Q: My son is a normal, active teen-ager. In fact, he takes great pride in being physically fit. He has been in karate for six years and exercises five to six times per week. My big problem is that he smokes. Even though I point out how unhealthy it is, he just replies that he is healthier than all of his other friends. Any ideas how I can get him to stop?
A: We agree that your son should stop smoking promptly, although the decision is ultimately up to him. Many experts in smoking cessation believe that smokers must reach a certain point before they are receptive to stop-smoking messages; your son may not yet be at that point.
If you feel your son is open to information that my help him change his mind, you may wish to point out that, even though he is in better shape than his friends, his smoking prevents him from being in the best shape he can be. Within a few months of quitting, his lung and heart capacity will show measurable signs of improvement. That extra second of quickness or period of endurance may enable him to reach the next plateau of personal best. It may be difference between finishing first or second in a tournament. You may also want to point out that karate emphasizes control and a body free of drugs. If he's smoking, he's not living up to his karate credo.
If health-related reasons won't work, have you tried appealing to his other interests? Assuming that cigarettes cost $1.50 to $2 per pack, a one-pack-a-day smoker spends approximately $550- $700 per year on cigarettes. That amount of money would buy him a nice stereo, a lot of new clothes or a new bicycle. Does he find any of his friends or potential dates avoiding him because his breath and clothing reek of cigarette smoke? If he ruins an article of clothing (his or yours) because of smoking, it should be his responsibility to replace it.
You haven't mentioned if you or anyone else in the family smokes. Teen-agers are masters at pointing out what they see as hypocrisy on the part of adults. If there is an adult smoker in the house, we suggest a deal: everyone stops smoking at the same time.
Alternatively, even if your son doesn't want to give up smoking, his habit should not be allowed to interfere with the health of others in the house, particularly young children. Studies have consistently shown that second-hand smoke adversely affects the lung function of children.
Therefore, he shouldn't be allowed to smoke anywhere in the house, not even in his room or the basement. Smoke from those places will find its way to other areas of the house. He also shouldn't smoke in the car. Putting these limits on him may be enough of an incentive to quit.
Perhaps one of these approaches may work. The longer he continues to smoke, the more difficult it will be for him to stop. If he abides by your no smoking rules but chooses to continue smoking outside the house, there is little else that you can do. In the end, only you can decide if you feel strongly enough about the issue to invoke further sanctions (no use of the car) or offer him an incentive to quit (a new pair of sneakers).
Dr. Wilson is director of general pediatrics at Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.