Preventing smoking in children and adolescents: Recommendations for practice and policy

Question 1

What percentage of Canadians >15yo were active smokers?

Answer 1

14.6%

Question 2

What are some prevalence data from the Health and Statistics Canada national survey 2013?

Answer 2

1. Smoking prevalence increased with age: 2% of youth in grades six to nine were smoking, 11% at 15 to 19 years of age, 18% at 20 to 24 years of age, and 19% at 25 to 34 years of age.
   Smoking rates in teens 15 to 19 years of age were two to three times lower than in 1999.
2. Smoking rates among teens 15 to 19 years of age were highest in Quebec (13.9%) and lowest in Alberta (8.8%).
3. There were more male than female smokers (13.2% versus 8.1%). Both genders tended to smoke approximately the same number of cigarettes per day.
4. Six out of ten smokers 15 to 19 years of age were seriously considering quitting in the next six months, and more than one-half (57%) had made an attempt to quit in the previous 12 months. These numbers have been relatively stable over the past 15 years
5. Sexual minority youth (LGBTQ) and Aboriginal/Indigenous youth have smoking rates are up to five times higher than other adolescents

Question 3

What are adverse effects of smokeless tobacco?

Answer 3

1. Bad breath
2. Dental problems
3. Increased risk of ENT cancers
4. Leukoplakia

Question 4

What are some alternative forms of tobacco?

Answer 4

Smoked tobacco: cigar, hookah, bidi, kretek

Smokeless tobacco: chewing tobacco, snuff, snus, dissolvable tobacco, electronic cigarette

Question 5

What factors increase the risk of smoking initiation?

Answer 5

1. Older age at time of parental smoking cessation (if parents are ex-smokers)
2. Low SES
3. Peer and family influence, including lack of parental support
4. Misinformation about the health consequences of smoking
5. Easy access to tobacco products
6. Influence of marketing, exposure to tobacco promotions
7. Previous experimentation
8. Depression and mental health conditions
9. Poor school performance
10. Adverse experiences such as:
    a) emotional and physical or sexual abuse
    b) parental separation or divorce
    c) a household member who is substance abusing, mentally ill or incarcerated
11. Substance abuse (smoking often precedes the use of illicit drugs)

Question 6

What are forms of counselling interventions?

Answer 6

1. face to face encounters
2. phone interactions with a health care provider
3. Providing printed materials in person, by mail, or by email
4. Guidance to computer applications or Internet sources that are known to be effective

Question 7

What are disease specific consequences of smoking in adolescents with asthma?

Answer 7

Increased frequency and severity of exacerbations, medication use, hospitalization and risk of respiratory arrest

Question 8

What are disease specific consequences of smoking in adolescents with CF?

Answer 8

Increased frequency and severity of bacterial lung infections and hospitalization; accelerated decline in lung function and lower nutritional status

Question 9

What are disease specific consequences of smoking in adolescents with JIA?

Answer 9

Greater disease severity, higher risks for cardiovascular disease and premature death, and exacerbation of osteopenia

Question 10

What are disease specific consequences of smoking in adolescents with cancer?

Answer 10

Greater risks from several cancer treatments, for respiratory infections when immunosuppressed, and exacerbated mucositis

Question 11

What are disease specific consequences of smoking in adolescents with sickle cell disease?

Answer 11

Increased risk of acute chest syndrome and possible increased risk of stroke

Question 12

What are disease specific consequences of smoking in adolescents with diabetes mellitus?

Answer 12

Accelerated cardiovascular and peripheral vascular disease, including atherosclerosis, retinopathy and nephropathy. Smoking increases the morbidity and mortality of type 1 diabetes by 50% to 75%.

Question 13

What counseling should be given to parents around the health effects of smoking?

Answer 13

Risks associated with second hand smoke on children and other household members:

1. Prematurity
2. Stillbirth
3. SIDS
4. Effects on fetal brain development
5. Asthma, colds, pneumonia, ear infection
6. Acquired heart disease
7. Becoming smokers (even when parents tell children not to start)

Long term health risks:

1. Heart disease
2. COPD
3. Lung and other cancers
4. Infertility

Question 14

What counseling should be given to school-aged children (5-11yo) around the health effects of smoking?

Answer 14

Negative effects and consequences of smoking:

1. Bad breath
2. Yellow teeth
3. Harder to keep up during active games or sports
4. Smoking just a few times can get your body hooked so that it is harder to stop
5. Cigarettes are expensive. Smokers spend money on cigarettes that they could use for more fun things
6. Tobacco companies use ads to trick you into thinking that smoking is cool and safe
7. Smoking has long-term effects on health, including several types of cancer and heart attacks
8. It is illegal to buy cigarettes when you are underage

Question 15

What counseling should be given to adolescents around the health effects of smoking?

Answer 15

Immediate effects of smoking:

1. Cosmetic effects (smell, bad breath, yellow teeth, early wrinkles)
2. Poorer endurance and athletic performance
3. Hacking coughs, more colds and pneumonias
4. You can get addicted to tobacco after smoking as few as 100 cigarettes
5. Cigarette smoking is expensive. The cost of buying one pack a day for a year could buy a used car (between $1500 and $3500)
6. When you smoke you might be ‘under the influence’ of marketing from tobacco companies

Long-term health consequences:

1. Selected long-term health risks listed for parents (above)
2. Alternative forms of tobacco (eg, snuff, e-cigarettes) may not be safer than cigarettes
3. Smoking exposes friends and family (including babies) to harm from second-hand smoke

Question 16

Are school based interventions effective in reducing long term smoking rates?

Answer 16

Yes, average 12% reduction in students who start smoking

Most effective if target both social competence and social skills development

Question 17

What are the most effective measures to reduce teenage smoking rates through government legislation and initiatives?

Answer 17

1. High taxation rates on tobacco products
2. Labelling disincentives: using explicit photos and smoking-associated health warnings on all tobacco products, packages, and labelling
3. Restricted marketing and sales: banning point of sale displays, advertising to minors and sponsorship of public events by tobacco companies
4. Smoke-free spaces: smoking bans in public places

Question 18

What should HCP do to prevent smoking initiation in young people?

Answer 18

1. Ask children, youth and families about tobacco use and exposure and provide age-appropriate information and counselling to prevent initiation as part of routine health care.
2. Use the ‘5A’s’ method to counsel smoking cessation. For details, see the practice point “Strategies to promote smoking cessation among adolescents”, published in this issue.
3. Stay aware of research on pharmaceutical cessation interventions for teens and adults and prescribe effective medications as indicated, in combination with counselling.
4. Advocate for medical schools and residency programs to address smoking prevention and cessation as a part of their core curriculums.

Question 19

What should schools and communities do to prevent smoking initiation in young people?

Answer 19

1. Legislate bans on smoking for all school and public properties and enforce such laws among school personnel and public sector workers.
2. Educate students and families on the negative health consequences of tobacco use as part of elementary and high school curriculums, and in tandem with public programming.
3. Offer regular programs to screen and counsel for smoking cessation.

Question 20

What should all levels of governments do to prevent smoking initiation in young people?

Answer 20

1. Continue to adopt and enforce laws and regulations that limit tobacco access for minors, including e-cigarettes and alternative tobacco products.
2. Legislate a universal ban on smoking in cars where youth younger than 18 years of age are passengers.
3. Continue to regulate tobacco advertising and packaging, and specifically control newer tobacco products aimed at minors.
4. Implement strict penalties for any establishment or individual selling contraband cigarettes.
5. Make all tobacco products less affordable by taxing them prohibitively.
6. Provide confidential access to and coverage for smoking cessation therapies, including medications under provincial/territorial health plans.
7. Fund and encourage research on the effects of tobacco use in youth and into smoking prevention and cessation interventions that work.