How to Keep Kids From Smoking

Cracking down on cigarette sellers really helps; so do higher prices and ads against tobacco.

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How can parents and society keep kids from smoking? One way is to make sure that merchants know they'll get in trouble if they sell cigarettes to minors. That can cut by 21 percent the odds that a 10th grader will become a daily smoker. And that's good news, because the earlier a person starts smoking, the more likely he or she will be hooked for life.

Public-health advocates have been trying for years to figure out how best to keep children and teens from taking up the cigarette habit. It's often hard to determine what works and why. Banning sales to minors doesn't work unless the bans are enforced, according to Joseph DiFranza, a professor of family medicine and community health at the University of Massachusetts Medical School. DiFranza, a family physician, became convinced that more needed to be done to keep kids from starting to smoke when he realized how hard it is for patients who smoke to quit. Back in 1987, he sent his daughter, who was then 11 years old, into 100 stores in Massachusetts to try to buy cigarettes. Seventy-five percent of the merchants sold them to her, even though it was illegal to sell cigarettes to minors in that state.

In 1996, Congress changed the game, requiring states to enforce laws barring sales to minors by sending underage decoys into stores to buy tobacco, much as DiFranza had done with his daughter. Between 1997 and 2003, that tougher enforcement led to a 20.8 percent decrease in the number of 10th graders who are daily smokers, according to new research that DiFranza and two colleagues have published in the current issue of BMC Public Health.  

Parents have power over how well the ban on selling cigarettes to kids is enforced, says DiFranza, because much of the enforcement is at the local level, from the police and local health department. "They get pushback from the merchants," he says. "If they're getting kudos from parents on how great they're doing, they will make a greater effort."

But tough enforcement is not the only thing that works to prevent teen smoking. For instance, the increasing price of cigarettes reduced daily smoking by 47 percent over the same 1997-to-2003 period, the new study's authors found. Antismoking restaurant policies and advertising campaigns against tobacco helped, too. The new study is the first to separate the effect of enforcing a ban on sales from these other factors. Banning sales helps over time, says DiFranza, because younger children see fewer older kids smoking. Teenage smoking declined by half between 1997 and 2003.

But this doesn't mean that parents are off the hook. The biggest predictor of whether a kid will smoke is whether Mom and Dad do. If there was ever a good reason to quit, this is it. The American Academy of Family Physicians explains the disgusting toxic tobacco facts for teenagers in this fact sheet, noting that tobacco causes more health problems and early deaths than all illegal drugs combined. It's full of good arguments against smoking, for kids and grown-ups alike.

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The earlier a child uses drugs, alcohol, or tobacco, the more likely it is that he or she will have problems as an adult. "Good" kids can get themselves in trouble, too. And researchers are discovering that teenage brains are uniquely susceptible to addiction, perhaps because teens are so good at learning.