TEENS & TOBACCO

Sophie J Balk MD, FAAP

Professor of Clinical Pediatrics
Albert Einstein College of Medicine
Bronx, NY

sbalk@montefiore.org
 GOALS: TO DESCRIBE..
• Prevalence of teen smoking
• Identifying teens at risk
• Working with parents to prevent teen
smoking
• Counseling teen smokers
• Counseling parents who smoke
 TEEN TOBACCO USE

• The onset of tobacco use usually occurs

during childhood and adolescence – 90%
initiate before age 191

• In the US, 3,900 people age 12 – 17 years

start smoking every day2
• 1,500 become regular, daily smokers2

1:Tobacco’s Toll: Implications for Pediatricians. Pediatrics 2001; 107:794-8.

2:Youth and Tobacco Use: Current Estimates.
www.cdc.gov/tobacco/research_data/youth/Youth_Factsheet.htm
 Teen
Cigarette
Use Has
Declined

http://monitoringthefuture
http://monitoringthefuture.org/pubs/
.org/pubs/
monographs/overview2006.pdf
monographs/overview2006.pdf
 RISK FACTORS FOR
INITIATING TOBACCO USE
• Friends who smoke
• Parents’ behaviors and attitudes
• Comorbid psychiatric disorders
• Anxiety, ADHD, substance abuse
• Concerns about weight gain

AAP Illinois Chapter. Adolescent Tobacco Use-

Use-Prevention and Cessation, April 2002
Sargent, DiFranza. Tobacco control for clinicians who treat adolescents.
adolescents. CA Cancer J Clin 2003; 53:102-
53:102-123.
 TEENS WHO USE TOBACCO
ARE…
• More likely to be psychologically
distressed, abuse other substances
• Less likely to be attached to parents,
do well in school, participate in
extracurricular activities, know the
adverse effects of smoking

Tobacco’
Tobacco’s Toll: Implications for Pediatricians. Pediatrics 2001; 107:794-
107:794-8.
 PROTECTIVE FACTORS

• Individual, family, and environmental

factors can guard against risky
behaviors
• Close communication with parents
• Parental support
• High self-esteem
• Regular church attendance
Tobacco’
Tobacco’s Toll: Implications for Pediatricians. Pediatrics 2001; 107:794-
107:794-8.
 TEEN TOBACCO ADDICTION
• Nicotine dependence is more severe if use
begins in adolescence
• Those who begin as teens
• Are more likely to become dependent
• Use for more years
• Use more heavily as adults
• Increased vulnerability may be due to still-
developing brain
Sargent,
Sargent, DiFranza.
DiFranza. Tobacco control for clinicians who treat adolescents. CA Cancer
Cancer J Clin 2003; 53:102-
53:102-123.
 TEEN TOBACCO USE
PROGRESSES QUICKLY
Experimentation

Nicotine dependence, as indicated by

craving, starts BEFORE daily or
regular use

Regular Use
Interventions may be delivered at any stage
DiFranza et al. Symptoms of tobacco dependence after brief intermittent use,. Arch Ped Adol Med 2007; 161: 704 - 710
 WHY DOES TOBACCO
USE BEGIN?
• Annual tobacco marketing - $10
billion/year
• Very effective with youth
• Promotions lower cost of cigarettes
• Free tobacco paraphernalia
• Smoking depicted in magazines,
movies
Sargent,
Sargent, DiFranza.
DiFranza. Tobacco control for clinicians who treat adolescents. CA Cancer
Cancer J Clin 2003; 53:102-
53:102-123.
 SMOKING IN MOVIES
• 90% show smoking
• Number of depictions rises with
rating
• G-rated: 1
• R-rated: 8
• Younger children routinely exposed
to movies meant for older children,
adults

Sargent,
Sargent, DiFranzaTobacco control for clinicians who treat adolescents. CA Cancer J Clin 2003; 53:102-
53:102-123.
 Viewing
Smoking in
Movies
Increases
Tobacco
Use

Sargent,
Sargent, DiFranza.
DiFranza. Tobacco control for
clinicians who treat adolescents.
CA Cancer J Clin 2003; 53:102-
53:102-123.
 IDENTIFYING TEEN
TOBACCO USE
• Ask about tobacco as part of
psychosocial history
• Privacy and confidentiality a must
• Use 5 A’s – ASK
• “Have you ever smoked a
cigarette?”
• “Have you ever used another
tobacco product?”
 TEENS WHO DON’T USE
TOBACCO
• Congratulate them for not using
tobacco – one of the most important
steps they can take for their health
 TREATING TEEN SMOKERS
• The 5 A’s:
• Ask
• Advise them to quit
• Assess readiness
• Assist –> refer
• Arrange follow-up
• Pharmacotherapy can be used, but has
not been shown to be effective with
teens

Treating Tobacco Use and Dependence: US Public Health Service 2000

2000
http://www.surgeongeneral
http://www.surgeongeneral..gov/tobacco/
gov/tobacco/clinpack
clinpack.html
.html
 COUNSELING TEENS
• Interested in quitting
• Even occasional users may be
addicted
• Provide education on nicotine
addiction and quitting strategies
• No evidence that quitting is easier for
teens than adults
Sargent,
Sargent, DiFranza.
DiFranza. Tobacco control for clinicians who treat adolescents. CA Cancer
Cancer J Clin 2003; 53:102-
53:102-123.
 COUNSELING TEENS’ PARENTS

• Advise parents to
• Express disapproval of tobacco use
• Discourage friends who are smokers
• Keep the home smoke free – even if
parents smoke
• Make tobacco products inaccessible
• Limit access to R-rated movies
SECONDHAND SMOKE & KIDS
 SHS CAUSES
DEATH AND DISEASE

Including increased risk for

• SIDS – Sudden Infant Death
Syndrome
• Respiratory infections
• Otitis media
• Asthma
• Decreased lung growth
SECONDHAND SMOKE & KIDS
• There is no safe level of exposure to
secondhand smoke
• Up to 34% of US children are exposed
to SHS at home
• To eliminate kids’ SHS exposure,
parents must eliminate smoking at
home

US Surgeon General’s Report 2006. The Health Consequences of Involuntary Exposure to Secondhand
Tobacco Smoke. http://www.surgeongeneral.gov/library/secondhandsmoke/report/executivesummary.pdf
COUNSELING PARENTS WHO
SMOKE
• Recommended by Public Health Service,
American Academy of Pediatrics,
American Academy of Family Physicians
• Use 5 A’s
• “A-A-R-P”: Ask, Advise, Refer, educate
about Pharmacotherapy
• Recommend smoke-free home and car,
even if parents can’t quit
 SUMMARY
• Prevalence of teen smoking
• Identifying teens at risk
• Working with parents to prevent teen
smoking
• Counseling teen smokers
• Counseling parents who smoke
Questions?