Youth (Children and Adolescents) ► Clinical Considerations
The following clinical considerations are included in CAN-ADAPTT's guideline and have been approved by the Guideline Development Group (GDG).
Youth, unlike adults who are usually established in their pattern of tobacco use, are more likely to be in the process of acquiring the smoking habit with its concomitant nicotine dependence. In addition to not beginning to smoke, prevention of transition from intermittent to regular smoking may be key in helping youth stop smoking. The following recommendations are relevant to inquiry about youth smoking.
· Ask questions to ascertain use of tobacco products in multiple ways; use language and terminology that youth are familiar with.
· Be aware of the natural history of tobacco use onset since there are important milestones from “first puff “ to nicotine dependence that may signal transition to regular or daily smoking. Smoking onset trajectories should be closely monitored, since intermittent smoking can quickly become regular smoking. Ask, for example about “puffing” or “trying” in addition to regular or daily use (which indicate sustained smoking).
· Use direct inquiry or a validated prognostic or screening tool to identify those at high risk of sustained smoking. Identify those with additional health risks (eg. Asthma).
· Any child or adolescent who consumes tobacco products should be advised to stop. The effectiveness of the 5 As has not been established in youth. However, asking and advising “are generally considered to be the entry points for providing effective individual intervention”1.
Types of Smoking Cessation Treatments
· Community-based (i.e., non-clinical) tobacco control programs for youth may be an important resource for referral purposes.
· There are few studies that evaluate if brief counselling by health professionals is effective in youth.
· Motivational interviewing techniques can be adapted for youth1.
· To date, there is little empirical evidence that either NRT2 or bupropion SR use1 are effective in young smokers. However they have been shown to be safe.
· The New Zealand guidelines recommend interventions for youth that are effective in adults (i.e., interventions that incorporate multi-session support)2.
To date, there is little empirical evidence that advising parents about the potential harmful effects of their smoking or of secondhand smoke on their child(ren), is effective. However, counselling parents in pediatric settings or “…during child hospitalizations may increase parents’ interest in stopping smoking, parents’ quit attempts and parents’ quit rates…”1.
1. U.S. Department of Health and Human Services Public Health Service. (2008, May). Clinical practice guideline: Treating tobacco use and dependence: 2008 update.
2. Ministry of Health. (2007, August). New Zealand smoking cessation guidelines. Wellington: Ministry of Health.
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Note that these clinical considerations were developed by the Guideline Development Group (GDG) and then edited or added to by CAN-ADAPTT network members.
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