In 2017 alone, about 3.6 million U.S. middle and high school students were using tobacco products, and about half of those students were using two or more. Ankoor Shah, M.D., M.P.H., M.B.A., previous medical director of IMPACT DC Asthma Clinic at Children’s National Health System, shares some advice on how to talk to your teen about smoking.

What are some of the dangers of smoking?
The dangers are vast. They can range from having bad breath, stained teeth and a cough, to significantly worsening asthma symptoms. Smoking can also influence the ability to exercise and perform well in sports. The most serious concerns are increasing your risk of developing emphysema and lung cancer.

Is there a difference between smoking e-cigarettes and tobacco cigarettes?
There is no evidence that shows that e-cigarettes are better in any way than regular cigarettes. E-cigarettes still have nicotine in them and can be very addictive. They also have multiple carcinogens and other chemicals that can really harm your body. Nicotine affects your brain development, so it can make it harder for you to concentrate and learn, and can affect your ability to control your emotions. Addiction to nicotine can also make you more susceptible to an addiction to other drugs as well.

What advice do you have for parents about how to talk to their teens about smoking?
Two simple pieces of advice are to create an open communication relationship between you and your teen and follow your parental intuition. Also, look for opportune moments to bring up smoking. For example, if smoking is seen on TV or in a movie, talk about it at that moment. Get your child’s thoughts on smoking and always keep the dialogue open.  We have seen some kids who start to smoke at 11 or 12 years old.

What should parents keep in mind as their child enters middle and high school?
Adolescents are undergoing an incredible amount of change with their bodies, peer groups and their identities. With all of this uncertainty, the most important thing is to have a loving and supportive home environment. It’s a good idea to develop an environment where your teen feels comfortable talking about anything in this sea of changes, including smoking. A couple practical tips are to know who their friends are and who they’re hanging out with, as well as addressing any suspicious or secretive behavior.

What should you do if you catch your teen smoking?
If you catch your teen smoking, the first thing you do is take a deep breath. How you react can shape you and your teen’s communication relationship in the future. It’s important to understand why they’re smoking. Is it stress, peer pressure or something else? Talk to them about alternatives to smoking. If they are stressed, exercise and meditation are better and safer than nicotine. Exercise releases endorphins and can make you feel great.  Meditation and breathing exercises help to calm your mind.

If the reason is peer-pressure, talk to them about self-confidence and defining their own identity. Honestly, handling peer pressure is tough! Maybe help your teen come up with a response so they are prepared when they are offered a cigarette or marijuana. They could respond by saying, “That’s gross!” or stating it would affect their performance in sports. Also, bring in reinforcements. Have your pediatrician and family members talk to your teen about smoking.

Is there a way parents can prevent their teen from smoking?
Be a good role model for your child or teen. For those parents who do not smoke, keep it up! For those that are currently smoking, reach out to your doctor or call 1-800-QUITNOW to begin your journey to quit smoking. Watching a parent go through the process to quit smoking can really resonate with your adolescent. For more information, visit cdc.gov/tobacco.

This blog post originally appeared in Northern Virginia Magazine online.