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Child and Teen Tobacco Use

Introduction

The good news: The number of younger Americans who smoke has been declining since the late 1990s. The bad news: The rates of smoking among teenagers are still as high or higher than those of adults.

Children and teens are easy targets for the tobacco industry. They're heavily influenced by TV, movies, advertising, and by what their friends do and say, and they don't think much about health consequences down the road.

This document talks about tobacco use among children and teens and provides some tips for parents, teachers, and other adults who want to keep their kids smoke-free.

Facts About Kids and Tobacco

Nearly all first use of tobacco occurs before high school graduation. For the most part, people who do not start using tobacco when they are teens never start using it.

Cigarette smoking causes significant health problems among children and adolescents, including coughing, shortness of breath, production of phlegm, respiratory illnesses, reduced physical fitness, poorer lung growth and function, and worse health overall.

The younger you begin to smoke, the more likely you are to be an adult smoker. Young people who start smoking at an earlier age are more likely to develop long-term nicotine addiction than people who start later in life.

Most young people who smoke regularly are already addicted to nicotine and experience the same addiction as adult smokers. Only 3 out of 100 high school smokers think they will be smoking in 5 years, but in reality, studies show that 60 out of 100 will still be smoking 7 to 9 years later.

Each day, more than 4,000 teens try their first cigarette, and another 2,000 become regular, daily smokers. Of those, about half will eventually die from a smoking-related disease.

Most teen smokers report that they would like to quit and have made unsuccessful attempts to do so. Those who try to quit smoking report withdrawal symptoms similar to those reported by adults.

Adolescent tobacco users are more likely to use alcohol and illegal drugs than are nonusers. Cigarette smokers are also more likely to get into fights, carry weapons, attempt suicide, suffer from mental health problems such as depression, and engage in high-risk sexual behaviors.

Tobacco Use Among Middle School Students

The most recent numbers on tobacco use among middle school students come from a 2004 survey by the US Centers for Disease Control and Prevention (CDC). These numbers have not changed significantly from those of the previous survey in 2002.

  • About 12% of students reported using some form of tobacco – cigarettes, spit (smokeless) tobacco and snuff, cigars, pipes, and flavored cigarettes like bidis or kreteks/clove cigarettes – at least once in the past month.

  • Cigarettes (about 8%) were the most common type of tobacco used, followed by cigars (about 5%), spit tobacco (about 3%), pipes (about 3%), bidis (about 2%), and kreteks/cloves (about 2%).

  • Boys (about 13%) were slightly more likely than girls (about 11%) to use some form of tobacco. Although girls were slightly more likely to smoke cigarettes, boys were more likely to use spit tobacco, bidis, kreteks/cloves, pipes, or cigars.

Tobacco Use Among High School Students

The most recent tobacco numbers for high school students also come from the 2004 CDC survey. These numbers are generally about the same as they were in 2002.

  • Nationwide, about 28% of high school students reported using some type of tobacco (cigarette, cigar, pipe, bidi, kretek/clove, or spit tobacco) on at least 1 of the 30 days before the survey.

  • On average, more than 1 out of 5 students (22%) smoked cigarettes. Girls were equally as likely to smoke as boys. White students (25%) were more likely to smoke than black (11%), Hispanic/Latino (22%), or Asian (11%) students.

  • About 6% of high school students reported using spit tobacco at least once in the 30 days before the survey. Male students were much more likely to use spit tobacco than female students.

  • About 13% of high school students had smoked cigars in the preceding 30 days. Male students (18%) were more likely to smoke cigars than female students (8%).

  • Other tobacco use among high school students included pipes (about 3%), bidis (about 3%), and kreteks (about 2%).

Special Concerns Among Youths: Clove Cigarettes and Bidis

Clove and other flavored cigarettes are used mostly by younger smokers. They are nearly ideal in design as a trainer cigarette for getting young people addicted to nicotine. The false image of these products as clean, natural, and safer than conventional cigarettes seems to attract some young people who may otherwise not start smoking.

Clove Cigarettes (Kreteks)

Clove cigarettes, also called kreteks (“kree-teks”), are a tobacco product with the same health risks as cigarettes. They are imported mainly from Indonesia or other Southeast Asian countries. Kreteks contain 60% to 70% tobacco and 30% to 40% ground cloves, clove oil, and other additives. Kretek smokers have higher risks of asthma and other lung diseases than nonsmokers. Regular kretek smokers have up to 20 times the risk for abnormal lung function. Unfortunately, users often have the mistaken notion that smoking clove cigarettes is a safe alternative to smoking tobacco.

Flavored Cigarettes (Bidis)

Flavored cigarettes, often called "bidis" or "beedies," are imported mainly from India. Their popularity has grown in recent years in part because they come in a variety of candy-like flavors such as chocolate, cherry, and mango, they are usually less expensive than regular cigarettes, and they give the smoker an immediate buzz.

Bidis are hand-rolled in a leaf and tied with strings on the ends. Even though bidis contain less tobacco than regular cigarettes, recent studies have found them to have higher levels of nicotine (the addictive chemical in tobacco) and other harmful substances such as tar and carbon monoxide. And because they are thinner than regular cigarettes, they require about 3 times as many puffs per cigarette. They are also unfiltered. Bidis appear to have all of the same health risks of regular cigarettes, if not more. For example, bidi smokers have higher risks of heart attacks, chronic bronchitis, and some cancers than nonsmokers.

Hookahs (Water Pipes)

Hookah (narghile) smoking, which started in the Middle East, involves burning tobacco (called shisha and often mixed with flavors such as molasses or dried fruit) in a water pipe and inhaling the flavored smoke through a long hose. It has become popular in Western countries among younger people in recent years. Hookahs are marketed as being a safe alternative to cigarettes. This claim is false. The water does not filter out many of the toxins, and hookah smoke contains varying amounts of nicotine, carbon monoxide, and other hazardous substances. Several types of cancer, as well as other negative health effects, have been linked to hookah smoking.

What Parents Can Do

Keeping Your Kids From Starting

Concerned parents may have more influence over whether their children take up smoking than they think they do. In a recent study, teens who thought their parents would disapprove of them smoking were less than half as likely to smoke as those who thought their parents didn’t care. This held true regardless of whether or not the parents were smokers themselves.

The CDC offers the following tips for parents to help them keep their kids smoke-free:

  • Remember that despite the impact of movies, music, and TV, parents can be the GREATEST INFLUENCE in their kids' lives.

  • Talk directly to your children about the risks of tobacco use; if friends or relatives suffer with or died from tobacco-related illnesses, let your kids know. Let them know it strains the heart, damages the lungs, and can cause a whole host of other problems, including cancer. That’s not even mentioning what it can do to appearance: making hair and clothes stink, causing bad breath, and staining teeth and fingernails.

  • If you use tobacco, you can still make a difference. Your best move, of course, is to try to quit. Meanwhile, don't use tobacco in your children’s presence, don't offer it to them, and don't leave it where they can easily get it.

  • Start talking about tobacco use when your children are 5 or 6 years old and continue through their high school years. Many kids start using tobacco by age 11, and many are addicted by age 14.

  • Know if your kids' friends use tobacco. Talk about ways to refuse tobacco.

  • Discuss with kids the false glamorization of tobacco on billboards, and in other media, such as movies, TV, and magazines.

If you are a smoker yourself and don't want your children to start, know that you probably won't have any less influence on your child's decision, and may even have more, because you've been there. You can speak to your child firsthand about:

  • how you got started smoking and what you thought about it at the time
  • how hard it is to quit
  • how it has affected your health
  • what it costs you, financially and socially

Helping Your Child Quit

If your child has already started smoking, the CDC offers these suggestions to help them kick the habit:

Try to avoid threats and ultimatums. Find out why your child is smoking. Your preteen or teen may want to be accepted by a peer group, or he or she might want your attention. Plus, adolescence alone can be stressful.

Show your interest in a non-threatening way. Ask a few questions and determine why your teen is smoking and what changes can be made in his or her life to help your child stop.

If you smoke, try to quit. If you did smoke and have already quit, talk to your child about your experience. Personalize the little problems around smoking and the big challenge of quitting. Teens and preteens often believe they can quit smoking whenever they want, but research shows many teens never do. Again, share those facts with them in a non-threatening way.

Be supportive. Both you and your teen need to prepare for the mood swings and crankiness that can come with nicotine withdrawal. Offer your teen the 5 Ds to get through the tough times:

  • Delay: The craving will eventually go away.
  • Deep breath: Take a few calming deep breaths.
  • Drink water: It will flush out the chemicals.
  • Do something else: Find a new habit.
  • Discuss: Talk about your thoughts and feelings.

Make a list with your teen or preteen of the reasons why they want to quit. Refer back to this list when your teen is tempted.

Finally, reward your teen when he or she quits. Plan something special for you to do together.

Helping your child quit smoking is one of the best parenting activities you could ever do.

Additional Resources

More Information From Your American Cancer Society

The following information may also be helpful to you and your child. These materials may be ordered from our toll-free number, 1-800-ACS-2345 (1-800-227-2345):

National Organizations and Web Sites

In addition to the American Cancer Society, other sources of patient information and support include*:

Centers for Disease Control and Prevention
Office on Smoking and Health
Telephone: 1-800-CDC-1311 (1-800-232-1311)
Internet Address: www.cdc.gov/tobacco/tips4youth.htm

American Lung Association
Telephone: 1-800-LUNG-USA (1-800-586-4872)
Internet Address: www.lungusa.org

National Cancer Institute
Telephone: 1-800-4-CANCER (1-800-422-6237)
Internet Address: www.cancer.gov

*Inclusion on this list does not imply endorsement by the American Cancer Society.

The American Cancer Society is happy to address almost any cancer-related topic. If you have any more questions, please call us at 1-800-ACS-2345 any time, 24 hours a day.

References

American Cancer Society. Cancer Prevention & Early Detection, Facts & Figures 2005. Atlanta, GA: American Cancer Society; 2005.

Campaign for Tobacco-Free Kids. The Path to Smoking Addiction Starts at Very Young Ages. 2005. Available at: www.tobaccofreekids.org/research/factsheets/pdf/0127.pdf. Accessed October 6, 2005.

Centers for Disease Control and Prevention (CDC). Got A Minute? Calling It Quits (brochure). Available at: www.cdc.gov/tobacco/educational_materials/parenting/gotaminbrochure.htm. Accessed October 7, 2005.

Centers for Disease Control and Prevention (CDC). Tobacco Use, Access, and Exposure to Tobacco in Media Among Middle and High School Students -- United States, 2004. MMWR. 2005; 54(12); 297-301. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/mm5412a1.htm. Accessed October 6, 2005.

Centers for Disease Control and Prevention (CDC). You(th) and Tobacco. Available at: www.cdc.gov/tobacco/educational_materials/yuthfax1.htm#Parents. Accessed October 7, 2005.

Centers for Disease Control and Prevention (CDC) Tobacco Information and Prevention Source. Bidis and Kreteks: Fact Sheet. July 2004. Available at:www.cdc.gov/tobacco/factsheets/bidisandkreteks.htm. Accessed October 7, 2005.

Knishkowy B, Amitai Y. Water-pipe (narghile) smoking: An emerging health risk behavior. Pediatrics. 2005;116:e113-e119.

Office of the US Surgeon General. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Centers for Disease Control and Prevention (CDC), Office on Smoking and Health. 1994. Available at: www.cdc.gov/tobacco/sgr/sgr_1994/index.htm. Accessed October 7, 2005.

Sargent JD, Dalton M. Does Parental Disapproval of Smoking Prevent Adolescents from Becoming Established Smokers? Pediatrics. 2001;108:1256-1262.

Revised: 10/25/2005

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