Q: I am mortified to find signs that my 14-year-old daughter is smoking – the tobacco smell, which I hate, a lighter in her purse, and so forth. I both want to forbid it and to remain her friend. What is your recommendation?
A: Starting to smoke as a teenager lets the young smoker in on a lifetime of disease and disability.
This is the 50th year since then-Surgeon General of the United States Luther Terry made clear data that had been accumulating for decades that tobacco use was associated with lung and heart disease and cancer, among other problems.
For those of us old enough to remember, smoking occupied the hands, mouths and minds of almost half of American adults; there was a smoking section at the back of planes and ashtrays in almost all workplaces; and advertisements on TV showed the Marlboro man and the motto I still remember, LSMFT – Lucky Strikes Mean Fine Tobacco. Doctors and nurses smoked too, standing behind hospitals filled with their patients suffering from heart attacks, emphysema, cancer of the larynx and lung and bladder all brought on by a smoking habit.
We’ve made a lot of progress since, both in realizing the range of diseases caused or made much worse by tobacco and in cutting the rate of adult smoking in the U.S. from about 42 percent at the time of the Surgeon General’s report to 18 percent now. You can read the original and subsequent Surgeon General reports on smoking and a history of efforts to control smoking in this country at cdc.gov/tobacco/data_statistics/sgr/history/index.htm.
The CDC notes that “Each day in the United States, nearly 4,000 people younger than 18 years of age smoke their first cigarette, and an estimated 1,000 youth in that age group become new daily cigarette smokers. This means that nearly 400,000 young people become daily smokers each year.” Eight of every nine adults who smoke one or more cigarettes a day got their start before age 18. More than 4 percent of middle schoolers are current smokers; the rate in high school is higher than 18 percent.
It has been estimated that the average smoker loses a full decade of life to his/her habit. It’s well known that lung cancer – about 85 percent of it – would not happen if no one smoked. It’s perhaps less known that cancers of the bladder, bone marrow and blood, cervix, esophagus, kidneys and ureters, larynx, mouth, nose, throat, pancreas, stomach and trachea are also much more common in smokers. The CDC estimates that one third of all cancers are associated with tobacco use!
Lung and heart disease and stroke are all among the reasons that smokers die early. Emphysema and chronic bronchitis, which together are called chronic obstructive pulmonary disease or COPD, blight the lives of smokers well before they die. You can tell your daughter’s male friends that tobacco decreases sperm counts, making some men less fertile. You can tell your daughter that smoking will eventually increase risks during pregnancy: infants of smoking mothers are smaller, more likely to be stillborn or to be born prematurely, and more likely to die of Sudden Infant Death Syndrome in the first year of life.
These are messages and statistics that you could give your daughter. Should you? I believe that the answer is “Yes.” I advise parents in my practice not to ask their children, “Are you smoking?” when you know full well they are. That invites a lie which compounds the problem. Instead, I would say “It looks to me as if you’re starting to experiment with tobacco. I see it in your purse, on your breath, and among your friends. I want you to stop, and these are the reasons.” Start out by noting how addictive nicotine is (and the new e-cigarettes are no better).
Talk about help being available to get her to quit. New Mexico has an excellent “Quit Line,” 1-800-QUIT-NOW (for Spanish-speakers, 1-855-DEJELO-YA), with live smoking specialists on the line in either language. Her doctor or yours should be able to help. Your disapproval of her smoking matters, and you can, in my opinion, bribe her monetarily or otherwise for staying cigarette free. Urine and saliva tests are available to help determine if she’s successful at quitting.
You probably don’t feel like celebrating the 50th anniversary of the Surgeon General’s report on smoking quite yet, but the momentum is behind ridding America and your family of this menace. Yes: this is one time when you need to be a parent first and a friend later.
Lance Chilton, M.D., is a pediatrician at the Young Children’s Health Center in Albuquerque, associated with the University of New Mexico. Send questions to firstname.lastname@example.org.