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The latest evidence for practice

Smoking cessation for adolescents

Many smokers start smoking in adolescence and so smoking cessation interventions may need to consider age-specific factors in order to be effective in this age group. This American qualitative study used grounded theory to explore the beliefs and experiences of adolescents related to quitting smoking. 

A total of 46 adolescents participated in individual interviews and 31 adolescents participated in focus group sessions that addressed different aspects of quitting smoking. These aspects included what quitting meant, a history of smoking, self-identification as smokers, reasons to quit and strategies for resisting urges to smoke. The interviews and focus groups were audiotaped, transcribed and then analysed.

The results found that most adolescents believed that quitting smoking meant stopping smoking for life, which was a major obstacle since they found it difficult to imagine achieving this goal. Adolescents who had attempted to quit had found it more difficult than anticipated and obstacles to quitting, such as stresses of daily life and giving up friends who smoked to avoid temptation, had felt impossible to overcome.  Quitting was difficult because smoking was used to manage stressful events and temptations were hard to avoid, such as seeing others smoke, being in places where people smoked, smelling smoke and seeing cigarettes on television, at home or in stores. Other stressors were family or friends who challenged the individual's ability to quit or offered them cigarettes. The study concluded that smoking cessation was hard for adolescents because of their life stresses and the major lifestyle changes that were needed to achieve quitting.

A commentary notes that when dealing with younger adolescent smokers, nurses should adopt a harm-minimisation approach. It also suggests that tobacco education campaigns that target young smokers should promote images of exsmokers that are relevant to young people and acknowledge the high social costs of quitting for this age group.

Reference
Falkin GP, Fryer CS, Mahadeo M. Smoking cessation and stress among teenagers. Qual Health Res 2007;17:812-23.

Commentary
Haines RJ. Evid Based Nurs 2008;11:27.

What is the most effective treatment for scabies?

Scabies is an infectious skin disorder that is caused by tiny mites burrowing under the skin which causes intense itching. The condition is spread by close physical contact and is most common in highly densely populated areas where there is poor access to medical help. Although scabies is therefore less common in Great Britain than in other parts of the world, healthcare workers  who care for people living in conditions of deprivation, such as the homeless, may often come across this clinical condition.

This Cochrane systematic review sought to discover whether topical or systemic medication is most effective for treating scabies. The review sought randomised controlled trials that had compared systemic or local drug treatment with placebo, no treatment or a different intervention in children or adults with scabies. Twenty trials met the inclusion criteria of which 17 were conducted in countries with higher levels of poverty, crowding and poor access to medical care than in the UK.

The review found evidence to suggest that topical permethrin had fewer treatment failures than topical crotamiton or lindane. Oral ivermectin had fewer treatment failures than lindane.

A commentary notes that these findings are of particular interest to primary care clinicians working with marginalised populations or in congregate settings such as long-term care. However, it also notes that this review does not fully address the issue of side-effects (although no serious adverse events were reported in any of the trials).

Reference
Strong M, Johnson PW. Interventions for treating scabies. Cochrane Database Syst Rev 2007;3:CD000320.

Commentary
Larson P. Evid Based Nurs 2008;11:47.