Doc­tors have role to play in pre­vent­ing youth smok­ing: task force


Pri­mary-care doc­tors need to take a more ac­tive role in pre­vent­ing young Cana­di­ans from start­ing smok­ing and help­ing those who have al­ready taken up the habit to butt out for good, says a group of ex­perts that de­vel­ops clin­i­cal prac­tice guide­lines.

That rec­om­men­da­tion is at the heart of the first-ever guid­ance on smok­ing in chil­dren and youth aged five to 18, de­vel­oped by the Cana­dian Task Force on Pre­ven­tive Health Care.

“Rates of smok­ing have de­creased over the last cou­ple of decades, but they seem to have plateaued and they’re still much too high,” said Dr. Brett Thombs, chair­man of the fourmem­ber tobacco work­ing group within the task force, which penned the guide­lines re­leased Mon­day.

“And among Cana­dian youth, by the time chil­dren and ado­les­cents are in 12th grade, 36 per cent have tried smok­ing,” said Thombs, a pro­fes­sor in the fac­ulty of medicine at McGill Univer­sity in Montreal. “And that’s sim­ply way too high given the mas­sive bur­den of smok­ing on health (and) on our econ­omy.”

The guide­line doc­u­ment, pub­lished in Mon­day’s edi­tion of the Cana­dian Med­i­cal As­so­ci­a­tion Jour­nal, cites data show­ing that 18 per cent of youth in Grades 6 to 12 have tried cig­a­rettes.

“Al­most 90 per cent of adult smok­ers started be­fore they were 18, and we know that peo­ple who start smok­ing as chil­dren and youth are much less likely to quit later on,” said Thombs, not­ing that although the ad­verse

health ef­fects may pri­mar­ily show up later in life, they are ac­crued over a life­time of tobacco use.

Smok­ers are at risk for lung, throat, pan­cre­atic and blad­der can­cers, as well as chronic ob­struc­tive pul­monary dis­ease (COPD) and car­dio­vas­cu­lar dis­ease that can lead to a heart at­tack or stroke.

“If we can stop (them smok­ing) dur­ing child­hood and ado­les­cence, there’s a much bet­ter chance that they won’t even get into that pe­riod of high risk,” he said.

For preven­tion, the task force rec­om­mends that pri­mary-care providers first as­cer­tain whether chil­dren and teens are smok­ing and pro­vide brief in­for­ma­tion to both them and their par­ents on the risks of tobacco use and strate­gies for deal­ing with any peer pres­sure to smoke.

The rec­om­men­da­tion for treat­ing youth who have smoked in the previous 30 days is sim­i­lar, but in­cludes ad­vice on ways to stop the po­ten­tially ad­dic­tive habit be­fore it be­comes in­grained.

While pri­mar­ily aimed at doc­tors, the guide­lines also ap­ply to other pri­mary-care providers, such as nurses and be­havioural-health spe­cial­ists, Thombs said.

“It’s only one piece of the puz­zle - no sin­gle in­ter­ven­tion is go­ing to stop chil­dren and ado­les­cents from smok­ing,” he said, adding that the an­ti­smok­ing mes­sage can also be de­liv­ered in schools and through pro­vin­cial and fed­eral gov­ern­ment me­dia cam­paigns.

Still, pri­mary-care providers have an im­por­tant role to play, Thombs em­pha­sized.

“By putting this guide­line out, we’re say­ing very clearly that this is an im­por­tant ac­tiv­ity, they should make time for it and they should in­ter­act with kids and their fam­i­lies about smok­ing.”

The task force, an in­de­pen­dent body of pri­ma­rycare and preven­tion ex­perts, based its rec­om­men­da­tions on a re­view of clin­i­cal tri­als that looked at be­havioural in­ter­ven­tions such as pro­vid­ing in­for­ma­tion and coun­selling.

Thombs said re­search showed that such in­ter­ven­tions re­sulted in an 18 per cent re­duc­tion in the like­li­hood of a child or teen start­ing to smoke in the six months fol­low­ing a clin­i­cal trial, while teens who smoked and took part in ces­sa­tion pro­grams were 34 per cent more likely to butt out af­ter the in­ter­ven­tion.

In an ac­com­pa­ny­ing CMAJ com­men­tary, Dr. John Oys­ton of Scar­bor­ough Rouge Hos­pi­tal in Toronto sug­gests Canada should pass leg­is­la­tion ban­ning the sup­ply of all tobacco and nicotinecon­tain­ing prod­ucts-ex­clud­ing smok­ing-ces­sa­tion prod­ucts-to any­one un­der age 21.

Oys­ton points out that ju­ris­dic­tions that have raised the le­gal age for pur­chas­ing tobacco prod­ucts have seen a de­cline in youth smok­ing rates.

“Rais­ing the min­i­mum le­gal age for ac­cess to tobacco is a sci­en­tif­i­cally proven, legally and po­lit­i­cally quick, cheap and ef­fec­tive way to de­prive the tobacco in­dus­try of re­cruit­ing a new gen­er­a­tion of young peo­ple as their cus­tomers,” writes Oys­ton.


RIGHT: A smoker puts out a cig­a­rette in a pub­lic ash tray in Ot­tawa. Pri­ma­rycare doc­tors need to take a more ac­tive role in pre­vent­ing young Cana­di­ans from start­ing smok­ing and help those who have the habit to butt out for good, says a group of ex­perts.

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