In this activity, you will assess nicotine dependence in three case studies for pediatric patients. These case studies were adapted from ASH Scotland, The Royal Australian College of General Practitioners, the AlbertaQuits Cessation Supports/Services, and the Journal of Medical Case Reports. For this, you will use the Modified Version of the Fagerstrom Tolerance Questionnaire (mFTQ) tool.

Step 1: Read the following case studies:

Case Study 1: 

GM is 17 years old; she has been referred by her GP to assess her cannabis and tobacco dependency, which she had turned to since she was 13 years old because of sexual abuse as a child, her dyslexia and bullying at school. She has a history of self-esteem issues and self-harm. In fighting back against people, due to her insecurities, she had developed aggressive tendencies and had become isolated and withdrawn. 

She admits that right after waking up she has a joint (cannabis cigarette), a cigarette, and very little breakfast. She had been underweight and very malnourished. She was, however, motivated to work on improving her health and lifestyle and in particular her cannabis dependency. 

Alcohol, tobacco, and cannabis as well as long bouts on her PlayStation were part of her coping strategy but she acknowledged that these needed to be tackled, she has a 60-a-day cigarette dependence and she inhales quite often. Her main concerns were regarding sleep. Cannabis was used as an aid to sleep and to relax and she wondered if less cannabis might result in heavier drinking or insomnia. 

She has been suspended 2 times from school for smoking cigarettes inside the building; she explains that it is impossible to refrain from smoking even when she knows the school rules forbid it, also because she usually smokes more at the beginning of the day. She has also been making attempts to quit smoking, has tried patches, as yet unsuccessfully but shows a commitment to reduce her smoking further.

Case Study 2: 

JD, currently 18 years old, started smoking at 17 years old; he tried his first cigarette during a youth group event, where a friend taught them how to inhale. A week after that event he was already smoking over 20 cigarettes a day. He has most of the cigars after waking up, even more than 10 before he has a cup of coffee.  

He admitted craving for this substance to the extent of doing dirty jobs for people to sustain the habit and neglecting other previous forms of enjoyment, such as watching television with family members.

He identifies himself as the kind of person who always goes out in any situation to have a smoke, even when sick in bed he can´t stop himself from smoking. He has tried several times to quit on his own, but now he is asking his General Practitioner for help.

Case Study 3: 

A 17-year-old is brought to a psychiatric hospital with a 5-year history of tobacco smoking and delinquent behaviors; he has been expelled from school because of consuming and sharing tobacco inside of the school. He lives with his mother who is of low socioeconomic status; she has a busy schedule and works full time. There is no history of mental illness or substance abuse in the family.

He was first introduced to tobacco smoking by his friends at age 12 years. He gradually stepped up his use from one cigarette/day over the next 2 to 3 years to approximately 20 to 30 cigarettes per day to sustain the relaxing and stimulating effect, he admits he inhales always, to get the ¨maximum effect¨. He has had several unsuccessful attempts at controlling the amount he took in a day despite the knowledge of its harmful consequences. His longest period of abstinence was 3 months in a rehabilitation center which was approximately 3.5 years ago. He had once experimented with cannabis and alcohol, but he never enjoyed these substances and so did not continue.

Two months ago he progressively neglected his personal hygiene and food, became emaciated to the point he could not even leave the bed, and spent more time cigarette smoking (that is, smoking continuously); he decided to seek medical attention at this time. 

Before he started smoking cigarettes, he was described as an easy child, quite cheerful, and an outgoing person who enjoyed the company of other children.

Step 2: Using the Modified Version of the Fagerstrom Tolerance Questionnaire (mFTQ), identify the level of dependence according to the score you calculated for each case. Prepare an assignment that specifies the mFTQ score and level of dependence for all three case studies. Include an explanation for your results. 

Step 3: Post your work on the course's designated discussion board for other learners to view. Click “add a new discussion topic” below, complete the fields, and paste a link to your product.

Step 4: Although not mandatory, you are encouraged to review the work of your fellow learners. You can engage with the posts and use the critical questions to guide your review. This will help you develop your assessment skills and learn from the analysis of others.

OPTIONAL Step 5: Interact (10 minutes)

If you would like to, you can reply to your peers' posts in a respectful and professional manner. Ensure that your post engages your peers' ideas by including a reflection on their comments, sharing ideas of other potential difficulties and parties involved, or asking thought-provoking questions. If a peer comments on your posting, please reply. To post a reply, click “Reply” on a particular discussion, write your feedback and then click on “Post to forum.”