Tobacco Use Prevention for Children and Youth

1. Tobacco Use Prevention for Children and Youth Susanne E. Tanski, MD, FAAP The AAP Julius B. Richmond Center of Excellence http://www.aap.org/richmondcenter/

2. Objectives • Learn prevalence of youth tobacco use worldwide • Understand the influences for youth tobacco use • Review some prevention/treatment for youth tobacco use

3. Section A Impact and Use of Tobacco

4. 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 Source: http://www.who.int/topics/tobacco/facts/en/

5. 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 Image source: Adapted from http://www.who.int/tobacco/en/atlas7.pdf

6. Youth Tobacco Use Image source: Adapted from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5701a1.htm

7. Tobacco Use Trends in Europe http://www.euro.who.int/Document/EHI/ENHIS_Factsheet_3_4.pdf

8. Gender Gap in Tobacco Use Initiation Image source: http://www.searo.who.int/EN/Section1174/Section2469/Section2481.htm

9. 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 Source: www.cdc.gov/mmwr/preview/mmwrhtml/ss5701a1.htm

10. Percentage of Tobacco Use in the Past 30 Days Image source: Adapted from http://monitoringthefuture.org/pubs/monographs/overview2005.pdf

11. 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

12. 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

13. 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 Source: http://tobaccocontrol.bmj.com/cgi/content/full/11/3/252/

14. 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)

15. 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 Image source: http://mrg.bz/dIZOXT

16. Advertising Influences Youth U.S. Germany Kenya Image source: http://www.tobaccofreekids.org/reports/products/

17. 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 Source: American Academy of Pediatrics. (2001).

18. Youth Who Start Smoking, Continue Smoking Source: Monitoring the future project, U.S., 1976-1986 senior classes.

19. 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!

20. 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 Source: Sargent. (2003).

21. 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

22. Progress of Tobacco Use Image source: DiFranza. (2007).