Scaring Smokers Straight in Germany

Pamphlets? Posters? Forget it. The "No Butts" project in the German town of Heidelberg takes a much more aggressive approach to antismoking education. It brings German youths between 12 and 17 to a hospital specializing in lung disease, giving them a firsthand look at the devastation wrought by smoking.

In Germany, 300 people die each day from tobacco-related illnesses, according to figures put out by the German state of Saxony. One quarter of all German 15-year-olds smoke. And while the overall percentage of teenage smokers has leveled off recently, the numbers of female teen smokers has soared in the past decade, from 16 percent in 1993 to 35 percent in 2004.

Yellow skin, black lungs

On a recent visit to the Thorax Clinic in Heidelberg, some 60 teenagers from the Bonhoeffer Technical School came for a day of education and confrontation. Before their day even started, they got their first lesson in the less than pleasant long-term effects of smoking. On their way into the building, they passed three pale men in jogging outfits and flip flops -- clearly patients -- who were standing outside the hospital doors, smoking. The men looked old, their faces deeply lined and their hair and skin had an unhealthy yellow tinge.

One of the students who visited the clinic was the 15 year old Jens -- himself a smoker for more than a year. In fact, just prior to the clinic visit, Jens said, he had a smoke.

When asked what he expected to get out of the project, he said he wasn't sure. He just hoped it would't be "too boring." But he was nonetheless worried about the group's plan to watch a lung endoscopy.

"I have nothing against blood and stuff, but it's probably not so great to have to look at a black lung," he said.

Long-term success?

The project is one of a growing array of education efforts in Germany, aimed at reducing smoking or scaring kids off of ever starting. The hope is that by looking at black lungs and endoscopies, students like Jens will be so terrified they will quit smoking.

While "No Butts" project leader Michael Ehmann said that such shock-tactic education often has an immediate resonance -- most attendees leave his seminars vowing to quit -- he added it often fails to translate into quitting smoking. He still continues to provide information, hoping that the facts he transmits will help combat the idealized images of smoking shown in the media. And he especially aims to reach those kids who have not yet started to smoke, but who might want to some day.

"I would like it if youths had 100 percent of the information, early enough, before they even get into the whole smoking thing," said Ehmann, himself an ex-smoker.

'Avoidable risk'

Ehmann's tactic with the students is to load them up with facts. They sit in an amphitheater while he delivers a talk via cordless microphone. His speech is short on pleading or criticism, long on facts and clear messages.

"For you, it's the single most important, avoidable health risk in the western world: whether to light up or not. It's your choice. None of my business. But first you have to know the information," Ehmann began and then proceeded to deliver anti-smoking information for the better part of an hour.

Despite the length of the talk, the kids stayed surprisingly quiet.

"It is a little exhausting to just sit and listen all the time," Jens said. "But if you really listen, it is actually interesting what you can learn."

Shock tactics

After the talk came the part with shock value: a video of a lung endoscopy was projected up on a large screen. During the endoscopy, a camera probe was sent into the lungs of a patient; endoscopies are used by physicians to view the damage to an internal organ and take tissue samples, among other things. During the video, the operating surgeon explained what he was doing as he pushed the probe into the patient's mouth.

"Those are some traces of blood that come from cancer..." he said.

The last part of the talk was perhaps the most effective. A lanky man, his right leg in a plaster cast, limped before the audience. He was introduced as a 54-year-old with lung cancer, but the disease has spread into his legs.

He told the students about his tobacco addiction; how he smoked his first cigarette at age 10 and eventually worked his way up to three packs a day. Even today, he said, he can't give up cigarettes despite his illness.

From legs to lungs

The room was silent as he told about his diagnosis.

"I asked the doctor, 'What do I have?' He said, 'A tumor in your leg'. So I came down here to Heidelberg, to a super doctor, and she said, 'Now we have to take a sample and see if it has moved into the bone.' So they did. And two days later, I came down here. And they told me..."

But the patient couldn't say the words "they told me I had lung cancer," so he was unable to finish his story. Instead, he broke down in tears.

His appearance clearly affected the kids who were watching.

"No way am I going to smoke a cigarette right now," Jens said. "I really felt sorry for that old man. Truthfully, I don't want to end up that way. I'm going to quit smoking."

In this case, then, Ehmann has done his job. He only hopes that the combination of facts and the firsthand knowledge of the illnesses caused by smoking will make Jens' and others like him stick to their promise to quit.