Smoking poses grave health threats to people of all ages, including children. Initially, second-hand smoke presents the greatest danger to young people, particularly in terms of their respiratory health and their susceptibility to ear infections. As children grow older, they may begin to smoke cigarettes, which can dramatically impact both their day-to-day and long-term health.

Most people associate smoking with cancer. However, tobacco smoke is also a leading cause of many other illnesses, including heart disease, emphysema (lung disease) and damage to various organs. In many cases, these diseases eventually result in fatalities.

The potential for smoking to damage a child’s health begins prior to birth. Pregnant women who smoke cause changes in maternal, fetal and placental blood-flow. Smoking during pregnancy has been linked to sudden infant death syndrome (SIDS), a leading cause of death in children from 1 month to 1 year of age. It also has been linked to behavioral problems later in childhood, such as hyperactivity and attention-deficit hyperactivity disorder (ADHD).

Following birth, second-hand smoke continues to adversely impact a child’s health. Each year, second-hand smoke is responsible for between 150,000 and 300,000 acute lower respiratory tract infections (e.g., bronchitis, pneumonia) in children 18 months of age and younger, according to the Environmental Protection Agency (EPA). Second-hand smoke is also associated with increased frequency and severity of childhood asthma and middle-ear infections (otitis media).

As children grow older, they may begin to experiment with smoking. By middle school, 12 percent of students use some type of tobacco, according to the American Cancer Society (ACS). By high school, 28 percent of students use some type of tobacco. Despite the dangers of smoking, many children are drawn to the habit in response to peer pressure. People who do not start smoking during adolescence are much less likely to ever start to smoke.

Children are often effective at hiding smoking from parents or caregivers. Nonetheless, there are certain signs that may indicate that a child is smoking, including bad breath, clothes that smell or are stained, and coughing and hoarseness.

Once children have begun to smoke, quitting is the single most important thing they can do for their health. Quitting smoking can dramatically reduce the risk of cancer and many other diseases. Many smokers and tobacco users find it difficult to quit, but over-the-counter and prescription treatments are available to help in this process.

Parents are urged to take several steps to reduce their child’s exposure to second-hand smoke. First and foremost, parents are urged to try to quit smoking. No single step will have a greater impact on their child’s long-term health.

Smoking is the single greatest cause of preventable death in the United States. It affects people of all ages, including children. The vast majority of smokers begin the habit before they are adults. The younger a person is when they start smoking, the more likely they are to smoke as an adult. In addition, second-hand smoke can cause long-term health problems in children – including fetuses and infants – because the carcinogens (cancer-causing substances) in tobacco smoke can damage organs that are still developing, such as the brain and lungs.

Tobacco use causes many forms of illness. It is the direct cause of more than 170,000 cancer deaths each year – or approximately one-third of all cancer-related deaths, according to the American Cancer Society (ACS). It also causes heart disease and lung diseases, such as emphysema. Overall, smoking is responsible for approximately 440,000 deaths a year in the United States alone.

Initially, the greatest tobacco-related threat to a child’s health comes in the form of second-hand smoke. Thousands of chemicals have been found to exist in second-hand smoke, and dozens are linked to cancer, according to the American Academy of Otolaryngology – Head and Neck Surgery. The academy estimates that between 50 and 67 percent of children under the age of 5 live in a home where at least one adult smokes.

As children grow older, they may try smoking. Many children experiment with smoking during the teenage years. This occurs for various reasons. Some children may be trying to establish maturity by adopting such an “adult” habit, whereas others use smoking as a way of appearing “cool” or rebellious. The vast majority of adult smokers (90 percent) started smoking before age 20 according to the National Institutes of Health.

Many of the chemicals in tobacco smoke are poisons. These include substances such as nicotine and cyanide. Other toxic elements include carbon monoxide, tar, formaldehyde, benzene, arsenic and lead. These chemical agents are known carcinogens (cancer-causing substances) and can cause harm to nearly every major organ of the body. Over time, these poisons can cause serious damage to a person’s body.

Most people associate smoking with cancer. Cigarettes and tobacco products are directly responsible for the high incidence of certain cancers. Lung cancer is the most notorious example. Before the 20^th century, when cigarettes were not mass produced or readily available, lung cancer was rarely seen.

As cigarettes became widely available, cases of lung cancer rose dramatically. Today, smoking is responsible for about 87 percent of lung cancer cases in the United States, according to the ACS. Lung cancer is the leading cause of cancer death in the United States for both men and women. In areas of the world where more people smoke, there has been a corresponding rise in lung cancer cases.

Besides lung cancer, tobacco is implicated in many other cancers, including those of the following body areas:

• Oral cavity and throat
• Stomach
• Liver
• Kidney
• Bladder
• Cervix
• Prostate
• Colon and rectum

Cancer is not the only health problem related to smoking. Tobacco smoke is a leading cause of many other illnesses, including heart disease, emphysema (lung disease) and damage to various organs. In many cases, these diseases eventually result in fatalities.

Smoking can also cause other less deadly but nonetheless serious health problems. Smoking affects bone density raising the risk of osteoporosis, a thinning of the bone that results in poor posture and more frequent bone breaks. Smoking also decreases lung capacity, which may in turn cause a person to be less active. Long-term smoking can affect fertility and lead to sexual dysfunction in men.

Other health problems related to smoking include:

• Increased incidence of illnesses such as tonsillitis, colds, flu, bronchitis, pneumonia and asthma
  
  
• Yellowing teeth
  
  
• Skin damage, including premature wrinkling
  
  
• Slower healing time following injuries or surgical procedures
  
  
• Increased risk of developing rheumatoid arthritis for women

In addition, children who smoke are at higher risk for adopting a number of other negative behaviors including alcohol and substance abuse. Studies show that children who smoke are more likely to fight, carry weapons, suffer from depression and other mental health disorders, attempt suicide and engage in high-risk sexual activity.

Cigarettes are the most commonly used form of tobacco, which is why they cause the most smoking-related deaths. However, other methods are just as or more deadly. Cigars, for instance, contain the same carcinogens as cigarettes. Depending on the size, it is not unusual for one cigar to contain the same amount of tobacco as an entire pack of cigarettes.

Smokeless tobacco is also dangerous. Smokeless tobacco contains up to 15 times as much nicotine as cigarettes, thereby increasing the risk of addiction, according to the American Academy of Family Physicians (AAFP). Many users, including a large number of high school students and professional athletes, mistakenly believe that smokeless tobacco is a “safe” form of tobacco. However, smokeless tobacco increases the risk of cancers of the mouth and throat. It is also common for smokeless tobacco users to develop leukoplakia, which are sores in the mouth that can lead to cancer.

Other tobacco products that can cause cancer and illness include the following:

• Clove cigarettes (kreteks). Particularly fashionable among the younger generation, clove cigarettes are popular “alternatives” to cigarettes and marijuana. Imported from Indonesia and other Southeast Asian countries, clove cigarettes contain approximately 65 percent tobacco and 35 percent ground cloves, clove oil and additives.
  
  
• Bidis (flavored cigarettes). Bidis are hand-rolled cigarettes that are offered in flavors such as chocolate, cherry and mango. Despite the fact that they contain less tobacco, bidis have much greater amounts of nicotine and other toxic substances than regular cigarettes. Often less expensive than regular cigarettes, bidis carry all the same health risks as regular cigarettes.
  
  
• Hookah. Hookah smoking, which originated centuries ago in the Middle East, is gaining popularity, especially among younger smokers. The process involves burning flavored tobacco, which is usually mixed with molasses and dried fruit. The tobacco mixture, known as shisha, is burned in a water pipe and the smoke from the mixture is inhaled through an elongated hose. Although frequently advertised as a safer alternative to cigarettes because of a lower percentage of tobacco in the product, this claim is actually false, according the ACS.

The potential for smoking to damage a child’s health begins prior to birth. Pregnant women who smoke cause changes in maternal, fetal and placental blood-flow. New research suggests that women who smoke while pregnant risk causing permanent damage to their baby’s developing circulatory system, which can increase the child’s likelihood for heart disease and stroke later in life. Other studies indicate that smoking during pregnancy may contribute to problems such as cleft lip and palate or Tourette syndrome (a neurological disorder characterized by involuntary tics). Pregnant women who smoke also produce less breast milk and tend to have more miscarriages, stillbirths, premature births and babies of lower birthweight.

Smoking during pregnancy has been linked to sudden infant death syndrome (SIDS), a leading cause of death in children from 1 month to 1 year of age. It has also been linked to behavioral or emotional problems such as hyperactivity, attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD).

Second-hand smoke continues to pose dangers throughout childhood. Many of these health risks are associated with a child’s breathing capacity. Each year, second-hand smoke is responsible for between 150,000 and 300,000 lower respiratory tract infections (bronchitis and pneumonia) in children 18 months of age and younger, according to the Environmental Protection Agency (EPA). Between 7,000 and 15,000 of these children require hospitalization.

Second-hand smoke is associated with increased frequency and severity of childhood asthma, worsening the condition of between 200,000 and 1 million children with this breathing disorder, according to the EPA. Children exposed to second-hand smoke tend to have more tonsillitis, colds and sore throats, and young children are at increased risk for bronchitis and pneumonia. Children of parents who smoke at least a half-pack of cigarettes a day have nearly double the risk of hospitalization due to respiratory illness.

Second-hand smoke may also impact other illnesses related to the lungs, including:

• Chronic conditions, such as coughing and post-nasal drip
  
  
• Cystic fibrosis (disease that causes thick, sticky mucus to build up in the lungs and digestive tract)
  
  
• Nasal allergies
  
  
• Sinusitis (inflammation of the sinuses)

Smoking and other forms of tobacco use are popular among children and teenagers. By middle school, 12 percent of students use some type of tobacco, according to the American Cancer Society (ACS). By high school, 28 percent of students use some type of tobacco. Most people who smoke started the habit during adolescence. According to the National Institutes of Health, 90 percent of smokers started before age 20.

The ACS estimates that more than 4,000 children try their first cigarette every day and 2,000 of them will become regular smokers. According to the Centers for Disease Control and Prevention (CDC), one-third of children who smoke will eventually die from the addiction due to cancer, heart disease or lung disease. The ACS estimates the rate of death to be even higher, with at least half of all daily smokers eventually dying of a smoking-related disease.

In addition, children who smoke have an increased risk of developing asthma during adolescence because, unlike the more serious consequences of smoking (e.g., cancer), asthma does not take years to develop. 

Despite the dangers of smoking, many children are drawn to the habit in response to peer pressure. Other motivations may include appearing older or tough, feeling independent, losing weight or winning merchandise given away by tobacco companies. Some youngsters may mistakenly believe that low-tar or filtered cigarettes are “safe” compared to regular cigarettes. According to the Surgeon General, there is no safe form of tobacco – and that includes tobacco in all of its various forms.

The number of young adults who smoke has been declining over the past decade. However, the number of teens who smoke is as high, if not higher than the number of adults, according to the ACS. Experts believe that the reason is due to the heavy influence of media including television, movies and advertising by the tobacco companies. The ACS points out that the tobacco industry often looks to children to replace all those customers who quit smoking or die from a smoking-related disease, such as lung cancer.

Children are often effective at hiding their smoking from parents. Nonetheless, there are certain signs that may indicate that a child is smoking. These include:

• Bad breath
• Clothes that smell or are stained
• Coughing and hoarseness
• Decreased performance when exercising or participating in athletics
• Increased production of phlegm
• Increased susceptibility to colds and flu
• Shortness of breath or wheezing
• Stained teeth
• Throat irritation

Parents or caregivers are urged to take several steps to reduce their child’s exposure to second-hand smoke. First and foremost, parents are urged to try to quit smoking. No single step will have a greater impact on their child’s long-term health.

Parents also are urged not to smoke in the car or to allow others to smoke in the car. Finally, parents are urged to make sure that their child’s daycare facilities and schools are smoke-free.

Eventually, children are likely to experiment with tobacco. Parents who accept this reality can take steps that will help reduce the odds that their child will continue to smoke after experimenting. Parental influence can have a big impact on whether or not children continue to smoke, even though this fact may not be obvious to parents who may feel shunned by their child during this age. Teens who believe their parents will disapprove of their smoking are less than half as likely to smoke as teens who think their parents do not care, according to the American Cancer Society (ACS).

Parents are urged to talk openly with their children about sensitive topics. In such households, a child is more likely to feel comfortable discussing their feelings about smoking. Parents are urged to avoid delivering ultimatums to their children, and to encourage open communication instead. This will allow parents to ask children what they find attractive about smoking, and will present an opportunity to explain the potential financial and health costs and addiction associated with smoking. With children, it is often especially helpful to concentrate on the short-term costs of smoking – such as bad-smelling clothes and breath, shortness of breath and yellowing teeth. It also may be helpful to talk about friends and family members who have died as a result of smoking.

Studies also show that self-confidence is a child’s best weapon against the peer pressure to smoke. Parents or caregivers can help to boost a child’s self-esteem by emphasizing accomplishments rather than focusing on the negative. Encouraging children to become involved in activities that prohibit smoking (such as athletics) can also be helpful in both building self-esteem and discouraging smoking. Parents are urged to help children formulate ways in advance to turn down cigarettes when offered by peers.

Preparing questions in advance can help patients and parents have more meaningful discussions with their physicians regarding smoking. The following questions related to smoking and children may be helpful:

1. I’m pregnant – how could my smoking affect my baby? What resources are available to help me quit smoking?
   
   
2. How can I prevent my child from being harmed by second-hand smoke?
   
   
3. At what age should I start to discuss the dangers of smoking with my child?
   
   
4. What kinds of things can I talk about that might discourage my child from smoking?
   
   
5. What do you recommend my teen should use to quit smoking?
   
   
6. How long before he/she is able to quit smoking?
   
   
7. If over-the-counter products don’t work for my teen, should he/she try prescription products?
   
   
8. Do you think there is any benefit to complementary and alternative methods to stop smoking?
   
   
9. Can you refer me to programs to help my teen quit smoking or support groups?
   
   
10. Do you think it is better for me to talk about the long-term consequences of smoking with my child or just forbid it?
    
    
11. How can I prevent my child from relapsing?