I'd be surprised if any reader isn't aware of the harmful effects of tobacco smoking, especially on adults.

Yet smoking may be thought of as a pediatric disease, since most adult smokers begin smoking before they attain adulthood.

Second-hand smoke represents another harmful effect of smoking. Here, innocent people such as children simply breath in the smoke that is in the environment, which can cause or worsen asthma, and may even lead to sudden infant death syndrome and cancer. Finally, pregnant mothers who smoke may cause severe damage to their fetus.

Getting adolescents to quit smoking is difficult, perhaps as difficult as adults. Unlike adults, many children want to hide their smoking from their parents. Also, parents who smoke give tacit approval to their children to smoke ("If my parent can do it, why can't I?"), so these parents must realize their smoking may be the barrier preventing their child from quitting.

Remember that tobacco smokers may be thought of as having a substance dependency, so quitting smoking has the same potential gains as quitting other drugs, and, as with other drugs, has serious repercussions if efforts fail.

Unfortunately, no single intervention is terribly effective, so the message may have to be delivered several times by several different people and in several forms. The first step to quitting is getting at the truth -- did the child smoke only once or is it a habit? In either case, explain to the child why smoking is harmful. Help the child-smoker pick a day to stop smoking, and then provide continuous reinforcement and encouragement to adhere to that target.

Some schools have peer counselors and group discussions, so if these are available, prod the child to participate in these smoking-cessation sessions.

Peer pressure is a powerful influence. Unfortunately, it may be what gets the child to try smoking in the first place, but it can also be used to have a beneficial effect.

If these strategies don't work (for example, if the smoking has been long-standing and has already caused addiction), it may be worthwhile to try nicotine-replacement therapy. Other medications such as bupropion (Wellbutrin) also may work.

As with other approaches, smoke-cessation medications by themselves are somewhat effective. The will power and desire to stop renders nicotine-replacement therapy much more effective than the medication alone.

Many of us remember the "Just Say No" slogan promulgated in the past to motivate children to stop using drugs. The suggestive tips mentioned above may have a similar low success rate, but for now, the approach mentioned above is probably the best we have to offer.

Even if the message takes root in about 3 percent of the cases (likely a conservative estimate of success), the effort will have paid off in lives saved.

The opinions expressed are solely those of the writer. Robert A. Dershewitz, M.D., Sc.M., FAAP, is a pediatrician at Healthy Kids Care Center in St. John and is affiliated with The Community Hospital in Munster.