Nicotine Replacement Therapy For Teenagers
Cigarette smoking is the number one cause of preventable disease and death in the US. Unfortunately, despite the drop in the prevalence of teen smoking, more than one out of four teenagers continue to smoke.
To help kids quit, current public health guidelines recommend physicians counsel students trying to quit to use nicotine replacement therapy (NRT) products such as gum and patches. However, this is in direct opposition to FDA labeling, which states that NRT products should not be sold to anyone under 18 years of age.
Recently, a group of researchers set out to see just how easy it was for minors to buy over the counter NRT products. Their study, published in the March 2004 issue of the Archives of Pediatrics & Adolescent Medicine, found that NRT products were easily obtainable by minors without proof of age.
About the Study
The researchers identified 165 stores (retail, drug, or grocery stores) that sold over-the-counter NRT products (either nicotine patches or nicotine gum). A 15-year old girl who attempted to purchase some type of NRT product visited each store. The girl carried no ID stating her age and was instructed to tell the truth about her age if questioned. An adult supervisor accompanied the girl on all her visits to the stores, but entered the store separately from the girl and did not interact with either the girl or the sales clerk.
The researchers found that 81% of the time, the 15-year old girl successfully purchased NRT products. They also found that 79% of the time, in most of the stores that sold NRT products, the girl was never questioned about her age. However, on those occasions when the girl was asked her age, she had much less success purchasing the NRT products.
How Does This Affect You?
Past research has shown that over-the-counter access to NRT products is effective in helping many adult smokers quit. This study demonstrates the ease with which teens may access these products and therefore the ineffectiveness of the current FDA warning label.
So, should the FDA’s labeling be changed so that NRT products become legally available to teens? This is a point of some controversy. While ease of access to NRT products is beneficial to teens who are attempting to quit smoking, what about teens who are looking to abuse these products? This concern, however, may be misplaced since the addictive properties of NRT products are quite low compared to cigarettes.
An editorial published with the study, however, takes a different view. According to the author, adolescents do not use tobacco for the same reasons adults do. For teens, he argues, smoking is generally about behavioral and social factors and is rarely due to true nicotine addiction. Therefore, NRT is not effective for helping teens quit and should not be made available.
A second study published in the same issue of the Archives of Pediatrics & Adolescent Medicine , looked at whether high school students who were involved in advocacy activities concerning the availability and use of tobacco products were less likely to smoke. These advocacy activities ranged from forming a task force of school administrators, teachers, and students to enforce smoking bans on campus to convincing city council members to decline campaign contributions from tobacco companies. In the end, the study found that participating in these types of activities lead to a reduction in regular smoking in the schools.
So, maybe the answer is a combination of the two approaches? If a teen can make it past 18 without becoming a smoker, it is very unlikely they will pick up the habit as adults. Advocacy programs may help many teens from ever becoming addicted to cigarettes, while access to NRT therapy may be one way to help those few who already have. The debate is sure to continue for some time. Meanwhile, whatever it takes to prevent children from becoming lifelong smokers is surely worth the effort.
The American Cancer Society
Adelman WP. Nicotine replacement therapy for teenagers: About time or a waste of time? Arch Pediatr Adolesc Med. 2004;158:205-206.
Johnson KC, Klesges LM, Somes GW, et al. Access of over-the-counter nicotine replacement therapy products to minors. Arch Pediatr Adolesc Med. 2004;158:212-216.
Winkleby MA, Feighery E, Dunn M, et al. Effects of an advocacy intervention to reduce smoking among teenagers.
Last reviewed March 5, 2004 by ]]>Richard Glickman-Simon, MD]]>
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