The Earliest Age of Exposure to Smoking
What is the earliest age at which children are exposed to smoking? The answer is day one of life. Newborns are exposed due to parental smoking habits, whether from the father, mother, or both, despite having a newborn, a child, or multiple children in the household.
Despite widespread knowledge of the dangers of smoking, many still remain ignorant. Some parents even go as far as handing a cigarette directly to a child and feeling proud of it. Others smoke in enclosed spaces in the presence of their loved ones, exposing them to harmful toxins.
A majority of young people learn—or more accurately, become victims—of smoking due to parental influence. They become third-hand, second-hand, or even active smokers due to direct exposure from their parents, as shown in previous slides. Reports indicate that acute nicotine intoxication has been documented in preschool children as young as two years old. The most common age group affected by this alarming trend is 13 to 17 years old, during the third phase of development, when peer influence, media exposure, easy accessibility, and aggressive marketing by e-cigarette companies play a major role. Over 90% of these individuals become smokers before reaching adulthood. Many start as social smokers before the age of 14—meaning during primary school years.
Why Does This Happen?
We cannot solely blame e-cigarette marketing strategies. Instead, we must examine the root cause—the home environment and family dynamics. Parents serve as the first teachers, and home is where education should begin. A father’s smoking habit is often the strongest influence leading a child to imitate the behavior. Additionally, low socioeconomic status is associated with inadequate supervision, limited health literacy, and poor parental values in preventing smoking exposure. Some parents irresponsibly allow nicotine exposure due to a lack of education and, more importantly, poor religious and spiritual understanding.
Other contributing factors include family conflicts, internal struggles faced by growing adolescents, and peer pressure. The availability of e-cigarettes, attractive packaging, curiosity, and the desire for independence further fuel this issue. Some parents, due to ignorance, even give implicit permission for their children to smoke.
Challenges in Engaging Youth in Smoking Cessation
One of the biggest challenges in smoking cessation programs for youth is gaining their trust. Adolescents are often resistant to authority, selective in sharing their thoughts, and hesitant to seek help. They value autonomy more than adults do and tend to trust their peers over adults. They also worry about confidentiality, fearing their secrets will be exposed to their parents.
Despite having access to information, many lack health literacy and fail to grasp the long-term consequences of smoking. Additionally, they see smoking as socially acceptable, so they question why they should be treated differently.
How Do We Address These Challenges?
- Be Diplomatic and Respectful – Adolescents need to feel respected and understood without judgment. Use simple language, an empathetic tone, and visual aids like diagrams and posters.
- Focus on Less Commonly Discussed Health Effects – Instead of emphasizing cardiovascular effects, highlight impacts on the brain and cognitive function.
- Educate Parents First – When parents change, children often follow. Parents must be made aware of their influence and take responsibility for reducing smoking exposure.
- Provide Alternative Coping Strategies – Many youths turn to smoking as a way to cope with stress. Encourage participation in sports, community engagement, or other positive outlets to help them channel their emotions constructively.
- Meet Adolescents Where They Are – Do not rush them to quit immediately. Be patient, and support them at their own pace.
- Leverage Technology and Peer Support – Share success stories from young adults who have quit smoking through YouTube channels or other platforms.
- Use Pharmacotherapy When Necessary – For older adolescents with nicotine addiction, medication may be considered in selected cases.
- Ask About Smoking Status Diplomatically – Even though adolescents tend to be defensive, studies show that most will admit to smoking if asked in a non-judgmental way.
The Role of Religion and Spirituality
Imam Al-Ghazali emphasized that our greatest enemy is our own desires (nafs). To control harmful habits like smoking, we must:
- Restrain Exposure to the Source – This means no smoking at home, restricted access in stores and public places, and banning cigarette advertisements.
- Increase Acts of Worship and Community Engagement – Engaging in meaningful activities with the intention of personal growth can serve as an alternative to smoking.
- Strengthen Spiritual Connection – A solid spiritual foundation helps individuals resist temptations and develop self-discipline.
Conclusion
When counseling youth, we should provide concise, meaningful information using simple language. Allow them to take the lead in the quitting process rather than forcing them to stop immediately. Offer encouragement and rewards.
As parents, we must set the example by changing our own behaviors first. Only then can we expect our children to follow.
This article was written by Dr Shaiful Ehsan, a Family Medicine Specialist at Kulliyyah of Medicine, International Islamic University Malaysia.
References
- Institute for Public Health (IPH). The National Health and Morbidity Survey: Malaysia Global School-Based Student Health Survey 2012. (Tahir A, Noor Ani A, Yaw SL, Nurrul Ashikin A, eds.). Kuala Lumpur: Ministry of Health Malaysia; 2012.
- Ford et al (2004). Confidential health care for adolescents: position paper of the Society for Adolescent Medicine. Journal of Adolescent Health.
- Ambresin et al (2013). Assessment of youth-friendly health care: a systematic review of indicators drawn from young people’s perspectives. J Adolesc Health.
- Massey et al (2012). Contextualizing an expanded definition of health literacy among adolescents in the health care setting. Health Educ Res.
- Somerville et al (2013). The medial prefrontal cortex and the emergence of self-conscious emotion in adolescence. Psychol Sci.
- Laursen et al (2021). Toward understanding the functions of peer influence: A summary and synthesis of recent empirical research. J Res Adolesc
- Al-Ghazali, Ihya’ Ulum al-Din, Jilid 4, Bab “Asrar al-Saum
- Farid, A. (2000). The Revival of the Religious Sciences (Ihya’ Ulum al-Din), Transl. Islamic Texts Society