1 / 31

Bio and Disclosures

Youth (Children and Adolescents) CAN-ADAPTT Guideline Webinar Series March 17, 2011 Guideline Section Lead: Jennifer O’Loughlin, PhD. Bio and Disclosures. Jennifer O’Loughlin is a Professor in the Department of Social and Preventive Medicine, University of Montreal

tamah
Download Presentation

Bio and Disclosures

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Youth (Children and Adolescents)CAN-ADAPTT Guideline Webinar Series March 17, 2011Guideline Section Lead: Jennifer O’Loughlin, PhD

  2. Bio and Disclosures Jennifer O’Loughlin is a Professor in the Department of Social and Preventive Medicine, University of Montreal She is a Canada Research Chair in the Early Determinants of Adult Chronic Disease and is also a consultant to the Tobacco Control Research Team at the Institut national de sante publique du Quebec. No disclosures.

  3. Guideline Development Group Peter Selby, MBBS, CCFP, MHSc, FASAM; Gerry Brosky, MD, MSc, CCFP; Charl Els, MBChB, FCPsych, MMed Psych (cum laude), Cert. ASAM, MRO; Rosa Dragonetti, MSc; Sheila Cote-Meek, BScN, MBA, PhD; Jennifer O’Loughlin, PhD; Paul McDonald, PhD, FRSPH; Alice Ordean, MD, CCFP, MHSc; Robert Reid, PhD, MBA

  4. Good News….Declining Prevalencein Youth

  5. Bad News….Too Many Young People Smoke • 12-13% of adolescents smoke • Mean age at onset 12.5y • Daily smoking by age 16 • Early smokers • consume more • smoke longer • less likely to quit • Co-occurs with alcohol, illicit drug use, poor diet, inactivity • Youth cessation is a new concept

  6. Youth Underestimate the Powerof the Puff • Many believe they are not dependent • 97% of puffers • 83% of occasional smokers • 33% of daily smokers • Most believe they can quit easily • 97% of puffers • 87% of occasional smokers • 70% of daily smokers

  7. Many Novice Smokers Want to Quit… • 68% try to quit each year • >half make several attempts • Most do not succeed • 34% relapse in 1 week • 92% relapse in 1 year Source: Bancej C. PhD Thesis, McGill 2008

  8. Young Smokers Dependent Despite Low Exposure

  9. Smoking Intensity Trajectories Rapid escalators (6%) Moderate escalators (11%) Slow escalators (11%) Non-progressing low-intensity onset (72%)

  10. No. Months to Cigarette Use Milestones 12 243648 Months 0 Smokes daily 23 Smokes monthly 9 Smokes weekly Lifetime 100 cigs 19 Whole cigarette 3 Inhalation 2

  11. Onset of ND Symptoms 12 243648 Months 0 Tolerance 14 Cravings 5 Smokes daily 23 Withdrawal 12 ICD-10 Tobacco dependence 46 Smokes monthly 9 Smokes weekly Lifetime 100 cigs 19 Whole cigarette 3 Inhalation 2

  12. Early Cessation Milestones Stopped smoking completely and forever Really want to quit 2 Not confident quitting 21 Serious quit attempt 3 Aware of difficulty quitting 32 12 243648 Months 0 Cravings 5 Smokes daily 23 Withdrawal 12 ICD-10 Tobacco dependence 46 Smokes monthly 9 Smokes weekly Lifetime 100 cigs 19 Whole cigarette 3 Inhalation 2

  13. Predictors of Abstinence • Longitudinal literature not well developed • Despite heterogeneity, 5 factors robustly predicted quitting • friends smoke • not having intentions to smoke • resist pressure to smoke • older at first use • negative beliefs about smoking • Cessation interventions less than optimally effective until there is a solid evidence base

  14. Does Anything Work? • Systematic review of 16 RCTs (2001-6) • 11 behavioral (motivational enhancement, cognitive-behavioral, social influences) • 1 acupuncture • 4 pharmacologic • 6623 youth aged 12-20 • Outcome: 5-day point prevalence abstinence • 12/16 used CO/saliva cotinine to validate • Drop-out was 8-64% Source: Gervais et al. 20078

  15. Findings • Abstinence 0-52% • Intervention>control in 14/16 • 4/16 statistically significant (2/4 not biochemically validated) • 3 school-based programs • 1 motivational interviewing in health care setting • But…..many difficulties with this literature (small samples, short follow-up, differing definitions) • Much more research is needed

  16. Since then….. Fiore et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

  17. CAN-ADAPTT • Goal: To inform the development of a Pan-Canadian clinical practice guidelines (CPG) for smoking cessation • 4 reviewers (MDs) used AGREE criteria plus 8 additional criteria (related to applicability in Canada) to identify 6 sets of high quality guidelines • Proposals for CAN-ADAPTT guidelines reviewed in workshops and by a Guidelines Development Group Funded by the Drugs and Tobacco Initiative, Health Canada

  18. Pregnant and Breastfeeding Women/ Femmes enceintes et qui allaitent Youth (Children and Adolescents)/ Jeunes (enfants et adolescents) Mental Health and/or Other Addictions/ Santé mentale et/ou autres dépendances Aboriginal Peoples/ Autochtones Hospital-based populations/ Populations des hôpitaux

  19. GRADE Framework Grade of Recommendation • Each summary statement for each set of guidelines reviewed according to GRADE criteria High Low Strong Level of Evidence Weak

  20. Background • In addition to counselling by healthcare practitioners. efforts needed across settings (home, schools, cars) to provide non-smoking messages • What is a youth smoker? Consensus needed as to when a youth is considered to be a smoker. First puff? • No widely accepted youth-specific definition of nicotine dependence for use by clinicians • No validated screening tools to practitioners identify when youth who need help

  21. Summary Statement #1 Health care providers, who work with youth (children and adolescents) should obtain information about tobacco use (cigarettes, cigarillos, waterpipe, etc.) on a regular basis. GRADE 1A

  22. Summary Statement #2 Health care providers are encouraged to provide counseling that supports abstinence from tobacco and/or cessation to youth (children and adolescents) that use tobacco. GRADE*: 2C

  23. Summary Statement #3 Health care providers in pediatric health care settings should counsel parents/guardians about the potential harmful effects of second-hand smoke on the health of their children. GRADE*: 2C5

  24. Clinical Considerations • Clinicians should be aware of natural history of tobacco use onset, to identify transition to regular or daily smoking • Effectiveness of 5 As not established in youth, but asking and advising “are generally considered to be entry points for providing effective individual intervention”1. • Ask questions about tobacco use in different ways using language adapted to youth • Use direct inquiry or validated screening tool to identify those at high risk of sustained smoking. • Identify youth with additional risk (asthma). • Youth who use tobacco should be advised to stop. 1US Department of Health and Human Services Public Health Service, Clinical Practice Guideline (2008)

  25. Clinical Considerations Community-based (i.e., non-clinical) tobacco control programs for youth may be important for referral Few studies evaluate if brief counselling by health professionals is effective in youth. Motivational interviewing techniques can be adapted for youth. Little evidence that either NRT or bupropion are effective in young smokers, although they are safe

  26. Clinical Considerations • New Zealand guidelines recommend interventions for youth that are effective in adults (i.e., interventions that incorporate multi-session support) • Little empirical evidence that advising parents about harmful effects of SHS is effective……. • But counselling parents in pediatric settings or “…during child hospitalizations may increase parents’ interest in stopping smoking, parents’ quit attempts and parents’ quit rates…”1. 1US Department of Health and Human Services Public Health Service, Clinical Practice Guideline (2008)

  27. Tools/Resources • BLAST Program • Leave the Pack Behind • MyLastDip.com • Quit4Life • Stupid.ca • Talk with your children about smoking • Upcoming prognostic tool • Youth Action Committee on Tobacco Issues/National Foum on Youth and Young Adult Tobacco Control Issues Know of others? Share them on www.can-adaptt.net

  28. Gap in Practice and Research • Evaluate effectiveness of: • 5As in pediatric settings • pharmacotherapy • counseling • child vs family vs peer-focused interventions • internet interventions • Quitlines • school-based programs • When should clinicians intervene and how often? • How do we increasing appeal and reach? • Should other addictions be addressed?

  29. Have Additional Feedback? • Join the CANADAPTT network • Review current version of guideline • Provide feedback online

  30. For More Info CAN-ADAPTT Centre for Addiction and Mental Health 175 College St. Toronto, ON M5T 1P7 T: 416-535-8501 ext. 7427 Au Québec: 514.864.1600, poste 3532 www.can-adaptt.net Note:These presentation slides may be used or reproduced for educational purposes only. Please acknowledge authorship of this content to CAN-ADAPTT and CAMH.

  31. Webinar Discussion: Suggested Resources • Quit Run Chill www.QuitRunChill.org • Something Stinks in Hollywood (DVD for purchase at http://medialiteracyproject.org) • Hooked on Nicotine Checklist (HONC) by Joseph R. Difranza

More Related