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John J. Whyte, MD, MPH
Mary Vest Mason, MD

JAMA. 1998;279:988.

The tobacco industry has come under intense scrutiny during the past few years. It is hard to pick up a newspaper without seeing an article about newly released documents from a tobacco company outlining its efforts to influence young people to smoke. At the same time, tobacco industry lobbyists are negotiating with Congress to settle several lawsuits filed by states and individuals against the tobacco companies.

The American Medical Association (AMA) has set a goal of a smoke-free America by the year 2000, with a strong emphasis on preventing children and adolescents from starting to smoke. Despite the efforts of the AMA, the American Cancer Society, and the American Lung Association, almost 20% of teenagers are smokers and more than 80% have tried smoking at least once. Almost a billion packs of cigarettes are illegally sold to minors each year. Even more alarming is that of those teens who have tried to stop smoking, fewer than 5% succeeded. Clearly, physicians can and should do more.

The AMA-Resident Physicians Section recently launched a project to educate teens about the dangers of smoking. This project, entitled "Smoking Is Not for Me," sponsors a national essay contest for sixth through eighth graders. Students are encouraged to write a 300-word essay explaining why smoking is not for them. With a generous grant from the AMA's Educational and Research Foundation, we are able to sponsor prizes in every state. The contest has been a huge success; we have received more than 8500 essays from children in 33 states.

A vital component of this project goes beyond the essays. We have encouraged residents and fellows to go into schools to talk about the ill-health effects of smoking. We engage in a dialogue with students and discuss the reasons they should not smoke. We explain the health effects and even bring in diseased lungs so they can see a concrete example of how smoking destroys the body. When time permits, we go over respiratory physiology as part of their science classes. We are proud to report that more than 2000 students have been reached in these classroom presentations.

At a time when Hollywood and advertising agencies continue to portray smoking as an activity for glamorous people, physicians need to present a more realistic perspective. Teenagers need to understand the cumulative effects of smoking; they also need to build greater self-confidence so they are less susceptible to peer pressure. As young physicians, we are in a unique position to relate to these young, maturing adults. We are adult authority figures, yet we are still relatively close to their age and cultures. Our presence in the schools allows us to use this identity to combat smoking. When as many 6-year-olds can identify Joe Camel as can identify Mickey Mouse, we know we have a long, tough battle. However, it is a battle that we must pursue.

One of our most rewarding experiences in this program has been when a student comes up to talk to us at the end of the program and tells us, "You know, Doc, smoking is not for me." Let's do what we can to hear these words more often.

Past Chair, AMA-RPS

Member-at-Large, AMA-RPS

Prepared by Ashish Bajaj, Department of Resident Physician Services, American Medical Association.

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