Overview

Researchersarestilltryingtounderstandthelinksbetweensmokingandtheimpactithasonadolescents.Smokingcan
affectthefunctionoftheprefrontalcortex,anareaofthebrainthatcontinuestodevelopthroughadolescenceandmay
thereforehaveamoreseriousandlastingimpactonbraindevelopmentduringthiscriticaldevelopmentalperiod.

TheLinkbetweenSmokingandAdolescentBrainDevelopment
Animalstudies1,2foundthatadolescentswhoareexposedtonicotinedemonstratedcognitivedeficitsresultingfrom
nicotineexposure.
Thetoxiceffectsoftobaccoonthenervoussystemmaybemostmarkedifsmokingcommencesintheearlyadolescent
years,whenthemainneurodevelopmentinvolvinginhibitorycontroloccurs.3
Inadolescents,depressionpredictssmoking(pooledestimates1.41[95%CI:1.21,1.63]),andsmokingpredicts
depression(pooledestimates1.73[95%CI:1.32,2.40]).4
Smokinginadolescencemaybeinfluencedbytheuseorabuseofothersubstancesandtroubleinschool,andbypoor
familyrelationsandlowinvolvementinactivepastimesamonggirls.Amongboys,smokingmaybeinfluencedbylow
religiosityanddelinquency.5Impulsivebehaviourmayplayanimportantroleinsmokinginitiation.6
Adolescentswithparentswhosmokehaveanincreasedriskforsubstanceuse.7
Astudy8ofadolescentsfoundthataccordingtotheHeavinessofSmokingIndex,whichisameasureofsmoking
behaviouranddependence,smokingadverselyaffectsneuralfunctioninthebraincortex.

Impact
Adolescentswhostopsmokingmayexperienceacutememoryimpairments,alongwithchronicdecrementsin
cognitiveperformance.Performanceproblemsweremoresevereamongthosewhostartedsmokingatearlierages.9,10
Inonestudy,adolescentswhosmokedwere4.5timesmorelikelytohavealcoholusedisordersthanthosewhonever
smoked.11
Nicotinedependenceinadulthoodcanbepredictedbyhighsmokinglevels,initiationofdailysmoking,durationof
smoking,timetoincreaseinsmoking,anddurationofstoppingsmokingduringadolescence.12

Actions
Bycontributingtoeducation,screening,detection,andmanagement/referral,healthcareproviderscanplayacrucial
roleinreducingtobaccouseandaddiction,therebyhelpingtodecreaseexposureofchildrentosecondhandtobacco
smoke.13,14
AmericanAcademyofPediatricsrecommendations13includeprohibitingtheadvertisingoftobaccoandtheuseof
tobaccoproductsinthemedia;attaininguniversalsmokefreeenvironmentsathome,inthecar,atschool,atwork,
andatplay;offeringtotreattobaccouseanddependence,andimplementingtobaccocontrolmeasures.

Actions(contd)
TheCANADAPTTGuidelineDevelopmentGroup15recommendsthathealthcareprovidersshould:
Askpatientsabouttobaccousestatusonaregularbasis.
Clearlyadvisepatients/clientstoquit.
Assessthewillingnessofpatientsorclientstobegintreatmenttoquitsmoking.
Offerassistancetoeverytobaccouserwhoexpressesthewillingnesstobegintreatmenttoquit.
Conductregularfollowuptoassessresponse,providesupportandmodifytreatmentasnecessary.
Referpatientsorclientstorelevantresourcesaspartofthetreatment,whereappropriate.

HelpfulResources
PublicHealthAgencyCanada.TrendsintheHealthofCanadianYouth.Chapter10:Tobacco,AlcoholandDrugs.
<http://www.phacaspc.gc.ca/hpps/dcadea/publications/trendstendances/hbsc_10eng.php>
PublicHealthAgencyCanada.YoungpeopleinCanada:theirhealthandwellbeingChapter6:YouthHealthRisk
Behaviours.<http://www.phacaspc.gc.ca/hpps/dcadea/publications/hbsc2004/chapter_6eng.php>
PublicHealthAgencyCanada.Schoolbasedtobaccocontrolprogrammingandstudentsmokingbehaviour.
<http://www.phacaspc.gc.ca/publicat/cdicmcc/294/ar_04eng.php>

References
1.

Counotte,D.S.,Spijker,S.,VandeBurgwal,L.H.,etal.(2009).LongLastingCognitiveDeficitsResultingfromAdolescentNicotine
ExposureinRats.Neuropsychopharmacology,34(2),299306.
Leslie,F.M.,Loughlin,S.E.,Wang,R.,etal.(2004).AdolescentDevelopmentofForebrainStimulantResponsiveness:Insightsfrom
AnimalStudies.AnnalsoftheNewYorkAcademyofSciences,1021(1),148159.
deBry,S.C.,Tiffany,S.T.(2008).TobaccoInducedNeurotoxicityofAdolescentCognitiveDevelopment(TINACD):AProposed
ModelfortheDevelopmentofImpulsivityinNicotineDependence.Nicotine&TobaccoResearch,10(1),1125.
Chaiton,M.,Cohen.J.,O'Loughlin,J.,etal.(2009).Asystematicreviewoflongitudinalstudiesontheassociationbetween
depressionandsmokinginadolescents.BMCPublicHealth,9(1),356.
VanDenBree,M.B.M.,Whitmer,M.D.,Pickworth,W.B.(2004).Predictorsofsmokingdevelopmentinapopulationbasedsample
ofadolescents:Aprospectivestudy.JournalofAdolescentHealth,35(3),172181.
Fields,S.,Collins,C.,Leraas,K.,etal.(2009).Dimensionsofimpulsivebehaviorinadolescentsmokersandnonsmokers.
ExperimentalandClinicalPsychopharmacology,17(5),30211.
Keyes,M.,Legrand,L.N.,Iacono,W.G.,etal.(2008).ParentalSmokingandAdolescentProblemBehavior:AnAdoptionStudyof
GeneralandSpecificEffects.AmericanJournalofPsychiatry,165(10),13381344.
Galvan,A.,Poldrack,R.A.,Baker,C.M.,etal.(2011).NeuralCorrelatesofResponseInhibitionandCigaretteSmokinginLate
Adolescence.Neuropsychopharmacology,36(5),970978.
Jacobsen,L.K.,Krystal,J.H.,Mencl,W.E.,etal.(2005).Effectsofsmokingandsmokingabstinenceoncognitioninadolescent
tobaccosmokers.BiologicalPsychiatry,57(1),5666.
Jacobsen,L.,Mencl,W.,Constable,R.,etal.(2007).Impactofsmokingabstinenceonworkingmemoryneurocircuitryin
adolescentdailytobaccosmokers.Psychopharmacology,193(4),557566.
Grucza,R.A.,Bierut,L.J.(2006).CigaretteSmokingandtheRiskforAlcoholUseDisordersAmongAdolescentDrinkers.
Alcoholism:ClinicalandExperimentalResearch,30(12),20462054.
VanDeVen,M.O.M.,Greenwood,P.A.,Engels,R.C.M.E.,etal.(2009).Patternsofadolescentsmokingandlaternicotine
dependenceinyoungadults:A10yearprospectivestudy.PublicHealth,124(2),6570.
CommitteeonEnvironmentalHealth,CommitteeonSubstanceAbuse,CommitteeonAdolescenceandCommitteeonNative
AmericanChildHealth.(2009).TobaccoUse:APediatricDisease.Pediatrics,124(5),14741487.
Sims,T.H.,(2009).TheCommitteeonSubstanceAbuse.TobaccoasaSubstanceofAbuse.Pediatrics,124(5),e1045e1053.
CANADAPTT.(2011Jan.).CanadianPracticeInformedSmokingCessationGuideline:SummaryStatement.Toronto:TheCanadian
ActionNetworkfortheAdvancement,DisseminationandAdoptionofPracticeinformedTobaccoTreatment,Centrefor
AddictionandMentalHealth.RetrievedJune27,2011from<http://www.can
adaptt.net/English/Guideline/Counselling%20and%20Psychosocial%20Approaches/Summary%20Statements.aspx>

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