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Advise parents to maintain a smoke-free environment. Message should include health risks to parent and child, and importance of parents as role models for child. (Educational and motivational materials available from CEASE website)*

Ask child -- how do you feel when someone is smoking near you, and what you do about it? -- do you think that it is harmful to try smoking and do you think that you will smoke when you are older? -- have you tried smoking, and do you have friends who smoke?

Advise child to stop experimenting, or give praise for remaining a non-smoker and/or making an effort to avoid smoke exposure. Remind child of the negative short-term effects of tobacco use, including smell and decreased athletic performance, and personalized health risks (eg, exacerbation of asthma).

Assess risk factors for initiating smoking or progressing to regular smoking, including level of experimentation, smoking among peers, depressive symptoms, school performance and attendance, and adverse experiences.

Arrange follow up visit within 1 to 2 months for any child who is experimenting with smoking or has concerning risk factors for smoking. Refer as needed for any identified risk factors such as social or learning difficulties, or mental health issues. Adolescents and young adults

Arrange follow up visit within 1 month for any teen who is smoking, to support quit attempt or assess motivation and barriers to quitting. Δ Refer as needed for any identified risk factors such as social or learning difficulties, or mental health issues. * CEASE (clinical effort against secondhand smoke exposure). Available at: www2.massgeneral.org/ceasetobacco/index.htm. • See topic review, "Management of smoking cessation in adults". Δ See topic review, "Management of smoking cessation in adolescents". Guidance based on Klein JD, Camenga DR. Pediatrics in review 2004; 25:17.