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Chapter 13 Involving Youth in Awareness of, Promotion of, and Political Activities for Tobacco Control Robert J. McGranaghan, Sharon Ann Rankins-Burd, and Ted Purcell INTRODUCTION Despite numerous efforts to prevent youth from beginning the addictive practice of smoking, the rates of youth smoking remain alarmingly high, with the age of onset varying between 11 and 15 (U.S. Department of Health and Human Services, 1989; Johnston et al., 1991; DiFranza et al., 1987). Surveys of youth tobacco use have been conducted regularly for the past 15 years. Although the figures for smoking prevalence vary by survey and definition, one trend emerges: There has been little change since 1981 in the percentage of high school seniors who smoke cigarettes. Recent data show a statistically significant increase of 1.8 percent in high school senior daily smoking from 1992 to 1993 (Johnston et al., 1994). Almost as many young females now smoke as males, and those with no plans for higher education have higher prevalence than those with such plans (U.S. Department of Health and Human Services, 1989 and 1994). White adolescents have a higher prevalence than their African-American or Hispanic counterparts (Centers for Disease Control, 1990). The data do not capture the dropouts who are likely to have higher smoking prevalence rates (U.S. Department of Health and Human Services, 1989). The use of smokeless tobacco also is increasing, with males more likely to use this form of tobacco than females. At present, more than 1 million adolescent males use smokeless tobacco (Centers for Disease Control, 1990). The addictive nature of tobacco is as evident in adolescents as it is in adults. Among adolescents who smoked at least half a pack of cigarettes per day, more than half had made an unsuccessful attempt to stop smoking. In addition, only a small portion (5 percent) thought they would still be smoking 5 years later; however, after 7 to 9 years, about 75 percent were still smoking (Johnston et al., 1991). The use of tobacco by adolescents is particularly important because almost all first tobacco use occurs before graduation from high school (U.S. Department of Health and Human Services, 1994). For all adults, 89 percent began smoking prior to age 18, and 71 percent began daily smoking by age 18 (U.S. Department of Health and Human Services, 1994). Adolescents, because of the addictive nature of nicotine, become “hooked” and are the smokers of the future. Preventing onset of tobacco use by youth will gradually result in the decline of smoking prevalence and, eventually, in the demise of all manner of tobacco use. The Community Intervention Trial for Smoking Cessation (COMMIT) did not initially target youth in its intervention plans. The primary reason for excluding youth was that the trial was seen as being oriented toward heavy smokers (25 or more cigarettes per day), and young smokers rarely fall into that category. Nevertheless, some investigators and policy advisory committee members encouraged the inclusion of activities that targeted and included youth in intervention activities (see Chapter 12). The activities that targeted youth were primarily school based and are described in Chapter 12 (Bowen and colleagues). Activities that involved youth were important because they contributed to building awareness of smoking as a public health problem, increasing visibility of tobacco control efforts, and changing policies on youth access to tobacco. This chapter describes some activities oriented toward youths in settings other than schools. Although Chapter 12 addresses in-school activities, it should be noted that schools were often the initial setting in which students were contacted or recruited to participate in communitywide campaigns and activities. This chapter also discusses the challenges encountered by COMMIT staff members and volunteers as they balanced a desire by volunteers for more attention to youth with COMMIT’s goal of increasing cessation rates among adults. Finally, the chapter includes some key lessons learned from the COMMIT communities about this intervention channel. The required activities involving youth in nonschool settings are discussed in Table 1. GOALS, ACTIVITIES, AND PROCESS OBJECTIVES FOR YOUTH The overall goals of this aspect of the youth channel were to:
 The range of creative activities within each category demonstrates the extent to which COMMIT communities involved youth in the overall intervention beyond what was minimally required by the protocol. One recurring theme found in the records of the COMMIT communities was the lament by volunteers that COMMIT could not focus more attention on prevention and youth. Many communities reported that their community Boards or public education task forces (under which most communities coordinated youth activities) were initially inclined to put more resources into youth activities than were justified by the design of the intervention. This may be the result of a tendency of COMMIT volunteers to prevent what had not begun rather than intervening to change the behavior of adults who had already chosen to smoke. At the same time, a natural tendency to protect youth from the mistakes of their elders may have inclined volunteers to be more interested in preventing youth from smoking. This dilemma, and how COMMIT communities dealt with it, are discussed below in the “Challenges” section of this chapter. Communities involved youth in a wide variety of campaigns and interventions. These campaigns focused on reframing the tobacco message to raise awareness of tobacco industry marketing tactics, especially advertising. Boards and task force members recognized that advertising of tobacco products is difficult to escape (Johnston et al., 1991; Centers for Disease Control, 1990). Despite industry disclaimers that influencing adolescents is a goal (O’Toole, 1986; Weil, 1986), there is much evidence that young people are aware of the images presented by the tobacco companies. A study of 6-year-olds showed that 91 percent were able to recognize Joe Camel (Fischer et al., 1991). A survey of 5,000 adolescents selected at random indicated that 42 percent identified Marlboro as the most advertised cigarette brand, followed by Camel at 30 percent (and also showed that Camel advertisements were most often recalled by the youngest adolescents and seldom recalled by older adult smokers) (Pierce et al., 1991). Similar results were reported in analyses of the 1992 California Tobacco Survey (McCan, 1992). In other studies amon youth, recall of cigarette advertisements is high, especially compared with recall of the U.S. Surgeon General’s warning labels (Fischer and Magnus, 1981). INVOLVING YOUTH IN COMMUNITYWIDE CAMPAIGNS AND INTERVENTION ACTIVITIES Involving Youth in Community Campaigns Tobacco advertising is seen in print media, billboards, sponsorship of events, and point-of-sale messages. Advertising and promotion are most likely to operate in an unconscious way; they provide images that support the attractiveness of smoking (U.S. Department of Health and Human Services, 1989 and 1991; Warner et al., 1992; Hensley, 1989). The images that are used are usually sexy, independent, adventure seeking, or funny (cartoon characters). Such images are often appealing to adolescents. Indirectly, adolescents may look at such advertising as evidence that it is “okay to smoke” because if smoking were not acceptable adolescent behavior, the Government would not allow the advertising of a product with such negative health consequences for adolescents (U.S. Department of Health and Human Services, 1989). For these reasons, many COMMIT communities conducted activities designed to reduce the appeal of tobacco advertising. Counteradvertising campaigns using posters developed by and targeted to youth were displayed on buses and in bus shelters in Vallejo, CA. Some antitobacco advertisements, such as those put on billboards in commercial districts, were designed by youth. Advertising of tobacco products was removed from several sporting events, including basketball in Yonkers, NY, baseball in Medford/Ashland, OR, and Bellingham, WA, and tennis in Santa Fe, NM. Other informational and awareness programs and campaigns involving youth and targeting adults included writing letters to the editor of local newspapers. For example, letter-writing campaigns by youth supported public discussions of enforcing or enhancing policies on youth access to tobacco. Videotape productions and slide shows, developed with creative input from youth, documented local examples of the pervasive marketing of tobacco to young people throughout the community. Theatrical events, such as puppet shows and musical plays, were produced to help youth deal with situations involving smoking and to highlight the dangers of secondhand smoke to children and adults. Some communities trained youth to be speakers or developed peer-to-peer education to prevent smoking and to raise awareness of the problem. This strategy used students who were trained to teach their peers how to refuse cigarettes. In some cases, youth were trained to make presentations to legislators and community leaders. Involving Youth in Magnet Evernts The protocol required communities to conduct community magnet events (Chapter 6). The Great American Smokeout (GASO) is a magnet event sponsored by the American Cancer Society, and every COMMIT community in the United States was involved in promoting this event. Youth played an important role in helping communities spread the message about the GASO. Some communities used youth brigades to distribute door hangers and fliers in targeted neighborhoods to advertise GASO events. Others involved youth in distributing information on quitting for the day. Many communities conducted poster contests in conjunction with the GASO. These contests were another strategy for youth to express themselves to peers and adults in creative ways, raise awareness, and spread basic information about the problem of smoking. Winning entries were displayed in shopping malls and community centers, and in Paterson, NJ, the winning entries were made into a calendar. In some cases, posters were judged by employees of companies participating in GASO activities and were displayed in their worksites. Newspaper coverage of the contests amplified the messages of the posters to the community. Local media also publicized essay contests by printing articles about the winning writers and their tobacco control messages. Essays were reprinted in local newspapers and, in some cases, were broadcast by radio stations, providing further promotion of the no-smoking message. Non-Dependence Day, the fifth of July, was a summertime event sponsored by the American Lung Association allowing for more community-based involvement by youth to promote antismoking messages. For example, youth participated in local Fourth of July parades to encourage smokers to be independent by overcoming their dependence on tobacco. As with the GASO, poster contests were used to involve youth and spread the no-smoking message of this campaign. MONITORING The national health objectives for the year 2000 have targeted AND PROMOTING substantial reductions in smoking among persons younger than ENFORCEMENT 20 years and reductions in smoking onset. Reducing access OF REGULATIONS to cigarettes through policies or laws is an important strategy ON YOUTH ACCESS in reaching this goal. Those younger than age 18 have little TO TOBACCO difficulty in purchasing tobacco products even though it is illegal in all of the United States and Canada. With few exceptions, there is little enforcement of the laws prohibiting tobacco access by minors. Studies indicate that the vast majority of tobacco retailers sell to children (Doctors and Lawyers for a Drug-Free Youth, 1991; Altman et al., 1989). For this reason, COMMIT communities were required to develop activities to monitor and promote enforcement of regulations on youth access to tobacco. Almost all communities used compliance checks as an initial step in the process of examining what their communities were doing about the accessibility to tobacco by youth compliance check was a systematic method to investigate whether merchants were adhering to local and State laws regarding the sale of tobacco to minors. In essence, a compliance check is an undercover buying operation using underage youth who have been trained in the operation to go into stores and attempt to purchase cigarettes. Prior arrangements are often made with law enforcement agencies so the youth are protected from legal action resulting from their purchasing tobacco. Accompanied by an adult driver who waits outside the retail establishment, an underage adolescent attempts to buy cigarettes or other tobacco products. The young people are trained to give truthful answers about their age if asked and to avoid any education of the retailer during the operation. The results of compliance checks were used to educate merchants and the general public. Merchants who refused to sell to minors were usually given a certificate or a letter of commendation. Those who did sell to minors received some type of education about sales to youth. As a followup to compliance checks, interviews with store personnel about their selling behavior were sometimes conducted. Checks also documented how and where tobacco products, promotional materials, and legal age warning signs were placed. Some communities began this activity with a merchant education campaign. Volunteers, often youth groups, visited local tobacco merchants and distributed information about local and State laws pertaining to sales to minors. Articles and letters to the editor about the dangers of smoking and the easy accessibility to tobacco by minors accompanied this outreach to merchants. Following this outreach, compliance checks were conducted to determine the extent of the problem and the effects, if any, from the merchant education campaign. Merchants were not informed at this point that a compliance check was in progress; however, some communities chose to publicize the campaign in local newspapers to warn the merchants before the youth buyers were sent out to the stores. Initial compliance checks demonstrated that a majority of underage buyers were able to purchase cigarettes. In most communities, this outcome resulted in widespread local publicity and paved the way for public debate about enforcement and stricter laws. Youth were instrumental in promoting the importance of enforcing laws and advocating for the strengthening or changing of existing laws, such as bans on cigarette vending machines. Young volunteers spoke at city council hearings and displayed packs of cigarettes they were able to purchase during compliance checks. Students wrote letters to the editor to encourage local lawmakers to consider tougher policies on access to tobacco by youth. The visible and enthusiastic involvement of youth in this activity was an important factor in getting communities to discuss and in some cases make policy changes restricting sales to minors. SUCCESSFUL ACTIVITIES The process objectives for youth activities required involving as many children as possible in smoking control activities and mounting at least one visible youth-related policy initiative each year. Success was measured primarily by meeting process objectives for the required activities, and the community measured success by the amount and frequency of media coverage, positive feedback from the community to staff members and volunteers after events, letters to the editor, attendance at public hearings, changes in local public policy, and attendance at and response to other special events that created an environment for public discussion of the issue. ENLISTING YOUTH IN COMMUNITYWIDE CAMPAIGNS COMMIT found many agencies eager to involve their youth groups in smoking control activities. Boy and Girl Scouts, youth activities commissions, church and synagogue youth groups, children’s program directors at YMCA’s and afterschool programs, Students Against Drunk Driving (SADD) chapters and Friday Night Live groups, and antidrug coalitions, such as Drug Abuse Resistance Education (DARE), were eager to incorporate COMMIT’s antismoking message into their activities. The extent to which communities became involved in youth activities was based on the priority given to youth issues by community Boards, public education task forces, and program staff. Some communities, such as Utica, NY, and Raleigh, NC, created youth subcommittees of the public education task forces. Other communities, such as Fitchburg/Leominster, MA, and Bellingham, assigned youth the status of a full task force, including direct representation on the community Board. Most communities did not separate youth from the public education task force but still devoted much time and attention to this channel. Counteradvertising campaigns helped to reframe the message of smoking as a public health issue and provided excellent activities to involve the creativity and enthusiasm of young volunteers. In Vallejo, a youth group called Students Against Cancer developed a poster titled “Fight It! Don’t Light It!” that was displayed in buses and bus shelters throughout the city. The Southern Oregon Drug Awareness (SODA) youth committee worked with the Medford/ Ashland COMMIT community and adopted a counteradvertising billboard project. Volunteers from this group also helped place antitobacco stickers on tobacco advertisements in magazines in school libraries. Essay contests were yet another method used to promote community campaigns and magnet events. Raleigh conducted an essay contest on the theme “Smoking Restrictions and Their Associated Benefits.” Winning entries were reprinted in a local newspaper. In Fitchburg/Leominster, winning essays on no-smoking themes were read over local radio stations. In both Santa Fe and Paterson, adults and children used their musical and dramatic talents to bring an antitobacco message to audiences. In Santa Fe, a puppet show was developed that stressed the hazards of secondhand smoke. Children were taught how to deal with situations involving smoking, including how to refuse cigarettes. Scripts were developed for both elementary and higher grades. Children who saw the show at school received brochures containing antitobacco information for their parents. In Paterson, the “Smart Moves” play also traveled to schools. The play was interactive and included a simple antitobacco song taught to the children who were encouraged to bring the song home to their parents. A teacher and student in Fitchburg/Leominster rewrote the screenplay “Cold Turkey” as a play titled “Unfiltered Rock.” The play was produced during the week of The Great American Smokeout. Advertisements were run in the newspaper and on the radio to promote the play and the GASO. Forty students participated in this theatrical venture, and 600 people attended the play. Training youth to be speakers and active participants in events was another strategy used by communities to involve youth in educational campaigns. Utica trained young people to participate in a hypertension screening project to talk about the risks of smoking to people who have high blood pressure. Medford/Ashland sponsored two students from the SODA youth committee to attend one of the annual Stop Teen Addiction to Tobacco (STAT) conferences. These students were an important source of ideas for involving Medford/Ashland youth in more visible and active antitobacco efforts. Vallejo’s Students Against Cancer provided important help in promoting antismoking messages to adults and youth through a wide variety of campaigns and activities. This group, a youth component of the Minority Coalition for Cancer Prevention, was recruited from Vallejo high schools and the Continentals of Omega Boys & Girls Club. Students Against Cancer was routinely involved in Vallejo’s community events, such as the GASO, summer antidrug block parties, and Fourth of July parades. In some cases, these youngsters helped to promote the events to their peers and adults, and in other cases, they participated actively at the events in skits and on floats that had no-smoking themes. Santa Fe COMMIT worked with student interns who developed a presentation for other children and adults focusing on cessation. During one summer, COMMIT sought office help from student interns who were asked to make these presentations. When the students returned to high school in the fall, they worked as volunteers within the school, helping other teens to give up tobacco. By the second year of the program, funding was obtained from outside sources to continue support of the peer-to-peer program. An at-risk student, also an ex-smoker, became one of the trainers who helped reach other at-risk youth in Santa Fe, thereby lending even more credibility to his work among teens and young adults. Vallejo’s slide show “Provocative and Pervasive: Tobacco Messages Bombard Our Youth” is another example of a strategy that used youth to raise awareness among adults. The slide show depicted locations in Vallejo where tobacco products, advertisements, and tobacco-like candies and gum are placed at eye level in and near areas frequented by youth. The show included facts about smoking and health and was targeted primarily to adult audiences who attended meetings of community organizations such as the Rotary Club and church groups. The slide show drew strong reactions. Adults were indignant and sometimes outraged when they saw the extent to which the products were promoted in local stores and other locations in Vallejo. This slide show was eventually made into a short videotape starring local youth titled “Reaping Profits by Stalking Youth” and was made available to local community groups and agencies as a COMMIT legacy at the end of the project. Similarly, Bellingham adopted “Ad-libbing It” as part of its curriculum in grades 5 through 9. The videotape, developed by a physician from the Washington State affiliate of Doctors Ought to Care (DOC), shows young people how the tobacco industry manipulates them by presenting false images of smokers. Some communities used athletic events and organizations to target both adults and youth with antismoking messages. In Medford/Ashland, a minor league baseball team sponsored a Family-No Smoking-No Drinking section for games. Medford/Ashland also purchased a billboard with an antismoking message for players and their adult supporters at a Little League field. Vallejo distributed promotional materials targeted to Little League supporters who smoke while watching the games. Over the years, several campaigns were developed in Utica, including one for the winter holidays. A radio commercial featured a young girl who wrote to Santa asking for a Quit Kit for her dad. People were encouraged to give the kits to loved ones who smoke. One local hospital extended its heart disease prevention program to include radio advertisements using youngsters who asked their parents to quit smoking or start exercising so they will live to see their children grow up. Vallejo offered minigrants (matched by the school district) to youth organizations, such as the Camp Fire Girls, YMCA, 4-H Club, and the Continentals of Omega Boys & Girls Club, for projects involving youth in magnet events. These grants were used as incentives to encourage youth organizations to think of creative ways to involve their members in activities targeting adults. The Boys & Girls Club used its grant to support an antidrug block party during which T-shirts with antismoking messages were distributed. The YMCA used its grant to develop a prevention curriculum for a summer day camp program. Antismoking youth groups were established through schools and community organizations and coalesced with antidrug groups. Communities reported that incorporating tobacco into their community’s antidrug movements, while challenging, was a promising strategy for raising awareness of the problem of smoking and involving new groups of youth and adults. MAGNET EVENTS Magnet events included poster contests to promote cessation themes. In Paterson, winning posters were produced as a calendar and distributed widely throughout the community. In Cedar Rapids/Marion, IA, third-grade students were matched to local companies for the GASO. Students created posters encouraging the employees at their company to stop smoking for the day. A committee of smokers and former smokers at each company judged the posters and displayed the winner at their worksites. In many communities, children marched in Fourth of July parades in conjunction with Non-Dependence Day or in other local parades. Young people contributed energy, enthusiasm, and much creativity during float-making enterprises for these parades. One of Vallejo’s July Fourth floats featured a dinosaur theme and relied on young volunteers riding on the floats to spread the message “Smoking: The Real Reason Dinosaurs Became Extinct.” Young people were recruited to attend rallies where antismoking speakers, such as David Goerlitz (the former Winston cigarette advertising-model-turned- antitobacco advocate) or Dr. Alan Blum (of DOC), were featured. Rallies with such notable speakers as Mr. Goerlitz and Dr. Blum were held in conjunction with magnet events and received local media coverage and enhanced the promotional activities of antismoking campaigns. In Raleigh, a local chapter of SADD was recruited to participate in a Non-Dependence Day rally at the city plaza. The students performed skits and rap songs with an antitobacco theme. As a followup to that event, Raleigh kept the SADD members involved in additional tobacco control activities. Thus, some members of this group became involved in the GASO later that year and organized a small-scale “Quit and Win” contest as part of the event. They recruited prizes; made a banner; signed up students, faculty, and staff; and learned how to use a carbon monoxide monitor to determine contest winners. MONITORING AND ENFORCING TOBACCO ACCESS All communities conducted compliance checks to demonstrate the easy access children have to tobacco. These compliance checks also served to raise community awareness of the problem of smoking generally and the need for enforcement of a minimum purchase age. In some communities, such as Raleigh and Vallejo, youth buys were the first step to new or additional legislation aimed at keeping children away from tobacco. In Vallejo, a concerted campaign that began with compliance checks resulted in the passage of local legislation banning cigarette vending machines and free distribution of tobacco products. In Fitchburg/Leominster, youth task force members became masterful at involving other young people in activities that focused on prevention of youth access to tobacco. This activity received extensive media coverage and succeeded in moving debate forward on the need for stricter regulations at the municipal level. This activity was controversial and not always popular among adults in the community. Some felt it was a form of entrapment and that it did not set a good example to youth in the community. Nevertheless, health officials in one community moved quickly to adopt stricter regulations concerning youth access to tobacco. Health officials in one Massachusetts COMMIT intervention community were reluctant to move as quickly because they were philosophically opposed to youth involvement in undercover operations. Board and task force members began to work with the community’s youth commission, a peer leadership group with a positive image among adults. Through a series of educational sessions, the youth commission adopted protection from tobacco as one of its charges. The youth commission made a proposal to the health department asking for adoption of stricter regulations. When the health department did not act, the commission took its proposal to the city council. Members of the commission testified at hearings and succeeded in convincing the city to adopt the regulations, including provisions for monitoring enforcement using compliance checks, which had been the major stumbling block for the health department. Youth also reminded the public and legislators about existing nonsmoking laws. Santa Fe held a major event at the State capitol building. COMMIT held a news conference in the rotunda and enlisted help and support from youth and adults. The youth issued smoking “tickets” to those who lit up in the building because New Mexico law prohibits smoking in public places. However, not every lawmaker had a sense of humor about the event. One refused to be seen on camera with his citation in hand. For many communities, compliance checks and merchant education programs provided an excellent opportunity to involve youth in an activity that sought to protect youth and raise awareness among adults about the dangers of smoking and the pervasiveness of tobacco advertising and products in places where youth congregate. Some communities were more aggressive in their willingness to tackle this activity, especially in their use of young people to purchase cigarettes in bars or cocktail lounges. Buying operations usually resulted in media attention that kept the issue alive for public discussion, although the attention was not always favorable. The payoff for communities that successfully used compliance checks and related activities was a more powerful groundswell of support among adults for enactment of local ordinances to strengthen access laws. In addition, a cadre of dedicated youth, now schooled by COMMIT’s buying operations, became involved in other COMMIT activities. CHALLENGES Perhaps the most significant challenge that communities encountered with this channel was the desire of many of their community Boards and public education task forces to focus more attention and resources on youth and prevention activities. Thus, COMMIT staff members were faced with the challenge of steering their volunteers away from this focus and providing consistent reminders to them that the goal of COMMIT was to increase cessation rates among adult smokers. For some communities, the emphasis was on policy change, thought to be the only effort worth supporting in this channel. For example, in Fitchburg/Leominster, disagreement arose in the third year among youth task force members as to which activities for youth were most worthwhile. Two members of the task force, who were the major forces behind the implementation and enforcement of regulations prohibiting youth access, were adamant that these types of activities were the only effective activities for preventing youth access and that educational programs were a waste of time and money. Ultimately, task force members agreed that both educational and enforcement activities were to be part of the action plan. In other communities, volunteers expressed many concerns and fears about involving youth in monitoring access to tobacco, resulting in much weaker compliance checks and, in some cases, cancellation of these types of operations. For example, the Paterson public education task force opposed a staff-planned compliance check because most members were concerned that it might be viewed as an attack on merchants, not on the law and its enforcement. They subsequently canceled all plans for that activity. In Utica, concerns also were raised during plans for a second compliance check. Volunteers felt that COMMIT might receive bad publicity and were also concerned about COMMIT’s liability if the local district attorney decided to file charges against merchants caught in the operation. No one wanted to risk that possibility, so the compliance check was canceled. Another challenge facing this channel was that most at-risk youth do not belong to the kinds of organizations and groups that rallied to COMMIT’s message. Targeting this hard-to-reach population, although not a primary objective of the intervention, was a challenge for project staff members and volunteers. Santa Fe used the peer-to-peer education program described above to target some of these students. LESSONS LEARNED The youth channel was not a major priority for the intervention; the majority of COMMIT’s required activities were targeted to adults. Nevertheless, most communities felt that their youth activities were among the most successful of all the interventions. In the final reports of the COMMIT intervention, 6 of the 11 communities included at least 1 youth-related intervention among their “most successful activities.” That subjective evaluation by the communities provides some indication of the degree to which their volunteers were eager to focus on youth issues. Almost every community noted in its final reports that the youth channel (and its implicit message of prevention) was an important issue for volunteers. Perhaps this reflects a natural “protective” tendency on the part of adults to be concerned about creating and maintaining a safe and healthy environment for children. Such a tendency for protectiveness toward children may override the desire to intervene in the choices adult smokers have already made in their lives. Staff members and community volunteers realized that youth could be used to heighten awareness of the problem of smoking among both adults and young people. Furthermore, youth served a critical public relations function in getting the cessation message to adults, a realization that helped communities with objectives that targeted adults and enhanced their work by involving youth and adults in magnet events and monitoring and promoting enforcement on youth access to tobacco. In fact, many communities documented that involving youth groups in monitoring youth access to tobacco became a galvanizing force for changes in local policy. For example, the Vallejo City Council ultimately responded to the strong foundation of community support given to bans on vending machines and free distribution of tobacco products. This strong foundation resulted largely from the coalescing of diverse segments of the community, a coalescing that ultimately became the “pulse” (perceived standard operating pattern) of Vallejo, to which the council responded. However, the participation of many enthusiastic, articulate, and sincere young people in the process may have been the most critical ingredient in this effort. The linkage of tobacco use with substance abuse programs met with initial resistance (especially from the community of recovering addicts) but, in some cases, proved to be an effective strategy to merge with other groups and increase resources directed to antidrug, antismoking messages. Young people also serve as a convenient channel from which to recruit volunteers. Youth can support program staff when adults are neither able nor willing to volunteer. As was borne out frequently with the youth-buying operations and merchant education programs, everyone seems to listen when young people deliver a message. This may be the most valuable lesson learned from COMMIT’s experiences with youth activities. REFERENCES
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