2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Susanne E. Tanski, MD, FAAPThe AAP Julius B. Richmond Center of Excellencehttp://www.aap.org/richmondcenter/
Tobacco Use Prevention for Children and YouthTobacco Use Prevention for Children and Youth
2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Objectives
Learn prevalence of youth tobacco use worldwide
Understand the influences for youth tobacco use
Review some prevention/treatment for youth tobacco use
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2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Section ASection A
Impact and Use of Tobacco
2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Worldwide Tobacco Impact
Global use of tobacco products is increasing Epidemic shifting to the developing world, 84% of
smokers decreasing in high-income countries
Almost half the world’s children breathe air polluted by tobacco smoke 700 million children
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Source: http://www.who.int/topics/tobacco/facts/en/http://www.who.int/topics/tobacco/facts/en/
2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Youth Tobacco Use Worldwide
Among young smokers, 25% smoked their first cigarette before the age of 10
The highest youth smoking rates can be found in Central and Eastern Europe, sections of India, and West Pacific Islands
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Image source: Adapted from http://www.who.int/tobacco/en/atlas7.pdf
2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Youth Tobacco Use
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Image source: Adapted from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5701a1.htm
2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Tobacco Use Trends in Europe
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http://www.euro.who.int/Document/EHI/ENHIS_Factsheet_3_4.pdf
2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Gender Gap in Tobacco Use Initiation
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Image source: http://www.searo.who.int/EN/Section1174/Section2469/Section2481.htm
2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Youth Tobacco Use: U.S.
In 2007, 50.3% of students surveyed in the U.S. Youth Risk Behavior Surveillance System (YRBSS) had smoked a cigarette 12.4% of students had at some point smoked daily 20% reported current smoking (within the last 30 days)
Of U.S. youth smokers, 49.7% had tried to quit Overall current tobacco use was reported at 25.7%
29.9% of White youth, 16% of Black youth, and 20.1% of Hispanic youth
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Source: www.cdc.gov/mmwr/preview/mmwrhtml/ss5701a1.htm
2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Percentage of Tobacco Use in the Past 30 Days
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Image source: Adapted from http://monitoringthefuture.org/pubs/monographs/overview2005.pdf
2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Smoking Effects on Youth
Addiction
Lower lung function
Decreased rate of lung growth
Cumulative effects over time increase risk of heart disease in adulthood
Tobacco use is associated with other risky behaviors: Among U.S. youth, tobacco users are three times more
likely to use alcohol, eight times more likely to use marijuana, twenty-two times more likely to use cocaine
Tobacco use is also associated with fighting and unprotected sex
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2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Smoking Initiation: Social and Individual Influences
Parents/siblings/family: modeling, access
Peers: social culture
Comorbid psychiatric disorders Anxiety, ADHD, substance abuse
Media Modeling behavior: the “SuperPeer” Social normalization
“Everybody” smokes
Image identification and branding
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2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Attitudes and Beliefs
28% of youth say boys who smoke have more friends; 16.8% say girls who smoke have more friends
13.5% say smoking makes boys look more attractive: 10% say this for girls
68% of youth want to stop smoking now and almost ¾ say they have tried to quit in the past year
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Source: http://tobaccocontrol.bmj.com/cgi/content/full/11/3/252/
2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Why Do Youth Start Smoking? Social Learning Theory
People can learn by observing others This can be real-life observation or symbolic
observation through movies and TV Can learn how to do things (smoke/drink) Can form expectations
Why people do things (stressed, upset, need to relax)
How you are supposed to respond to things (craving)
Consequences of behavior (reinforcing/punishing)
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2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Why Do Youth Start Smoking?
Marketing Roughly seven cents per
pack to make, $4.50+ sold
$70 billion a year industry
Most profitable crop in the U.S.
$12 billion a year in advertising
$500 million a year in sales to children
Number one sold product in the world: Marlboro cigarettes
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Image source: http://mrg.bz/dIZOXT
2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Advertising Influences Youth
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Image source: http://www.tobaccofreekids.org/reports/products/
U.S. Germany Kenya
2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Youth Tobacco Users Are . . .
More likely to be psychologically distressed, abuse other substances
Less likely to be attached to parents, do well in school, participate in extracurricular activities, know the adverse effects of smoking
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Source: American Academy of Pediatrics. (2001).
2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Source: Monitoring the future project, U.S., 1976-1986 senior classes.
Youth Who Start Smoking, Continue Smoking
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Smoking status 5-6 years later
Senior-year smoking status (use in past 30 days)
QuitLess use
Same level
More use
None 85.6 14.4
< 1 cigarette per day 57.8 14.4 27.8
1-5 cigarettes/day1-5 cigarettes/day 29.6 8.8 17.2 44.4
About 1/2 pack/dayAbout 1/2 pack/day 18.8 13.6 21.7 46.0
>> 1 pack a day 1 pack a day 13.2 17.7 40.2 29.0
2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Youth Are Especially Susceptible to Addiction
For some youth, symptoms of dependence develop Before daily use begins Within days after inhalation
There is no minimum requirement of number smoked, frequency, or duration of use!
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2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Youth Tobacco Addiction
Dependence is more severe if use begins in adolescence
Those who begin as teens are more likely to become dependent, use for more years, and use more heavily
Increased vulnerability to addiction may be due to still-developing brain
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Source: Sargent. (2003).
2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
That First Puff . . .
The nicotine in one to two puffs occupies 50% of nicotinic receptors in the brain
A single dose increases the following: Noradrenaline synthesis in the hippocampus Neuronal potentiation can last for weeks
Meaning that neurons discharge action potentials at lower threshold
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2009 Johns Hopkins Bloomberg School of Public Health;American Academy of Pediatrics Julius B. Richmond Center of Excellence
Progress of Tobacco Use
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Image source: DiFranza. (2007).
