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Tobacco Use: An Introduction



It can be difficult talking to your kids about risk behaviors like tobacco use, and it’s easy to feel as if your words don’t make a difference. But, in fact, research shows that you are a very influential factor in your children's decision-making.1 Positive identification with parents is associated with decreased cigarette use.8 That's why it's so important to start talking about tobacco use while your kids are young, to tailor your approach to their stage of development, and to continue the conversation throughout their adolescence.
While it can be tough to start the conversation, open communication is the key to making sure your children make smart choices about tobacco use and other risk behaviors. By starting early, you can help lay the foundation that will help your child develop the resistance skills needed for staying tobacco-free.

Did You Know?

  • Smoking is the leading cause of premature, preventable death and disease in the United States.2
  • Each year, tobacco use results in more deaths than AIDS, unintentional injuries, suicide, homicide, and alcohol and drug abuse combined. 7 3
  • Twenty percent of high school students report having smoked a cigarette in the last month.4
  • In 2008, approximately 1,000 young people (under the age of 18) became daily smokers every day.5
  • Involvement in structured activities, parental boundary setting, adult mentoring, perceived school connectedness, religious involvement, and other protective factors lower the chance that youth will engage in health-compromising behavior, including smoking.6

Frequent Questions and Concerns about Tobacco Use

When do kids start using tobacco?

Children can become smokers at almost any age. Almost 11 percent of surveyed teenagers said they had smoked at least one cigarette before they were 13 years old.1 It’s never too early to start preparing your child to say no to tobacco; the younger kids are when they start smoking, the more likely they are to develop a long-term addiction.2

Why do kids start using tobacco?

There are various reasons for preteen and teen smoking. A 2000 survey asked over 600 middle and high school students why they smoked; the most common answer was “It helps me to relieve my stress.” Youths experiment with or begin smoking for a variety of reasons, including societal and parental norms, tobacco product advertising, depictions of smoking in movies and other popular media, and peer influences.6 In addition, adolescence can be a time of rebellion, and extraordinary peer pressure, all which can encourage your teen or pre-teen to smoke. Parents can help their children by addressing issues such as these before they lead to tobacco use.
Read more about peer pressure and tobacco use.

What are the different types of tobacco?

  • Bidis: small, hand-rolled cigarettes that may have colorful string tied at one or both ends. They come in cherry, mango,chocolate, and unflavored. 7
  • Kreteks: clove cigarettes imported from Indonesia. 7
  • Hookahs: water pipes to smoke tobacco in flavors from watermelon to licorice. 7
  • Electronic cigarettes: these tar-free cigarettes (also known as “Ecigs” or “e-cigarettes”) still contain nicotine and have not been evaluated by the FDA.
  • Cigars and cigarillos: according to a recent study, 13.6% of high school students smoked cigars in the past 30 days. 7
  • Chewing tobacco (loose leaf, plug, twist): some young people may appear to be chewing gum when they’re actually chewing smokeless tobacco. Almost one out of five white high-school-age males currently use smokeless tobacco. 8
  • Snuff or “Dip”: moist ground tobacco that is placed between the lip and gums, usually leading to spitting.
  • Snus: small pouches of dry tobacco that are placed between the gum and lip but are usually not spitted.

Are smokeless tobacco products just as harmful as smoking?

The two main types of smokeless tobacco in the United States are chewing tobacco and snuff.1,2 Smokeless tobacco is not a safe alternative to smoking cigarettes. 2 Smokeless tobacco use can cause cancer, oral health problems, and nicotine addiction. 2

What can I tell my child to deter her from using tobacco?

Try some of the following discussion points:

  • Let your child know that using tobacco is not common; many children who smoke greatly overestimate the number of teenagers who smoke. Talk about how the large majority of teens don’t smoke.
  • Point out how using tobacco will limit how well your child will do in sports and other activities, and that it affects her stamina and breathing.
  • Emphasize how much money it costs to use tobacco, and that she will have less money to spend on things that she wants. Calculate how much cigarettes cost (365 x packs per day x price per pack) and talk about what else she could do with that money.
  • Remind your child that using tobacco products is not a sign of maturity, and that many adults regret using. Talk about how real maturity means standing up to social pressure.

See The Effects of Smoking for more short- and long-term effects of tobacco use

If I take away my child’s allowance, he won’t be able to buy tobacco products like cigarettes or snuff, right?

Many parents believe that if their children don’t have the money to buy tobacco products, they won’t start (or continue) to use them. However, taking away an allowance is not usually a very effective method of tobacco use prevention. Some teens illegally buy cigarettes or other tobacco products themselves, but most give money to someone else to buy them or simply borrow or are given them. In fact, in 2009, only 14 percent of surveyed underage smokers bought their cigarettes from a store.4

Should I punish my child if I catch her using tobacco products?

Boundaries and rules are only effective if they’re reinforced with discipline. However, it’s important to not let your punishments backfire. If you’re too harsh, your child may simply be angry at you and not learn the lesson you’re trying to teach. Explain why you set the rules you did, and why it’s important that your child not use tobacco. Your goal is not to punish your child, but to keep her from smoking or using other tobacco products.

Isn’t this just a phase my child will grow out of?

That’s not a risk you can afford to take. According to the Centers for Disease Control, approximately 57 percent of adult smokers started before they turned 18.5 And because there are very serious short- and long-term effects of tobacco use, it’s important that you take tobacco prevention seriously and equip your children with the knowledge and tools they need to stay tobacco-free.
See The Effects of Tobacco Use for more short- and long-term effects of tobacco use

Talking to Your Kids about Not Using Tobacco

Bringing up the topic of tobacco use can be tough, but it’s important to talk about it—especially if you think your child may have already have tried or using other tobacco products. It’s easy to feel like your child will just brush you off and tell you to “stop worrying so much.” This, combined with the fact that bringing up the topic can be a little awkward, can make it tough to start the conversation. Fortunately, there are some ways to make broaching the subject easier.

  • Bring up the topic when you’re doing something together, like riding in the car, walking the dog, watching TV, or any other activity that doesn’t require your child’s full attention.
  • You can also start the conversation if your child is going to be in a place where she might see tobacco use, such as a party—talk about how she could deal with situations she might encounter.
  • Don’t insist on eye contact—some kids find it easier to talk when they’re not looking you straight in the eye.
  • Comment on an advertisement or TV show that shows someone smoking, or a story in the newspaper about a celebrity using tobacco.
  • If you see someone using tobacco—such as a relative at a family gathering or one of your own friends—ask your child what he thinks about it.
  • Ask your child if any of her friends who use tobacco.
  • Many schools and sports teams have rules about tobacco use—discuss some of the health reasons for these rules.

Even though you may feel like your teen doesn’t listen to what you say, research shows that parents are a strong influence on whether teens smoke.1 Even pre-teens—who might roll their eyes when you start talking about the dangers of tobacco—are paying attention to what you say. To make sure you have the best possible influence on your child, start talking about tobacco early.

  • Remember—keep it light! You’re trying to have a conversation, not give a lecture. Don’t do all of the talking. Really listen to what your child has to say without judging.
    • Learn effective listening skills to make your conversations more positive.
  • Talk about your values, even when your children are young. Tell your kids why you disapprove of smoking and that you will be disappointed if they pick it up.
  • Focus on short-term consequences. Even though adults know that using tobacco has dire long-term consequences, teens may be more affected by the idea of the short-term ones, such as bad breath, foul-smelling clothes, or stained teeth.
  • Talk about peer pressure. The best way to address peer pressure is to talk about it directly. Let your kids know that you understand how difficult it can be to say no to friends, but that it’s important to stand by your values and beliefs.
  • Tell your child about the consequences for smoking in your family, and let him know that you will follow through on them.

It’s easy to feel like you’re not getting through to your kids when you talk about tough issues like tobacco use. But remember that you do have an effect on their decisions and that your expectations matter to them. To help your child make smart decisions about tobacco use, bring up the topic early and talk with your children about it on a regular basis.

Does Your Child Use Tobacco?

Warning Signs of Tobacco Use

Do you think your child might be smoking or using other tobacco products? Watch for the following signs, any of which may indicate that he has been smoking:

  • Friends who use tobacco products
  • The smell of smoke or tobacco in her hair or clothes
  • Starting to use mouthwash, breath mints, or chewing gum
  • Leaving windows open in her bedroom for no reason
  • Frequently making excuses to go outside
  • Burn holes in clothing or carpet
  • Finding matches or a lighter in his bedroom or backpack

Your Child’s Reaction

There are many ways that you child might react to you bringing up the subject of tobacco use. Here are some ways to deal with different responses to the topic:

  • If your child denies tobacco use, and you believe him, keep checking in periodically.
  • Point out that being a “smoker” can mean different things to different people
  • If your child denies tobacco use, and you don’t believe her, don’t give up on communication.
  • Don’t overreact if your child tries to explain away evidence by saying things like “I was holding the cigarettes for my friend,” or “My clothes smell like smoke because other kids were smoking in the car.”
  • Focus on the smoking, not on the lying. Saying something like, “Well, maybe you didn’t smoke, but I want to talk about tobacco anyway,” may help you bring up the subject less contentiously.
  • If your child admits to smoking, give him credit for his honesty. It’s not easy to tell your parents that you smoke.

Finding out That Your Child Uses Tobacco Products

It can be very upsetting finding out that your child has been using smoking or using other tobacco products, and you may be tempted to confront your son or daughter angrily. This, however, can turn the conversation into a battle, make your child defensive, and make it much more difficult to help your child. Instead, stay calm and use some of the following strategies:

  • Keep your cool. If you need to postpone the conversation so you can collect your thoughts, just say “I’m pretty upset by this right now—let’s talk about it later.”
  • Gather information. Try to find out why your child smokes, how often, how much, and how she got started. Remember: you’re not an interrogator, you’re a parent. If you discover what appeal smoking holds for your child, you can help her address the relevant issues.
  • Many teens are hesitant to talk to their parents about smoking or other tobacco use, because they fear being punished.1 If your child admits to smoking when you ask about it, give him credit for his honesty—it’s not easy to tell your parents that you smoke or chew!

If Your Child Uses Tobacco

Finding out that your child smokes or uses other tobacco products can be tough, but supporting their efforts to quit can be even more difficult. Quitting is a process that can take a very long time, and usually requires multiple attempts. In order to make it as easy for your teen as possible, you have to be prepared.

  • Make sure your child knows that he can talk to you about his habit, even though you disapprove of the behavior. Keep the lines of communication open.
  • Work with your teen to find out which smoking cessation programs are available in your area. Encourage your child to talk with a physician about quitting. Talk to a school guidance counselor and ask if there are any school-based cessation programs available. Look online to see if organizations such as the American Lung Association have local chapters that may be able to help.
  • If you smoke, join a cessation program with your child. Having a “support buddy” can be a big help in sticking to your commitment to quit.
  • Realize that, like adults, teens experience withdrawal symptoms when trying to quit smoking. The symptoms may be different, however; many teens have reported that cravings and anxiety are their strongest symptoms.2 Try to be understanding of the difficulty that she is experiencing and help her schedule low-stress days away from friends who use tobacco.
  • Be prepared for relapses, especially within the first week.3 Many smokers stop and start smoking again several times before they successfully quit. Stay supportive and don’t act disappointed if your teen relapses. Let him know that you realize how difficult the process is.
  • Understand that stress is one of the most common reasons for kids to start smoking.4 Keep your home as stress-free as possible, and help your teen deal with the issues in her life that are causing stress.
  • Many teen smokers do not seek out help with quitting. If we reach out to teens, however, without pressuring them to quit, many will talk to counselors about their smoking and some of those teens will decide to quit. 5
  • Don’t stop providing support. Encourage your teen often, and express your pride in the fact that he is trying to quit. Make sure he knows that you are always available to talk.

Whether your child just started using tobacco or has been using for several months or years, it’s important to start the conversation about quitting right away. No matter how old your child is, tobacco use could have dire consequences for many years to come, so start taking positive action today.

Peer Pressure and Tobacco Use

No matter how old your children are, peer pressure is an important factor in their decision-making process. In fact, research shows that the influence of peers is especially powerful in determining when and how young people first try cigarettes.1 You may think your child is “too smart” to experience peer pressure, or has a group of friends that provides a positive influence, but all kids are vulnerable.

  • The smoking rate among kids who have three or more friends who smoke is 10 times higher than those who report that none of their friends smoke.2
  • Peers’ cigarette use makes it more likely that a child will progress from experimental or intermittent smoking to daily smoking.3
  • Positive peer pressure also has a strong effect: research has shown that while children may be influenced by their peers to engage in risk behaviors such as smoking, they may also be encouraged to quit.4

So how can you help your child resist peer pressure? Try some of these strategies:

  • Let them know you understand. Kids say peer pressure makes them feel like they’re being pulled in two directions—on one hand, they don’t want to do what they’re feeling pressured to do. At the same time, they don’t want to lose their friends if they say no.
  • Perceived smoking rates are actually more influential on kids’ decision to smoke than actual smoking rates, and researchers found that over 75% of students overestimated the prevalence of smoking at their school.5 Help your child gain a more accurate perception of reality by sharing your experiences and a more factual perspective.
  • If you know one of your child’s friends smokes, have a conversation about it. Ask your child why he thinks his friend does so, and what he thinks about it. Don’t belittle your child’s friend for smoking, but make it clear that you don’t support the behavior.
  • Make sure your kids know that they can always call you for a “no-questions-asked-until-later” ride home from a party where others are doing illegal activities, including smoking, drinking, or using drugs.
  • See Peer Pressure for more advice on helping your child deal with peer pressure.
  • Help your child understand that smokeless tobacco is just as harmful as smoking, a known cause of human cancer, and is strongly associated with leukoplakia. 6

Your child’s friends are one of the strongest influences in her or his life, especially when it comes to risk behaviors like tobacco use. Help prepare your child to deal with peer pressure so that when he or she has to make a decision about tobacco, that decision is a smart, well-informed one.

The Effects of Using Tobacco

Although the negative effects of smoking are well documented, many people are not aware of them. Your teen may think that the health-related consequences of smoking aren’t so bad, or that they will only see the effects after many years of tobacco use. Be sure to let them know that even the short-term effects can be serious and that it’s not worth risking the long-term effects just to relieve stress or fit in.

Read about more about talking with your child about the health consequences of smoking.

Short-Term Effects of Smoking

  • Increased susceptibility to respiratory illness 1
  • Shortness of breath 2
  • Impaired lung growth and function
  • Bad breath
  • Foul-smelling clothes

Long-Term Effects of Smoking

  • Lung, mouth, throat, kidney, and stomach cancers
  • Coronary heart disease 3
  • Emphysema and other chronic diseases 1
  • Significantly reduced lifespan – If teens continue their habit into adulthood, they can expect to spend over $75,000 in excess medical care related to their smoking, and a life expectancy up to 20 years shorter than non-smokers.5
  • Contrary to common belief, smoking may also increase depressive symptoms in some adolescents. 6

Health Effects of Smokeless Tobacco

Cancer:

  • Smokeless tobacco contains 28 cancer-causing agents (carcinogens).7,9
  • Smokeless tobacco is a known cause of human cancer; it increases the risk of developing cancer of the oral cavity and pancreas. 9,10

Oral Health:

  • Smokeless tobacco is also strongly associated with leukoplakia—a precancerous lesion of the soft tissue in the mouth that consists of a white patch or plaque that cannot be scraped off. 8
  • Smokeless tobacco is associated with recession of the gums, gum disease, and tooth decay. 8

Reproductive Health:

  • Smokeless tobacco use during pregnancy increases the risks for preeclampsia (i.e., a condition that may include high blood pressure, fluid retention, and swelling), premature birth, and low birth weight.9
  • Smokeless tobacco use by men causes reduced sperm count and abnormal sperm cells.9

Nicotine Addiction:

  • Smokeless tobacco use can lead to nicotine addiction and dependence.7,9
  • Adolescents who use smokeless tobacco are more likely to become cigarette smokers.8

Even though it may seem obvious to adults that the risks of smoking and smokeless tobacco use outweigh the benefits, teens don’t always see it that way. Remind your teen of the effects, both short- and long-term, that smoking and tobacco use can have, even if you think he or she should already know.

Stay Involved and Informed

One of the most important things you can do to help your children be tobacco-free is to stay involved in their lives. By staying informed and keeping lines of communication open, you can be well equipped to address any issues that may arise.

  • Know that cigarettes aren’t the only form of tobacco that teens use. Bidis (“bee-dees”), kreteks (“kree-tex”), dip, cigars, and chew are all different forms of tobacco, and all are addictive and can pose significant health risks to your child. Make sure to talk with your child about all forms of tobacco, including smokeless.1
Read more about bidis and kreteks. Read more about smokeless tobacco.
  • Be aware of your child’s friends and their habits. If one of your kid’s friends smokes, make sure to let your child know that you disapprove of the behavior and talk to her about resisting peer pressure.
    • Find out how to help your child overcome negative peer pressure.
  • Just because your teen does very well in school, participates in organized athletics, is very young, or doesn’t have spending money does not mean that he is not at risk. All kids experience peer pressure and may be tempted to try smoking.2

Children, especially teens, are eager to assert their independence. You, as a parent, want to support this, but at the same time, want to make sure your teen is making good decisions. Fortunately, it’s possible to do both.

  • Spend time explaining the reasons for your rules and decisions. This lets your child know that your expectations for her have good reasoning behind them. Showing your child respect through this and other measures will make it more likely that she will listen to your opinions and appreciate your values on issues like tobacco use.3
  • Remember that rebellion can be a sign of growth. Let your teen speak his mind, even if you disagree with him. If you listen to him, he will be more likely to listen to you when you have things to say.
  • Encourage your teen to demonstrate her maturity in healthy ways, such as through sports, music, theater, or a part-time job. Help her see that tobacco use is not a part of growing up.
  • Acknowledge that your kids face tough situations. Let them know you understand that it’s tough to make decisions between doing what’s right and seeming “uncool.”

Research also shows that your parenting approach has an effect on how likely your kids are to pick up smoking. The following strategies have been shown to decrease the likelihood of your child beginning tobacco use:3

  • Being sensitive to your child’s changing needs as she grows. Teenagers, for example, feel the need to demonstrate their independence—this is not, however, something you need to be concerned about if you have an elementary-age child.
  • Clearly explaining the reasons for your rules and decisions. If you expect all family members to do chores, explain that this is because you expect all members of your family to help each other out in taking care of the family as a whole.
  • Having high expectations for your kid’s behavior. By setting the expectation that your child will finish her homework every night, you teach her the importance of school and the discipline needed to prioritize academic and social activities.

Staying involved in your child’s life and tailoring your parenting approach are key in raising successful kids, even beyond preventing underage tobacco use. Keep these ideas in the back of your mind at all times to encourage your kids to grow up to be healthy, caring, responsible adults.

For Parents Who Use Tobacco

It can be especially difficult to talk to your kids about tobacco use if you smoke or use other forms of tobacco—you may feel like you’re being hypocritical or that your words won’t be effective at all. But don’t let that stop you. Although it’s tough, it’s still important that you talk to your kids about tobacco use. You also need to be especially watchful for warning signs of your child smoking, as children of smokers are much more likely to become smokers themselves.1 However, parental disapproval of smoking is a consistent protective factor against kids’ future smoking.2 Quitting smoking yourself is on the best things that you can do to help your child quit, but if you’re not ready for that, here are a few other tips:

  • Speaking candidly is often the best way to go about this conversation. For example, “I smoke, but then I tell you not to. Does that seem hypocritical?” Be direct, and explain why you don’t want your child to start smoking. Don’t be afraid to admit it if you wish you hadn’t started smoking; your child will respect your honesty.
  • Often, young children who complained about their parents’ smoking grow into teens who are silent on the matter. Just because your child doesn’t talk about smoking does mean that he won’t try it. Be sure to keep talking about tobacco use: “I notice that you haven’t complained about my smoking lately. Why is that?”
  • Share your story with your child. Talk about why you started smoking—did your friends smoke? Did your parents? Talk about your addiction to tobacco and the effect that it has had on your health. If you’ve tried to quit, make sure your child knows how difficult it is.
  • Don’t allow smoking by anyone inside your home, including yourself. Even a partial ban on smoking at home relays negative attitudes toward smoking and may decrease the chances that your child will start smoking. 5
  • Spell out the reasons why your child shouldn’t smoke, and keep in mind that teens are more likely to respond to the short-term effects, such as the cost.
    • See The Effects of Smoking for more short- and long-term effects.
  • Realize that you may be less attuned to the smell of smoke in your house—keep your eyes open for other warning signs, such as burn holes in your child’s clothes, making excuses to go outside often, or finding lighters or matches in your child’s belongings. If your child avoids questions about these things, she may be trying to cover up her smoking.
  • Many teen smokers take cigarettes from their parents’ packs—make sure to keep your cigarettes where your children can’t easily get them.
  • If you’re considering quitting, remember that adolescent smokers are almost twice as likely to quit if their parents quit—if your child smokes as well, make an effort to quit together.4 Tell your child why you’re quitting and encourage him to do the same.

Talking to your kids about tobacco use is hard. And it can be even harder if you smoke. But that doesn’t mean you can’t have positive, insightful conversations about tobacco use with your child.

Tobacco Use: Summary and Next Steps

Whether or not you use tobacco products, you want to keep your kids from picking up the habit. And while there are many things that increase the likelihood of your kids using tobacco, there are also many things you can do to help keep your kids away from harmful behaviors, including smoking.

By educating your children and preparing them to resist peer pressure and make good decisions, you can give them the tools they need to stay tobacco-free. And if you find out that one of your children is using tobacco, you can take positive action to help him or her quit.

Other Useful Web Sites

  • CDC’s Office on Smoking and Health — Including state, federal, and online resources, as well as research and tools, the OSH site is a valuable central location for tobacco use prevention information.
  • TeensHealth: Drugs and Alcohol — This site provides useful articles for teens on tobacco use, quitting, and information on alcohol and other drugs.
  • What You(th) Should Know about Tobacco — A tip sheet that contains useful information for youth, parents, and coaches.
  • How to Quit — A collection of useful resources to help anyone trying to quit smoking or smokeless tobacco use.
  • Smoking and How to Quit — WomensHealth.gov provides a great deal of information for women trying to quit smoking.
  • National Cancer Institute: Smoking — NCI’s compilation of resources will help you find research and learn more about smoking, and provides links to many useful quitting resources.
  • Smokefree Teen —This website, created specifically for teens by the National Cancer Institute, provides information and resources to help teens better understand the decisions they make—especially the decision to quit smoking—and how those decisions fit into their lives.

Downloadable Resources

• Parenting Kids Who Don’t Use Tobacco: This tip sheet will help you initiate the difficult tobacco conversation and effectively inform your child on the dangers of tobacco use.

• Smoking and Kids – The Latest Trends: This booklet contains research facts, talking points, and important issues for parents.

• Preventing Kids From Smoking—When You Smoke: This tip sheet provides useful, concise tips on how to keep your kids from smoking.