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The Guidance Of Treatment Selection Of Stop Smoking According To Suitability For Adolescent, Psychiatric Patient, Pregnant And Nursing Women

Introduction

There are several groups for whom there are particular implications regarding nicotine dependence and the effects of smoking, as well as the use of medicines for smoking cessation. These special groups include adolescents, pregnant and nursing women and people with psychiatric illnesses.

However, the same guidelines for quitting smoking apply to all groups i.e. every opportunity should be taken to offer all smokers advice and support to stop smoking. Counseling and behavioural interventions may be modified to suit for the individual smoker.

Adolescent

Adolescents are likely to model parents’ behavior and adopt similar norms. As a result, adolescents who have family members and close friends who smoke have a stronger predilection to pick up smoking. The role of socio-economic and demographic factors in smoking initiation is also well documented. These factors include low socio-economic status, low self esteem, poor academic performances and behavioural problems.

Smoking cessation interventions in adolescent:

  • Each adolescent patient and their parents should be screened for tobacco use and exposure at each visit.
  • They should be provided with a strong anti-smoking message.
  • Counseling is considered to be an important intervention in this age group.
  • They should be assessed regarding the nicotine dependence, motivation to quit and willingness to accept counseling before recommending NRT.
  • Nicotine Replacement Therapy (NRT) may be considered (if indicated) with precautions.

Psychiatric Patient

Psychiatric patients are more likely to smoke and to be heavier smokers. However, stopping smoking does not make those psychiatric problems worse and smokers with psychiatric problems are just as likely to quit successfully as other smokers.

Smoking cessation interventions in psychiatric patient:

  • All psychiatric patients can be offered equal opportunity to quit smoking when identified.
  • However, they are more likely to need more intensive help for longer period of time.
  • Current treatments to treat the general population are effective and work almost equally well for patient with psychiatric illnesses.
  • However, psychiatric patient will need more closely monitoring while on treatment due to known drug-smoking interaction, higher relapse rates among this population and risk of suicide with certain medications.
  • The dose of any medication which patients are using for their psychiatric problem, particularly anti-psychotic medications should be
  • The team treating their psychiatric problems needs to be liaised closely.

Pregnant and Nursing Women

Smoking in pregnant and nursing mother imparts risks to both the mother and the baby. Cigarette smoking by pregnant women has been shown to cause adverse baby outcomes, including stillbirths, abortions, decreased fetal growth, premature births, low birth-weight, placental abruption and sudden infant death syndrome (SIDS). Smoking also has been linked to cognitive, emotional and behavioral problems in children.

Many women are motivated to quit smoking during pregnancy. It should be reinforced with the knowledge that smoking cessation will reduce health risks to the both the mother and child.

Smoking cessation interventions in pregnant and nursing women :

  • All pregnant and nursing women should be encouraged to stop smoking completely by using counseling, advice and support interventions before using medications.
  • The efficacy and safety of these medications during pregnancy and lactation are not well documented.
  • Use of medication should be considered only if a pregnant woman is otherwise unable to quit.
  • Intermittent short-acting Nicotine Replacement Therapy (NRT) e.g. nicotine gum is preferred to patches and other oral medications.

References

American College of Obstetricians and Gynecologists. Smoking Cessation During Pregnancy. Obstet Gynecol. 2005; 106:883–8.

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