Prevention of tobacco use during childhood and adolescence. Five steps to prevent the onset of smoking

A Lifespan Developmental-Stage Approach to Tobacco and Other Drug Abuse Prevention

At least by informal design, tobacco and other drug abuse prevention programs are tailored to human developmental stage. However, few papers have been written to examine how programming has been formulated as a function of developmental stage throughout the lifespan. In this paper, I briefly define lifespan development, how it pertains to etiology of tobacco and other drug use, and how prevention programming might be constructed by five developmental stages: (a) young child, (b) older child, (c) young teen, (d) older teen, and (e) adult (emerging, young-to-middle and older adult substages). A search of the literature on tobacco and other drug abuse prevention by developmental stage was conducted, and multiple examples of programs are provided for each stage. A total of 34 programs are described as examples of each stage (five-young children, 12-older children, eight-young teens, four-older teens, and five-adults). Implications for future program development research are stated. In particular, I suggest that programming continue to be developed for all stages in the lifespan, as opposed to focusing on a single stage and that developmentally appropriate features continues to be pursued to maximize program impact.

Smoking rates and the state of smoking interventions for children and adolescents with chronic illness

Engaging in smoking is particularly risky for children and adolescents with chronic illness whose health status is already compromised because of disease- and treatment-related complications. Yet, some of these youngsters smoke at rates at least comparable to those of their healthy peers. To date, few randomized smoking-prevention and cessation trials have been conducted in children with chronic medical problems. In this review we report on the smoking rates among youngsters with chronic illness, identify specific disease- and treatment-related complications that can be exacerbated by smoking, examine risk factors associated with tobacco use among medically compromised youngsters, and review smoking interventions that have been conducted to date with pediatric populations in the health care setting. The following chronic illnesses are included in this review: asthma, cystic fibrosis, cancer, sickle cell disease, juvenile-onset diabetes, and juvenile rheumatoid arthritis. Objectives for a tobacco-control agenda and recommendations for future tobacco studies in chronically ill pediatric populations are provided. Finally, tobacco counseling strategies are suggested for clinicians who treat these youngsters in their practices.

Association of adolescent cigar use with other high-risk behaviors

OBJECTIVES

To describe the association of cigar use with use of cigarettes, smokeless tobacco, and alcohol among adolescents; and to examine the association of self-esteem, physical activity, and use of tobacco promotional items with cigar use.

METHODS

A cross-sectional study of 7104 girls and 5499 boys 10 to 15 years of age in 1997. Data were collected from self-report questionnaires.

RESULTS

The prevalence of cigar use increased with age among both girls and boys. Among 11-year-olds, only 1% of girls and 3% of boys had used a cigar, whereas among 15-year-olds, 11% of girls and 25% of boys had used a cigar. Cigar users were much more likely than nonusers to have experimented with cigarettes (girls, odds ratio [OR]: 23.6; 95% confidence interval [CI]: 17.2-32.3; boys, OR: 21.3; 95% CI: 17.1-26.6), smokeless tobacco (girls, OR: 7.5; 95% CI: 4. 5-12.4; boys, OR: 13.0; 95% CI: 9.8-17.4), and alcohol (girls, OR: 6. 6; 95% CI: 4.8-9.1; boys, OR: 6.8; 95% CI: 5.3-8.8). There was a strong association between cigar use and binge drinking, especially among boys (girls, OR: 11.6; 95% CI: 7.9-16.9; boys, OR: 34.8; 95% CI: 19.4-62.3). Cigar users reported more hours of weekly physical activity than did nonusers. Additionally, cigar users were more likely to report high social self-esteem and to possess a tobacco promotional item.

CONCLUSIONS

Adolescents who use cigars are more likely to use other tobacco products and alcohol, to report high social self-esteem, and to possess tobacco promotional items. Health care professionals and teachers should include cigar use in discussions with adolescents addressing substance use.

Diagnosis and treatment of teen drug use

Small but significant decreases in adolescent abuse of tobacco, alcohol, and marijuana in recent national surveys allow clinicians to feel some optimism about defeating the specter of substance abuse. It appears that changing the perception of risk and increasing adolescent disapproval of substance abuse are key goals. For every adolescent, reducing risk factors while identifying and enhancing protective factors optimizes an individual's opportunity to avoid potentially harmful behaviors. While focusing energy and commitment on each adolescent, however, clinicians cannot ignore the need for wider social change because the proximal adolescent domains of individual, family, and school factors are interrelated and embedded in the community and societal contexts. Every sector in society plays a crucial role in preventing adolescents from experimenting with and continuing to abuse tobacco, alcohol, or illicit drugs, from parents, physicians, educators, and policy makers to every adult invested in the health and well-being of adolescents.

Tobacco cessation and youth: the feasibility of brief office interventions for adolescents

BACKGROUND

The prevalence of tobacco use among adolescents remains high and the great majority of adult smokers begin smoking prior to the age of 18. While there have been a number of primary prevention projects in communities and schools, less attention has been given to smoking cessation for adolescents. This paper reviews the literature on the theory and practice of cessation as applicable to adolescents.

METHODS

The relevant literature was culled from a MEDLINE search and supplemented with secondary searches from those articles.

RESULTS

There have been few studies on brief interventions for adolescent smoking cessation in health care settings. However, there are several models for smoking cessation that are either applicable to or designed for adolescents. Pharmacologic treatments are also beginning to be used.

CONCLUSIONS

There is a great need for the development and evaluation of models for adolescent smoking cessation in health care settings. Recent developments, however, give cause for optimism in helping adolescent smokers in tobacco cessation.

A secondary analysis of smoking among rural and urban youth using the MTF data set

This paper compares rural and urban youth cigarette-smoking behavior using the Monitoring the Future data set, a national, probability-based, multi-stage sample design. Cigarette smoking was examined by region, race, and gender over time. Results indicated that rural White males smoked more often (30-day prevalence of 34%) than any other group. Urban Black males smoked the least (10%). Urban White females smoked more (30-day prevalence of 33%) than urban Black females (7%). In general, rural and urban Whites reported smoking at significantly higher rates than rural and urban Blacks. Smoking rates declined steadily for both rural and urban Black females and urban Black males over the study period. These data document distinctive patterns of tobacco use among the nation's youth, which can be used by program planners for specific targeted interventions.

Promotion of cardiovascular health in children by nurse practitioners and physicians in family practice

The purpose of this study was to describe cardiovascular (CV) health promotion practices of nurse practitioners (NPs) and physicians (MDs). Clinical practice was described for three age groups of children both with and without parental premature heart disease. Differences in clinical practice by type of provider and by age and risk level of the child were examined. A 42-question survey was mailed to all family NPs in North Carolina and to MDs randomly selected from the roster of the North Carolina Academy of Family Physicians; 94 responded. A high level of blood pressure measurement for all children and counseling regarding smoking for 13 to 19 year olds was found among all participants. Fewer health promotion activities were reported for other risk factors for the oldest group and for the younger children in general. Health promotion practices increased with the age of the child. Nurse practitioners had significantly higher total CV health promotion scores than did MDs, regardless of the age or risk level of the child. An increase in counseling about prudent diet and increased physical activity is needed for all children, regardless of risk level. In addition, there should be an increase in CV health promotion activities with younger children.