MD Mama

If We Raise the Smoking Age Are We Letting Parents Off the Hook?

teen smoking.jpgAccording to the Institutes of Medicine, if we want fewer youth to smoke, we should raise the minimum legal age for purchasing tobacco products to 21 or 25.

I'm down for raising the minimum legal age. But in my opinion, if we want fewer youth to smoke we need parents to, well, do more parenting.

Decreasing youth smoking is actually pretty crucial, because nearly 90 percent of smokers start by the time they are 18, and 99 percent start by the time they are 26. As everyone knows, quitting is hard. When it comes to smoking, prevention is key.

And that's exactly what this Institute of Medicine (IOM) report is all about. Commissioned by the Food and Drug Administration, which now regulates tobacco, the study used "mathematical models" to predict what would happen if the minimum legal age (MLA) was raised to 19, 21, or 25.

The report found that the biggest effects would be on 15 to 17-year-olds, which makes sense. Those are the high school kids. It found that raising the MLA to 19 didn't do much. But raising it to 21 translated into 12 percent fewer smokers when today's teens reach adulthood, and raising it to 25 increased that number to 16 percent. The issue, they said, was social networks. Underage smokers get their tobacco from friends and family. Young adults at 21 and 25 years old are less likely to hang out with high schoolers than 19 year olds.

This is all great. I say raise it. It would translate not only into less tobacco use but less disease and death. But we'd save even more lives if parents did more talking to their kids--about tobacco, about life as a teen, about anything and everything.

When my patients get to fifth or sixth grade (around age 10 or 11), I start asking families if they talk about tobacco, alcohol, and other drugs at home. Some look at me blankly as if it hadn't occurred to them. Some say the kids are too young to talk about it--or that they just don't feel comfortable. Some say they do talk about it--but when asked what they say, they usually reply, "We tell them it's bad and not to do it."

That's true and a good bottom-line message, but it may not be incredibly effective or helpful. It's not like most kids think that smoking is good for them. They just don't realize how bad it could be--which is why it's important to talk (clearly and graphically) about how tobacco causes all sorts of horrible cancers, lung disease, and heart disease (and other stuff too, but those are the big three). Talk about different kinds of tobacco. I've met some teens who didn't realize that hookah is tobacco, for example. It's also important to talk about addiction, because that's a concept many youth don't really get at all.

It's also really important to talk about social context and media messaging and the other reasons kids start using tobacco. It's best to start young, even before 10 or 11, and have conversations about why kids might start smoking--and help them think it through before they encounter it. It's also helpful to give kids strategies they can use if someone offers them tobacco, especially someone they want to impress, or someone they feel could do them social harm if they don't.

These aren't easy conversations. They get harder as teens get older, too, when most conversations are either a bunch of grunts or extremely frustrating. But conversations are a crucial part of parenting--not just conversations about drugs and sex, but general conversations. Teens keep secrets, that's part of becoming independent. But parents should try as much as possible to talk about how they spend their days, who they spend them with, what their friends are like, what makes them happy or sad. Because peers hugely influence decisions, and happy, involved teens are less likely to use tobacco or other substances.

Interrogations don't work all that well (I know this from experience, as I can't seem to stop myself from occasional interrogations of my children). But casual conversation might--and teens are more likely to talk if they don't feel judged, and if they feel like they have your love and support overall.

"Little kids, little problems. Big kids, big problems." That saying is so true--and yet so many parents back off from active parenting as their kids get older. Schools, doctors, lawmakers and society at large can help keep teens safe, and they should--but it's supportive, involved, proactive parents that teens really need.

Photo credit: 2008 nerissa's ring, Flickr | CC-BY | via Wylio

Continue Reading Below