ROKOK & ANAK

Oleh
NURHAYATI

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US Adolescents
67% identified drugs or drug abuse
13% identified alcohol abuse
6% identified smoking.
INDONESIA
-

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 Pattern
Before the late 1960s, it was predominantly adults who were
abusing alcohol and other psychoactive drugs, including tobacco.
Beginning in the late 1960s and early 1970s, substance abuse
became widespread among adolescents and, more recently, among
preadolescents.
Alcohol and tobacco as well as opiates, cocaine, amphetamines,
barbiturates, marijuana, hallucinogens, anabolic steroids, and
prescription and nonprescription medications and inhalants
(volatile substances) are used and abused by many adolescents and
a growing number of preadolescents.
Tobacco use in these groups represents a significant health threat
and is associated with an increased likelihood of future use of
marijuana and other illicit drugs.

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 Risk and Protective Factors Associated With Adolescent
Use of Tobacco, Alcohol, and Other Drugs

Risk Factors Protective Factors

Individual Early initiation of substance use Late initiation of substance use

Attitude favorable to substance use Perceived risk of substance use
Low self-esteem or poor coping skills Positive sense of self, assertiveness, social
competence
Early antisocial or delinquent behavior

Psychopathologic problems, particularly

depression
Attention-deficit/hyperactivity disorder Pharmacotherapy for attention-
deficit/hyperactivity disorder
Conduct disorder or aggressive behavior

Sensation seeking, impulsivity, distractibility Resilient temperament

Perinatal complications or brain injury

Low intensity of religious beliefs and observance High intensity of religious beliefs and observance

Rebelliousness and alienation from the dominant Positive social orientation, adoption of
values of society and conventional norms conventional norms about substance use
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Family Permissive or authoritarian parenting
Parental and older sibling use of alcohol, tobacco, or other
drugs
Family history of alcoholism
High levels of family conflict
Parental divorce during adolescence
Child abuse and neglect or sexual abuse
Peers Friends who drink, smoke, or use other drugs
Perceived peer drug use
School Poor academic achievement and school failure
Low interest in school and achievement
Community Disorganization in the community or neighborhood
Availability of tobacco and alcohol
Marketing of tobacco and alcohol
Availability of licit and illicit drugs
Sociocultural Media portrayal of substance use
Advertising licit substances
Authoritative parenting, parental monitoring of
activities
Clearly communicated parental expectation of
nonuse and clear rules of conduct consistently
enforced
Parent in recovery
Positive, supportive relationships with family
Open communication with parents
Supportive relationships with prosocial adults
Friends not engaged in substance use
Peer disapproval of substance use
Good academic achievement and school success
High academic aspirations
Less acculturation and higher ethnic identification
Increased legal smoking and drinking ages
Increased excise taxes on tobacco and alcohol
Strict law enforcement
Media literacy
Comprehensive, theory-based antidrug education
programs
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 time indoors >>
>> 3800 different chemical compounds
Concentrations of respirable suspended
particulate matter (particulates of <2.5 m) can
be two to three times higher in homes with
smokers than in homes with no smokers
Cigarette smoking is the most important factor
determining the level of suspended particulate
matter and respirable sulfates and particles in
indoor air
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 Lower respiratory illness during their first year
of life
Middle ear effusion
Sudden infant death syndrome
Asthma symptoms and more frequent
exacerbations
Cancer
Coronary heart disesase
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 Smoking and Breastfeeding

Breastfed babies of mothers who smoke cigarettes have fewer respiratory

infections than formula-fed babies of mothers who smoke.
Breastfeeding mothers who smoke should smoke as few cigarettes as possible
each day.
Mothers who smoke should smoke away from the baby, outdoors, or in a separate,
well-ventilated area to reduce amount of second-hand smoke and particulate
matter the baby is exposed to.
Mothers who smoke should do so after feedings to allow time for the level of
nicotine in the milk to decrease before the next feeding.
Mothers who smoke and breastfeed may discuss iodine and other vitamin and
mineral supplementation with their health care provider.
Smoking may reduce the protection against SIDS that breastfeeding offers.
If a mother who is breastfeeding uses nicotine replacement products, she should
not smoke any cigarettes while using the products.
Mothers who want to quit smoking should seek support to do so.
Smoking is often an anxiety-related activity. Encourage the mother to find other
ways to reduce stress.

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 REKOMENDASI
R. Ortu dan pengasuh
Informasi ke ortu bahaya rokok dan panduan
Memberi contoh
Promosi policy
Tidak menjual rokok di fasilitas kesehatan
Policy publik
Lingkungan bebas asap rokok

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 Kerjasama dengan sekolah
Legislasi sarana publik
Media, sponsor
Pesan
Pajak
Hubungan pasien ortu dan petugas kesehatan
Peningkatan kecurigaan diagnosis terutama
berhubungan dengan komorbid psikiatri

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 Pengenalan dini manifestasi perilaku sakit
kepala, sakit tenggorokan, batuk kronik, nyeri
dada, perburukan asma yang tidak berespon
terhadap terapi, keluhan abdomen yang
berhubungan dengan gastritis dan hepatitis
dan pankreatitis,

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 Pelatihan

Tersedianya fasilitas pengobatan

Dukungan program

Masyarakat maupun asuransi mendukung

pengobatan termasuk konseling

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Frequently Asked Questions

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 1. What can parents do to prevent
their kids from smoking?
Despite the impact of movies, music, and TV, parents can be the GREATEST
INFLUENCE in their kids' lives.
Talk directly to children about the risks of tobacco use; if friends or
relatives died from tobacco-related illnesses, let your kids know.
If you use tobacco, you can still make a difference. Your best move, of
course, is to try to quit. Meanwhile, don't use tobacco in your children's
presence, don't offer it to them, and don't leave it where they can easily
get it.
Start the dialog about tobacco use at age 5 or 6 and continue through
their high school years. Many kids start using tobacco by age 11, and many
are addicted by age 14.
Know if your kids' friends use tobacco. Talk about ways to refuse tobacco.
Discuss with kids the false glamorization of tobacco on billboards, and
other media, such as movies, TV, and magazines.

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 2. How is second-hand smoke bad?

Secondhand smoke is associated with an

increased risk for lung cancer and coronary heart
disease in nonsmoking adults. Secondhand
smoke is a known human carcinogen (cancer-
causing agent).
Young children are particularly susceptible to
secondhand smoke because their lungs are not
fully developed,. Exposure to secondhand smoke
is associated with an increased risk for sudden
infant death syndrome (SIDS), asthma, bronchitis,
and pneumonia in young children.

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 3. What are bidis and kreteks?

Bidis (pronounced "bee-dees") are small, thin hand-rolled cigarettes

imported to the United States primarily from India and other
Southeast Asian countries. They consist of tobacco wrapped in a
tendu or temburni leaf (plants native to Asia), and may be secured
with a colorful string at one or both ends. Bidis can be flavored
(e.g., chocolate, cherry, and mango) or unflavored. They have
higher concentrations of nicotine, tar, and carbon monoxide than
conventional cigarettes sold in the United States.
Kreteks (pronounced "cree-techs") are sometimes referred to as
clove cigarettes. Imported from Indonesia, kreteks typically contain
a mixture consisting of tobacco, cloves, and other additives. As with
bidis, standardized machine-smoking analyses indicate that kreteks
deliver more nicotine, carbon monoxide, and tar than conventional
cigarettes. There is no evidence to indicate that bidis or kreteks are
safe alternatives to conventional cigarettes.

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 4. What kind of bad things are in
cigarettes?
Cigarettes contain formaldehyde-the same
stuff used to preserve dead frogs.
The same cyanide found in rat poison is in
cigarette smoke.
Nicotine is an addictive compound in
cigarettes, but nicotine is also a potent
insecticide found in bug spray.

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 5. Can smoking change how I look?

Yes! And not for the better.

Tobacco smoke can make hair and clothes stink.
Tobacco stains teeth and causes bad breath.
Short-term use of spit tobacco can cause cracked
lips, white spots, sores, and bleeding in the
mouth.
Surgery to remove oral cancers caused by
tobacco use can lead to serious changes in the
face. Sean Marcee, a high school star athlete who
used spit tobacco, died of oral cancer when he
was 19 years old.
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 6. Are low-tar cigarettes better than
regular cigarettes?
No. The risk for lung cancer is only slightly lower
with low tar cigarettes. Reduced tar levels have
little, if any, effect on other lung diseases or heart
disease. Existing research does not support
recommending that smokers switch to low-yield
cigarette brands. There is no convincing evidence
that changes in cigarette design have resulted in
an important decrease in the diseases caused by
cigarettes. The best thing you can do for your
health is to quit now.

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 7. What about clove cigarettes (kreteks), bidis or
cigars? Are they any safer than regular cigarettes?

There is no evidence to indicate that clove

cigarettes, bidis or cigars are safe alternatives
to conventional cigarettes.

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 8. Is smokeless tobacco or chew bad
for your health?
Smokeless tobacco is a significant health risk and is not a
safe substitute for smoking cigarettes.
Smokeless tobacco contains 28 cancer-causing agents
(carcinogens). It is a known cause of human cancer, as it
increases the risk of developing cancer of the oral cavity.
Oral health problems strongly associated with smokeless
tobacco use are leukoplakia (a lesion of the soft tissue that
consists of a white patch or plaque that cannot be scraped
off) and recession of the gums.
Smokeless tobacco use can lead to nicotine addiction and
dependence.
Adolescents who use smokeless tobacco are more likely to
become cigarette smokers.

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 9. Can smoking affect my ability to
play sports?
Yes, smoking really hurts athletic performance. Here's how.
Nicotine in cigarettes, cigars, and spit tobacco is addictive.
Nicotine narrows your blood vessels and puts added strain
on your heart.
Smoking can wreck lungs and reduce oxygen available for
muscles used during sports.
Smokers suffer shortness of breath (gasp!) almost 3 times
more often than nonsmokers.
Smokers run slower and can't run as far, affecting overall
athletic performance.
Cigars and spit tobacco are NOT safe alternatives.

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10. Why is it so hard to quit smoking?
Nicotine is the psychoactive drug in tobacco products that
produces dependence. Most smokers are dependent on
nicotine, and smokeless tobacco use can also lead to
nicotine dependence. Nicotine dependence is the most
common form of chemical dependence in the United
States. Research suggests that nicotine is as addictive as
heroin, cocaine, or alcohol. Examples of nicotine
withdrawal symptoms include irritability, anxiety, difficulty
concentrating, and increased appetite. Quitting tobacco
use is difficult and may require multiple attempts, as users
often relapse because of withdrawal symptoms. Tobacco
dependence is a chronic condition that often requires
repeated intervention.

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 11. What are some ways to quit
smoking?
Brief clinical interventions by a physician or nurse can increase the
chances of successful quitting. Also behavioral therapy with a
psychologist, social worker or psychiatrist can be helpful in quitting.
Treatments with more person-to-person contact and intensity (e.g.,
more time with therapist) are more effective.
Individual, group, or telephone counseling are all effective.
Prescription and non-prescription medications can be effective in
treating tobacco dependence. These include nicotine replacement
products (e.g., gum, inhaler, patch) and non-nicotine medications,
such as Bupropion SR (Zyban).
Hypnosis and acupuncture are reported by some people to be
helpful. Ask your doctor for a referral.

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12. Can free telephone counseling be
effective?
People who use telephone counseling are
twice as likely to quit as people who don't get
any counseling. Telephone counselors are
trained to help quitters avoid common
mistakes that might lead to relapse. Also most
states offer some kind of free telephone
counseling or a "Quitline" for people seeking
to quit smoking. To find a Quitline in your
area, call the American Cancer Society at 1-
800-ACS-2345.
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 13. What kinds of in-person counseling
are effective for adolescents?
A recent comprehensive review of adolescent
smoking cessation programs indicated that
classroom programs had the highest cessation
rates (17%), followed by computer-based
programs (13%) and school-based clinics (12%).
Brief office based interventions, such as videos,
in-person counseling, referrals to quitting support
and diligent follow-up, can also boost an
adolescents chances of quitting.

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14. Does medication increase success
in quitting?
Yes. Medication almost doubles a person's
chances of quitting and quitting for good.

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 15. What are the first-choice
medications?
All five of the FDA-approved medications for smoking cessation are
recommended including bupropion SR, nicotine gum, nicotine
inhaler, nicotine nasal spray, and the nicotine patch.
But because of the lack of sufficient data to rank-order these five
medications, choice of a specific first-line medication must be
guided by factors such as clinician familiarity with the medications,
contraindications for selected patients, patient preference, previous
patient experience with a specific pharmacotherapy (positive or
negative), and patient characteristics (e.g., history of depression,
concerns about weight gain).
Special consideration should be given before using medication with
selected populations: those with medical contraindications, those
smoking less than 10 cigarettes/day, pregnant, and adolescent
smokers.

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 16. Are medications appropriate for lighter
smokers (e.g., 10-15 cigarettes/day)?
If medication is used with lighter smokers,
clinicians should consider reducing the dose of
first-line medications.

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17. What second-choice medications
are recommended
Clonidine and nortriptyline. Consider
prescribing these second-choice agents for
patients unable to use first-choice
medications because of contraindications or
for patients for whom first- choice
medications are not helpful. Monitor patients
for the known side effects of second- choice
agents.

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 18. Which medications should be considered with
patients particularly concerned about weight gain?

Bupropion SR and nicotine replacement

therapies (NRTs), in particular nicotine gum,
have been shown to delay, but not prevent,
weight gain.

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 19. Which medications should be considered
with patients with a history of depression?
Bupropion SR and nortriptyline appear to be
effective with this population.

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 20. May tobacco dependence medications be
used long-term (e.g., 6 months or more)?
Yes. This approach may be helpful with smokers
who report persistent withdrawal symptoms
during the course of pharmacotherapy or who
desire long-term therapy. A minority of
individuals who successfully quit smoking use
over-the-counter nicotine replacement
medications (gum, nasal spray, inhaler) long-
term. The use of these medications long-term
does not present a known health risk.
Additionally, the FDA has approved the use of
bupropion SR for a long-term maintenance
indication.
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 21. Is combining nicotine replacement medications
okay and does it increase rates of success?

Yes. There is evidence that combining the

nicotine patch with either nicotine gum or
nicotine nasal spray increases long-term
abstinence rates over those produced by a
single form of NRT.

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 Benefits of quitting
After you quit smoking your risk of many medical problems goes down significantly.
Compared to smokers, your...
Stroke risk is reduced to that of a person who never smoked after 5 to 15 years of not
smoking.
Cancers of the mouth, throat, and esophagus risks are halved 5 years after quitting.
Cancer of the larynx risk is reduced after quitting.
Coronary heart disease risk is cut by half 1 year after quitting and is nearly the same as
someone who never smoked 15 years after quitting.
Chronic obstructive pulmonary disease risk of death is reduced after you quit.
Lung cancer risk drops by as much as half 10 years after quitting.
Ulcer risk drops after quitting.
Bladder cancer risk is halved a few years after quitting.
Peripheral artery disease goes down after quitting.
Cervical cancer risk is reduced a few years after quitting.
Low birth weight baby risk drops to normal if you quit before pregnancy or during your first
trimester the benefits of quitting.

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