Most adult smokers begin smoking during adolescence. They quickly become addicted and most struggle to quit for decades afterwards. Prevention in the early years can prevent this battle from even starting. Here are 5 strategies that can help:


1. Avoid that first cigarette

Young people vastly underestimate the addictive potential of smoking and think that it takes years to become addicted to smoking. However, research by Professor Joseph DiFranza from Boston has shown that addiction develops surprisingly quickly.


Ten per cent of those who become addicted have already done so within 2 days of inhaling for the first time. Half are addicted by the time they are smoking 7 cigarettes per month. (DiFranza J 2007)


Tell young people how rapidly addiction can occur. Explain how nicotine from even one cigarette can change the brain and create withdrawal symptoms and cravings that can be hard to resist. The only sure way to avoid addiction is to never smoke that first cigarette.


2. Encourage parents and older siblings to quit

Parental smoking is a powerful influence on whether children take up the habit. A teenager is twice as likely to start smoking if one parent smokes at home, especially the mother. (Leonardi-Bee J. 2011) The risk is greater if both parents smoke or if an older sibling smokes.


It also helps to encourage parents to express their disapproval of smoking. Even with parents who smoke, adolescents have a lower risk of smoking if parents express these negative views. (Sasco A 1999)


3. Don’t smoke in pregnancy

Children whose mothers smoke heavily in pregnancy are twice as likely to become addicted to nicotine if they try cigarettes than children of mothers who do not smoke in pregnancy. (Buka S 2003) If the brain of the foetus is exposed to nicotine it becomes more responsive if re-exposed later in life, even if the mother quits after the baby is born.


4. Teach children how to refuse a cigarette

The peer group is even more influential than parents in whether children take up smoking. Teach children how to say no when offered a cigarette, for example, ‘No thanks, I don’t smoke’ or ‘I tried it and didn’t like it’.


Here are some alternative strategies:

1. Use an excuse: “No thanks. It makes my asthma worse”

2. Avoid the situation: avoid places where smokers get together

3. Use humour: “I don’t like the taste of ashtrays”

4. Change the topic: “I’m hungry, let’s go get something to eat”, “It’s getting late, I gotta go”

5. Suggest an alternative: “Hey let’s go and play football”

(Tobacco. The truth is out there! Quit SA 2012)


5. Run a school-based prevention program

A recent review of 134 studies of school-based prevention programs (430,000 children) found that overall they were effective in reducing smoking uptake by about 12%. (Thomas R 2013). Programs led by adults are more effective than peer-led programs.


References available on request.

Adolescent smoking is one of the key themes of the inaugural Australian Smoking Cessation Conference, being held at the University of Sydney from 6-8 November 2013. Professor Joseph DiFranza (, the world’s foremost expert and researcher on adolescent smoking will be conducting a 4-hour workshop and giving presentations, along with other experts in the field. For more information go to



Dr Colin Mendelsohn is a Tobacco Treatment Specialist and Vice-President of the Australian Association of Smoking Cessation Professionals.