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Parent Effects of secondhand smoke on their children and other household members Personal health risks (emphasize those with personal relevance) Higher rates of asthma, colds, pneumonia, and ear infections, even if parents do not smoke in the house Increases rates of heart disease in the long term Children are much more likely to become smokers if their parents smoke, even if parents tell children not to start Heart disease: chance of heart attack is 3 to 6 times higher in smokers Lung cancer: chance of getting lung cancer is up to 30 times higher in smokers Other cancers: smoking increases the risk for at least 10 types of cancer, including kidney, liver, lung, pancreas, stomach, and cervix Other lung disease: smoking increases asthma, bronchitis, pneumonia, chronic cough Other: smoking increases risk for infertility, premature birth, ulcers, osteoporosis, and diabetes

School age (5 to 11 years) Immediate effects of smoking Long-term or less concrete consequences Bad breath and smell Yellow teeth Harder to keep up in sports Even trying smoking just a few times can get your body hooked so that it is harder to stop Cigarettes are expensive. Smokers spend money on cigarettes that they could use for more fun things. Tobacco companys use ads to try to trick you into thinking that smoking is cool and safe Smoking has long-term effects on health, including several types of cancer, and heart attacks It is illegal to buy cigarettes when you are under-age

Adolescent Immediate effects of smoking Long-term health consequences Cosmetic effects (smell, bad breath, yellow teeth, early wrinkles) Reduced endurance and athletic performance More hacking coughs, colds and pneumonias Smoking does not cause weight loss in teens You can get addicted to tobacco after smoking as few as 100 cigarettes Cigarette smoking is expensive. The cost of buying one pack a day for a year could buy a used car (as high as $4300 a year in some states). When you smoke you are being controlled by the tobacco companies' marketing; when you do not smoke you show smart independent thinking Selected long-term health risks listed under "parents" above - Emphasize issues that are common rather than dire - Emphasize issues that are relevant to patient's experience (ie, health problems in a parent or close relative) Alternative forms of tobacco (snuff, e-cigarettes) are no safer than cigarettes Smoking exposes your friends and family to health risks from secondhand smoke This table summarizes the authors' approaches to advising patients about the health risks of smoking in different age groups. Courtesy of Drs. Marianna Sockrider and JB Rosen.