CVS recently pulled all tobacco off of its shelves in a major re-branding of the convenience store chain and is urging others to follow suit. With the release of the 32nd Surgeon General’s Report on health and smoking, acting official Boris Lushniak said, “Enough is enough.” And the Associated Press even ran a headline that read “Experts Increasingly Contemplate End of Smoking.” I wish I were as optimistic.
Smoking kills more people in the United States than any other behavioral cause of death, but it takes its toll primarily on Americans who are less educated; these are the people with the highest smoking rates. But before deciding that college is the answer, there is one more fact to consider: Differences in smoking habits by education level appear as early as age 12, long before that education is actually completed.
We should think about teaching good decision-making skills as the job of both parents and schools.
Research on smoking focuses primarily on two key areas: why adolescents start to smoke, and how to help smokers quit. CVS’s decision to stop selling tobacco products will hopefully help more adults quit smoking and may even reduce teenagers’ access to cigarettes. But there is an important lesson in the different patterns of smoking by education level: The people who go on to earn a college degree in large part never start smoking regularly in the first place. If we want to end smoking, we need to better understand why children who will go on to obtain college degrees never start using tobacco in early adolescence.
At this point we don’t know exactly what the defining traits are. Academics argue that those who obtain more education have more resources—such as money, social networks, insurance, and information—and thus make better health-related choices. But if the inequalities in smoking by education level are already present in the early teenage years, then these explanations are not possible because the education has not yet been obtained. Instead, we have to re-focus our explanations on the resources available to children. In the case of smoking, we should be thinking about the resources of families and schools, and the decision-making skills they impart.
In the U.S., the families, neighborhoods, and schools that different children experience are hugely unequal. Ideally, we would address poverty and income inequality directly. But even without solving these complex social issues, we can focus on a more tractable goal: teaching kids skills for making good choices. Regardless of the resources at their disposal, most parents attempt to teach these skills at home. Children from well-off families, however, learn these skills in many overlapping parts of their lives, including schools, neighborhoods, and among peers.
Although less well-off children do not have as many resources available to them, this is an area where schools could help to level the playing field. The childhood years are a time when school policies could actually make a difference, since nearly all children attend the primary grades. If, for example, the root causes of choosing not to start smoking are nurtured in childhood—be these optimism, self-esteem, thinking about the future, or self-control—schools could teach these skills as part of their curriculum.
I am not suggesting that schools should be doing the job of parents or that smoking is a symptom of bad parenting. Rather, we should think about teaching good decision-making skills as the job of both parents and schools. If we want to see the end of smoking, this is where we should focus.