A pediatrician friend recently referred one of his former patients to me.
The 21 year old forklift driver was reasonably healthy, but clearly smelled of cigarettes.
I asked him if he was interested in quitting, and asked how long he had been smoking.
"About 10 years"
My math skills aren't that great .. but this one .. I got in a millisecond (!)
Turns out that he grew up as the youngest kid in the development, and learned to smoke from the 16 year-olds.
But the pediatrician never knew. He never asked.
As one who also cares for kids, I know how this goes. We've seen these kids since they were infants. Hard to see them as adults. I think that sometimes our judgement is influenced by what we WANT to hear. "I can't imagine that Johnny would ever smoke .. nah .. not little Johnny … I remember when he was just a little .. " So maybe we don't ask the questions.
A few years ago I was teaching interviewing skills to the third-year medical students. We have a great program with so-called "standardized patients." These folks are actors who have been trained to be "patients" for the medical students. We videotape the interviews, and play them back with the students to give them feedback.
One student was taking a sexual health history from a "patient." It's a hard history to take for many students .. and there are parts of the history that they are often uncomfortable with. "You're not gay are you?" Asked the student .. shaking his head ever-so-slowly as he asked the question. "Of course not" confirmed the patient. oops.
You'll get the answer you're subconsciously looking for if you make mistakes like this. Yet we all do it in some way .. telegraphing our cultural biases. The more aware we are about such biases .. the more prepared we'll be to ask questions in an honest, open manner.
A few ways to ask a teenager if they smoke:
"Do you Smoke?" (Not-so-good: literal teens will say no if they only smoke occasionally)
"Have you tried smoking yet?" (Better .. lets them say yes .. opens door for more detail, but may offend sensitive folk)
"Do you have friends who smoke?" (Easy entry .. follow-up with "how about you .. have you smoked?")
(Don't froget to learn WHAT they're smoking)
And give parents this handout – available in quantity from the CDC for free.