Teen Tobacco Use

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Teen Tobacco UsePrevention and Treatment

• This activity is made possible through a grant
  from the Illinois Department of Public Health,
  Illinois Tobacco-Free Communities Program.

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Learning Objectives

• Define the problem.
• Identify the risk factors.
• Understand readiness for change.
• Develop and implement effective interventions.
• Discuss role in implementing health policies.

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The Scope of the Problem
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An Epidemic Disease

• Two-thirds of 12th graders have tried tobacco.
• Each day more than 6,000 teens smoke their first
  cigarette, and 3,000 teens become daily smokers.
• 4.5 million teens are now tobacco users.
• 30 of 12th graders and 12 of 8th graders
  currently use tobacco products.
• Most adult smokers developed a regular smoking
  habit by the age of 18.

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Short-term Health Effects

• Smoking
• Greater susceptibility to colds and flu
• Increased severity of respiratory infections
• Decreased physical fitness
• Precursors of peripheral artery disease
• Chewing tobacco
• Cracked lips, mouth sores, bleeding gums

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Long-term Health Risks

• Addiction to nicotine
• Increased risk of cancer
• Increased risk for developing
• Cardiovascular disease
• COPD
• Hypertension
• Premature death

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Trends in Current Cigarette Use
__12th Grade __10th Grade __ 8th Grade

Smoked cigarettes within the last 30 days
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Current Cigarette Use
Smoked cigarettes within the last 30 days
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Addiction and Risk
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Addiction via the Brains Reward Center
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Withdrawal Symptoms

• Cravings for nicotine
• Insomnia
• Irritability and anxiety
• Frustration
• Anger
• Depression
• Difficulty concentrating
• Restlessness
• Increased appetite

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Risk Factors

• Association with friends who smoke
• Parents who smoke
• Comorbid psychiatric disorders
• Weight concerns

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Environmental Influences Tobacco Use Seen in
Films
Age (years) ___14-15 ___13 ___12 ___9-11
who Tried Smoking
( of Exposures)
Sargent et al., 2001
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Smoker Characteristics

• Less attachment to parents
• Poor school performance
• Less involvement in extracurricular activities
• More psychological stress

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Cycle of Adolescent Tobacco Use
Secondaryabstinence
Abstinence
Environmentalfactors
Cessation
Experimentaluse
Relapse
Personal and pharmacological factors
Dependentuse
Regularuse
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Stages of Change
Precontemplation
Contemplation
Preparation
Action
Maintenance
Termination
Relapse
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Prevention and Treatment
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Role of Primary Care

• Ask about tobacco use at every visit.
• Overcome barriers to treatment.
• Establish an office system.
• Use established interview tools and treatments.

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Barriers Faced by Physicians

• Lack of comfort
• Lack of training
• Lack of information
• Lack of time

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Establishing an Office System

• Enforce a smoke-free office.
• Remove tobacco ads from magazines.
• Have routines to identify users.
• Name an office tobacco expert.
• Offer treatment to all tobacco users.
• Make educational materials available.
• Get everyone in the office involved.
• Follow-up on quitters.

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Vital Signs Stamp
Vital Signs Blood Pressure
Pulse Temperature Respiration Weight H
eight Tobacco Use ____Current ____Former
____Never ____Mom ____Dad
____Inside ____Outside
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Identifying the Users Confidentiality

• Interview teens separately from parents, and
  guarantee confidentiality.
• Include parents in the interview, and enlist
  support.

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Smoking Assessment Form

• Name ______________________ Date ______________
• Have you ever smoked cigarettes
• or used tobacco (cigars, chew)? Yes No
• 2. Do you currently smoke cigarettes? Yes No
• 3. Do you currently use other tobacco
• products (cigars, chew)? Yes No
• 4. Do any of your close friends smoke cigarettes
• or use tobacco? Yes No
• 5. How often do you smoke?
• Every day 3-5 days/week 1 day/week Less then 1
  day/week

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Smoking Assessment Form

• 6. How interested are you in stopping smoking or
  using tobacco?
• Not at all A little Very
• 7. If you decided to quit smoking or using
  tobacco in the next 2 weeks, do you think you
  would succeed?
• Definitely Maybe I doubt it

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Getting into their HEADS
Home Who lives with you? Education How is
school? Activities What do you do for
fun? Drugs Do you ever use tobacco? Sex
Are you are having a sexual relationship?
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Prevention Strategies

• Counsel parents to quit.
• Encourage parents to discourage tobacco use.
• Adapt the message.
• Reinforce tobacco-avoidance behaviors.

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3-Minute Smoking Facts

• Lack of control when addicted.
• The tobacco industry is manipulating you.
• Tobacco use is expensive.
• Smoking causes yellow teeth and bad breath.
• Cigarettes are bad for your health.
• Most kids do not use tobacco products.
• Cigarettes contain toxic chemicals.

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Common Chemicals

• Acetone
• Ammonia
• Arsenic
• Butane
• Cyanide
• DDT
• Formaldehyde
• Naphthalene
• Tar

If you wouldnt put it on your pizza, why would
you smoke it?
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Tobacco QuitLine
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Tailoring the intervention
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Treatment Strategiesthe 5 As

• Ask
• Advise
• Assist
• Arrange
• Anticipatory Guidance

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Treatment Strategiesthe 5 As

• Ask all patients
• about tobacco use.
• Advise all tobacco users to quit.
• Assist in the development of a
• plan for quitting.

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Quit Date Form

• Tobacco-Use Quit Date Agreement
• I,____________, agree to stop smoking/using
• tobacco on _____________.
• I understand that stopping smoking/using tobacco
  is the single best thing I can do for my health.
  My doctor has strongly encouraged me to quit and
  will assist me with quitting.
• ______________________ ___________________
• Patients Signature Physicians Signature

Adapted from Ammerman, 1998
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Treatment Strategiesthe 5 As

• Arrange follow up and provide support.
• Anticipatory Guidance Discuss obstacles to
  quitting and potential relapse.

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Practical Suggestions

• Remember why you are quitting.
• Chew gum.
• Breath deeply.
• Call a friend.

• Change your. routine
• Exercise.
• Drink water.
• Reward yourself.

Take one day at a time
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Relapse Prevention

• Critical timeframefirst 3 months.
• Encourage continued abstinence.
• Discuss benefits, milestones, problems.
• Unsuccessful attempts
• Reinforce decision to quit.
• Review benefits of quitting.
• Resolve barriers to quitting.

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Pharmacotherapy

• 5 safe, FDA-approved, first-line therapies
• Approximately double the rate of cessation
  compared to placebo.
• All help with symptoms of withdrawal.

Only approved by the FDA for tobacco-use
cessation in patients aged 18 years and older.
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Adverse Effects of Pharmacotherapy
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Pharmacotherapy Research

• Study 1 (n22)
• Nicotine patch for 8 weeks (22 mg/day for 1st 6
  weeks 11 mg/day for rest of study).
• 3 (14) quit by week 8 1 was smoke-free at 3 and
  6 months.1
• Study 2 (n101)
• Nicotine patch for 6 weeks (15 mg/16 hr).
• 11 quit at end of study 6 were smoke-free at 6
  months.2

1 Smith, et al. 1996 2 Hurt, et al. 2000
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Pharmacotherapy Comparison
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Pharmacotherapy Comparison
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Estimated Cost Per Day
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Health Policy
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Tobacco Control Measures

• Purchasing restrictions
• Advertising restrictions
• Increased tobacco excise taxes
• Comprehensive state-wide programs

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Need for Improvement

• Build awareness of health risks.
• Block availability of tobacco products.
• Limit tobacco advertising.
• Increase prices.
• Restrict public smoking.
• Increase funding for state programs.

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Health Policy

• Promote school-based programs.
• In Florida, smoking rates ? by 40.
• Tar Wars program

Winning poster from the Tar Wars 2001 National
Poster Contest, drawn by Leah Norsworthy from
Oklahoma
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Health Policy

• Get involved in community programs.
• Support the Great American Smokeout.
• Join tobacco-control coalitions.

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Health Policy

• Change tobacco-use legislation.
• Minors access to tobacco products
• Environmental tobacco smoke
• Preemptive legislation
• Participate in counter-marketing campaigns.

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Conclusions

• Adolescent tobacco use is prevalent.
• The key risk factor for teen smoking is friends
  who smoke.
• Physicians must ask about tobacco use and assess
  readiness to change.
• Tobacco-treatment intervention by physicians with
  teens is essential.

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Teen Tobacco UsePrevention and Treatment

• is a CME program co-sponsored by the IAFP, FPEN,
  ICAAP, AAP, and IDPH.