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Use of nicotine replacement therapy in young people entering custody in New South Wales, Australia
Leigh Haysom1, Dianne Lawrence1, Donna Mellish1
1Justice Health and Forensic Mental Health Network, Adolescent Health, Sydney, New South Wales, Australia.
Aim:
To describe the prevalence of nicotine dependence and acceptance of nicotine replacement therapy (NRT) in young people entering custody, where smoking is not allowed.
Methods:
Cross-sectional study in 2013.
Setting:
All New South Wales Juvenile Justice Centres.
Participants:
Incarcerated youth, aged 12-21 years.
Main Exposures:
gender, age, ethnicity, cannabis use.
Main Outcomes:
rates of smoking, cannabis use, nicotine dependence, NRT acceptance.
Results:
Data were collected from 252 Initial Reception Assessments (90.1% male, 56.3% Aboriginal, mean age 16.6 years ± 1.2 standard deviation). According to Fagerstrom screening, 207 (82.1%) young people smoked cigarettes immediately prior to their current incarceration, and of the smokers, 78 (38.4%) were nicotine dependent. Most young people (76.4%) were also daily cannabis users, with 85.6% of cigarette smokers also using cannabis daily. NRT (as 24-h nicotine patches prescribed for 2 weeks) was offered to 54 nicotine dependent and 7 non-dependent young people. Only 13 (21.3%) young people accepted NRT (all daily cannabis-using males), and only 2 young people completed the full prescription. Reasons for refusing or not completing NRT were a fear of 'weird dreams', sleeping issues or that it was no longer needed.
Conclusions:
Many young people entering custody are nicotine-dependent cigarette smokers and daily cannabis users, and are at high risk of nicotine withdrawal on abstinence. NRT as patch therapy has poor acceptance in this group, except in young men who are daily cannabis users. Screening for nicotine dependence in high-risk young people should include questions about cannabis use, and alternatives to patch therapy deserve further research.