[What measures can be taken to reduce the number of smoking adolescents and young women?].
A proper understanding of the factors exposing adolescents and young women to the risk of smoking dependence is necessary to develop effective preventive measures. These measures will be different depending on whether they are designed for adolescents and young women in general or for the context of pregnancy. For adolescents, efforts should be continued to provide information about smoking and the dangers of tobacco as well as about the social manipulation involved. The image of a natural, active woman, free of tobacco and capable of making her own decisions should be promoted. Health education and communication professionals should make use of different media with an audience among the young. Messages should be validated with a target population before diffusion. A better coherence between the adult and young populations concerning legal obligations and mutual respect is significantly useful. Educational structures (schools and universities) should participate in long-term community projects implicating peer groups and trained professionals. Values which should be reinforced include self-esteem, affirmation of personal competence and difference, self-respect and respect of others. Early identification of factors favoring psychosocial vulnerability at this age is indispensable to facilitate referral to professional support and care centers, the number of which remains insufficient to date. Support when ceasing smoking, based on individual and group assistance, should take into account the individual's phase of maturation, and must be proposed and operated by trained professionals working in a network. During pregnancy, it is crucial to recognize that the woman's specific physical and psychological situation is a unique opportunity to propose a new approach to smoking, taking into consideration the fragile context during this period of maturation and its impact on the woman's general life. Beyond sociopolitical measures and a philosophical debate on the position of women, men, and the family in the 21st century, propositions can be put forward for actions before, during and after the maternity period. It is important to continue the educational aspect without creating a guilt feeling. Messages should be elaborated with women. Healthcare professionals should be trained about smoking and smoking dependence. They should repeat minimal advice and continuously propose stopping smoking, taking into consideration the woman's stage of maturation and her motivation. Carbon monoxide monitoring should become a routine practice. Prognostic factors and possible difficulties should be identified early, if possible before pregnancy or at least during pregnancy, in order to propose adapted multidisciplinary support. The health booklet for the mother and the infant should be improved. Midwives should play an important role in prevention. A multidisciplinary effort will have the greatest impact: smoke-free environment in maternities, professional clinics, and the real-life territory of the pregnant woman. Individual care and support are more appropriate than group support. The partner should be implicated. For very dependent women, basically psychological support of smoking cessation should be completed with nicotine substitution therapy using protocols which should be redefined with more extensive studies. All these measures should be continued for six months after birth whether the woman has stopped smoking during pregnancy or not.
Unité de Tabacologie du CHU de Tours, 2 boulevard Tonnellé, 37044 Tours Cedex.
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Errard-Lalande
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Halimi
D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D018743:Perinatal Care; D011247:Pregnancy; D012907:Smoking / Q000523:psychology; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention