WASHINGTONWhen David Satcher, MD,
was 6 years old, he told everyone he wanted to be a doctor. Now 58,
Dr. Satcher presides as the nations top physician, the US
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 Generals report last year on tobacco
use among the nations minority groups, you called minority teen
smoking a time bomb. How are you working to defuse that
DR. SATCHER: We are going directly to schools and spending a lot of
time talking with young people. But its when the young people
themselves speak out against it that smoking becomes unacceptable in
Weve 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 smokingthey 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 peoplethere were several hundredit
was not acceptable to smoke.
We must continue to educate, to motivate, and to mobilize young
people against smoking. But weve 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 its so
difficult for you. Why is it that American Indians have the highest
rate of smokers of any group in the country?
The point were trying to make with every group is that smoking
hurts children. Were trying to really get inside a culture to
see whats giving rise to smoking and to see if it can be fought
from within. Thats the strategy.
These are not just racial issues, theyre directly related to
socioeconomic status and educational level. For example, when the
first Surgeon Generals report on smoking came out in 1964, more
than 60% of physicians were smokers. Today, its 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: Its hard to get people energized about
smokings long-term effects, so were trying to point out
that the impact of smoking on children is immediate. For instance,
weve seen a significant increase in asthma hospitalization and
asthma deaths of children, and, clearly, its related to
smoking. Smoking is not the only risk factor, but its 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 its 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 thats 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 its not
easy to quit smoking once you start and thats why you
shouldnt start. Most smokers will become addicted before
theyre 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 were talking to
physicians about putting prevention at the forefront. Were
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 cant 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
DR. SATCHER: I lived on a farm, but nobody in the area where I grew
up raised tobaccothey raised cotton, peanuts, and cornso
I must admit I dont 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
its 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 midwifenot 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 didnt; 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 didnt go to college; most
didnt finish high school, but they supported each other. If
someones crop didnt 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 didnt finish first grade. My mother and the
church taught him how to readmy mother, who had only finished
the fifth grade herself.
Community support was on a very personal levelpeople 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
didnt allow blacks in the store. Thats the way life was.
But there was an undertone to that, which was: You could change this
if you could get educatedit didnt 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. Youre not giving children hope for the future if you walk
around smoking, knowing that it causes cancer.
Youre not giving children hope for the future if you say you
have no time to exercise. Youre not giving children hope for
the future if you dont eat right. Were busy? Thats
ridiculous! Theres 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.
Were dealing here with a generation of people who make up all
kinds of excuses. Thats not good for our childrenit sends
a very negative message about the future. Whatever we show them about
our lives relates to theirs. Thats my bottom line. We must give
our children hope for the future.