As Liggett agrees to new warnings, a study questions effectiveness

Research finds many adolescents don't read labels.
Nicotine is found to be the key obstacle to quitting.

By Robert S. Boyd
INQUIRER WASHINGTON BUREAU

WASHINGTON Will tougher cigarette warnings work?

The Liggett Group's agreement to mark its packages with a warning that
cigarettes are addictive comes after 30 years of increasingly somber cautions
about the danger of tobacco.

During that time, cigarette smoking has dropped by half among adult males and
by onethird among adult women. But it is increasing sharply among teenagers,
when the habit is usually picked up.

In fact, teenage smoking increased by 30 percent from 1991 to 1995, according
to a study published yesterday by the Stanford University School of Medicine.

``Sizable proportions of adolescents are not seeing, reading and remembering
cigarette warning labels,'' said the study, which surveyed 1,700 high school
freshmen in San Jose. ``Knowledge of warning labels was not associated with
subsequent decreased smoking.''

The labels now say that smoking causes cancer, emphysema and other diseases,
but do not mention addiction.

Researchers say that three out of four people who start smoking become
confirmed addicts, and that 90 percent of those who try to quit each year
fail.

A major part of the reason is that nicotine is as addictive as cocaine and
heroin, and even more habitforming than alcohol, according to scientists who
study addiction.

Using modern electronic brainscanners, researchers can see how chemicals in
tobacco smoke permanently change the way brain cells, called neurons,
communicate with one another. The changes make it extremely difficult and
often impossible for people to quit.

``Nicotine meets all the criteria of a highly addictive drug,'' said Jack
Henningfield, an expert on drug and tobacco addiction at Penny Associates in
Baltimore.

Until a halfcentury ago, tobacco was considered neither harmful nor
addictive. By the end of World War II, it was widely accepted that cigarettes
were unhealthful, but not nearly as bad as hard drugs. Smokers called them
``coffin nails'' as they cheerfully puffed away.

But during the 1970s, researchers began to unravel nicotine's addictive
powers. In 1988, President Ronald Reagan's surgeon general, C. Everett Koop,
issued a 618page report declaring that ``cigarettes are addicting in the
same sense as are drugs such as heroin and cocaine.''

Koop ordered stiffer warning labels on cigarette packs. Smoking began
dropping among adults, but kept rising among adolescents.

Last year, President Clinton authorized the Food and Drug Administration to
regulate nicotine as a dangerous substance. The FDA's proposed rules limiting
access to minors are being challenged by a coalition of tobacco companies in
federal court in North Carolina.

The companies, with the exception of Liggett, deny that smoking is addictive,
and point to the millions of Americans who have quit.

In its settlement yesterday, Liggett, the maker of Chesterfield and other
brands, agreed to add a prominent warning to each cigarette pack
acknowledging that smoking is addictive and causes health problems, including
lung cancer.

A colorless, oily liquid composed of carbon, hydrogen and nitrogen, nicotine
itself does not cause disease. Scientists say it is the other toxic
substances in tobacco smoke chiefly tar and carbon monoxide that lead
to cancer of the lungs, throat and other organs.

But nicotine is indirectly responsible for the damage because it makes it so
hard for smokers to quit.

According to Henningfield, 5 milligrams of nicotine a day is enough to cause
addiction. Each cigarette delivers about 1 milligram of nicotine into the
bloodstream of a smoker.

Within 20 seconds after it hits the bloodstream, nicotine reaches the brain
and is distributed among the trillions of neurons that govern thinking,
memory, perception and emotion.

At that point, it stimulates the production of a chemical messenger, called
dopamine, that helps pass signals from one neuron to another. This excess of
dopamine produces the pleasurable sensations that accompany smoking, or the
``high'' that goes with cocaine.