Teens smoke for the same reason adults report they do: They see it as a way to cope with stress.
But Jefferson City may have a bigger problem with teen smoking than most cities. According to recent survey data, more than a third of the city's public school students have used cigarettes or chewing tobacco, compared with 20.6 percent statewide.
And, culturally, our tolerance of smoking - statewide - is taking a toll on Missourians' health.
Matthew Thompson is a 15-year-old high school student at the Jefferson City Academic Center today. But he was only 8 or 9 years old the first time he smoked a cigarette with a friend. The boys were hanging out near a creek not far from Apache Flats.
"It was gross. I puked and coughed the whole day," he recalled.
For Thompson, who has a slight frame and a mop of ash-blond hair, smoking was something he did to ignore and fend off bullies. In his mind, it was a better strategy than fighting. It calmed his nerves and diverted the impulse to fight.
"I was getting bullied," he said. "There was a lot of stress on me. And that's the reason I kept on doing it."
Today, Thompson wished he'd never started, and he's trying to quit. He's already found that having a pretend cigarette in his hands - a pen - quells the urge a bit.
But for now, he still smokes.
And often, he and about 10 other teens at the alternative school, indulge the habit over their lunch hour. Although they aren't permitted to smoke on campus, students are permitted to "take walks" at midday.
Without that opportunity, Thompson isn't sure if he could make it through a whole day at the alternative school.
"I would be fidgeting and nervous, and my ADHD would kick in," he said.
Like Thompson, 15-year-old Josh Houston smokes to cope with stress. His family struggles financially; finding adequate food and housing are problems, he said. And members of his family feel cigarettes might be less dangerous than other addictions, like alcohol dependency.
Houston smoked his first cigarette at a friend's house in the eighth grade. His friend's father offered him "a taste."
"It helped me relieve my anger and depression. It helped me calm down," he said. "That's why I smoke now."
Smoking's a relief, he said. Someday he'd like to quit, he said, but he sounded less than convinced.
"Well, yeah, it's kind of hard to think about now. The main thing to think about is school and graduation. I've got a whole life ahead of me."
Earl Fuller, a 17-year-old junior at JCAC, started smoking by age 11 or 12. A cousin "really got me hooked," he said.
Like the other boys, Fuller uses smoking as a way to handle stress.
"When I get mad or frustrated, it calms me down. It gives me a second or two to get my mind on other things," he said.
For administrators, permitting the teens to leave campus is a difficult call, and one that might be difficult for observers to accept. State law prohibits people 17 years and under from possessing cigarettes; 17-year-olds can be ticketed and arrested and teens 16 and under can be reported to the juvenile justice system.
JCAC Principal Deanne Fisher said the facility is an alternative school whose main mission is to move at-risk students toward diplomas. Often that involved helping sometimes explosive, angry students figure out better ways to process their emotions.
"Interviews with students show that stress, anxiety and depression are reasons why kids need to be here," she said.
JCAC helps those students with smaller classes and more individualized attention.
"We try to work on plans to reduce stress and frustration," she said. "So they don't leave. So they stay."
The process involves a lot of two-way communication. And, students are trained to take breaks - talk to counselors, put their heads down, deep breathing exercise and yes, take walks - when they feel overwhelmed, rather than engaging in angry outbursts.
She noted Fuller was getting in a lot of trouble at school, but he's developed an awareness of what triggers his outbursts and can prevent them now.
"Now he's a leader in the building," she said.
Is smoking an issue in Capital City?
Jefferson City may have a problem with teen smoking, according to survey data collected by the Council for Drug Free Youth (CDFY).
According to the latest study, more than a third of Jefferson City students have used cigarettes or chewing tobacco, compared with 20.6 percent statewide. For electronic cigarettes, almost a quarter of Jefferson City students have tried them, compared to almost 10 percent statewide.
The problem is worse at the high school level than it is at the middle schools.
More than 40 percent of Jefferson City High School students reported having used tobacco, compared to 5.2 percent at Thomas Jefferson Middle School.
Joy Sweeney, executive director of CDFY, was particularly alarmed that 18 percent of Jefferson City's teens rated the perception of harm - from one or more packs of cigarettes a day - as "no risk at all" or "slight risk." And the perception of harm is much higher in the lower grades, when kids understand how dangerous cigarettes are, than it is in the higher grades, when they appear to have forgotten that lesson.
"Our program stops in the ninth grade," she lamented. "This is really telling ... we need to provide more life skills in the 10th, 11th and 12th grades."
Jefferson City's teens also feel less pressure from their friends and parents, according to survey data. For example, 88.1 percent of local students reported their parents feel it's wrong to smoke, compared with 94 percent statewide.
Sweeney's goal is to persuade students not to start. She knows that if they can make it to age 18 without smoking, only one in 10 will take up the habit.
"So guess who the tobacco companies target?" she said. "They target youth, and that's really scary."
She's particularly concerned young people are switching from cigarettes and chewing tobacco to hookahs, water pipes and e-cigarettes. Some of these products aren't illegal for youth to purchase, she said.
The Behavioral Health Epidemiology Workgroup asked Missouri teens about e-cigarettes for the first time in 2014. They found that one in 10 students reported using them in the last month. This is higher than those who are currently reporting using regular cigarettes (8 percent).
(In good news, the same BHEW study found conventional tobacco use among students had fallen.)
Sweeney said: "The sellers make (e-cigarettes) look cool. But guess what? They are still addictive, and they'll be smoking when they are 50 and 60."
Efforts to help teens stop smoking
To combat the problem, three local agencies - CDFY, the school district and the Cole County Health Department - are working on at least two initiatives.
Ashley Varner, healthy lifestyles coordinator for the health department, is using grant money provided by the Missouri Foundation for Health to launch a "Healthy Beginnings" program. The program stresses tobacco cessation, education and stress management.
The grant gives Varner funding she can use to provide students like Thompson - who want to quit - vouchers to get smoking-cessation patches from a local pharmacy. As a counselor, Varner will work with teens, teaching them to recognize triggers and to develop "quit plans."
She's talked Thompson into trying the program.
"We'll meet three more times, every two weeks," Varner said.
Sweeney is helping students develop a research-based youth leadership training program called "Making Our Mark II."
"It's being created by youth, for youth to impact youth in the community. The goals are to empower and inspire youth leaders to combat youth tobacco initiation and exposure to second-hand smoke," she said.
The group attended its first learning session earlier this week and will facilitate more with their peers later this month.
Sweeney asked: "If people 15 and 16 years old are willing to speak out, why aren't adults? We should be able to support them in a healthy way."
Missouri has lowest tobacco excise tax rate
As a state, Missouri doesn't contribute much in the way of tobacco cessation programming.
Of the $2.17 billion the state has received from the Master Tobacco Settlement Agreement since 2001, only $6.6 million has been spent on tobacco prevention, education and cessation.
"It's three-tenths of 1 percent," said Tom Kruckemeyer, former chief economist for the state and a anti-tobacco advocate who lives in Jefferson City. "To be fair, some of that money was spent on Medicaid. But essentially, we've spent basically nothing to prevent tobacco addiction.
"We're going against the spirit of the settlement agreement, but not the letter of the law."
(Historical recap: In the 1998 agreement, the attorneys general of 46 states settled their lawsuits against the tobacco industry - including exempting the companies from tort liability regarding the harm caused by tobacco use - in exchange for the perpetual payments to compensate the states for some of the costs for caring for people with smoking-related illnesses.)
At 17 cents, Missouri has the lowest per-pack tobacco excise tax rate in the nation. It's even lower than tobacco-producing states like Kentucky (60 cents) and West Virginia (55 cents). The national average is $1.54 per pack.
It's also the lowest it's ever been. In 1956, the actual tax was 2 cents per pack. But adjusted for inflation, 17 cents today has the same buying power that 1.95 cents did in the mid-1950s.
"In addition to being the lowest in the nation, it's actually lower now, in constant dollars adjusted for inflation, than any time since 1956," he said.
Missouri has a cigarette excise tax, but collections are declining, Kruckemeyer said. In 2008, the state collected $97.2 million in tax revenue, which has fallen to $82.3 million in 2014 - a 15 percent decrease. Kruckemeyer attributed the decline to two potential factors.
"More people, but not enough, are no longer smoking. And e-cigarettes - which are nicotine delivery systems - are untaxed," he said.
Because lawmakers and voters repeatedly have rejected raising taxes on smokers, he noted cigarette taxes now are a very small - less than half of 1 percent - of the state's 2014 operating budget.
Kruckemeyer contends Missouri's unwillingness to discourage smoking by enacting excise taxes has taken a toll on the health of its residents. Almost a quarter of its residents smoke, placing the state among the top eight states in the nation.
"We have some of the highest smoking rates. And thus we have the highest lung cancer rates," Kruckemeyer lamented. "It's killing us."
For deaths caused by heart disease, Missouri is among the Top 10 states in the nation, according to the U.S. Department of Health and Human Services. For deaths caused by lung disease, Missouri is among the Top 5 states, he added.
"One would think public officials would be interested in this," he said.
And he said the rate of lung cancer in women is getting worse, not better. Twenty-four years ago, 1,170 women died from lung cancer; by 2012, that number rose to 1,763 - a 51 percent increase.
Inversely, breast cancer rates are falling.
For every two women who die of lung cancer, only one dies of breast cancer.
Kruckemeyer said he'd like to see a public advocacy campaign to fight lung cancer, similar to the vigorous efforts launched on behalf of breast cancer sufferers.
"When are we going to have lung cancer awareness month?" he wondered. "Why is this happening? In part because Missouri has the lowest cigarette tax in the nation and spends nothing on tobacco control."
For Kruckemeyer, the fight is a personal one. He was only 12 years old when his father died from a smoking-related illness.
He feels there's a reason why smoking rates plummeted from 50 percent in the 1950s to less than 20 percent today.
"Why did that happen?" he posed. "Well, the federal government analyzed the health trends and took action. The first official report documenting the dangers of smoking came out in 1964. By that time, my mom and dad were already addicted to smoking.
"My dad was only 43 when he died."
Raising taxes non-starter with smoke shops
Employees in area smoke shops don't embrace the idea of raising tobacco taxes.
The Missouri electorate has rejected raising the cigarette excise tax three times, albeit by narrow margins. In 2002, an initiative failed with 49 percent of the vote and in 2006 another failed with 48 percent of the vote. A third attempt failed again in 2012.
"Even some of the people I know who don't smoke, still don't want taxes raised," said Darline Knight, employee at Welcome Smokers.
Knight says it's unfair to single out one product for an extra tax burden. "Everybody has their own addictions," she scoffed.
Russ Hart, who works at the Up in Smoke shop, dismissed the idea that raising tobacco taxes will have much of an impact on Missourians' health, noting that heart disease is as likely to be linked to obesity as tobacco. He argued if tobacco taxes are ever raised, Missouri can expect to see an increase in smuggling across state lines.
"Prohibition never helped ... it always causes more crime," he said.