According to the article, an estimated 28.5 percent of high school students smoke cigarettes and more than half try to quit each year. Public health guidelines recommend that health care providers counsel adolescents to stop smoking, and to try nicotine replacement therapy (NRT, including gum, patches, etc.) to help in smoking cessation. Many NRT products are sold over-the-counter, but the labeling on these items indicates that they should not be sold to anyone under 18 years.
Karen C. Johnson, M.D., M.P.H., from The University of Tennessee Health Science Center, Memphis, and colleagues investigated the ability of a minor to purchase over the counter NRT products.
The researchers identified 165 stores (retail, drug stores and grocery stores) in Memphis that sold over the counter NRT products. A 15-year-old girl visited the stores and attempted to buy NRT. She was instructed not to lie about her age, and carried no identification indicating her age. The minor was accompanied by an adult supervisor who entered the stores separately to observe the purchase attempts. The supervisor had no direct contact with the minor or the sales clerks.
In 81 percent of purchase attempts, the minor was able to purchase NRT. She was not questioned about her age in 79 percent of purchase attempts. The researchers also found that if the clerk asked the girl's age, she was much less likely to be allowed to buy NRT.
"Our study demonstrates that most purchases of NRT were obtained by a minor buyer without proof of age, despite warnings printed on the product," the authors write. "Given these findings, we conclude that the FDA-approved product labeling has little effect on actual sales practice. However, health practitioners recommending NRT to adolescent smokers attempting to quit should consider potential barriers to youth access."
(Arch Pediatr Adolesc Med. 2004;158:212-216. Available post-embargo at archpediatrics.com)
Editor's Note: This study was supported by a grant from the Partnership for Women's and Children's Health (Methodist Hospital, Le Bonheur Children's Medical Center, and The University of Tennessee, all in Memphis).
Editorial: Nicotine Replacement Therapy for Teenagers
In an accompanying editorial, William P. Adelman, M.D., of the National Naval Medical Center, Bethesda, Md., writes that adolescents may not use tobacco for the same reasons adults do: "Although a proportion of adolescent smokers meet subjective criteria for nicotine dependence, it is not necessarily nicotine that commits the adolescent to smoke as much as the unique behavioral and social factors associated with smoking at this developmental stage," Dr. Adelman writes.
He also notes that because adolescents may smoke more for social reasons than because they are addicted, NRT does not work very well in adolescents. "These behavioral and social influences on smoking are not altered with NRT, and NRT predictably fails as an effective aid in tobacco use cessation," he writes.
Dr. Adelman concludes: "Nicotine replacement therapy is not a primary therapy for adolescent smoking cessation. Improving access to NRT for teens is unlikely to improve cessation rates except perhaps in carefully selected individuals, under supervision by a physician, within the context of a smoking cessation program. As new, more rigorous and comprehensive studies are executed and their findings published, our understanding of this problem and our approach to the adolescent tobacco user will evolve."
(Arch Pediatr Adolesc Med. 2004;158:205-206. Available post-embargo at archpediatrics.com)
To contact Karen C. Johnson, M.D., M.P.H., call Elizabeth Maynard-Garrett at 901-448-4957. To contact editorialist William P. Adelman, M.D., call Chito Peppler at 301-295-5727.
For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or e-mail mediarelations@jama-archives.org .
Journal
Archives of Pediatrics and Adolescent Medicine