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The issue of young people smoking is an important one because it can affect the health of an entire society as those young smokers grow older and continue in the habit. People would not have to go through the difficult process of stopping smoking if they had never started in the first place. For many people, their first puff on a cigarette happens during their teenage years and this forms the basis for their addiction to nicotine. What may start innocently enough as one forbidden cigarette in an effort to be "cool" can actually develop into a serious life-threatening habit. While not all of them will go on to become dependent on cigarettes, the numbers who do so are significant enough to warrant concerted efforts to educate young people to the dangers of smoking. And yet many young people all ready know the risks involved and decide to smoke anyway. Despite all of the information now available on how harmful smoking is to the health of young people, the smoking rates among teenage girls is actually on the increase in some countries. This article examines teenage girls as a microcosm of this wider phenomenon and examines some of the reasons and rationalisations given for girls to begin smoking during their teenage years. A study involving approximately 3,000 teenage girls in Britain and Canada aged between 11 and 18 years shows how smoking feeds on the insecurities of young girls. About 20% of the sample surveyed in the study smoked, with the habit most prevalent amongst girls aged 15 and 16 years. Published in the Post Graduate Medical Journal, the report showed that those who smoked cigarettes were 30% more likely to be overweight and prone to over-eating. Interestingly enough, it is these girls that tend to be the most image-conscious, being twice as likely as their peers to worry about their body shape. Although most of the girls stated that they smoked to help them relax, many of them specifically mentioned weight control as the primary reason that they started smoking. About a quarter of the girls said that smoking reduced their appetite and felt that it worked as a substitute for eating. The majority of girl smokers wanted to be considerably thinner than they currently were and associated with this attitude was the increased risk of developing an eating disorder. Over 30% of the girls surveyed were afraid that they would eat more and put on weight if they stopped smoking and considered this a significant disincentive to quit. The disturbing message contained in a report like this is that so many teenage girls were experiencing angst at what they considered their unsatisfactory body image. This may not be surprising when you take into account that they are constantly bombarded by the unrealistic images of perfection in advertising and the media in general. What is more distressing is the seemingly conscious decision that they are better to smoke and keep off a few kilograms or pounds of weight at the cost of doing serious long-term damage to their health. This may be why this group appears so resistant to the antismoking message. Girls were three times more likely to take up smoking after they started having their periods. Part of the explanation for this is that they mistakenly perceived that the changes which were taking place with their bodies were signs of "fatness". In fact, some of the British girls that took part in the survey claimed that they had lost a stone or more since puberty. Interestingly, although the girls who did smoke were considered moderately overweight, those girls who were classified as very obese were less likely to smoke, perhaps because they were less concerned about their weight or had abandoned efforts to control it. Smoking does burn up some calories and may serve to suppress appetite but the long-term cost of these changes is far too great. Exercise will also burn up calories and you will feel better for it. You are less likely to exercise if you smoke and you start to cough whenever you try to exert yourself. The lack of physical fitness that often accompanies the smoking habit would seem to be less than helpful in one's efforts to create a positive self-image. While older women who smoke may on average be thinner they are also much more likely to have lung cancer and die prematurely. Weight is only ever one part of the image equation and while these girls are young they do not appreciate that smoking can cause other long-term cosmetic changes such as premature aging or increased wrinkling and greying of the skin. They do not consider that they will have to give up smoking later on in life if they want to have a baby. Risking one's own health is one thing but the health of their family should take precedence over any selfish concerns they have about their weight. They may think that they can quit at any time without appreciating that, for both physiological and sociological reasons, women generally find it harder to give up smoking than men. They may also not know that, on average, women are more at risk from smoking related diseases than men. Other factors, such as peer pressure and the desire to "fit in" obviously have a role to play in a teenage girl's decision to smoke, as does their level of emotional wellbeing. Smoking may be seen as a glamorous or dangerous thing to do which is linked to the image that a particular individual wishes to portray. It is interesting, for example, that of the girls surveyed, those who drank alcohol were about seven times more likely to smoke as those who did not. What this study shows is that the teenage girls concern about their weight may be a crucial factor in their decision to start smoking. Paradoxically, it also seems to be an important factor in their decision to continue smoking because they fear that they will put on even more weight if they stop. The problem of alleviating the concerns of young females regarding their body image is a very broad one that needs to be addressed by society as a whole. What we can do is emphasise to teenage girls the dangers of smoking are serious and that it is not worth sacrificing their health for the sake of a few pounds.