Young people in Tuolumne and Calaveras counties continue to use tobacco at higher levels than their peers statewide, prompting educators to scale up tobacco-use-prevention efforts and enlist students as a new ally in the fight.
In Calaveras County, where the rate of tobacco use among young people is estimated at more than double the state's, teenagers have joined the effort to keep their peers from smoking or chewing tobacco.
Meanwhile, Tuolumne County is seeking more funding for drug use education and cessation programs.
The most recent results of the California Healthy Kids Survey, given to students in fifth through 12th grades, suggest that 29 percent of Calaveras County's 11th graders have chewed tobacco - compared with roughly 10 percent of 11th graders in California.
Not all students take California Healthy Kids surveys, and there are inevitably some who don't answer truthfully. But the numbers are still cause for concern, according to Kathryn Eustis, director of Youth Development and Prevention Programs at the Calaveras County Office of Education.
"With our chew-tobacco numbers, somebody needs to take this seriously," she said. "Nobody's talking about it."
The reasons behind the higher rates may be cultural, she suggested. Chewing tobacco is something of a tradition among ranchers, with fathers simply telling their sons that they're "old enough to chew now."
Athletes represent another population more likely to chew tobacco, particularly baseball players and wrestlers. Eustis said there has been a cultural movement to "deglorify" tobacco use among athletes, but tobacco companies have multimillion-dollar war chests to combat it.
Tuolumne County's Healthy Kids survey results appear slightly higher than Calaveras County's for chewing tobacco, with 30 percent of 11th graders having chewed tobacco at some point in their lives.
Furthermore, 12 percent had chewed tobacco within the past 30 days, which may indicate habitual use.
The Tuolumne County Healthy Kids data reflects the years between 2009-11, while Calaveras County's is from 2011-12. Schools administer the surveys in two-year cycles. Tuolumne County does not yet have data from the past academic year.
According to the survey results, both counties also had a relatively high percentage of students smoking cigarettes. In Calaveras County, 35 percent of high school juniors had smoked cigarettes, as had 32 percent of their Tuolumne County peers.
Tuolumne County Public Health Officer Dr. Todd Stolp said tobacco remains the No. 1 cause of death in Tuolumne County, above car accidents and other hazards.
Nationwide, an estimated 435,000 people die every year from tobacco-related causes. That number topped deaths from diet-related causes by about 35,000, and motor-vehicle accidents by almost 360,000.
Smoking has long been correlated with a greatly increased risk for cancer, heart disease, strokes and a variety of other ailments. Contrary to some beliefs, chewing tobacco is not a safe alternative and causes many of the same diseases.
The threats aren't abstract, even to teenagers - some of whom already observe their peers' health decline as a result of smoking or tobacco use.
"I have never been a smoker, but I've been around a lot of people who do," said Arianna Zylstra, 15, a sophomore at Calaveras High School. "I hate seeing that they do worse in PE or can't walk up a hill without breathing hard."
Zylstra participates in Teens Against Tobacco, a group run by the Calaveras County Public Health Department, and a youth mentoring program. Both are part of a collaborative effort in Calaveras County to steer young people away from tobacco and drugs.
With an annual grant of $111,000, the Calaveras County Office of Education administers a tobacco cessation program at the Calaveras River Academy, a Saturday School intervention program for at-risk students across the county, and an anti-drug curriculum at middle and high schools.
Collaborating with the public health department, it has also undertaken youth development programs to involve students in prevention efforts. When it comes to drug prevention, Zylstra said she and other teens have power that adults may not.
"When someone has a question, they're going to ask their friends," she said. "Adults can be intimidating, as far as telling them things."
Some students have joined the charge on their own initiative. Bret Harte High senior Chloe Ponce, 17, is making tobacco education the centerpiece of her senior project.
"What I want to do is create sort of a sustainable program at Bret Harte, an alliance of some sort," Ponce said. "I was hoping to create a video about the dangers of chewing tobacco."
She added that one of the project's goals would be making more students aware of tools they can use, including a phone hotline, to quit chewing or smoking tobacco.
"If we find out that students don't want to quit, then we need to go back a few steps and figure out why," she said. "We're just trying to do as much research as we can."
Calaveras County's Saturday School intervention program was "phenomenally successful" last year, Eustis said. The three-hour course targets students who are first offenders, or those referred there by faculty.
The Calaveras County grant, part of a state initiative called Tobacco Use Prevention Education, is entering its second of three school years. Without the grant money and cooperation between county agencies, efforts to combat tobacco use might no longer be possible, Eustis said.
One source of funding for drug education, the federal Safe and Drug-Free Schools and Communities program, evaporated a few years ago. In the past, the Tuolumne County Office of Education was able to offer cessation programs at high schools. Money for those programs has also disappeared.
But Sonora High School Principal Todd Dearden said tobacco use on his campus seems to have decreased in the recent past, which may be the result of a stricter approach to giving students in-school or out-of-school suspensions.
"We've been much more severe about it," he said. "Possession of tobacco, tobacco products and tobacco paraphernalia are all suspendable offenses."
Dearden added he would like to see the tobacco cessation program return to Sonora High, but the school will most likely maintain its disciplinary approach to tobacco prevention.
In Tuolumne County, the nonprofit YES Partnership and Friday Night Live run additional anti-drug programs for young people. The Tuolumne County Office of Education is in its last year of funding from its own Tobacco Use Prevention Education grant. The program has provided an anti-drug curriculum called Project Alert.
Tuolumne County Deputy Superintendent of Schools Margie Bulkin said she's applying for another grant, but the selection process is "very competitive."