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Home > Tobacco Use Cessation Program > Didactic Components > Tobacco Use: A Pediatric Disease

Tobacco Use: A Pediatric Disease

Studies show that if people don't begin to use tobacco during adolescence, there is a good chance they never will. Eighty-nine percent of daily adult smokers began by age 18.

Cigarette Use

  • 22 % of high school students in the US are current cigarette smokers 21.9 % of females & 21.8 % of males.
  • 25 % of whites, 18 % of Hispanics, and 15 % of African Americans in high school are current cigarette smokers.
  • 8 % of middle school students are current cigarette smokers - females 9 % & males 8 %.
  • 9 % of whites, 10 % of Hispanics, 8 % of African Americans, and 3 % of Asian Americans in middle school are current smokers.
  • Each day, 3,900 young people between the ages of 12 and 17 initiate cigarette smoking in the US. In this age group, each day 1,500 young people become daily cigarette smokers.

Other Tobacco Use

  • Nationally, 13 % of high school students and 5 % of all middle school students are current cigar smokers.
  • 10 % of males in high school and 4 % of males in middle school are current smokeless (spit) tobacco users.
  • The use of bidis, kreteks (clove cigarettes), and pipes among high school students was each about 3%. Bidis are the latest craze among teens. Bidis are cheap, unfiltered, flavored mini cigarettes imported from India. They produce 3X the amount of CO and nicotine and 5X the amount of tar than American cigarettes.

Teens who smoke are 3X more likely to use alcohol, 8X more likely to use marijuana, and 22X more likely to use cocaine than nonsmokers. Illegal drug use is rare among those who have never smoked.

Smoking during pregnancy increases the chance of a:

  • low-birth-weight baby
  • miscarriage
  • premature birth
  • stillbirth
  • sudden infant death syndrome (SIDS)
  • 6X greater chance of cleft palate formation

Secondhand (passive) smoke from parents has an effect on their children:

  • Increased risk of:
    • colds, pneumonia, bronchitis
    • middle-ear infections
    • increased severity of symptoms in asthmatic children
    • reduction in lung function
    • delayed development of permanent teeth by as many as 4 months
    • more caries in their deciduous teeth
Personal characteristics of adolescent tobacco users:
  • low self-esteem, low aspirations, depression/anxiety, sensation-seeking
Behavioral characteristics of adolescent tobacco users:
  • poor school performance, school absences, school drop-out, alcohol and other drug use
Environmental characteristics of adolescent tobacco users:
  • cultural messages (advertising, role models in movies and music), peer tobacco use, parental tobacco use

Smokeless (Spit) tobacco use by adolescents

  • 25% of young users start by he 6th grade and 75% start by the 9th grade
  • regular use often begins by age 12
  • use is more common among:
    • athletes, males living in rural areas, Am Indians & Alaska Natives, those employed in the military & lumber industry, white males between 18-35, those living in Arkansas, Kentucky, So. Dakota, W. Virginia, Wyoming

The average spit tobacco user dips 1 1/2 cans per week

  • under 1/2 can per week = light use
  • over 2 1/2 cans per week = heavy use
One can delivers as much nicotine as 3 packs of cigarettes
Nitrosamine content in spit tobacco is higher than in cigarettes

Types of Spit Tobacco Products: Snuff and Chewing tobacco

  • Snuff: finely ground or shredded form of tobacco sold in round tin cans
    • Moist (most common form used by adolescents)
    • Dry
    • Sachet (packaged similar to teabags and marketed as starter kits for youth)
  • Chewing Tobacco: coarsely cut tobacco
    • Loose leaf (shredded form sold in pouches)
    • Plugs (bricks)
    • Twists (rope-like strands)

Health Implications of Spit Tobacco:

  • Addiction (nicotine is as addictive as cocaine or heroin)
  • Disease

Major carcinogens in Spit Tobacco:

  • Nitrosamines, polynuclear aromatic hydrocarbons, radioactive compounds, metallic compounds
  • Nitrosamine concentration exceeds by >1000X the nitrosamine content allowed by the FDA in products like beer and bacon

Spit tobacco risk of oral cancer

  • Early users: risk 4X greater than nonusers
  • Prolonged users: risk 48X greater than nonusers
  • Incidence of dysplasia or carcinoma:
    • leukoplakia 5%
    • erythroplakia 90%
>90% of lesions occur at the site where the dip or chew is held
ST is dangerous...but Smoking is 2x more likely to cause oral cancer than smokeless tobacco.

Nicotine in spit tobacco is buffered (increased pH) to facilitate absorption

  • absorption is slower than with smoking
  • peak concentration at 30 minutes
  • persistent absorption for up to 60 minutes after tobacco removed (slow release from mucous membrane and from swallowed nicotine)
Other health implications
  • Spit tobacco may be a risk factor for severe active periodontal disease
  • Spit tobacco use is associated with risk factors for cardiovascular disease (elevated blood pressure and cholesterol levels)

Methods of Treating Spit Tobacco Use

  • Behavioral and pharmacotherapy
  • Predictors of high nicotine dependence in ST users
    • using ST within 30 minutes of waking
    • using ST when sick/mouth sores
    • ST in mouth more than 30 minutes
    • intentionally swallowing tobacco juice
    • ST in mouth most of the day
    • strong cravings when abstinent
    • greater than 15 dips per day
  • Behavioral treatment
    • record use patterns (cans or pouches per week)
    • determine stage of readiness to stop use
    • recognize cues to use
    • recognize urges and withdrawal
    • develop coping skills
    • managing stress
  • Behavioral skills
    • Avoidance (oral substitutes, alternative activities/distractions)
    • Cognitive (delay use)
    • Emphasize (health consequences-oral exam & social consequences)

Literature review conclusions (Meta-analysis)

  • Behavioral interventions are effective for ST users
  • Zyban is probably effective for ST users
  • NRT may be effective for ST users
  • Among behavioral interventions, the use of an oral examination appears to be associated with greater treatment effect
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