Module: Tobacco and Adolescents TOBACCO PREVENTION AND CESSATION FOR ADOLESCENTS Mini Lecture 5 Module: Tobacco and Adolescents

Objectives of the Mini Lecture GOAL OF MINI LECTURE: Provide students with knowledge about effective prevention and cessation strategies. LEARNING OBJECTIVES Students will be able to: Identify effective school-based prevention strategies and understand the role of parents in prevention. Understand how doctors can facilitate cessation among youth.

Contents Core Slides Effective Prevention in Schools School-based Prevention Parental Role in Youth Prevention and Cessation Strategies for Smoking Prevention Cessation among Adolescents Ways to Engage Youth to Quit Smoking Doctor’s Role in Youth Cessation

CORE SLIDES Tobacco Prevention and Cessation for Adolescents Mini Lecture 5 Module: Tobacco and Adolescents

Effective Prevention in Schools Implementing school-based tobacco prevention programs to educate young people about the harm of tobacco Developing and enforcing no smoking rules in schools and on college campuses Popularizing a smoke free norm where non-smoking is admired and seen as desirable by popular groups Involving young women in expressing dislike of smoking to young men, where such is the case Notes: School based prevention activities are important because they provide important information to students about the harmful effects of tobacco. In addition to education, it is also important to develop a non smoking norm on campuses and to prohibit the sale of tobacco near schools.

School-based Prevention It is easier to educate youth while they are still in school. Schools provide access to youth and are already an arena for teaching. Studies in the West show that 70% of youth who smoke want to quit and over 50% have made quit attempts, but were unsuccessful. Notes: Once youth have finished their schooling, it becomes increasingly difficult to provide them education about the harm of tobacco. It is important to recognize that a vast majority of youth who smoke express a desire to quit, although they are often unsuccessful at doing so. As role models to students, teachers should not smoke near the school campus.

Parental Role in Youth Prevention and Cessation Establishing smoke-free households sends a strong message that smoking is inappropriate behavior. Restrictive home smoking policies are associated with a lower likelihood of trying smoking among youth. Even if a parent is a smoker, parents can enforce a household ban on smoking and can give strong anti-smoking messages to their children. Notes: Parents have an important role to play in helping their children not begin smoking, and if they already smoke, to encourage them to quit.

Strategies for Smoking Prevention Restriction to tobacco access: promoting regulation against sales of tobacco to minors and limiting access to social sources of cigarettes. Restriction of exposure to second-hand smoke: change the social norm of smoking in public spaces, reduce visibility of smokers, limit opportunities to smoke alone or in a group. Tobacco excise tax: adolescents are very sensitive to pricing measures.

Cessation among Adolescents Earlier misconceptions: Adolescent tobacco users were not dependent on nicotine and could stop at any time. Adolescents did not want to quit. Adult tobacco cessation programs would be effective with adolescents.1 1. Sargent et al. 1998 Notes: Young people who try to quit suffer the same nicotine withdrawal symptoms as adults who try to quit, including increased tobacco craving, anxiety, and depressed mood. Because smoking among adolescents and young adults is often a very social event, it is difficult for them to quit if their friends are continuing to smoke. Among youth, the cessation rate is highest for those who smoke only occasionally, among whom 50% can be expected to quit smoking in the future. Given the social nature of smoking among youth, group cessation services, which counsel groups of youth to quit, may be more effective than individual counseling services. References: Sargent JD, Mott LA, Stevens M. Predictors of smoking cessation in adolescents. Arch Pediatr Adolesc Med. 1998; 152:388–93. Albert DA, Severson HH, Andrews JA. Tobacco use by adolescents: the role of the oral health professional in evidence-based cessation programs. Pediatr Dent. 2006; 28(2):177–87; discussion 192–8.

Ways to Engage Youth to Quit Smoking Immediate consequences relevant to youth: Tobacco stains teeth and causes bad breath. Smoking contributes to wrinkles even in your 20s and 30s. Smokers have less athletic endurance. Quitting smoking has immediate benefits including improving health in general and reducing risks for tobacco-related diseases.

Doctors’ Role in Youth Cessation Asking adolescents about their tobacco use status. Advising them to quit smoking/chewing even if their level of use is low or occasional, and addressing concerns relevant to youth. Assessing their willingness to quit at teachable moments. Assisting youth to quit by offering practical quit advice and enlisting the support of their parents. Arranging to continue talking to youth about their tobacco use whether they are ready to quit or not. Notes: Health care practitioners need to talk to their adolescent clients not only about the overall risks of smoking/chewing, but also about the specific risks associated with smoking light cigarettes and other tobacco varieties, including the potential for addiction and long-term health consequences.1 Practitioners should focus on keeping occasional smokers/chewers from moving into daily smoking/chewing status, where nicotine addiction begins to play a prominent role in maintaining the behavior.2 Given that social influence during youth is strong, practitioners need to work with educators in giving cessation a positive social identity in school environments through such things as youth quit challenges. References: Sargent JD, Mott LA, Stevens M. Predictors of smoking cessation in adolescents. Arch Pediatr Adolesc Med. 1998; 152:388–93. Zhu S. Predictors of smoking cessation in U.S. adolescents. Am J Prev Med. 1999; 16(3):202–7. Lantz PM, Jacobson PD, Warner KE, Wasserman J, Pollack HA, Berson J, et al. Investing in youth tobacco control: a review of smoking prevention and control strategies. Tob Control. 2000; 9:47–63. Kropp RY, Halpern-Felsher BL. Adolescents' beliefs about the risks involved in smoking "light" cigarettes. Pediatrics. 2004; 114(4):e445–51.

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