Tobacco use among adolescents. Strategies for prevention

Fatores de risco para uso do tabaco em adolescentes de duas escolas do município de Santo André, São Paulo

OBJETIVO: Avaliar fatores de risco para uso de tabaco em estudantes de duas escolas do ensino médio do município de Santo André (SP) em 2005, bem como traçar o perfil do adolescente experimentador do fumo. MÉTODOS: Estudo transversal, com questionário padronizado, autoaplicável e anônimo aplicado a adolescentes escolares de ambos os sexos, matriculados no primeiro ano do ensino médio de duas escolas de Santo André, uma particular e outra pública. Foram levantadas as seguintes variáveis: idade, sexo, raça, prática de esportes, religião e hábitos do adolescente e da família. Definiu-se como "experimentador do fumo" o adolescente que experimentou cigarro (tabaco) e não continuou o hábito tabagista. Foi feita a análise descritiva com o teste do qui-quadrado e os fatores de risco para "experimentar fumo" foram analisados por regressão logística. RESULTADOS: Dos 232 questionários aplicados, 226 (90%) foram respondidos, sendo 137 (61%) na escola particular e 89 (39%) na estadual. Dentre os entrevistados, 54 (24%) referiram já ter experimentado tabaco uma vez na vida (35 na escola privada e 19 na pública). Foram fatores de risco significativos para experimentar fumo na escola particular: mãe fumante (OR 12,4; IC95% 4,1-37,8) e amigos fumantes (OR 9,6; IC95% 3,1-29,9). Na escola pública, os fatores de risco para a mesma variável foram: consumo de bebida alcoólica (OR 8,8; IC95% 1,9-40,1), amigos fumantes, (OR 7,9; IC95% 1,9-31,3) e contato com fumaça do cigarro (OR 6,4; IC95% 1,6-26,2). CONCLUSÕES: Observou-se influência significativa do meio ambiente do adolescente, inclusive social e familiar, para a experimentação do tabaco.

Adherence to National Asthma Education and Prevention Program's "How Asthma-Friendly Is Your School?" recommendations

School health policies and programs provide the framework for a safe and supportive environment for students with asthma. School Health Policies and Programs Study 2006 data were examined to assess whether schools nationwide have policies and programs consistent with the "How Asthma-Friendly Is Your School?" checklist from the National Asthma Education and Prevention Program. Adherence to some of the recommendations on the checklist was high. For example, 80% or more of schools allowed students to carry and self-administer asthma medications, and obtained and kept asthma action plans. For other recommendations, however, far fewer schools had the recommended polices or programs; most notably, less than one third of schools had a full-time Registered Nurse. Improvements in many school policies and programs are needed so that students have a safe and supportive school environment to help them control their asthma while away from home.

Adolescents and tobacco use: systematic review of qualitative research methodologies and partial synthesis of findings

After a brief overview of adolescent tobacco control, methodological features and content areas of 78 qualitative studies of adolescent smoking published in English prior to September 2002 were assessed. Narrative syntheses of three content areas - peer influences, access/sales issues, and dependence/addiction - were also undertaken. Many studies failed to provide sufficient sampling and subject characterization details and more effort was required to demonstrate data validity and reliability. Syntheses of the content areas revealed important common themes. Relationships to quantitative research were informative and suggested other research questions. The review highlights the heuristic value of qualitative research on adolescent smoking. Funding was provided by The Cancer Council New South Wales and NSW Health/Hunter Medical Research Institute.

The state of office-based interventions for youth tobacco use

Tobacco use is a serious pediatric health issue as dependence begins during childhood or adolescence in the majority of tobacco users. Primary care settings provide tremendous opportunities for delivering tobacco treatment to young tobacco users. Although evidence-based practice guidelines for treating nicotine dependence in youths are not yet available, professional organizations and the current clinical practice guideline for adults provide recommendations based on expert opinion. This article reports on the current tobacco treatment practices of pediatric and family practice clinicians, discusses similarities and differences between adolescent and adult tobacco use, summarizes research efforts to date and current cutting-edge research that may ultimately help to inform and guide clinicians, and presents existing recommendations regarding treating tobacco use in youths. Finally, recommendations are made for the primary care clinician, professional organizations, and health care systems and policies. Pediatricians and other clinicians can and should play an important role in treating tobacco dependence in youths.

Mitochondrial volume densities in the smokeless tobacco-treated hamster cheek pouch epithelium

OBJECTIVES

To compare the morphological changes and quantitative distribution of mitochondria in the hamster cheek pouch (HCP) epithelium treated with smokeless tobacco (ST).

MATERIALS AND METHODS

Archives of experimental material from previously published studies (Ashrafi et al., 1992) were utilized. Animals in experimental group received moist ST (snuff) in their right pouch, 5 days weekly for 24 months, while no snuff was given to control group. After 24 months, the epithelial tissues were processed for electron microscopy study. Volume densities of mitochondria were assessed by morphometry.

MAIN OUTCOME MEASURES

Mitochondrial volume densities in the two groups, experimental vs control.

RESULTS

In both control and experimental groups mitochondria were concentrated between the nucleus and basal cell plasma membrane. A decrease in the mean mitochondrial volume density (Vvmit) was observed from the basal layer to the more superficial layers in both groups. The experimental HCP displayed more mitochondria than control, and the granular epithelial cell layer in experimental group showed significantly a higher mean Vvmit than the control group (P = 0.03). It was concluded that greater numbers of mitochondria were retained in ST-treated granular cells of the hyperplastic epithelia than in the normal epithelium.

Smoking and children

Tobacco use by children and adolescents is a major health threat. A number of carcinogens and other harmful compounds have been identified in tobacco smoke. The major component, nicotine, is highly addictive. In India, approximately 5500 children and adolescents start using tobacco products daily, some as young as 10 years old. The majority of users have first tried tobacco prior to age 18. Children and adolescents are exposed to the harmful effects of nicotine from smoking or second hand smoke from others; and from use of smokeless tobacco. There is increased prevalence of respiratory disease, ear and sinus infections, asthma, oral disease, and many long-term complications such as cardiovascular disease and cancers due to tobacco use. Prevention and treatment strategies include behavioural approaches and pharmacotherapy. There is an increased urgency especially, for countries like India to address the problem of tobacco use by children and adolescents as the tobacco industry faces legal and public opinion obstacles in Western countries like United States. The medical practitioner can play an important role by implementing the preventive and treatment strategies in his or her practice.

Factors influencing implementation of the legislated smoking ban on school property in Ontario

BACKGROUND

Implementation of legislation in Ontario, Canada, that banned smoking on school property gave rise to perceptions of problems in some schools. A telephone survey was conducted to assess these problems. This analysis identifies risk or protective factors in the school environment associated with administrators' reports of problems.

METHODS

Survey data were obtained from key informants in 213 high schools. Multiple logistic regression was used to identify school-related characteristics associated with: (1) major problems in implementing the ban and (2) recommendations that schools return to designated smoking areas.

RESULTS

A protective factor against both outcomes was having a school no-smoking policy prior to the ban. Also protective against major problems was a perceived decrease in student smoking during the school day. The identification of safety risks to students who leave school property to smoke was a strong risk factor for both outcomes. Beliefs that the ban was not effective and opposition to it from teachers/staff were associated with desires for its repeal.

CONCLUSIONS

In implementing legislated school smoking bans, attention should be given to informing teachers and gaining their support. Strategies for dealing with potential safety risks to students who leave school property to smoke should also be devised.

The Ontario ban on smoking on school property: perceived impact on smoking

We evaluated the impact of the November 1994 ban on smoking on school property in Ontario. Telephone interviews were conducted at the end of the 1995-96 school year with 213 high school administrators. Almost all high schools (96%) prohibit smoking on school property. Although some smoking still occurs on school property, the location of smoking by students has changed, giving rise to perceptions of both benefits and risks, as well as varying complaints from parents, students, neighbours, and nearby businesses. Most of the problems arising from the ban are viewed as minor. Local conditions, particularly the geographic environment of the school, appear to be important determinants of complaints and problems. While sizeable minorities of school administrators felt the ban had favourable effects, the majority perceived little effect on either smoking behaviour or attitudes towards smoking.

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.

Women and smoking: an update for the 1990s

Cigarette smoking is associated with many health hazards, ranging from lung cancer to low infant birth weight. In the United States in 1994, 23.1% of all women and 14.6% of pregnant women smoked. Few physicians ask their patients about smoking, although minimal effort by physicians could help many smokers to quit. This article summarizes the current data on smoking prevalence, reviews quitting techniques, covers topics of particular interest to physicians caring for women, and suggests ways in which physicians may become more active in preventing smoking among teens.