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Helping teens stop smoking

Despite widespread efforts at education and prevention, roughly one-quarter of U.S. teenagers are smoking cigarettes at least occasionally by the time they graduate from high school. Sadly, about three-fourths of those who smoke on a regular basis will continue smoking into adulthood.

In part, this is because adolescents are more vulnerable than adults to becoming hooked on cigarettes. When researchers compared people of different ages who smoked the same number of cigarettes per day, they found that young people ages 12 to 17 demonstrated higher levels of nicotine dependence than any other age group.

Although there are plenty of evidence-based guidelines for adults who want to quit smoking, until recently there’s been a dearth of research about how to help adolescents quit. Initially, the advice was simply to adapt adult stop-smoking strategies for teens. But more recent analyses have concluded that teens are not just “little adults” when it comes to quitting, so different approaches may be in order.

A number of options are available — in medical clinics, at schools, and on the Internet — to help teens quit smoking. Some guidance is emerging about which approaches work best for teens and which are not effective.

Progress and challenges

Several public health initiatives are aimed at preventing teens from smoking. These include raising taxes on cigarettes; passing laws to restrict exposure to secondhand smoke and tobacco advertising and to prevent young people from purchasing cigarettes; and launching mass media campaigns to encourage prevention. In addition, a number of school-based prevention programs are offered nationwide.

These efforts seem to be having an impact. Data collected by the Centers for Disease Control and Prevention indicate that the proportion of teens who smoked in any given month fell from a high of 36% in 1997 to 23% in 2005. But that still means nearly one in four teens are smoking cigarettes.

Once hooked, many teens do try to quit. But most teens (like most adults) need help to kick the habit.

Clinical approaches

The most current clinical practice guideline encourages clinicians to ask teens about smoking behavior during office visits, and then use age-appropriate methods to help teens to quit. The guideline recommends that clinicians do the following:

  • Regularly screen adolescents and their parents to determine whether they smoke and, if so, suggest interventions to stop.
  • Use behavioral and counseling interventions.
  • If an adolescent has become dependent on nicotine and expresses a desire to quit smoking, consider prescriptions for bupropion (Zyban) or nicotine replacement therapy. (Be aware, however, that a review published since this recommendation was published indicates bupropion may not be effective for teens.)

Although more specific advice is hard to come by, case reports provide the following practical tips, which may help make a clinical intervention more effective.

Ask specific questions. Concrete questions may better elicit smoking status. Ask, for example, if a teenager has smoked even one cigarette in the past 30 days.

Keep confidences. Adolescents may be more open to talking about smoking behavior if they are assured the information is kept confidential.

Understand how teens think. Adolescents tend to spend less time than adults mentally preparing to quit smoking, which may reduce the chances that they will succeed. They are also less able to plan for the future, are more likely than adults to act on impulse and discount long-term consequences.

For these reasons, a clinician may need to spend extra time educating a teen about why it’s important to stop smoking, and then provide specific instructions about what to do when the temptation to smoke occurs. Offering concrete tips for how to deal with cravings and find other habits to substitute may also help.

January 2008 update

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