There was a telling indicator of how the tobacco industry does business among documents obtained as it came under a legal cosh wielded by 40 US states seeking medical compensation. It was a file on market strategy and defending its interests. It contained the following: "The basis of our business is the high school student."

With smoking among young people elsewhere, particularly in Ireland and most of Europe, reflecting similar patterns, it is hard to avoid the conclusion that the strategy was applied on a global basis.

The slight decline since 1987 in smoking in Europe, including Ireland, masks the number of young people, notably females, starting to smoke, says Prof Peter Boyle of the European Institute of Oncology. "Smoking in many respects represents a great failure of public health. Forty years after the hazards of smoking were established, cigarettes are still responsible for 30 per cent of deaths in Britain and the US."

Within that appalling statistic lurk the statistics on young smokers. He is concerned by indications that after a decline for some years, smoking among young people is increasing in the US. A survey of UCLA freshmen showed an increase in smoking from 9 to 15 per cent between 1987 and 1996, back to the 1966 level. Similar trends are recorded in Europe.

Why are young people, especially girls, smoking? Why do they choose to ignore health messages? The price of ignoring increasing evidence that cigarettes pose a particularly insidious threat to women is a new kind of lung cancer epidemic. Lung cancer specialists meeting in Dublin this week heard results of the latest research, a Norwegian study indicating that women smokers have a genetic predisposition to lung cancer, even if they smoke less.

Peer pressure is always trotted out as a reason young people smoke, according to Ms Carolyn Aldige, president of the Cancer Research Foundation of America. She believes there are other factors. "I think it's a lot to do with who their role model is. We are now worried about children as young as nine and 10 years, and their model is their parents."

Studies show that if parents smoke, the chances of their children smoking are significantly higher. With women - as far as the US is concerned but probably globally - she believes it's a function of weight control. Society values slimness. Girls comprise the demographic group starting to smoke in highest numbers. Health education messages have not come far enough in understanding what motivates them to start smoking. Often intended to shock, information is received but does not affect behavioural change in either adults or children.

"They're 10 years old and immortal. They are subjected to poorly targeted messages designed for adults. Children hate to be lied to and manipulated by adults. We have to teach them that tobacco companies are the ultimate liars and manipulators. It's legal but they are being manipulated by an addictive substance."

Addictive nicotine should be "the pressure point", she says. Banning advertising and increasing taxes in cigarettes are all very well but high smoking rates exist in countries with restricted ads and where prices are high, such as Ireland. She is, nonetheless, acutely aware of advertising power, particularly cartoon figures or "humanised" animals.

Cue Joe Camel, a "human camel" who shoots mean pool with a cigarette dangling out of the side of his mouth. A survey found that as many American six-year-olds identified with Joe Camel as with Mickey Mouse. Joe has been withdrawn from the market following the US tobacco industry settlement.

The power of advertising and image casts its shadow over the growing bands of young smokers, says Prof Boyle. "They associate smooth moves with Joe Camel, macho-ness with the Marlboro man and elegance with Virginia Slims. That is why it's so important to get back to using the company rather the brand in sponsorship."

The battle between health education, as currently framed, and image/advertising is a non-contest, says an Irish oncologist, Dr Des Carney. The message to young people is to smoke. It is reflected in up 50 per cent of Irish people in their early teens smoking and facilitated by easy availability of cigarettes and poorly implemented anti-smoking legislation.

One of the most persuasive figures on young smoker patterns, Ms Aldige feels, is the finding that 90 per cent of smokers have started smoking by the age of 19. Moreover, it has been medically established that it takes just three weeks for teenagers to become addicted to tobacco. Women should also be aware, she adds. Within five years lung cancer will kill twice as many females as "the disease of the moment", breast cancer.

Asked to account for the difference in smoking pattern between the sexes, reflected in more girls smoking than boys in many age categories, she says it is back to the issue of weight control. In addition, "boys are more strongly attracted to sport, particularly organised team sports. Boys are much more conscious of athletic ability. They do recognise that smoking cuts down on stamina and that ability."

Weight-control considerations dominate with girls. Numerous studies have shown that smoking curbs appetite. Adult women who give up gain an average of 15 lb. Men do not gain as much; this could be hormone-related.

If evidence of the effects of smoking were to ensure behavioural change, a visit to the 8th World Conference on Lung Cancer would have been an effective persuader. Unfortunately, successful health education is more complex.

The evidence, nonetheless, is becoming more and more persuasive. Dr Pamela Rabbitts of Cambridge University told delegates her research had shown that a teenager who smoked just one pack of cigarette a day for a year while in college was found six years later to have "extensive genetic damage" to her lungs, which means a high risk of cancer.

The $368 billion US tobacco settlement has its critics, according to the American cancer prevention expert, Dr Daniel Ihde; but in the 68-page agreement is a requirement that the tobacco industry pay substantial fines unless smoking by young people declines to specified levels. The American Cancer Society says it has the potential to cut teenage smokers by three million.

The US tobacco industry has been bought to book. All the charges have yet to stick, but at least there's a new brand of accountability for the sins of its past of which its targeting of young smokers was the most sinister. Such a process has yet to be embraced in Europe, and to an even greater extent in Ireland.