Almost all adult smokers say they got their start before age 18.
Doctors do make a difference when it comes to keeping children and teenagers from taking up tobacco. This may sound like a no-brainer, but until recently there wasn't strong evidence that anti-smoking efforts by pediatricians and other primary care doctors make a difference.
That evidence is now clear, according to the U.S. Preventive Services Task Force, an independent group that today called for pediatricians and other primary care doctors to talk with children, teenagers and parents about the harms of smoking. The independent task force also endorsed doctors' use of computer programs, videos and print materials with anti-tobacco messages.
"Parents ought to be looking for these conversations," Sue Curry, dean of the college of public health at the University of Iowa, tells Shots. She's a member of the task force, and also researches anti-tobacco efforts.
Pediatricians have a long list of things they're supposed to ask about during visits, from diet and exercise to bike helmets. So it's easy to imagine how yet another preventive health effort might not make it on the list. But tobacco intervention should be a high priority, Curry says. "This is one of the most effective things that a provider can do to keep kids healthy over their life course," she says. "They can make a big difference in a relatively short amount of time."
In 2009, the American Academy of Pediatrics recommended that pediatricians urge their patients and parents to avoid tobacco, and make homes and cars smoke-free. In 2003 the USPSTF hadn't found enough evidence for a broad call for primary care interventions; this recommendation now says there is.
Most adult smokers started as children or teens, which explains the focus on trying to keep children and teenagers from taking up the habit. It can take up to two years for a child to progress from experimenting with cigarettes to becoming addicted according to the report, which was published in the journal Pediatrics and also in Annals of Internal Medicine.
Each year, about 443,000 people die from smoking-related causes, including cancer, heart disease and lung diseases.
About 8 percent of middle schoolers say they smoke, as do 24 percent of high school students, according to 2009 data from the Centers for Disease Control and Prevention.
The interventions tested in the studies that the task force evaluated varied widely. Some were simple conversations with a doctor or other health care provider. Others involved sending home a 28-minute video with a viewing guide, with follow-up calls from a counselor. The most intensive had a teenager and at least one parent participating in seven two-hour group sessions, with workbooks to complete at home.
But even just having doctors mail out material to a child's home had an impact.
Most of the interventions focused on the participants' attitudes, beliefs and knowledge about smoking and its consequences. They also addressed tobacco marketing and other social influences, and gave tips on how to say "no thanks" when offered a cigarette by a peer.
Several interventions focused on parents, including their attitudes about smoking, and how they communicate with their children. That's probably a good thing, since one of the biggest reasons that children and teens start smoking is because Mom or Dad do.
But what about that one-quarter of high schoolers who say they're already smoking? The task force found only limited evidence on the effectiveness of school-based and community-based programs in helping teen smokers quit.
But another group that focuses on community health efforts rather than medical professionals found that higher tobacco prices and anti-tobacco mass media campaigns, as well as mobile apps, phone quit lines, and local efforts to restrict underage sales, work well to reduce tobacco use in both teens and adults.
The National Cancer Institute offers a long list of tested tools for quitting, from exercise programs for women to a DIY get-off-the-snuff manual.