Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents

Purpose of the Protocol

Tobacco use is the leading cause of preventable death in the US. An estimated annual 480,000 deaths are attributable to tobacco use in adults, including secondhand smoke.1 It is estimated that every day about 1600 youth aged 12 to 17 years smoke their first cigarette and that about 5.6 million adolescents alive today will die prematurely of a smoking-related illness.

Target Population

• School-aged children and adolescents (age < 18 years).

Recommendations

• Prevent Initiation:
  • Primary care clinicians should provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents. (Grade B recommendation).
• Cessation:
  • Current evidence is insufficient to assess the balance of benefits and harms of primary care–feasible interventions for the cessation of tobacco use among school-aged children and adolescents. (I statement).

Importance

• Tobacco use is the leading cause of preventable death in the US.
• Each year, an estimated 480,000 deaths in adults are attributable to tobacco use, including deaths from secondhand smoke.
• Every day, about 1,600 youth aged 12 to 17 years smoke their first cigarette.
• Approximately 5.6 million adolescents alive today will die prematurely from a smoking-related illness.
• While conventional cigarette use has declined among children, use of e-cigarettes (which contain addictive nicotine) has rapidly increased.
• Exposure to nicotine during adolescence can harm the developing brain, affecting cognition, attention, and mood.

Conclusion

The USPSTF concludes with moderate certainty that primary care–feasible behavioral interventions, including education or brief counseling, to prevent tobacco use in school-aged children and adolescents have a moderate net benefit. There is insufficient evidence to determine the balance of benefits and harms of primary care interventions for tobacco cessation among school-aged children and adolescents who already smoke due to a lack of adequately powered studies on behavioral counseling interventions and studies on medications.