US Surgeon General Talks About Antismoking Efforts in Kids and Lessons Learned From His Own Childhood

WASHINGTON—When David Satcher, MD, was 6 years old, he told everyone he wanted to be a doctor. Now 58, Dr. Satcher presides as the nation’s top physician, the US Surgeon General.

The father of four grown children, Dr. Satcher has a special place in his heart for young people. He visits schools all over the country to talk with kids about all facets of good health, including exercise, healthy eating, and not smoking.

He talked with ONI writer Pam Janis about his efforts to prevent smoking among children and their parents, and described the important lessons he learned from his own childhood in rural Alabama.

ONI: In your Surgeon General’s report last year on tobacco use among the nation’s minority groups, you called minority teen smoking a “time bomb.” How are you working to defuse that time bomb?

DR. SATCHER: We are going directly to schools and spending a lot of time talking with young people. But it’s when the young people themselves speak out against it that smoking becomes unacceptable in a community.

We’ve seen some of that already in our visits. I went to a middle school in the Charlestown area of Boston where the kids were predominantly Hispanic and African American. Those kids organized a major program against smoking—they even brought in parents who smoked, including one who had had a lung removed. They had x-rays showing the dangers of smoking. They talked about second-hand smoke. In that group of young people—there were several hundred—it was not acceptable to smoke.

We must continue to educate, to motivate, and to mobilize young people against smoking. But we’ve also got to find a way as a society to change the environment that gives rise to teen smoking. We have to change the environment so that smoking is not considered cool.

Toward that end, we plan to make an outreach effort to the entertainment industry to encourage them not to glamorize smoking on TV and in the movies.

ONI: How else are you conveying the urgency of the antismoking message to the most at-risk groups?

DR. SATCHER: We go to other groups besides students and directly involve them in the efforts. When I go to American Indian reservations, my message to them is, “We need you to help us. Tell us how we can better communicate. Tell us why it’s so difficult for you. Why is it that American Indians have the highest rate of smokers of any group in the country?”

The point we’re trying to make with every group is that smoking hurts children. We’re trying to really get inside a culture to see what’s giving rise to smoking and to see if it can be fought from within. That’s the strategy.

These are not just racial issues, they’re directly related to socioeconomic status and educational level. For example, when the first Surgeon General’s report on smoking came out in 1964, more than 60% of physicians were smokers. Today, it’s less than 10%. Doctors went from being the group with one of the highest percentages of smokers to the lowest. So educational level has had a lot to do with the way people have responded to the antismoking message.

ONI: What do you tell parents to convince them to stop smoking?

DR. SATCHER: It’s hard to get people energized about smoking’s long-term effects, so we’re trying to point out that the impact of smoking on children is immediate. For instance, we’ve seen a significant increase in asthma hospitalization and asthma deaths of children, and, clearly, it’s related to smoking. Smoking is not the only risk factor, but it’s one of the major risk factors.

ONI: I have to ask you: Have you ever smoked?

DR. SATCHER: When I was a graduate student, I smoked a pipe. It was a classic thing. You know, the graduate student doing research, smoking a pipe. When I noticed my children admiring me smoking that pipe, I said it’s time to put this thing away. I never picked it up again. I was becoming a negative role model. I was making smoking look glamorous to my children.

ONI: It seems that as much as parents influence kids, kids can influence parents, too.

DR. SATCHER: Exactly. And that’s part of what we hope is going to happen. I hope parents get the message that children really look at what they do. I also try to explain to children that it’s not easy to quit smoking once you start and that’s why you shouldn’t start. Most smokers will become addicted before they’re 18 years old. Then it becomes very difficult to stop. Based on our studies, 70% of people who smoke would like to quit, and yet every year only 2% to 3% actually succeed in quitting.

ONI: Why is there such a low quitting rate?

DR. SATCHER: Part of the problem has been that we in the health profession have not been aggressive enough. So we’re talking to physicians about putting prevention at the forefront. We’re urging them to ask their patients if they smoke. If they do, they should ask them to quit and ask them how they can help them quit. Provide the opportunity. If the physician can’t do it, he or she should send them somewhere that can.

ONI: Having grown up in the South, do you have any mixed feelings of sympathy or understanding about the tobacco economy and the tobacco culture?

DR. SATCHER: I lived on a farm, but nobody in the area where I grew up raised tobacco—they raised cotton, peanuts, and corn—so I must admit I don’t have the sensitivity of one who grew up depending upon tobacco as a crop. But I do have the sensitivity of one who grew up depending upon the farm for food. I know what it’s like to be dependent upon crops for your livelihood.

ONI: What do you remember about your early years?

DR. SATCHER: I saw the values my parents demonstrated. And the fact that they had so much hope for their children. Neither of my parents finished grade school, but they felt that our education was very important. So even though people around us would keep their children out of school to work the fields, school always came first in our home.

I said I was going to be a doctor from the time I was 6. My parents had never known a physician personally. My mother went through all her pregnancies with a midwife—not a nurse-midwife. The only time I ever saw a doctor was when I had the whooping cough, and one came up from town to the farm.

I never went to the hospital because you didn’t; people died at home. Even now, I remember, although I was only 2 years old, how the members of my community gathered around when they thought I was going to die. I remember the singing on the porch.

ONI: You must have grown up with a strong sense of community.

DR. SATCHER: We did. People didn’t go to college; most didn’t finish high school, but they supported each other. If someone’s crop didn’t grow and ours did, my mother would send me to take vegetables to our neighbors. I grew up knowing people cared about me. People cared about each other.

ONI: Was the community your whole world?

DR. SATCHER: Home and community. And in our home a big part of that was church. The church was the only institution that my parents were a part of. The only offices they ever held were in the church. My dad was a deacon and the superintendent of the Sunday School. This is the same person who didn’t finish first grade. My mother and the church taught him how to read—my mother, who had only finished the fifth grade herself.

Community support was on a very personal level—people cared about you and were proud when you did well. We accepted certain things, though, before the Rev. Dr. Martin Luther King came to Montgomery, Alabama, and showed us what organized resistance to racism could do.

We accepted that you were supposed to ride in the back of the bus. The first time I went to town with my sisters and brothers, I remember I wanted to buy ice cream. I went into that store and that lady looked at me as if I had committed the worst crime, because they didn’t allow blacks in the store. That’s the way life was. But there was an undertone to that, which was: You could change this if you could get educated—it didn’t have to be that way for you.

ONI: What is the one thing you most want our readers to remember from this conversation?

DR. SATCHER: That the most important thing we can do for our children, the responsibility we have as adults, is to give them hope for the future and convince them that they can help shape a better one. You’re not giving children hope for the future if you walk around smoking, knowing that it causes cancer.

You’re not giving children hope for the future if you say you have no time to exercise. You’re not giving children hope for the future if you don’t eat right. We’re busy? That’s ridiculous! There’s no such thing as not having time to eat right; it takes as much time to eat wrong. If you have time to sleep and to go out and have a beer, you have time to be physically active.

We’re dealing here with a generation of people who make up all kinds of excuses. That’s not good for our children—it sends a very negative message about the future. Whatever we show them about our lives relates to theirs. That’s my bottom line. We must give our children hope for the future.