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Some Schools Helping Kids Unhook the Smoking Habit

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Nov. 14, 2000 -- Along with lunch and homework, some schools are handing out nicotine patches. Here's why: One of every three adolescent smokers eventually will die of a tobacco-related disease. Another way to look at it: Five million people currently under the age of 18 today will die prematurely from disorders linked to cigarettes.

These figures from the National Institute for Drug Abuse underscore the importance of breaking the addiction that researchers have shown can grab a teenager after only 10 puffs, the average amount in one cigarette. According to the CDC, more than 36% of high school students were smoking in 1997, an almost 9% increase over 1991.

Though conflicting figures exist on how many young people smoke, the experts all agree on three things: It's dangerous, it's addictive, and they need to quit.

With those things in mind, some school officials are getting into the role of helping teens break the habit. At least one school district gives nicotine patches and gum to students, and another is considering it.

The plan is not without controversy. Some researchers, doctors, and educators think it's a good route to halt the potentially deadly habit in the approximately 3,000 youngsters who become regular users of tobacco each day. However, many believe that the use of the patch on youngsters has not been thoroughly studied and may not be an effective method for those under age 18.

Jed Rose, PhD, co-inventor of the nicotine patch and director of Duke University's Nicotine Research Program, says he doesn't know of any schools handing out the patch to students. "I doubt that any would be doing that in view of the negative results of a trial with the patch and adolescents," he tells WebMD.

He's referring to research by Richard Hurt, MD, director of the Mayo Clinic Nicotine Dependence Center in Rochester, Minn. Indeed, the study -- in which about 100 smokers aged 13 to 17 wore the patch for six weeks -- was not a roaring success when it came to getting the teens to kick the habit. At the end of treatment, only 11 were no longer smoking, and by six months, six of those were puffing again.

Nonetheless, Hurt believes that using the patch for adolescents is worthwhile. "In the kids who didn't stop, they significantly reduced their smoking and stayed that way long term," he tells WebMD. All of the students in the study decreased their number of daily cigarettes from an average of 18 to less than three. Doctors followed their progress for a year.

Hurt says that the patch could be a successful antismoking treatment for those under age 18 if they receive more counseling. "We can treat them [with drugs] as we would adults, but we need to be aware of the special needs that teens have," he cautions.

Douglas Jorenby, PhD, clinical services director of the University of Wisconsin Center for Tobacco Research and Intervention in Madison, warns of possible complications in using the patch for adolescents and distributing it through schools.

"In theory, it's a wonderful idea," he says. "But there are potential complications: If they are under 18, they can't buy the patches so their parents would have to buy them or a physician would have to give them a prescription."

Patches are available over the counter but only for those over 18, because nicotine use -- as are cigarettes -- is illegal for those who are younger.

Another problem with more serious implications is the possibility of nicotine poisoning if the patch is worn while smoking at the same time. This could be especially dangerous for teenagers because, Jorenby says, "adolescents tend to be more impulsive in their smoking."

He disagrees with Hurt as to teens' motivation to quit smoking. He says most teens don't want to quit, while the Mayo Clinic researcher says their study showed they did. "We were encouraged that so many of them wanted to quit," Hurt says. "It's mythology in the public that teens don't want to stop."

However, Patricia Chandler, MD, of the University of Texas Southwestern Medical Center at Dallas, says the biggest problem she faces in working with youngsters addicted to cigarettes is their lack of desire to kick the habit. "They don't want to," Chandler says. "It's a prestige thing. And dancers smoke because they think it will keep the weight off." Chandler is a family practice doctor specializing in addictions.

Nevertheless, some schools think they can help wean these easily hooked youngsters off what's sometimes called the cancer stick, since smoking is responsible for about one-third of all cases of cancer in America.

School health clinics in Multnomah County, Ore., have given a few students nicotine patches over the past three years, and a school in the Chicago suburb of Arlington Heights is considering it as well. Hurt and Jorenby both believe the Oregon distribution through school-based health clinics system is an option. "If they are smoking in school restrooms, then it becomes a public health hazard," Jorenby says.

Other educators don't think they should be responsible for this type of treatment. Richard Adams, MD, Dallas Independent School District medical director, says it's unlikely to happen in schools in the Dallas area. He says that no one has instituted a district-wide smoking cessation program for students.

"The board of education doesn't see our role as providing general health treatment," Adams says. "If a student is on a prescription from a physician that must be taken during school, then we will administer it. However, we feel something like using the nicotine patch should be the decision of the physicians and the parents."

Recently, the U.S. Public Health Service issued new guidelines making treatment of tobacco dependence a national priority. In a statement on the guidelines, Surgeon General David Satcher, MD, urged "every doctor, nurse, health plan, purchaser, and medical school in America" to make this No. 1 on their health care list.

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