Talking to your child about smoking

Middle school marks the beginning of many social, physical, and emotional changes. Kids become more prone to bad decisions based on what their friends say and do.

Most adult smokers had their first cigarette by the age of 11 and were hooked by the time they turned 14.

There are laws against marketing cigarettes to kids. Unfortunately, this does not stop kids from seeing images in ads and movies that make smokers look cool. Coupons, free samples, and promotions on cigarette companies' websites make cigarettes easier for kids to get.

Start early. It is a good idea to start talking with your children about the dangers of cigarettes when they are 5 or 6 years old. Keep the conversation going as your children get older.

Make it a two-way talk. Give your children a chance to speak openly, particularly as they get older. Ask them if they know people who smoke and how they feel about it.

Stay connected. Studies show that kids who feel close to their parents are less likely to start smoking than kids who are not close to their parents.

Be clear about your rules and expectations. Kids who know their parents are paying attention and disapprove of smoking are less likely to start.

Talk about the risks of tobacco. Kids might think they do not have to worry about things like cancer and heart disease until they get older. Let your children know that smoking can affect their health right away. It can also affect other areas of their life. Explain these risks:

• Breathing problems. By senior year of high school, kids who smoke are more likely to become short of breath, have coughing fits, wheeze, and get sick more often than kids who never smoked. Smoking also makes kids more prone to asthma.
• Addiction. Explain that cigarettes are made to be as addicting as possible. Tell kids that they will have a very hard time quitting if they start to smoke.
• Money. Cigarettes are expensive. Have your child figure out how much it would cost to buy a pack a day for 6 months, and what they could buy with that money instead.
• Smell. Long after a cigarette is gone, the smell lingers on the smoker's breath, hair, and clothes. Because they are used to the smell of cigarettes, smokers can stink of smoke and not even know it.

Know your kids' friends. As kids get older, their friends influence their choices more. The risk your children will smoke goes up if their friends smoke.

Talk about how the tobacco industry targets kids. Cigarette companies spend billions of dollars each year to try to get people to smoke. Ask your children if they want to support companies that make products that make people sick.

Help your child practice saying no. If a friend offers your children a cigarette, what will they say? Suggest responses like:

• "I do not want to smell like an ashtray."
• "I do not want tobacco companies making money off of me."
• "I do not want to be out of breath at soccer practice."

Get your child involved in non-smoking activities. Playing sports, taking dance, or being involved in school or church groups can help reduce the risk that your child will start smoking.

Be savvy about "smoke-free" alternatives. Some kids have turned to smokeless tobacco or electronic cigarettes. They may think these are ways to dodge the dangers of cigarettes and still get a nicotine fix. Let your kids know this is not true.

• Smokeless tobacco ("chew") is addictive and has almost 30 cancer-causing chemicals. Kids who chew tobacco are at risk of cancer.
• Electronic cigarettes, also known as vaping and electronic hookahs, are new to the market. They have come in flavors like bubble gum and pina colada that appeal to kids.
• Many e-cigarettes contain nicotine. Experts worry that e-cigarettes will increase the number of kids who get addicted and smoke cigarettes as adults.

If your child smokes and needs help quitting, talk to your health care provider.

Nicotine - talking to your child; Tobacco - talking to your children; Cigarettes - talking to your child

American Lung Association website. Tips for talking to kids about smoking. www.lung.org/quit-smoking/helping-teens-quit/tips-for-talking-to-kids. Updated November 17, 2022. Accessed November 24, 2022.

Breuner CC. Substance abuse. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier;2020:chap 140.

Smokefree.gov website. What we know about electronic cigarettes. smokefree.gov/quit-smoking/ecigs-menthol-dip/ecigs. Accessed November 24, 2022.

US Food & Drug Administration website. FDA's youth tobacco prevention plan. www.fda.gov/tobacco-products/youth-and-tobacco/fdas-youth-tobacco-prevention-plan. Updated September 14, 2020. Accessed November 24, 2022.

Updated by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.