Smoking prevention: behavioral prescriptions for the pediatrician

Pediatricians are important instigators of behavior change for the promotion of nonsmoking. Smoking is harmful to infants, children, and adolescents, and evidence is reviewed that passive smoking can have potent deleterious effects. Interventions with young adolescents based on social-psychologic theory have shown promise in changing smoking behavior and reducing smoking onset rates. Interventions are described, based on epidemiologic and etiologic data, that are appropriate for infants, children, adolescents, and parents. Interventions for parents should encourage cessation and the creation of a smoke-free environment for children. Interventions for children should emphasize the negative health effects of smoking and help them build an armamentarium against factors that promote experimentation with smoking. Interventions for adolescents should encourage them to remain nonsmokers in an environment of social pressure to smoke. The rationale for these strategies and methods of implementation in the pediatrician's office are described.