Childhood smoking: the research, clinical and theoretical imperative for nursing action

BACKGROUND: Tobacco smoking is a major international health issue which nurses are ideally positioned to address. Childhood represents a critical period for intervention to prevent/reduce smoking. During childhood, the majority of smokers first experiment with smoking, are initiated into the smoking subculture and become addicted to tobacco. Children are highly susceptible to smoking as a result of developmental factors, which promote or facilitate high-risk behaviours, limited coping skills, limited defences and inadequate legal protection against youth-focused marketing of tobacco. AIM: This paper is intended to sensitize nurses to the magnitude of childhood smoking as an international health problem and to familiarize them with current intervention approaches and care issues pertinent to child and adolescent populations. METHOD: An extensive literature review was conducted to determine the impact of childhood smoking at the personal and community level, characteristics of child smokers, the processes associated with smoking cessation, intervention approaches and intervention models for use by nurses across the spectrum of clinical settings. FINDINGS: Evidence exists that behaviourally based interventions by nurses for smoking prevention/cessation are effective with children. Key components of effective behaviourally based antismoking approaches for smokers include addressing self-efficacy to quit, providing social support, resisting temptation to smoke and discussing issues related to relapse and relapse prevention. For all children, the reinforcement of non-smoking behaviour is essential. Intervention models, which can be incorporated into routine clinical care of individual children or with groups, emphasize the importance of parental involvement, routine screening for tobacco use and provision of a clear message that smoking and tobacco use is unhealthy.