Children and adolescents

  Population considerations:

  • Tobacco advertising. Children may be particularly susceptible to tobacco advertisements and are twice as likely to recall such ads as adults. The tobacco industry has long targeted young people with its cigarette advertising and promotional campaigns (AHA, 2009).
  • Body image. Dieting and weight concerns are associated with increased odds of smoking (Costas, 2009; Moolchan, 2000).
  • Peer pressure. Children and adolescents are more influenced by peer pressure. They may be pressured by their friends and peers to smoke, thinking that smoking will make them look cool or older. One of the strongest predictors of adolescent smoking is having peers that smoke (Costas, 2009). Relaxation and pleasure, peer pressure, self-image, curiosity, stress, boredom, self-assertiveness and rebelliousness have all been cited as contributing to smoking initiation (Moolchan, 2000).
  • Family influence. Having parents or grandparents that smoke is a statistically significant predictor of adolescent smoking (Costas, 2009; Moolchan, 2000).
  • Availability of cigarettes to minors. Even though cigarettes are not to be distributed to anyone under eighteen, many retailers still sell to underage children. Children can also access cigarettes in some vending machines, from parents or other older friends and adults. Ease of buying cigarettes is a statistically significant predictor of smoking (Costas, 2009). Children are even able to purchase cigarettes through the internet (Fix, 2006). More than 500 websites sell tobacco products; many of these sites offer reduced prices by avoiding tobacco and sales taxes, and many have lax age verification requirements (Rosen, 2008).
  • Short sightedness. Youth may not see the harm related to tobacco exposure. Even in adults, the immediately perceived “positive” effects mask the longer-term health threat of smoking. Given that many adolescents are in the “honeymoon phase” of their nicotine addiction, recognition of addiction and its consequences remains limited (Moolchan, 2000).
  • Lack of cessation resources. Most adolescents smoke cigarettes less often and in smaller quantities than adults. Despite lower levels of consumption, studies to date suggest that adolescent smokers, especially daily smokers, experience nicotine dependence, and the majority report experiencing withdrawal symptoms upon cessation (Hatsukami, 1999). Youth addicted to nicotine may lack resources for cessation services and treatment devices since adolescents do not currently benefit from the same level of support for quitting as adults (Moolchan, 2000).
  • Access to money. Having access to pocket money is a statically significant predictor of smoking (Costas, 2009).
  • Family conflict. The presence of family conflict has been identified as a significant predictor of regular tobacco use among adolescents (Moolchan, 2000).
  • Use of other types of tobacco. Spit tobacco users tend to be male and younger (Hatsukami, 1999).
  • Exposure to secondhand smoke. The level of secondhand smoke a child is exposed to is directly proportional to the likelihood of the child becoming a smoker as an adolescent or an adult. Children are significantly affected by secondhand smoke, which may hinder the growth of their lungs, cause Sudden Infant Death Syndrome, asthma, bronchitis, pneumonia, middle ear infection and other diseases (ALA, 2009; ANR, 2007).

  Strategies to address these considerations:

  • Restrict access. Strategies that make it harder for youth to access cigarettes may be particularly effective. Interventions that make getting cigarettes inconvenient, difficult or expensive may be useful in reducing the number of adolescents who smoke.
  • Use developmentally-appropriate programs. Treatment success will depend on individually-tailored and developmentally-appropriate ways to enhance motivation (Moolchan, 2000). Smoking cigarettes plays and important role in adolescent issues of identity, autonomy and independence and group affiliation. Each of these areas needs to be addressed in treatment (Hatsukami, 1999). Peer influences and motivation for change are especially important considerations for any adolescent-focused tobacco use intervention (Myers, 2006).
  • Increase price of tobacco. Adolescents may be more sensitive to increases in the unit price of tobacco. Multiple studies have shown that increased tobacco prices are effective in decreasing tobacco use in adolescents and adults (Rosen, 2008).
  • Change perception of smoking. Because smoking is a normal behavior for alcohol- and other drug-involved youth, particular attention should be focused on youth perceptions regarding the acceptability of smoking, adolescents’ beliefs about the social role of cigarettes, beliefs regarding the relationship between smoking and other drug use (e.g. enhanced effects) and skills to resist temptations to smoke (Hatsukami, 1999).
  • Address nicotine dependence.  Because a majority of alcohol- and other drug-abusing youth appear to be daily smokers, nicotine dependence should be addressed in the intervention. This can be accomplished by educating adolescents about the features of nicotine dependence (e.g. anticipating withdrawal symptoms), teaching strategies for coping with urges and withdrawal and providing medication if appropriate (Hatsukami, 1999).
  • Involve community. Any treatment program that is developed for adolescents must be integrated with community, school and parental educational programs. Media campaigns to promote cessation attempts, support from school administration for treating students who want to quit and educating parents regarding the consequences of tobacco use and support for cessation efforts are all crucial (Hatsukami, 1999). Effective community programs involve and influence people in their homes, worksites, schools, places of worship, places of entertainment, health care settings, civic organizations and other public places. Changing policies that can influence societal organizations, systems and networks requires the involvement of community partners (CDC, 1999).
  • Provide support. Addressing the social role of smoking in the lives and self-image of adolescents may improve the effectiveness of treatment programs. Focus groups and peer-facilitated groups could enhance such a process (Moolchan, 2000).
  • Use media. Evidence shows that anti-tobacco media campaigns, especially paid television advertising, have significantly decreased tobacco use in adolescents since 1998. A dose-response relationship has been found in the number or exposures to advertising and adolescents’ ability to recall them. Exposure to at least one state-funded, anti-tobacco advertisement in the previous four months is associated with lower perceived rates of friends’ smoking and greater perceived harm of smoking (Rosen, 2008).
  • Target treatments and education. With spit tobacco users who are adolescents, the most effective treatment studies have been in dental care settings, in which dental hygienists play an active role in educating and treating spit tobacco users. Direct linkage and demonstration of spit tobacco use with tangible negative health consequences may be particularly effective in enhancing motivation to quit. (Hatsukami, 1999).

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