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The Great American Smokeout is held each year on the third Thursday of November to encourage smokers to quit. In addition, all parents can use this event to start talking about the dangers of tobacco with their children.

Tobacco use is currently the single most preventable cause of death in the United States. People who start smoking early in life have the highest risk of smoking-related symptoms and illnesses including coughing, shortness of breath, colds, sinus infections, lung infections (pneumonia), lung cancer, poor physical fitness, heart disease and overall poorer health. Adolescents who smoke are more likely to use alcohol and illegal drugs, carry weapons, attempt suicide and engage in high-risk sexual behaviors.

The best way to prevent the problems that can develop due to smoking is to prevent children from ever smoking in the first place. When children and adolescents smoke, this often starts a lifelong smoking pattern. It is very easy for children and adolescents to become addicted to nicotine. An adolescent who completes high school without ever smoking is very unlikely to become a smoker in adulthood.

To prevent smoking in children, it is important for all parents to talk with their children about tobacco, starting at an early age. Here are some suggestions for getting the important messages about tobacco across to your children:

Explain that smoking is extremely dangerous and very unhealthy. It definitely causes trouble breathing and makes it harder to run and play sports.

Point out that tobacco smoke smells bad; stains teeth, fingernails and skin, and even makes clothes, hair and breath smell bad, too.

Remind your child that most young people do NOT smoke or chew tobacco. Children see many cigarette ads and references to smoking in the media and may think that smoking is more common than it truly is.

Role play with your child to prepare him for dealing with pressure from friends to try tobacco. Pretend to be a classmate or friend offering your child a cigarette and let your child practice different responses.

When you see cigarette ads, talk with your child about what the ads are actually trying to sell: maturity, beauty, sexual attraction, wealth and "coolness." Make it clear that cigarette smoking cannot provide anybody with these things.

If your child or adolescent begins smoking, try the following suggestions, adapted from the U.S. Centers for Disease Control and Prevention (CDC):

If you smoke, try to quit. If you did smoke and have already quit, talk to your child about your experience. Talk about the challenges you faced when trying to quit. Teens and preteens often believe they can quit smoking whenever they want, but research shows many teens never do.

Ask what changes can be made in your child's life to help her stop smoking.

Avoid threats and ultimatums. Ask a few questions and find out why your child feels the need to smoke. Your child may want to be accepted by his peers or may be looking for attention. We also know how stressful adolescence can be — your child could be smoking to relieve stress. If so, try to help your child lower their stress level and find another outlet for it.

Be supportive. Both you and your teen need to be ready for the mood swings and crankiness that can come with nicotine withdrawal when someone tries to stop smoking. Offer your teen the Five Ds to get through the tough times:
- Delay — The craving will eventually go away.
- Deep breathe — Take a few calming deep breaths.
- Drink water — It helps cool the oral desire for a cigarette.
- Do something else — Find a new habit.
- Discuss — Talk about your thoughts and feelings.
Have your teen or preteen write down all the reasons why she wants to quit. Refer back to this list when your teen is tempted.

Finally, reward your teen when she quits. Plan something special to do together.

If you smoke, plan to quit today! You can use the Five Ds to help. Don't forget that exposure to secondhand smoke is also a significant health issue for children. Some of the harmful chemicals in secondhand smoke include nicotine, carbon monoxide and benzene. Exposure to passive smoke has been associated with ear infections, chronic breathing symptoms and infections, and poor lung function. Childhood exposure to smoke may increase the risk of developing environmental allergies and asthma, and can increase the number of emergency-room visits made by children who have asthma. Children of smokers also have more than three times the risk of sudden infant death syndrome (SIDS) than children of nonsmokers, and risk is increased with number of cigarettes smoked per day.

If you cannot yet quit, keep the dangers to a minimum by limiting as much of your children’s exposure to tobacco as possible. Smoke outside, and NEVER smoke in the car. If you smoke in the house, use a room with good ventilation. Air-cleaning machines do not remove all the dangerous particles from the air. As we move toward the winter holiday season, remember that one of the best gifts you can give your children is keeping the air clean around them.

Henry H. Bernstein, D.O., is a senior lecturer in Pediatrics at Harvard Medical School. In addition, he is chief of General Academic Pediatrics at Children's Hospital at Dartmouth and professor of pediatrics at Dartmouth Medical School. He is the former associate chief of General Pediatrics and director of Primary Care at Children's Hospital Boston.

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