Monday, 18 Feb 2019

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What’s the Deal With Kids Who Smoke?

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Experts suggest effective ways parents can stop kids from starting or appeal to them to quit.

Toddlers put small, nonfood objects in their mouths – that's what they do. As a parent, you breathe a sigh of relief when kids grow old enough to know better. But don't relax your vigilance just yet. Teens and tweens put cigarettes, chewing tobacco and e-cigarettes in their mouths all too often – that's what they do. Read on as experts describe trends in teen smoking, explain why kids are prime marketing targets and suggest how parents can either prevent their kids from starting or encourage them to quit. 

When Dr. Cora Breuner talks one-on-one with kids about smoking, she appeals to their intelligence and desire to look out for themselves. "They should be aware of what marketers and advertisers have known for a long, long time – there are a lot more nicotine receptors in the brains of kids below 18 years of age," says Breuner, a professor of pediatrics and adolescent medicine at Seattle Children's Hospital and the University of Washington. "If you don't flood those receptors with nicotine, they just fade into the woodwork and go away." 

It's difficult to get someone 30 or older to start smoking, says Breuner, who heads the Committee on Adolescence for the American Academy of Pediatrics. That, she says, is why tobacco advertising has been geared to kids over decades past, when young children were found to be just as aware of Joe Camel as Mickey Mouse.

Platforms may change, but marketing to youth persists. Kids aren't exposed to tobacco-industry ads on TV anymore, Breuner notes, but they see smoking in movies and online, in music videos and on YouTube and elsewhere. "I say this to kids: 'You know that the tobacco industry is a huge, multibillion-dollar enterprise that is aware that young smokers can easily become addicted to nicotine. You don't need to fall into this trap.'"

Veering to Vaping

Over the past two decades, smoking rates dropped among adults and kids alike – for traditional cigarettes or cigars. The percentage of high school students who reported current cigarette use dropped from nearly 16 percent in 2011 to slightly more than 9 percent in 2014, according to the National Youth Tobacco Survey from the Centers for Disease Control and Prevention and the Food and Drug Administration.

But that's just part of the picture. Overall tobacco use by students failed to drop during that period, the survey found. Rising use of e-cigarettes and hookahs by students offset the healthy decrease in their use of traditional tobacco products.

E-cigarettes indeed qualify as tobacco products, says Vince Willmore, vice president of communications with the Campaign for Tobacco-Free Kids. "They contain nicotine that's derived from tobacco, and they meet the definition of tobacco products that are in the law," he says, pointing to last week's FDA announcementof sweeping new rules that will require e-cigarette devices and ingredients to undergo review.

That's certainly a step in the right direction, Willmore says. Proven, large-scale methods for reducing smoking include hiking cigarette taxes to significantly boost the price of a pack, he says, and mass-media efforts like the CDC's Tips From Former Smokers campaign, which educates the public about the disastrous effects of smoking in a vivid way.

Last week, California became the second state (after Hawaii) to raise the age for buying tobacco products to 21, joining more than 145 cities and counties throughout the country. That, Willmore says, adds a new tool to the anti-tobacco arsenal.

Nicotine in and of itself is harmful, research suggests, particularly to younger brains that are still developing. So a shift toward e-cigarettes is a "double-edged sword," says Steven Kelder, co-director of the Michael & Susan Dell Center for Healthy Living at UTHealth School of Public Health in Austin, Texas. 

"Those of us that have been working in the tobacco-control movement for the last 30 years love it that cigarette rates are going down," says Kelder, who helps lead the school's Tobacco Center of Regulatory Science on Youth and Young Adults. In short, he says: "Cigarettes are bad – real bad." Cigarettes contain tar and carbon monoxide, he says, among a host of chemicals known to cause cancer. E-cigarettes don't contain those ingredients, which is a plus. But nicotine exposure is a negative, no matter how you consume it, he says, making vaping a questionable choice.

Teen brains are wired to make risky decisions, Kelder notes. "The prefrontal cortex finishes maturing the last, and that's the place where you have more advance reasoning and you can start projecting what the consequences of your actions are," he says. Until then, he says, kids and even young adults have less impulse control over their own behavior: "Almost by definition, they're going to stick things in their mouth. The question is, do we want them to have e-cigarettes versus something safer or better?"

Hookahs and little cigars come with health concerns as well, Kelder says. An evening spent huddling around the hookah (or water pipe) is roughly equivalent to smoking two packs of cigarettes, he says. Little cigars contain the same hazardous ingredient as cigarettes, while offering youthful users a variety of flavors.

Reaching Kids

Parents play an important role in preventing kids from smoking or helping them quit before the habit takes too strong a hold. Being a role model by not smoking is foremost, while quitting gives kids another kind of good example.

If you are a parent who smokes, Breuner says, you can still take care to avoid certain messages. Don't say things like, "I need a cigarette to calm down," she advises, or complain about gaining weight if you try to quit.

When kids smoke, zero tolerance is the best strategy for parents, Breuner says. That means making and consistently reinforcing restrictions, such as no smoking inside or within 100 yards of the house. "Really make it difficult for a kid to smoke," she says. "And don't cave in."

As a physician, Breuner says, heaping dire warnings about long-term cancer risk or breathing problems likely won't get young smokers to stop. First, she says, kids have to want to quit. "Once you get a wedge in the door, then it's, 'Do you really want to kiss your boyfriend with cigarette breath?' Or, 'Do you really want more wrinkles on your face? Do you really want your fingers to look yellow? Do you really want your teeth to look yellow?'"

Among other smoking-cessation treatments, a type of counseling called motivational interviewing has been shown to help kids (and others) quit smoking. Motivational interviewing helps people explore and resolve uncertainties about changing their behavior, according to the Cochrane Collaboration. Rather than taking an aggressive or confrontational style, it steers people toward changing their behavior to reach their own goals and encourages self-belief in their ability to do so. 

Health care providers need to keep up with smoking trends, Breuner says. Even today, she says, pediatricians and other doctors tend to ask only about smoking or chewing tobacco. "They should include other products as they take a patient's current medical history," she says. "You have to ask about e-cigarettes or vaping. Kids will tell you if you ask, but they aren't going to offer that."

Prevention is golden, of course, and parents can eventually take heart, Breuner says: "If you can get a kid past 21 and not have them smoke, you're done. You can cross that off the list."

Copyright 2016 U.S. News & World Report