SCHOOLS URGED TO TREAT TEEN SMOKERS WITH NICOTINE PATCH

Time was that a teen smoker was considered more rebel than addict. Put them
in detention, take away the car keys and hope they "grow out of it." It
wasn't enough.

Now a Rolling Meadows anti-tobacco group wants to try a more grown-up
approach: distributing nicotine patches to high school students.

If officials approve, Vanguard School in Arlington Heights will join a
handful of schools nationwide that provide nicotine-replacement products to
students. But the idea is gaining favor as educators and health officials
start to agree that teen smokers need to be treated, not just punished.

"Now we treat it as if it's something kids do just to be annoying. We need
to make the cessation issue real," said Judy Sopenski, director of the
Boston-based Stop Teenage Addiction to Tobacco. "We need to recognize that
young people need more than willpower to quit."

Only now are scientists providing health officials with the data they need
to confidently prescribe nicotine replacement.

By year's end, Minnesota researchers plan to publish the most ambitious
study on nicotine-patch use by teens, and new federal guidelines issued
last summer give clinicians unprecedented leeway to prescribe nicotine
replacement to teen patients.

Some health officials warn nicotine replacement is risky until scientists
know more. And they wonder how schools can justify giving students
nicotine, a substance harmful and illegal for minors, even for a good reason.

Doctors see nicotine patches, gum and similar products as useful because
they deliver small, steady doses of nicotine to relieve withdrawal
symptoms. More important is what they don't deliver: tar, carbon monoxide
and other ingredients responsible for smoking's health dangers.

Some studies show the products can double the chances of quitting smoking.

But the users of nicotine-replacement products are almost exclusively
adults. The Food and Drug Administration approved the over-the-counter sale
of nicotine patches and gum in 1996, but only for adults. Teens can get
them with a prescription, but most doctors are reluctant to prescribe
patches, and teens are reluctant to ask because it would disclose their
habit to their parents.

Conventional wisdom holds that teens haven't been smoking long enough to
become truly addicted. Scientists are learning that's not true.

A study by Harvard University and the University of Massachusetts,
published last month, found that 16 percent of 12- and 13-year-old smokers
developed symptoms of addiction within two weeks of their first cigarette.
The Centers for Disease Control and Prevention say teens frequently find
themselves unable to quit after as few as 100 cigarettes--five packs. Three
out of four teen smokers have tried unsuccessfully to quit, according to
federal statistics.

As a former smoker, Dr. Arvind K. Goyal knows the agony of trying to kick
the habit. As a physician, he knows the risks of not quitting. The Rolling
Meadows family practitioner thinks teens can use all the help they can get.

In April, Goyal visited a wellness fair at Vanguard School, an alternative
school in Arlington Heights. In one class, nine of 10 students smoked. He
asked them what it would take to stop.

One blurted out: "If I could afford those patches you were talking about,
maybe I would quit." If free nicotine patches were provided, Goyal asked
the students, would they be willing to try? Seven said yes.

Goyal brought the idea back to the city's Tobacco Information Prevention
Committee, which he chairs. The committee agreed to obtain a 10-week supply
from SmithKline Beecham, manufacturer of Nicoderm.

School administrators received the committee's proposal last week and say
they have yet to review its details. Jan Schneider, Vanguard's director,
said she is sympathetic to the group's goals but thinks patches would be a
tough sell to her superiors because of liability concerns.

Goyal likens this project to carrying a shield to a soldier on a
battlefield. Lives are at stake, he said.

"If one kid quits, that's one life saved," Goyal said. "With everything we
know about what cigarettes can do, how can we not try it?"

If the district agrees to the program, Goyal said, the school will
determine how the patches will be distributed and whether parents will be
notified.

Some teens already know how tough it can be to quit.

Gary Scheck, a 16-year-old junior at Hoffman Estates High School, has been
smoking for only six months but felt withdrawal symptoms after trying to
cut back on his habit when football practice started.

"We all talk about quitting, but no one seems to do it," said Scheck, who
smokes about 10 cigarettes a day. "It's not going to be easy, but I don't
feel like I'm addicted yet."

But fellow smoker Oliver Urrego, 16, said he has seen classmates at Hoffman
Estates High School suffer from "nicotine fits," depression and mood swings
after trying to kick the habit. "It's like the nicotine has a hold on
them," he said.

Nationwide, only a handful of schools distribute patches. For about three
years, the Multnomah County Health Department in Oregon has provided
patches and gum to a handful of students in its school-based health
clinics. Although several counties have inquired about Multnomah's
teen-smoking program, Multnomah officials don't know of another that has
adopted nicotine replacement.

"Everyone has to go at their own comfort level. It's human nature," said
Jill Daniels, a clinical program manager for the county department. "It
always takes a few champions to try something new and see how it works."

Even schools that reject the patch are recognizing their role in helping
students kick tobacco. That new attitude is unlike the days when a school's
only response to smoking was a heavy dose of detention, experts said.

School-based programs haven't taken off locally yet, but the American Lung
Association of Metropolitan Chicago is seeking at least 25 local high
schools to join its Not on Tobacco cessation program.

Lung association officials don't plan to use patches because they want to
concentrate on other treatments, such as counseling. Officials say money
from a national tobacco settlement will help efforts to get teens off
tobacco, which might someday include widespread use of the patch.

In guidelines adopted in June, the U.S. Department of Health and Human
Services gave clinicians more leeway in prescribing nicotine replacement to
teens. Guidelines from 1996 required clearer evidence of addiction before
clinicians could even consider nicotine replacement.

The department also recommended more research because there were too few
studies to yield definitive conclusions. Some clinicians do not want to
endorse the patch until that research is complete.

"I'd love to see how it would work, but we're not ready to recommend it,"
said Dave Hurley, director of the Adolescent Smoking Cessation Program at
Christ Hospital and Medical Center in Oak Lawn. "It's controversial
because, after all, [nicotine] is still illegal for minors."

One of the few studies on the topic, by the Mayo Clinic in 1995, found the
patch seemed to be "safe and well-tolerated" among teenagers. None of the
22 study participants experienced serious side effects. Most suffered from
moderate effects common to adults, such as skin irritation and nausea.

Later this year, University of Minnesota researchers plan to publish a
wide-ranging study to gauge the success, compliance and withdrawal symptoms
of teens using the patch. Researchers say they hope their pilot study spurs
full-scale research by the FDA that could be the next step toward
over-the-counter approval for teen use.

A second Mayo Clinic study, published in January, found that patch therapy
plus minimal behavior intervention "does not appear to be effective" for
treating teen smokers after six months.

But Dr. Richard D. Hurt, the study's lead author and director of the
clinic's Nicotine Dependence Center, still supports giving more teen
smokers access to the patch, especially with more intensive counseling than
his own study used. He called the Rolling Meadows committee's plan
"exciting and innovative."

"It's taken a long time to get to this point--too long," Hurt said. "We're
finally turning our attention to these other options. We missed the boat
all these years."

Hurt noted that prevention efforts have seemed to stall. After years of
decline, smoking among high school seniors rose 27 percent from 1991 to 1999.

Experts agree that teens using the patch will need special monitoring.
Users can become seriously ill, for example, if they smoke while wearing a
patch.

In Oregon, all students working with schools to quit smoking, even those
not using patches, must check in daily at their high school clinic. Each
visit is a chance for staff to provide advice and support, if only for a
few minutes.

The Rolling Meadows committee is far less demanding. Under a draft
contract, students would be required to work with health professionals at a
minimum of two monthly committee meetings.

That sort of support is just as important as the patch, experts say.
Scheck, the Hoffman Estates teen, said classmates find it tough to quit in
an environment where all their friends smoke. No patch will overcome those
influences, he said.

As he spoke, the phone rang. A classmate wanted to go buy cigarettes.