Adolescents and young people
It is estimated that more than 80% of smokers become addicted to nicotine as teenagers. Adolescence is the primary time when cigarette smoking is initiated and transition from experimentation to dependence occurs. In Australia in 2010, 3.8% of teenagers (aged 12–17 years) smoked tobacco and 2.5% smoked daily.1 Although men were generally more likely to be daily smokers than women, in the 12–17 years age group, young women were more likely to be daily smokers (3.2%) than young men (1.8%). However, young Australians aged 12–17 years were the age group least likely to smoke daily (2.5%).1 It has been estimated that one-third of teenagers who become regular smokers will eventually die prematurely from smoking-related diseases.190
The reasons young people commence smoking are varied and relate to genetic factors, peer influence, parental smoking, weight control and stress.190 Recruitment and retention of adolescents in formal smoking cessation programs are difficult and are a major determinant of intervention targeting young people.7 Computer and internet cessation programs are potential vehicles for programs aimed at young people, but as yet there is no clear evidence on efficacy.
Many adolescent anti-tobacco programs focus on preventing teenagers from starting to smoke, rather than quitting. These programs are largely ineffective. Likewise, there is insufficient evidence to show that smoking cessation programs to help teenagers who already smoke to quit are effective.191 There are also few studies with evidence about the effectiveness of pharmacological interventions for adolescent smokers.
Some quitting medications can be used by younger smokers. NRT can be offered if the smoker is nicotine-dependent and ready to quit. Although NRT has been shown to be safe in adolescents, there is little evidence that these medications and bupropion or varenicline are effective in promoting long-term quitting in adolescent smokers. The majority of studies included an intensive counselling component (six or more sessions).11
Recommended smoking cessation treatment
- Counselling is considered to be vital in this age group.
- Health professionals should ask about smoking and provide a strong anti-smoking message.
- NRT is recommended to adolescents only with precautions. The health professional should assess the nicotine dependence, motivation to quit and willingness to accept counselling before recommending NRT.
- Bupropion and varenicline are not approved for use by smokers under 18 years of age.
- Australian Institute of Health and Welfare. 2010 National Drug Strategy Household Survey report. Drug statistics series no. 25. Cat. no. PHE 145. Canberra: AIHW, 2011. Available at http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737421314 [accessed 12 August 2011].
- Zwar N, Richmond R, Borland R, Stillman S, Cunningham M, Litt J. Smoking cessation guidelines for Australian general practice: practice handbook. Canberra: Australian Government Department of Health and Ageing, 2004.
- Fiore MC, Jaén CR, Baker TB, Bailey WC, et al. for the Guideline Panel. Treating tobacco use and dependence: 2008 update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service, May 2008. Available at http://www.ncbi.nlm.nih.gov/books/NBK63952/ [accessed 20 March 2011].
- Mendelsohn C. Teenage smoking. How the GP can help. Medicine Today 2010;11:30–7.
- Stanton A, Grimshaw G. Tobacco cessation interventions for young people. Cochrane Database Syst Rev 2013, Issue 8. Art. no. CD003289.