To improve the learners' understanding of age-appropriate tobacco interventions for teens that address their special needs.
After completing this activity participants will be able to:
Consider the prevalence of tobacco use among teens in planning tobacco prevention and intervention policies in your practice
Consider the health and psychosocial risks that tobacco use poses specifically for young patients in their patient care
Tailor tobacco interventions to teens and address the needs of special patient populations
Use current recommendations on using nicotine replacement and other pharmacological therapies with young patients who are quitting smoking
Despite common use of tobacco by teens (SAMHSA, 2009) the effectiveness of tobacco interventions by health care providers (Fiore et al, 2008), many physicians are not providing teens with tobacco screening and preventive interventions (Alfano, et al, 2002). The US PHS Clinical Practice Guideline recommends tobacco cessation and prevention interventions for teens (Fiore et al, 2008).
Tobacco use is still fairly common; in the United States. Approximately 28.4% of persons aged 12 or older used a tobacco product in the last month in a 2008 survey (NSDUH, 2009). Past month use of tobacco by youths aged 12 to 17 has decreased slightly over the past 6 years but was still at 11.4% in 2008 (NSDUH, 2009). A small but significant number of children are already using tobacco at ages 12 to 13 (2.1% past month cigarette use in 2008). In youths, tobacco use is responsible for significant health effects including more respiratory symptoms and illnesses, poorer lung function, decreased physical fitness, diminished defense against infectious disease, and early cardiovascular disease (USDHHS, 1994). Another important consideration with respect to children is the effect of secondhand smoke on their health; it has been linked to increased respiratory effects including asthma morbidity and increased otitis media, among others (NCI, 1999). Furthermore, early tobacco use is associated with heavier tobacco use later in life and longer potential time to be users (USDHHS, 1994) with all the associated significant morbidity and mortality associated with long term use of tobacco (Surgeon General, 2004).
The effectiveness of tobacco interventions by health care providers was evaluated in a review of the literature by the review panel for the U.S. Public Health Service Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update (Fiore, et al., 2008). The Clinical Practice Guideline (Fiore, et al., 2008), provided evidence-based guidelines for clinicians on how to provide brief and more extensive interventions in tobacco use. A number of studies have found that screening for tobacco use and recommending cessation occurs at the most around 75% of the time and other appropriate tobacco interventions are made by primary care physicians less frequently (Schnoll R et al, 2004; Braun et al, 2004; Jaen et al, 2001; Ellerbeck et al, 2001).
Children and teens initiate smoking most often in grades 6 through 9 (ages 11-15) (Johnston et al., 2004). The US PHS Clinical Guidelines, recommended that health care providers screen all of their child and teen patients as well as their parents for tobacco use and provide a strong message recommending complete abstinence (Fiore, et al, 2008).
Many physicians are not providing teens with tobacco screening and interventions. A survey of over 5000 teens found that fewer than half had been screened or counseled by their physicians regarding tobacco use (Alfano, et al, 2002). Furthermore, despite documented negative health effects of secondhand smoke, parents of teens are rarely asked about their smoking (Key and Marsh, 2004).
Training physicians in evidence-based, brief tobacco interventions in order to assure that all physicians know and are confident to provide teen tobacco interventions will help address this practice gap.