoking.
"They basically made up the number and I think it was
totally irresponsible of them," said Dr. Stanton Glantz, a professor of
medicine at the University of California at San Francisco. "It is like assuming
that by snapping our fingers we could make breast cancer go away."
In a letter to Dr. Glantz, Dr. Michael Thun, the cancer
society's vice president for epidemiology and surveillance research,
acknowledged that the group's statement was based on an "if-then" projection,
rather than an analysis of whether the proposal's programs would accomplish
"The way the number was derived has nothing to do with
what will effectively get us there," Dr. Thun said in a recent interview.
The new 60 percent estimate is based on a different
formulation. But it, like the cancer society statistic, also coincides with a
target for reducing youth smoking that would result in industry penalties if
not reached. And along with questioning the impact of price on reaching such a
goal, experts are at odds over whether advertising bans and sales restrictions
would produce the projected 30 percent drop in youth smoking.
In California, for example, youth smoking began to
decline in the early 1990's, soon after the state began one of the most
aggressive anti-smoking campaigns in the country. But it has begun to rise
again in recent years.
Dr. John Pierce, a professor of cancer prevention at the
University of California at San Diego, said he thought that reversal might
reflect the ability of cigarette makers to alter their promotional strategies
to keep tobacco attractive to teen-agers even as regulators try to block them.
For their part, cigarette makers, whose internal
documents suggest a significant impact on youth smoking from price increases,
appear happy to play both sides of the statistical fence.
Last year, they estimated that the price increase in the
June plan would cause sales to drop by nearly 43 percent among all smokers over
a decade. But now that Congress is considering raising prices by twice that
much, producers have turned around and said that higher prices would undermine,
rather than help, efforts to reduce youth smoking.
Steven Duchesne, an industry spokesman, said tobacco
companies thought that high cigarette prices would encourage those in the black
market to target teen-agers.
"Smugglers would sell cigarettes out of the back of
trucks without checking ID's," Mr. Duchesne said.
Experts agree that unless significant changes are made in
areas like price and advertising, youth smoking rates will not decline. But
unlike politicians, many of them are unwilling to make predictions. Instead,
they say that the passage of tobacco legislation would guarantee only one
thing: the start of a vast social experiment whose outcome is by no means