How can we help teens stop smoking?

Me: "Smoking causes cancer."

My teen patient:  "I know."

Me: "Smoking causes heart disease."

My teen patient: "I know."

Me: "Each cigarette takes away about 11 minutes of your life."

My teen patient: "That's bad."

Me: "People who smoke a pack a day die, on average 7 years earlier than people who have never smoked."

My teen patient: "That's really bad."

Me: "Can I help you quit smoking?"

My teen patient: "No; I'm still going to smoke."

Unfortunately, I've had this conversation many times. One of the most challenging aspects of adolescent medicine is changing unhealthy behaviors like smoking. My patients know that it's bad, really bad, but they don't stop. They're not surprised if I tell them that smoking is linked to nearly 29 percent of U.S. cancer deaths or that smoking-related illnesses claim more American lives than alcohol, car accidents, suicide, AIDS, homicide and illegal drugs combined.

Some of the problem is their belief that "it's not going to happen to me." Others have seen more death and violence in their young lives than one should see in a lifetime — leading them to question whether they will even be alive in 20 years. Every day in the U.S., about 4,000 kids under the age of 18 try their first cigarette, and 1,000 of those become smokers. It is estimated that approximately 4.5 million adolescents in the U.S. are smokers.

For teenagers it's appearance, appearance, appearance.  One thing that teens really care about is appearance. They never seem to pass a mirror without a glance. Many studies have demonstrated the influence of teens' perceived attractiveness on their self-confidence and quality of life, for example, the relationship between acne and self-esteem. Tapping into this, a recent study done in German secondary schools used a free photo aging mobile app called Smoking Time Machine, which alters a person's self-portrait (selfie) to predict future appearance. The students' altered three-dimensional selfies on mobile phones or tablets were "mirrored" via a projector in front of their whole grade. Using an anonymous questionnaire, the researchers then measured the perceptions of 125 students of both genders whose average age was about 13 years old. Most (62 percent) of the students perceived the intervention as fun. More important, most (63 percent) said that the intervention motivated them not to smoke and most (65 percent) said that they learned new benefits of non-smoking.

The apple doesn't fall far from the tree. The cancers and illnesses may appear during adulthood, but most adult smokers began smoking during adolescence. In a study reported in Pediatrics, parental smoking was associated with a significantly higher risk of adolescent children starting to smoke. In addition, the likelihood of children starting to smoke increased with the number of parents who smoked and the length of time that children were exposed to parental smoking. There is a silver lining to this study: Offspring of parents who had quit smoking were no more likely to smoke than offspring of parents who had never smoked.

My advice: 

1. Parents who smoke should literally quit for their children.

2. Show your kids the Smoking Time Machine app. They'll probably laugh and think they look silly…that's what I call a teachable moment!

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