Skip to main content
Log in

Adolescent Smoking

Epidemiology and Approaches for Achieving Cessation

  • Therapy In Practice
  • Published:
Pediatric Drugs Aims and scope Submit manuscript

Abstract

The initiation of smoking typically occurs during adolescence. To date, most adolescent smoking control efforts have focused on prevention; attempting to identify and influence factors that contribute to experimentation and initiation. However, given the large number of adolescent smokers, it is important that effort also be directed toward facilitating cessation.

Many adolescents are addicted to cigarettes and report withdrawal symptoms that are similar to those experienced by adults. Relapse rates are high; few adolescents who try to quit on their own are successful. Clinician-delivered smoking cessation interventions have a positive impact in adults and should be applied to adolescents to promote and sustain abstinence.

Although pharmaceutical aids for cessation have been shown to be well tolerated and effective in adults, less is known about their use in adolescents. As such, clinicians are encouraged to explore whether pharmaceutical aids have been approved for use in adolescents in their country and to use discretion when considering their use in patients <18 years of age. Because pediatricians are in a unique position to facilitate tobacco cessation counseling, they should routinely ask their patients whether they use tobacco, advise users to quit, assess readiness to quit, assist with quitting, and arrange follow-up counseling. Tobacco cessation efforts can be enhanced by teaming with other health professionals (e.g. nurses, dentists, pharmacists, social workers) or worksite and community-based organizations that provide health promotion services.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Table I
Fig. 1

Similar content being viewed by others

References

  1. World Health Organization. Tobacco and the rights of the child. Geneva: World Health Organization, 2001

    Google Scholar 

  2. United States Department of Health and Human Services. Preventing tobacco use among young people: a report of the Surgeon General. Atlanta (GA): United States Department of Health and Human Service, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994

    Google Scholar 

  3. Gilpin EA, Lee L, Evans N, et al. Smoking initiation rates in adults and minors: United States, 1984–1988. Am J Epidemiol 1994; 140(6): 535–43

    PubMed  CAS  Google Scholar 

  4. Centers for Disease Control and Prevention. Trends in cigarette smoking among high school students: United States, 1991–2001. MMWR Morb Mortal Wkly Rep 2002; 51(19): 409–12

    Google Scholar 

  5. Gritz ER, Prokhorov AV, Hudmon KS, et al. Cigarette smoking in a multiethnic population of youth: methods and baseline findings. Prev Med 1998; 27(3): 365–84

    Article  PubMed  CAS  Google Scholar 

  6. Gritz ER, Prokhorov AV, Hudmon KS, et al. Predictors of susceptibility to smoking and ever smoking: a longitudinal study in tri-ethnic sample of adolescents. Nicotine Tob Res. In press

  7. Kelder SH, Prokhorov AV, Barosso C, et al. Smoking differences among African American, Hispanic and White middle school students in an urban setting. Addict Behav. In press

  8. United States Department of Health and Human Services. Women and smoking: a report of the Surgeon General. Rockville (MD): United States Department of Health and Human Services, Public Health Service, 2001

    Google Scholar 

  9. American Psychiatric Association. Substance-related disorders. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994: 244–7

    Google Scholar 

  10. McNeill AD, West RJ, Jarvis M, et al. Cigarette withdrawal symptoms in adolescent smokers. Psychopharmacology 1986; 90(4): 533–6

    Article  PubMed  CAS  Google Scholar 

  11. Charlton A, Melia P, Moyer C. Manual on tobacco and young people for the industrialized world. Geneva: Canadian Cancer Society, Toronto, for UICC, 1990

    Google Scholar 

  12. Drug abuse and drug abuse research: triennial report to congress from the Secretary, Department of Health and Human Services. Washington, DC: US Department of Health and Human Services, National Institute on Drug Abuse, 1987. DHHS Publication No. (ADM) 87-1486

  13. Johnston LD, O’Malley PM, Bachman JG. Cigarette smoking among American teens declines sharply in 2001 [national press release]. Ann Arbor (MI): University of Michigan News and Information Services, 2001 Dec 19

    Google Scholar 

  14. Centres for Disease Control and Prevention. Youth tobacco surveillance: United States 2000. MMWR Morb Mortal Wkly Rep 2001; 50(SS-04): 1–84

    Google Scholar 

  15. Centres for Disease Control and Prevention. Youth tobacco surveillance: United States, 1998–1999. MMWR Morb Mortal Wkly Rep 2000; 49(SS-10): 1–44

    Google Scholar 

  16. Ershler J, Leventhal H, Fleming R, et al. The quitting experience for smokers in sixth through twelfth grades. Addict Behav 1989; 14(4): 365–78

    Article  PubMed  CAS  Google Scholar 

  17. Burt RD, Peterson AV. Smoking cessation among high school seniors. Prevent Med 1998; 27: 319–27

    Article  CAS  Google Scholar 

  18. Dozois DN, Farrow JA, Miser A. Smoking patterns and cessation motivations during adolescence. Int J Addict 1995; 30(11): 1485–98

    PubMed  CAS  Google Scholar 

  19. Kandel DB, Johnson JG, Bird HR, et al. Psychiatric disorders associated with substance use among children and adolescents: findings from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) study. J Abnorm Child Psychol 1997; 25(2): 121–32

    Article  PubMed  CAS  Google Scholar 

  20. Prokhorov AV, Pallonen UE, Fava JL, et al. Measuring nicotine dependence among high-risk adolescent smokers. J Addict Behav 1996; 21(1): 117–27

    Article  CAS  Google Scholar 

  21. Smith TA, House Jr RF, Croghan IT, et al. Nicotine patch therapy in adolescent smokers. Pediatrics 1996; 98 (4 Pt 1): 659–67

    PubMed  CAS  Google Scholar 

  22. Stanton W. DSM-III-R tobacco dependence and quitting during late adolescence. Addict Behav 1995; 20(5): 595–603

    Article  PubMed  CAS  Google Scholar 

  23. Fagerström KO. Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment. Addict Behav 1978; 3: 235–46

    Article  PubMed  Google Scholar 

  24. Prokhorov AV, Koehly LM, Pallonen UE, et al. Adolescent nicotine dependence measured by the modified Fagerström Tolerance Questionnaire at two time points. J Child Adolesc Subst Abuse 1998; 7(4): 35–46

    Article  Google Scholar 

  25. Prokhorov AV, De Moor C, Pallonen UE, et al. Validation of the modified Fagerström tolerance questionnaire with salivary cotinine among adolescents. Addict Behav 2000; 25(3): 429–33

    Article  PubMed  CAS  Google Scholar 

  26. Prokhorov AV, Hudmon KS, de Moor CA, et al. Nicotine dependence, withdrawal symptoms, and adolescents’ readiness to quit smoking. Nicotine Tob Res 2001; 3(2): 151–5

    Article  PubMed  CAS  Google Scholar 

  27. Centers for Disease Control. Selected cigarette smoking initiation and quitting behaviors among high school students: United States, 1997. MMWR Morb Mortal Wkly Rep 1998; 47(19): 386–9

    Google Scholar 

  28. Centers for Disease Control. Reasons for tobacco use and symptoms of nicotine withdrawal among adolescent and young adult tobacco users, US 1993. MMWR Morb Mortal Wkly Rep 1994; 43(41): 745–50

    Google Scholar 

  29. Moolchan ET, Ernst M, Henningfield JE. A review of tobacco smoking in adolescents: treatment implications. J Am Acad Child Adolesc Psychiatry 2000; 39(6): 682–93

    Article  PubMed  CAS  Google Scholar 

  30. DiClemente CC, Prochaska JO. Self-change and therapy change of smoking behavior: a comparison of processes of change in cessation and maintenance. Addict Behav 1982; 7(2): 133–42

    Article  PubMed  CAS  Google Scholar 

  31. Pallonen UE. Transtheoretical measures for adolescent and adult smokers: similarities and differences. Prev Med 1998; 27 (5 Pt 3): A29–38

    Article  PubMed  CAS  Google Scholar 

  32. Prochaska JO. Assessing how people change. Cancer 1991; 67(3 Suppl.): 805–7

    Article  PubMed  CAS  Google Scholar 

  33. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change: applications to addictive behaviors. Am Psychologist 1992; 47(9): 1102–14

    Article  CAS  Google Scholar 

  34. Prochaska JO, DiClemente CC. Stages of change in the modification of problem behaviors. In: Hersen M, Eisler RM, Miller PM, editors. Progress in behavior modification. Sycamore (IL): Sycamore Press, 1992: 184–218

    Google Scholar 

  35. Prochaska JO, Velicer WF, Rossi JS, et al. Stages of change and decisional balance for 12 problem behaviors. Health Psychol 1994; 13(1): 39–46

    Article  PubMed  CAS  Google Scholar 

  36. Prochaska JO. Systems of psychotherapy: a transtheoretical analysis. Homewood (IL): Dorsey Press, 1979

    Google Scholar 

  37. Prochaska JO, DiClemente CC. The transtheoretical approach: crossing traditional boundaries of therapy. Homewood (IL): Dow Jones-Irwin Publications, 1984

    Google Scholar 

  38. Prochaska JO, DiClemente CC, Norcross JC. Changing: process approaches to initiation and maintenance of changes. In: Klar Y, Fisher JD, Chinsky JM, et al., editors. Self change: social psychological and clinical perspectives. New York: Springer-Verlag, 1992: 87–114

    Google Scholar 

  39. Fiore MC, Bailey WC, Cohen SJ, et al. Treating tobacco use and dependence: clinical practice guideline. Rockville (MD): US Department of Health and Human Services, 2000

    Google Scholar 

  40. Klein JD. Incorporating effective smoking prevention and cessation counseling into practice. Pediatr Ann 1995; 24(12): 646–52

    PubMed  CAS  Google Scholar 

  41. Perry CL, Silvis G. Smoking prevention: behavioral prescriptions for the pediatrician. Pediatrics 1987; 79(5): 790–9

    PubMed  CAS  Google Scholar 

  42. Burton D. Tobacco cessation programs for adolescents. In: Richmond R, Retford DC, editors. Interventions for smokers, an international perspective. Baltimore (MD): Williams & Wilkins, 1994: 95–105

    Google Scholar 

  43. Alfano CM, Zbikowski SM, Robinson LA, et al. Adolescent reports of physician counseling for smoking. Pediatrics 2002; 109(3): E47

    Article  PubMed  Google Scholar 

  44. Glynn TJ, Manley MW. How to help your patients stop smoking: a National Cancer Institute manual for physicians. Bethesda (MD): The United States Department of Health and Human Services, Public Health Service, National Institute of Health, National Cancer Institute, 1989: Report no. 90-3064

    Google Scholar 

  45. Hudmon KS, Corelli RL, Kroon LA, et al. Reducing pulmonary disease: the pharmacist’s role in smoking cessation. J Pharm Prac 2001; 14(2): 143–59

    Article  Google Scholar 

  46. Prokhorov AV, Perry CL, Kelder SH, et al. Lifestyle values of adolescents: results from Minnesota Heart Health Youth Program. J Adolesc 1993; 28(111): 637–47

    CAS  Google Scholar 

  47. Fagan P, Eisenberg M, Stoddard AM, et al. Social influences, social norms, social support, and smoking behavior among adolescent workers. Am J Health Promot 2001; 15(6): 414–21

    Article  PubMed  CAS  Google Scholar 

  48. Lawrance KG. Adolescent smokers’ preferred smoking cessation methods. Can J Public Health 2001; 92(6): 423–6

    PubMed  CAS  Google Scholar 

  49. Donovan KA. Smoking cessation programs for adolescents. J Sch Nurs 2000; 16(4): 36–43

    Article  PubMed  CAS  Google Scholar 

  50. Hurt RD, Croghan GA, Beede SD, et al. Nicotine patch therapy in 101 adolescent smokers: efficacy, withdrawal symptom relief, and carbon monoxide and plasma cotinine levels. Arch Pediatr Adolesc Med 2000; 154(1): 31–7

    PubMed  CAS  Google Scholar 

  51. Hughes JR, Goldstein MG, Hurt RD, et al. Recent advances in the pharmacotherapy of smoking. JAMA 1999; 281(1): 72–6

    Article  PubMed  CAS  Google Scholar 

  52. Henningfield JE, Michaelides T, Sussman S. Developing treatment for tobacco addicted youth: issues and challenges. J Child Adolesc Subst Abuse 2000; 9: 5–26

    Article  Google Scholar 

  53. McNeill A, Foulds J, Bates C. Regulation of nicotine replacement therapies (NRT): a critique of current practice. Addiction 2001; 96(12): 1757–68

    Article  PubMed  CAS  Google Scholar 

  54. Silagy C, Lancaster T, Stead L, et al. Nicotine replacement therapy for smoking cessation (Cochrane Review). The Cochrane Database of Systematic Reviews. Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; Issue 4. Oxford: Oxford Update Software, 2002

    Google Scholar 

  55. Corelli RL, Hudmon KS. Medications for smoking cessation. West J Med 2002; 176(2): 131–5

    PubMed  Google Scholar 

  56. Foulds J. Smoking cessation in youth people: should we do more to help young smokers to quit. London: Health Development Agency, 1999

    Google Scholar 

  57. Hughes JR, Stead LF, Lancaster T. Antidepressants for smoking cessation (Cochrane Review). The Cochrane Database of Systematic Reviews. Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; Issue 3. Oxford: Oxford Update Software, 2000

    Google Scholar 

  58. Covey LS, Sullivan MA, Johnston JA, et al. Advances in non-nicotine pharmacotherapy for smoking cessation. Drugs 2000; 59(1): 17–31

    Article  PubMed  CAS  Google Scholar 

  59. Ferry LH. Non-nicotine pharmacotherapy for smoking cessation. Prim Care 1999; 26(3): 653–69

    Article  PubMed  CAS  Google Scholar 

  60. Wechsler H, Levine S, Idelson RK, et al. The physician’s role in health promotion revisited: a survey of primary care practitioners. N Engl J Med 1996; 334(15): 996–8

    Article  PubMed  CAS  Google Scholar 

  61. Goldstein MG, Niaura R, Willey-Lessne C, et al. Physicians counseling smokers: a population-based survey of patients’ perceptions of health care provider-delivered smoking cessation interventions. Arch Intern Med 1997; 157(12): 1313–9

    Article  PubMed  CAS  Google Scholar 

  62. Thorndike AN, Rigotti NA, Stafford RS, et al. National patterns in the treatment of smokers by physicians. JAMA 1998; 279(8): 604–8

    Article  PubMed  CAS  Google Scholar 

  63. Prokhorov AV, Wetter DW, Padgett D, et al. Spit tobacco prevention and cessation counseling: statewide survey of health-care professionals and educators. Subst Use Misuse. In press

  64. McBride PE, Plane MB, Underbakke G, et al. Smoking screening and management in primary care practices. Arch Fam Med 1997; 6(2): 165–72

    Article  PubMed  CAS  Google Scholar 

  65. Cabana MD, Rand CS, Powe NR, et al. Why don’t physicians follow clinical practice guidelines: a framework for improvement. JAMA 1999; 282(15): 1458–65

    Article  PubMed  CAS  Google Scholar 

  66. Jaen CR, Crabtree BF, Zyzanski SJ, et al. Making time for tobacco cessation counseling. J Fam Pract 1998; 46(5): 425–8

    PubMed  CAS  Google Scholar 

  67. Solberg LI, Kottke TE, Conn SA, et al. Delivering clinical preventive services is a systems problem. Ann Behav Med 1997; 19(3): 271–8

    Article  PubMed  CAS  Google Scholar 

  68. Secker-Walker RH, Solomon LJ, Flynn BS, et al. Comparisons of the smoking cessation counseling activities of six types of health professionals. Prev Med 1994; 23(6): 800–8

    Article  PubMed  CAS  Google Scholar 

  69. Secker-Walker RH, Dana GS, Solomon LJ, et al. The role of health professionals in a community-based program to help women quit smoking. Prev Med 2000; 30(2): 126–37

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

Supported by National Cancer Institute grant R01 CA69425 to AV Prokhorov, and the University of California Tobacco-Related Disease Research Program grant 10ST-0339 to KS Hudmon.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alexander V. Prokhorov.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Prokhorov, A.V., Hudmon, K.S. & Stancic, N. Adolescent Smoking. Pediatr-Drugs 5, 1–10 (2003). https://doi.org/10.2165/00128072-200305010-00001

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00128072-200305010-00001

Keywords

Navigation