Nicotine replacement therapy … - Carlos A ... - Entretiens du Carla

Discussion
Smoking is a serious problem in adolescents
(17), and the earlier they start, the faster
dependence is established, and greater is the
problem (18), (19).
Prevention programs are relatively
ineffective (20), (21) and the transtheoretical
model of change has not been shown to apply
in this age-group (22), probably due to the fact
that nicotine dependence is multifactorial (23).
In this context, the use of nicotine
replacement therapy as an aid to smoking
cessation seems a good idea and is well
accepted by the majority of adolescents (24),
but the results of the studies that have been
published to date are not encouraging (25).
It is noteworthy that all of the studies (apart
from one (11)) used nicotine patches and no
prospective or randomized studies have been
conducted with other forms of nicotine
replacement therapy.
The neuronal toxicity of nicotine is a genuine
concern (26), but in any case smoking tobacco
is more toxic than using nicotine replacement
therapy.
Writing of recommendations.
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Moreover none of the studies have
reported major adverse effects or any
difference between the adverse effects
associated with nicotine replacement therapy
and placebo.
There is therefore no need to worry about
using nicotine replacement products in this
age-group but, given their low efficacy in
smoking cessation, they probably ought to be
restricted to cases of strong dependence and
supervised closely (25). Prospective studies of
the efficacy of other forms of nicotine
replacement are urgently required (27).
Conclusions:
• Nicotine replacement therapy is well
tolerated by adolescents.
• Nicotine replacement therapy is not a
very effective aid to smoking cessation.
• The possible reasons are:
- Inappropriate use (used for a too
short time, at insufficient doses),
- Inadequate delivery system (patches
are too slow-acting),
- Inadequate indications (in smokers
with no intention of quitting),
- Poor evaluation of the degree of
nicotine dependence.
• When the indications are satisfied and
close supervision provided, nicotine
replacement therapy could be used as an aid to
smoking cessation in adolescents.
• Studies on the use of other forms of
nicotine replacement therapy besides patches
are needed. ■
Use of NRTs among adolescents - Jean-Pierre Zellweger
(21) Myers MG, et al.
Measuring adolescent
smoking cessation strategies:
instrument
development and initial
validation. Nicotine Tob
Res 2007; 9(11): 1131-
1138.
(22) Kleinjan M, et al.
Associations between
the transtheoretical
processes of change,
nicotine dependence
and adolescent smokers'
transition through
the stages of change.
Addiction 2008; 103(2):
331-338.
(23) Kleinjan M, et al.
Factorial and convergent
validity of nicotine
dependence measures
in adolescents:
toward a multidimensional
approach.
Nicotine Tob Res 2007;
9(11): 1109-1118.
(24) Leatherdale ST,
McDonald PW. Youth
smokers' beliefs about
different cessation
approaches: are we
providing cessation
interventions they
never intend to use?
Cancer Causes Control
2007; 18(7): 783-791.
(25) Adelman WP.
Nicotine replacement
therapy for teenagers:
about time or a waste
of time? Arch Pediatr
Adolesc Med 2004;
158(3): 205-206.
(26) Ginzel KH, Maritz
GS, Marks DF et al.
Critical review: nicotine
for the fetus, the infant
and the adolescent? J
Health Psychol 2007;
12(2): 215-224.
(27) Moolchan ET, Ernst
M, Henningfield JE. A
review of tobacco smoking
in adolescents:
treatment implications.
J Am Acad Child
Adolesc Psychiatry
2000; 39(6): 682-693.