Tobacco in Teens: A Case
Goal:

To improve the learners' understanding of age-appropriate tobacco interventions for teens that address their special needs.

: 1 hr

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


Professional Practice Gaps

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.

References
Alfano CM, Zbikowski SM, Robinson LA, Klesges RC, Scarinci IC. Adolescent reports of physician counseling for smoking. Pediatrics. 2002; 109(3): E47.
BSAS. Adolescent Screening, Brief Intervention, and Referral to Treatment for Alcohol and Other Drug Use: Using the CRAFFT Screening Tool. Massachusetts Department of Public Health Bureau of Substance Abuse Service. 2009. Available at: http://www.integration.samhsa.gov/clinical-practice/sbirt/adolescent_screening,_brieft_intervention_and_referral_to_treatment_for_alcohol.pdf Accessed on: 2015-03-11.
Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.
Key JD, Marsh LD. Missed opportunities for prevention: failure to identify smoking in the parents of adolescent patients.. Substance Abuse. 2002; 23(4): 215-221. Available at: http://www.ncbi.nlm.nih.gov/pubmed/12438834 Accessed on: 2015-09-22.
McAfee T, Ludman E, Grothaus L, et al. Physician tobacco advice to preteens in a smoking-prevention randomized trial: steering clear. J Pediatr Psychol. 2005; 30(4): 371-376.
Smoking cessation treatment by primary care physicians: An update and call for training. American Journal of Preventive Medicine. 2006; 31(3): 233-239.
Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses --- United States, 2000--2004. Morbidity and Mortality Weekly Report (MMWR). 2008; 57(45): 1226–1228. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5745a3.htm
Smoking-related attitudes and clinical practices of medical personnel in Minnesota. American Journal of Preventive Medicine. 2004; 27(4): 316-322.
Substance Abuse and Mental Health Services Administration (SAMHSA). Results from the 2008 National Survey on Drug Use and Health: National Findings. Office of Applied Studies, NSDUH Series H-36, DHHS Publication SMA 09-4434 . 2009. Available at: http://archive.samhsa.gov/data/NSDUH/2k8nsduh/2k8Results.htm Accessed on: 2009-09-10.
Tailoring tobacco counseling to the competing demands in the clinical encounter. Journal of Family Practice. 2001; 50(10): .
US Dept of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta, Ga: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Public Health Service, US Dept of Health and Human Services. 1994.
US Dept of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, US Dept of Health and Human Services. 2004. Available at: http://www.cdc.gov/tobacco/data_statistics/sgr/2004/pdfs/executivesummary.pdf Accessed on: 2004-12-17.