Complexities of smoking education.

Cigarette smoking is a many-headed Hydra, which grows new smokers' heads as fast as they are lopped off. Efforts to change smokers' behavior usually reach a point of diminishing returns, as evidenced by experiences in smoking withdrawal clinics and in public anti-smoking education campaigns. Obviously, many smokers are refactory to anti-smoking education, a situation which has generated a great deal of pharmacological, neurochemical, psychological, and sociological research. The National Clearinghouse for Smoking and Health in the U.S.A. has used a "gradualist" or permissive approach in anti-smoking messages, aimed at less hazardous smoking "if you must smoke," rather than at complete cessation, and found this approach to be useful. U.S.A. school-children are exposed to anti-smoking education in lower grades than formerly, when it was offered in high school. Thus a population of as yet non-smoking children is being educated. Perhaps the adult non-smokers should be enlisted in an effort to create a social climate wherein smoking is not an acceptable behavior-an approach reflecting the concept of smoking as a social disease. Health education addressed to the receptive non-smoker would circumvent the refractory smoker. A theme with appeal to non-smokers is the protest against environmental pollution by smokers. It is possible that if a movement by non-smokers against smoking would gather momentum, it could turn the present accepting social climate into one rejecting smoking, thus striking at the regeneration of the Hydra: the incessant recruitment of smokers among ex-smokers and non-smokers. With recruitment below replacement level, the Hydra would in time wither away.