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Management of smoking cessation in adolescents

Authors
Joseph B Rosen, MD
Marianna Sockrider, MD, DrPH
Section Editors
George B Mallory, MD
Diane Blake, MD
Deputy Editor
Alison G Hoppin, MD

INTRODUCTION

Long-term tobacco smoking can have adverse effects in nearly every organ of the body and cause a variety of diseases. In the United States, the adverse health effects from cigarette smoking account for more than 480,000 deaths among adults, or nearly one of every five deaths; more deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined [1].

Cancer was among the first diseases causally linked to smoking. Smoking causes cancers of the bladder, oral cavity, pharynx, larynx, esophagus, cervix, kidney, lung, pancreas, and stomach, and acute myeloid leukemia [1]. Smoking causes about 90 percent of lung cancer deaths in men and women. The epidemiology of smoking and the benefits of smoking cessation in adults are discussed in separate topic reviews. (See "Patterns of tobacco use" and "Cigarette smoking and other possible risk factors for lung cancer".)

The prevalence of tobacco smoking among adolescents in the United States has gradually declined since the late 1990s. In 2013, 25.6 percent of 12th grade students reported smoking in the past 30 days, compared with 39 percent in 2001 (figure 1) [2,3]. Regional variations, prevalence, and trends in smoking among adolescents are discussed in a separate topic review. (See "Prevention of smoking initiation in children and adolescents".)  

Smoking cessation is particularly important in the adolescent population because intervention at this time may prevent nicotine dependence and severe health consequences later in life. Smoking in adulthood is closely associated with smoking during adolescence: 90 percent of adult smokers smoked their first cigarette before the age of 18 [4]. Youth are particularly vulnerable to becoming dependent on nicotine, as compared with adults. Nicotine dependence can develop after as few as 100 cigarettes. The first symptoms of nicotine dependence can appear within days to weeks of the onset of occasional cigarette use, and often appear before the onset of daily smoking. (See 'Nicotine dependence' below.)

Motivation to quit smoking, as well as methods to help adolescent patients stop smoking, including smoking bans, adolescent smoking cessation programs, and pharmacological interventions are reviewed here. Behavioral and pharmacological interventions to support smoking cessation in adults are presented separately. (See "Behavioral approaches to smoking cessation" and "Overview of smoking cessation management in adults".)

                                 

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