Youth (Children and Adolescents) ► Background
Youth have their own social network of individuals whom they trust and who exert influence over them. Healthcare practitioners may or may not be part of these networks. Cooperative efforts to provide non-smoking messages between adults other than healthcare practitioners might increase effectiveness. Community mobilization in tobacco use prevention provides a model for shared efforts between parties.
Tobacco use habits among youth evolve during adolescence and the timing and trajectory of smoking and addiction differ between youth depending on factors such as access to tobacco, genetic predisposition, family and peer influence etc. There are no guidelines as to what constitutes “smoking” in youth so consensus is needed as to when a youth is considered to be a smoker (the recommendation is that first puff be viewed as a risk factor for continued smoking).
There is as yet, no widely accepted, standardized youth-specific definition of nicotine dependence for use by clinicians. Similarly there are no validated screening tools, which would help practitioners identify when a youth is dependent. What is needed is a tool that helps clinicians identify youth at risk of sustained smoking and nicotine dependence before these outcomes are established (i.e., before it is too late), since successful intervention among dependent youth is challenging. Research is needed to better understand what clinicians should ask about in identifying youth at risk for sustained smoking. Work is ongoing to develop a prognostic tool for identifying adolescents at risk of becoming daily smokers, who may benefit from counselling aimed at preventing sustained smoking1.
Regarding the effectiveness of treatments for youth, more research needs to be done. There are few RCTs testing cessation interventions for youth. Among 16 trials reviewed recently2, 3 school-based programs and one in a clinic setting provided evidence of effectiveness. An intervention that combined NRT and behavioural counselling also showed promise.
There is little evidence to date on whether or not to recommend NRT to youth and this issue requires further research. As indicated in the UK and New Zealand guidelines, however, measures for treating smoking cessation in adults may be suitable for youth.
1. Karp I, Paradis G, Lambert M, Dugas E, O'Loughlin J. A prognostic tool to identify adolescents at high risk of becoming daily smokers. BMC Pediatr. 2011 Aug 11;11:70
2. Gervais A, O'Loughlin J, Dugas E, Eisenberg MJ, Wellman RJ, DiFranza JR: “A systematic review of randomized controlled trials of youth smoking cessation interventions”. Drogues, santé et société 2007, 6 (Supplement II): ii1-ii26
Youth (Children and Adolescents)