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Q What approach do you suggest for encouraging young adolescent patients, ages 13 to 16, to stop smoking. Is there anything that actually works?
A When taking a history from a teenager all pediatricians dread hearing an affirmative answer to the question "Do you smoke cigarettes?" Sadly, the smoking epidemic has not relented in recent years. Nicotine is so addictive, and the risks of heart disease, cancer, and lung disease increase with the length of time one smokes. Hence, you can do your patients a real service by helping them to quit.
No good studies have been reported on the efficacy of nicotine replacement therapies, such as nicotine patches, in adolescents, but some programs are incorporating these therapies. Many teen smoking cessation programs offered across the nation include educational sessions about the risks of smoking and provide counseling and group sessions. These programs have been moderately successful. Many of them use a gender-sensitive approach since young men tend to smoke for different reasons than young women do. The young men hope to look "cool" or tough, or to create some other image. Smoking may reflect boredom or rebellion. Young women may be attracted to smoking because it suppresses the appetite, they think a cigarette enhances their desirability to teenage men, or because they feel peer pressure to look like an adult. Many of the smoking cessation programs initially aim to reduce the number of cigarettes smoked each day. Rather than taking a "cold turkey" approach, they work slowly towards the goal of eliminating all cigarette smoking. Like their adult counterparts, many of the teens in these programs have a high recidivism rate; as many as two thirds of them begin smoking again. Giving up smoking is still a goal that is well worth working towards, even if the teenager fails once, twice, or a dozen times.
The well-known teenage propensity to view themselves as invincible and immune to the ravages of cancer makes this worthy pursuit more difficult. You need to use a nonjudgmental manner as you encourage your patient to try to quit and educate parents to do the same. For additional help, call your local chapter of the American Cancer Society (800-TRY-TO-STOP) or the American Lung Association (800-LUNG-USA) to find out about teen-focused smoking cessation programs that are available in your area. Several good Web sites aimed at helping teens to quit smoking may also be useful: smokefreekids.com; quitnet.org; youthtobacco.com; communityintervention.com; dc.gov/tobacco.how2quit.htm.
Q My son Jesse, who has no siblings, is now 4 1/2 years old and has been sharing our bed (sleeps in the middle) since he was about 1 year of age. I must admit I love having him there, but it has a really bad effect on marital intimacy. Sometimes I also become concerned about all the theoretical issues of the Oedipus complex, as it really irritates my son when I show my wife affection and he is not in the "family hug." My son is a wonderful, bright, compassionate child. In preschool he makes lots of friends and is the focus of good attention, though he does need the occasional time-out. I believe Jesse is basically just fine. I do need to know, however, when and how to get him into his own beautiful room. Besides, I miss my wife.
A American pediatric thinking about co-sleeping has shifted in the last generation. The practice used to be regarded as dangerous and unhealthy. Now many, perhaps most, pediatricians support co-sleeping because they recognize that it is practiced throughout the world and has some advantages and few hazards. Many parents want to limit the co-sleeping for the same reason you do: It interferes with marital intimacy. The most common temporary solution to that inconvenience is to avail yourselves of opportunities at other times in different locations.
How do you get Jesse out of your bed? As with other unacceptable habits, you can choose the rapid or gradual approach. In either case, you will want to tell Jesse that now that he is a big boy he should be in his own bed. Using the abrupt method, you would inform him that as of a certain date he will be expected to stay in his own bed in his own room. Having said this, you have to be prepared to enforce the rule. This means calmly and persistently taking him back to his own bed when he tries to slip into yours. The gradual approach presents various possibilities. One method would be to let Jesse go to sleep in your bed and then move him to his own. No matter which approach you choose, the transition won't be easy. Your determination will have to outweigh your sense of loss at no longer having him with you. The sooner you accomplish the plan the better; the longer you wait the harder it will be.
Cuddling between you two and your son does not have to stop when Jesse moves to his own bed. You can cuddle with him in his bed at bedtime and elsewhere during the day. On Sunday morning or other special occasions you can invite him into your bed to enjoy the closeness you used to have there.
Don't worry about the Oedipus complex. That theory is no longer revered as it once was. Besides, Jesse sounds like a normal child.
Morris Green. Behavior: Ask the experts. Contemporary Pediatrics 2001;1:41.