eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics

Substance Abuse, Nicotine: Follow-up

Author: Donna G Grigsby, MD, Associate Professor, Department of Pediatrics, University of Kentucky College of Medicine
Coauthor(s): Kristin M Rager, MD, MPH, Assistant Professor of Pediatrics, Department of Pediatrics, Division of Adolescent Medicine, University of Kentucky College of Medicine; Todd R Cheever, MD, Consulting Staff, Department of Psychiatry, University of Kentucky College of Medicine
Contributor Information and Disclosures

Updated: Jun 12, 2009

Follow-up

Deterrence/Prevention

  • Preventing initiation of smoking is crucial to decrease tobacco use and its health-related complications in adolescents and children for the following reasons:
    • Because of the highly addictive nature of nicotine, smoking cessation is not a matter of choice for most users.
    • Tobacco is addictive physiologically and psychologically and use is socially reinforced.
    • No amount of tobacco use has been proven to be safe.
  • The US Public Health Service made 3 specific recommendations regarding children and adolescents in their 2008 clinical practice update on treating tobacco use and dependence, as follows:9
    • Clinicians caring for children and adolescents should ask about tobacco use and should strongly discourage tobacco use in this population.
    • Because of the effectiveness of counseling programs, adolescent smokers should be provided with counseling interventions to help in smoking cessation.
    • Because of the harmful affects of secondhand smoke and the effectiveness of cessation counseling in increasing abstinence in parents who smoke, clinicians should ask parents about smoking and offer cessation advice and assistance.

Complications

  • Smoking and tobacco use are associated with various health-related illnesses, including the following:
    • Chronic lung disease
    • Cardiovascular diseases, including coronary artery disease, peripheral vascular disease, and stroke
    • Cancers of the head and neck, lung, and GI tract

Prognosis

  • Because of the highly addictive nature of nicotine, smoking a few cigarettes in adolescence increases the probability of nicotine dependence and is associated with a marked increase in the likelihood of adult smoking.
  • More than 50% of adolescents report trying to quit each year.
    • Of adolescents who smoke more than 10 cigarettes per day, fewer than 20% of those who quit will be successful for 1 month.
    • One study reported that only 5% of adolescent smokers expected to be smoking in 5 years, while the rate of those who still smoke after 5 years is actually close to 75%.

Patient Education

For excellent patient education resources, visit eMedicine's Public Health Center, Lung and Airway Center, and Substance Abuse Center. Also, see eMedicine's patient education articles Cigarette Smoking and Substance Abuse.

 


More on Substance Abuse, Nicotine

Overview: Substance Abuse, Nicotine
Differential Diagnoses & Workup: Substance Abuse, Nicotine
Treatment & Medication: Substance Abuse, Nicotine
Follow-up: Substance Abuse, Nicotine
References
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References

  1. Wiencke JK, Kelsey KT. Teen smoking, field cancerization, and a "critical period" hypothesis for lung cancer susceptibility. Environ Health Perspect. Jun 2002;110(6):555-8. [Medline]. [Full Text].

  2. CDC. The Health Consequences of Smoking: A report of the Surgeon General. 2004;[Full Text].

  3. Faulkner DL, Merritt RK. Race and cigarette smoking among United States adolescents: the role of lifestyle behaviors and demographic factors. Pediatrics. Feb 1998;101(2):E4. [Medline]. [Full Text].

  4. Mayhew KP, Flay BR, Mott JA. Stages in the development of adolescent smoking. Drug Alcohol Depend. May 1 2000;59 Suppl 1:S61-81. [Medline].

  5. Becklake MR, Ghezzo H, Ernst P. Childhood predictors of smoking in adolescence: a follow-up study of Montreal schoolchildren. CMAJ. Aug 16 2005;173(4):377-9. [Medline]. [Full Text].

  6. Colby SM, Tiffany ST, Shiffman S, Niaura RS. Measuring nicotine dependence among youth: a review of available approaches and instruments. Drug Alcohol Depend. May 1 2000;59 Suppl 1:S23-39. [Medline].

  7. U.S. Preventive Services Task Force. Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. Apr 21 2009;150(8):551-5. [Medline]. [Full Text].

  8. Tanski SE, Klein JD, Winickoff JP, Auinger P, Weitzman M. Tobacco counseling at well-child and tobacco-influenced illness visits: opportunities for improvement. Pediatrics. Feb 2003;111(2):E162-7. [Medline].

  9. Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: US Department of Health and Human Services. Public Health Service; May 2008. [Full Text].

  10. American Academy of Pediatrics. American Academy of Pediatrics: Tobacco's toll: implications for the pediatrician. Pediatrics. Apr 2001;107(4):794-8. [Medline].

  11. American Academy of Pediatrics. Committee on Substance Abuse. Tobacco, alcohol, and other drugs: the role of the pediatrician in prevention and management of substance abuse. Pediatrics. Jan 1998;101(1 Pt 1):125-8. [Medline]. [Full Text].

  12. Anczak JD, Nogler RA. Tobacco cessation in primary care: maximizing intervention strategies. Clin Med Res. Jul 2003;1(3):201-16. [Medline]. [Full Text].

  13. Cohen DA, Richardson J, LaBree L. Parenting behaviors and the onset of smoking and alcohol use: a longitudinal study. Pediatrics. Sep 1994;94(3):368-75. [Medline].

  14. Colby SM, Tiffany ST, Shiffman S, Niaura RS. Are adolescent smokers dependent on nicotine? A review of the evidence. Drug Alcohol Depend. May 1 2000;59 Suppl 1:S83-95. [Medline].

  15. Coleman T. Special groups of smokers. BMJ. Mar 6 2004;328(7439):575-7. [Medline].

  16. Eissenberg T, Balster RL. Initial tobacco use episodes in children and adolescents: current knowledge, future directions. Drug Alcohol Depend. May 1 2000;59 Suppl 1:S41-60. [Medline].

  17. Jarvis MJ. Why people smoke. BMJ. Jan 31 2004;328(7434):277-9. [Medline].

  18. Klesges LM, Johnson KC, Somes G, et al. Use of nicotine replacement therapy in adolescent smokers and nonsmokers. Arch Pediatr Adolesc Med. Jun 2003;157(6):517-22. [Medline].

  19. Shadel WG, Shiffman S, Niaura R, et al. Current models of nicotine dependence: what is known and what is needed to advance understanding of tobacco etiology among youth. Drug Alcohol Depend. May 1 2000;59 Suppl 1:S9-22. [Medline].

  20. Zapka JG, Fletcher K, Pbert L, et al. The perceptions and practices of pediatricians: tobacco intervention. Pediatrics. May 1999;103(5):e65. [Medline]. [Full Text].

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Further Reading

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Keywords

nicotine abuse, nicotine dependence, tobacco use, cigarette use, smoking, tobacco-related disease, smoking-related disease

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Contributor Information and Disclosures

Author

Donna G Grigsby, MD, Associate Professor, Department of Pediatrics, University of Kentucky College of Medicine
Donna G Grigsby, MD is a member of the following medical societies: American Academy of Pediatrics and Kentucky Pediatric Society
Disclosure: Nothing to disclose.

Coauthor(s)

Kristin M Rager, MD, MPH, Assistant Professor of Pediatrics, Department of Pediatrics, Division of Adolescent Medicine, University of Kentucky College of Medicine
Kristin M Rager, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, Kentucky Pediatric Society, North American Society for Pediatric and Adolescent Gynecology, and Society for Adolescent Medicine
Disclosure: Nothing to disclose.

Todd R Cheever, MD, Consulting Staff, Department of Psychiatry, University of Kentucky College of Medicine
Todd R Cheever, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Kentucky Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Chet Johnson, MD, Medical Director, Child Development Unit, Department of Pediatrics, Professor, University of Kansas Medical Center
Chet Johnson, MD is a member of the following medical societies: American Academy of Pediatrics
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

CME Editor

Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry
Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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