Youths Tie Tobacco Use to Marijuana

By Jane Gross
Copyright 1998 The New York Times
April 22, 1998

YONKERS, N.Y. -- In the search to explain the spike in smoking among black teen-agers, a range of theories has evolved, from the proliferation of tobacco advertising in minority communities to the stress of adolescence to the identification with entertainment idols who appear with cigarettes dangling from their lips.

Teen-agers themselves, and some experts who have studied adolescent smoking, add another, less predictable explanation to the mix of factors: the decision to take up smoking because of a belief that cigarettes prolong the heady rush of marijuana.

"It makes the high go higher," said Marquette, a 16-year-old student at Saunders Trades and Technical High School in Yonkers, who, like other students, spoke about her marijuana use on the condition that only her first name be used.

At Washington Preparatory High School in South-Central Los Angeles, Tifanni, also 16, said she took up cigarettes two months ago because, "If the marijuana goes down and you get a cigarette, it will go up again."

Black teen-agers like Marquette and Tifanni are not unusual, judging by interviews with dozens of adolescents around the United States, and the results of national surveys. These surveys show that blacks begin smoking cigarettes later than white teen-agers, but start using marijuana earlier, a difference experts say they cannot explain.

The surveys also show a sharp rise in both cigarette and marijuana use among teen-agers in recent years, evident among all races but most pronounced among blacks. White teen-agers still smoke cigarettes at twice the rate of blacks, but the gap is narrowing, signaling the end of low smoking rates among black youth that had been considered a public-health success story.

It is not clear how much of the increase in smoking among black teen-agers is a result of the use of cigarettes with marijuana, but that behavior is notable because it is the reverse of the more common progression from legal drug use to illegal drugs.

Many black teen-agers said in interviews that they were lured to cigarettes by friends who told them that nicotine would enhance their high from marijuana, which has been part of drug users' lore for decades. And this is apparently no mere myth. Many scientists who study brain chemistry say the link between cigarettes and marijuana is unproved but likely true.

"African-American youth talk very explicitly about using smoking to maintain a high," said Robin Mermelstein, a professor at the University of Illinois at Chicago and the principal investigator in a study of why teen-agers smoke, for the federal Centers for Disease Control and Prevention. "It's a commonly stated motivator."

Dr. Mermelstein said that in focus groups with 1,200 teen-agers around the country, about half the blacks mentioned taking up cigarettes to enhance a marijuana high, but no white teen-agers volunteered that as an explanation for smoking. "Cigarettes have a totally different functional value for black and white kids," she said.

Even so, Dr. Mermelstein and others say that they still think the main cause of increased smoking by black teen-agers is the abundance of advertising and other media messages in minority neighborhoods. "Kids are extraordinarily aware of the entertainment media," Dr. Mermelstein said. "They are very reluctant to see the link between any of these and their behavior. But the influence is undoubtedly there."

Tiffany Faulkner, a 15-year-old in New York City, said "Tupac smoked, and he's my man," referring to the slain rap star Tupac Shakur. "But I didn't smoke because of him," she said. "I have my own head."

Brand loyalty, however, suggests youth are more moved by the advertising than they realize, or are willing to admit. In general, Marlboro and Camel have white characters on billboards and are the brands of choice among white teen-agers, while Kool and Newport use minority images and are favored by African-Americans teen-agers, as they are by their parents.

Outside Brighton High School in Boston, for instance, every black student in a group of smokers chose Newports. "They're the cool cigarette," said Joey Simone, 18, a smoker since she was 11.

A 16-year-old Chicago girl who tried cigarettes briefly, said she is certain advertising is the key. "When I was little, I would see pictures of people standing around with a cigarette, and it looked like fun," said Coleco Davis at DuSable High School. "They were all having a good time and it didn't look like it could hurt you."

This wave of new black smokers, drawn to a habit that kills more people each year than all illegal drugs combined, has researchers worried, because once teen-agers have experienced the booster-rocket effect of cigarettes prolonging a marijuana high, they often find themselves addicted. "Because I was getting high, I needed it," said Mary Vargas, 16, at Norman Thomas High School in New York City. "The cigarettes made me more high. Now it's become a habit. I feel bad because there's nothing I can do to stop."

The growing concern about teen-age smoking is behind pending federal legislation that would raise the price of cigarettes, control advertising to young people and penalize manufacturers if there is not a gradual reduction in smoking by teen-agers. That legislation took center stage in Washington just as a new study earlier this month showed a steep rise in the smoking rate among black youth.

The nationwide federal study showed overall smoking rates had increased by one-third among high school students between 1991 and 1997. Most alarming to experts was the sharp rise among black youth: 22.7 percent in 1997, up from 12.6 percent six years earlier.

Charyn Sutton, whose Philadelphia marketing company conducts focus groups for federal research agencies, said she first heard about the current progression from marijuana to cigarettes -- what she calls the "reverse gateway effect" -- during focus groups in 1995 involving black middle school students.

Ms. Sutton already knew about blunts, cigars with the tobacco replaced by marijuana. But now the teen-agers told her that a practice familiar to the drug cognoscenti of all races as early as the 1960s and 1970s was popular in the school yard of the late 1990s -- enhancing the high of a joint with a cigarette.

She tested what the teen-agers told her by talking to addicts in recovery, who concurred. And to be sure that the pattern she was seeing in Philadelphia was not a local anomaly, she interviewed young African-Americans across the nation. And, she said, she discovered that they were doing the same thing.

The enhancing effect that teen-agers describe is consistent with what is already known about the working of nicotine and THC, the active ingredient in marijuana. Both spur production of dopamine, a brain chemical that produces pleasurable sensations, said George Koob, a professor of neuropharmacology at the Scripps Research Institute in La Jolla, Calif. "It makes a lot of sense," Koob said.

At the National Institute on Drug Abuse, which funds most of the world's research on addiction, Alan Lesher, the director, went a step further, saying the anecdotal findings cried out for rigorous investigation. "This is a reasonable scientific question," he said. "And if enough people report experiencing it, it merits consideration."

Researchers elsewhere have also taken note of strange glitches in substance-abuse data comparing blacks and whites. For instance, Denise Kandel, a professor of public health and psychology at Columbia University's College of Physicians and Surgeons, found that while most substance abusers progressed logically from legal to illegal substances, "the pattern of progression is less regular among blacks, and nobody really knows why."

In 1991, according to the Centers for Disease Control and Prevention, 14.7 percent of students said they had used marijuana in the last 30 days; by 1995, the latest year for which data is available, that rate had jumped to 25.3 percent. Among white youth, the rate increased to 24.6 percent from 15.2. Among Hispanics, it shot up to 27.8 from 14.4 and among blacks to 28.8 from 13.5, vaulting them from last place to first in marijuana usage by racial group.

The CDC cigarette study, which tracks use through 1997, shows a parallel pattern. Among white students, 39.7 percent said they smoked cigarettes, up from 30.9 percent six years ago. Among Hispanic students, more than one-third now say they smoke, up from roughly a quarter. Among black youth, 22.7 percent list themselves as smokers, compared with the 12.6 who said they smoked in 1991. Worst of all were the smoking rates for black males, which doubled in the course of the study, to 28.2 from 14.1.

The progression from marijuana to cigarettes among black youth was the most provocative finding in interviews in recent days with high school students in New York City, its suburbs, Los Angeles, Chicago and Boston, who consistently raised the issue without being asked. But their comments raised several other troubling issues, as well.

The students were perfectly aware of the health hazards of cigarette smoking. A 17-year-old in New York said she was quitting because she might be pregnant. A 15-year-old at Saunders said she did not smoke during basketball and softball season but resumed in between.

But most paid no attention to the danger.

And despite laws prohibiting sales to anyone under 18, virtually all the teen-agers said they had no difficulty buying cigarettes at small grocery stores.

The federal legislation to curb teen-age smoking, currently being debated in Congress, depends in large measure on steep price increases as a deterrent. Sponsors of the bill say that raising the price by $1.10 per pack would reduce youth smoking by as much as 40 percent. But talking to high school students suggests this prediction is optimistic.

The adolescents said overwhelmingly that they would pay $3.60 a pack -- the current $2.50 plus the additional $1.10 envisioned in the legislation. A few said that $5 a pack might inspire them to quit, or at least to try.

But faced with so high a tariff, 17-year-old Robert Reid, a student in Yonkers, had another idea. "At that price," he said, "you might as well buy weed."

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