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Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and AdolescentsUS Preventive Services Task Force Recommendation Statement

Educational Objective
To review the USPSTF recommendations regarding interventions to prevent tobacco use in children and adolescents and to help youth quit tobacco use.
1 Credit CME
Abstract

Importance  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 from secondhand smoke. 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 from a smoking-related illness. Although conventional cigarette use has gradually declined among children in the US since the late 1990s, tobacco use via electronic cigarettes (e-cigarettes) is quickly rising and is now more common among youth than cigarette smoking. e-Cigarette products usually contain nicotine, which is addictive, raising concerns about e-cigarette use and nicotine addiction in children. Exposure to nicotine during adolescence can harm the developing brain, which may affect brain function and cognition, attention, and mood; thus, minimizing nicotine exposure from any tobacco product in youth is important.

Objective  To update its 2013 recommendation, the USPSTF commissioned a review of the evidence on the benefits and harms of primary care interventions for tobacco use prevention and cessation in children and adolescents. The current systematic review newly included e-cigarettes as a tobacco product.

Population  This recommendation applies to school-aged children and adolescents younger than 18 years.

Evidence Assessment  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. The USPSTF concludes that 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, because of a lack of adequately powered studies on behavioral counseling interventions and a lack of studies on medications.

Recommendation  The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents. (B recommendation) The USPSTF concludes that the 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)

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Article Information

Corresponding Author: Douglas K. Owens, MD, MS, Stanford University, 615 Crothers Way, Encina Commons, Mail Code 6019, Stanford, CA 94305-6006 (chair@uspstf.net).

The US Preventive Services Task Force (USPSTF) members: Douglas K. Owens, MD, MS; Karina W. Davidson, PhD, MASc; Alex H. Krist, MD, MPH; Michael J. Barry, MD; Michael Cabana, MD, MA, MPH; Aaron B. Caughey, MD, PhD; Susan J. Curry, PhD; Katrina Donahue, MD, MPH; Chyke A. Doubeni, MD, MPH; John W. Epling Jr, MD, MSEd; Martha Kubik, PhD, RN; Gbenga Ogedegbe, MD, MPH; Lori Pbert, PhD; Michael Silverstein, MD, MPH; Melissa A. Simon, MD, MPH; Chien-Wen Tseng, MD, MPH, MSEE; John B. Wong, MD.

Affiliations of The US Preventive Services Task Force (USPSTF) members: Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Owens); Stanford University, Stanford, California (Owens); Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York (Davidson); Fairfax Family Practice Residency, Fairfax, Virginia (Krist); Virginia Commonwealth University, Richmond (Krist); Harvard Medical School, Boston, Massachusetts (Barry); University of California, San Francisco (Cabana); Oregon Health & Science University, Portland (Caughey); University of Iowa, Iowa City (Curry); University of North Carolina at Chapel Hill (Donahue); Mayo Clinic, Rochester, Minnesota (Doubeni); Virginia Tech Carilion School of Medicine, Roanoke (Epling Jr); Temple University, Philadelphia, Pennsylvania (Kubik); New York University, New York, New York (Ogedegbe); University of Massachusetts Medical School, Worcester (Pbert); Boston University, Boston, Massachusetts (Silverstein); Northwestern University, Evanston, Illinois (Simon); University of Hawaii, Honolulu (Tseng); Pacific Health Research and Education Institute, Honolulu, Hawaii (Tseng); Tufts University School of Medicine, Boston, Massachusetts (Wong).

Author Contributions: Dr Owens had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The USPSTF members contributed equally to the recommendation statement.

Conflict of Interest Disclosures: Authors followed the policy regarding conflicts of interest described at https://www.uspreventiveservicestaskforce.org/Page/Name/conflict-of-interest-disclosures. All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings. Dr Barry reported receiving grants and personal fees from Healthwise.

Funding/Support: The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality (AHRQ) support the operations of the USPSTF.

Role of the Funder/Sponsor: AHRQ staff assisted in the following: development and review of the research plan, commission of the systematic evidence review from an Evidence-based Practice Center, coordination of expert review and public comment of the draft evidence report and draft recommendation statement, and the writing and preparation of the final recommendation statement and its submission for publication. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication.

Disclaimer: Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of AHRQ or the US Department of Health and Human Services.

Additional Contributions: We thank Tina Fan, MD, MPH (AHRQ), who contributed to the writing of the manuscript, and Lisa Nicolella, MA (AHRQ), who assisted with coordination and editing.

Additional Information: The USPSTF makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms. It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment. The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision-making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.

References
1.
US Department of Health and Human Services.  The Health Consequences of Smoking: 50 Years of Progress: A Report of the Surgeon General. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014.
2.
Key Substance Use and Mental Health Indicators in the United States. Results from the 2018 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Published 2019. Accessed March 17, 2020. https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf
3.
Singh  T , Arrazola  RA , Corey  CG ,  et al.  Tobacco use among middle and high school students—United States, 2011-2015.   MMWR Morb Mortal Wkly Rep. 2016;65(14):361-367. doi:10.15585/mmwr.mm6514a1PubMedGoogle ScholarCrossref
4.
National Center for HIV/AIDS. Vital Hepatitis, STD, and TB. Trends in the prevalence of tobacco use: national YRBS: 1991-2017. Centers for Disease Control and Prevention. Accessed June 5, 2019. https://www.cdc.gov/healthyyouth/data/yrbs/pdf/trends/2017_tobacco_trend_yrbs.pdf
5.
US Department of Health and Human Services.  E-Cigarette Use Among Youth and Young Adults: A Report of the Surgeon General. Office of the Surgeon General; 2016.
6.
Cullen  KA , Ambrose  BK , Gentzke  AS , Apelberg  BJ , Jamal  A , King  BA .  Notes from the field: use of electronic cigarettes and any tobacco product among middle and high school students—United States, 2011-2018.   MMWR Morb Mortal Wkly Rep. 2018;67(45):1276-1277. doi:10.15585/mmwr.mm6745a5PubMedGoogle ScholarCrossref
7.
Wang  TW , Gentzke  AS , Creamer  MR ,  et al.  Tobacco product use and associated factors among middle and high school students—United States, 2019.   MMWR Surveill Summ. 2019;68(12):1-22. doi:10.15585/mmwr.ss6812a1PubMedGoogle ScholarCrossref
8.
Marynak  KL , Gammon  DG , Rogers  T , Coats  EM , Singh  T , King  BA .  Sales of nicotine-containing electronic cigarette products: United States, 2015.   Am J Public Health. 2017;107(5):702-705. doi:10.2105/AJPH.2017.303660PubMedGoogle ScholarCrossref
9.
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Review of the Health Effects of Electronic Nicotine Delivery Systems.  Public Health Consequences of E-Cigarettes. National Academies Press; 2018.
10.
Goriounova  NA , Mansvelder  HD .  Short- and long-term consequences of nicotine exposure during adolescence for prefrontal cortex neuronal network function.   Cold Spring Harb Perspect Med. 2012;2(12):a012120. doi:10.1101/cshperspect.a012120PubMedGoogle Scholar
11.
Musso  F , Bettermann  F , Vucurevic  G , Stoeter  P , Konrad  A , Winterer  G .  Smoking impacts on prefrontal attentional network function in young adult brains.   Psychopharmacology (Berl). 2007;191(1):159-169. doi:10.1007/s00213-006-0499-8PubMedGoogle ScholarCrossref
12.
Outbreak of lung injury associated with the use of e-cigarette, or vaping, products. Centers for Disease Control and Prevention. Updated February 25, 2020. Accessed March 17, 2020. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html?s_cid=osh-stu-home-spotlight-006#cdc-recommends
13.
US Preventive Services Task Force. Procedure Manual. Published 2018. Accessed March 17, 2020. https://www.uspreventiveservicestaskforce.org/Page/Name/procedure-manual
14.
Selph  S , Patnode  C , Bailey  S ,  et al  Primary Care Relevant Interventions for Tobacco and Nicotine Use Prevention and Cessation in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force: Evidence Synthesis No. 185. Agency for Healthcare Research and Quality; 2020. AHRQ publication 19-05254-EF-1.
15.
Selph  S , Patnode  C , Bailey  SR , Pappas  M , Stoner  R , Chou  R .  Primary care–relevant interventions for tobacco and nicotine use prevention and cessation in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.   JAMA. Published April 28, 2020. doi:10.1001/jama.2020.3332Google Scholar
16.
Siu  AL ; US Preventive Services Task Force.  Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. Preventive Services Task Force recommendation statement.   Ann Intern Med. 2015;163(8):622-634. doi:10.7326/M15-2023PubMedGoogle ScholarCrossref
17.
Recreational vaping 101: what is vaping? Center on Addiction. Published October 2018. Accessed June 5, 2019. https://www.centeronaddiction.org/e-cigarettes/recreational-vaping/what-vaping
18.
Johnston  LD , Miech  RA , O’Malley  PM , Bachman  JG , Schulenberg  JE , Patrick  ME .  Monitoring the Future: National Survey Results on Drug Use 1975-2018: 2018 Overview: Key Findings on Adolescent Drug Use. Institute for Social Research, University of Michigan; 2019. doi:10.3998/2027.42/150621
19.
Office of Adolescent Health. Adolescents and tobacco: risk and protective factors. US Department of Health and Human Services. Published April 8, 2019. Accessed June 5, 2019. https://www.hhs.gov/ash/oah/adolescent-development/substance-use/drugs/tobacco/risk-and-protective-factors/index.html
20.
Hovell  MF , Slymen  DJ , Jones  JA ,  et al.  An adolescent tobacco-use prevention trial in orthodontic offices.   Am J Public Health. 1996;86(12):1760-1766. doi:10.2105/AJPH.86.12.1760PubMedGoogle ScholarCrossref
21.
Hollis  JF , Polen  MR , Whitlock  EP ,  et al.  Teen reach: outcomes from a randomized, controlled trial of a tobacco reduction program for teens seen in primary medical care.   Pediatrics. 2005;115(4):981-989. doi:10.1542/peds.2004-0981PubMedGoogle ScholarCrossref
22.
Bauman  KE , Foshee  VA , Ennett  ST ,  et al.  The influence of a family program on adolescent tobacco and alcohol use.   Am J Public Health. 2001;91(4):604-610. doi:10.2105/AJPH.91.4.604PubMedGoogle ScholarCrossref
23.
Ausems  M , Mesters  I , van Breukelen  G , De Vries  H .  Short-term effects of a randomized computer-based out-of-school smoking prevention trial aimed at elementary schoolchildren.   Prev Med. 2002;34(6):581-589. doi:10.1006/pmed.2002.1021PubMedGoogle ScholarCrossref
24.
Curry  SJ , Hollis  J , Bush  T ,  et al.  A randomized trial of a family-based smoking prevention intervention in managed care.   Prev Med. 2003;37(6, pt 1):617-626. doi:10.1016/j.ypmed.2003.09.015PubMedGoogle ScholarCrossref
25.
Fidler  W , Lambert  TW .  A prescription for health: a primary care based intervention to maintain the non-smoking status of young people.   Tob Control. 2001;10(1):23-26. doi:10.1136/tc.10.1.23PubMedGoogle ScholarCrossref
26.
Hiemstra  M , Ringlever  L , Otten  R , van Schayck  OC , Jackson  C , Engels  RC .  Long-term effects of a home-based smoking prevention program on smoking initiation: a cluster randomized controlled trial.   Prev Med. 2014;60:65-70. doi:10.1016/j.ypmed.2013.12.012PubMedGoogle ScholarCrossref
27.
Jackson  C , Dickinson  D .  Enabling parents who smoke to prevent their children from initiating smoking: results from a 3-year intervention evaluation.   Arch Pediatr Adolesc Med. 2006;160(1):56-62. doi:10.1001/archpedi.160.1.56PubMedGoogle ScholarCrossref
28.
Schuck  K , Otten  R , Kleinjan  M , Bricker  JB , Engels  RC .  Promoting smoking cessation among parents: effects on smoking-related cognitions and smoking initiation in children.   Addict Behav. 2015;40:66-72. doi:10.1016/j.addbeh.2014.09.002PubMedGoogle ScholarCrossref
29.
Pbert  L , Flint  AJ , Fletcher  KE , Young  MH , Druker  S , DiFranza  JR .  Effect of a pediatric practice-based smoking prevention and cessation intervention for adolescents: a randomized, controlled trial.   Pediatrics. 2008;121(4):e738-e747. doi:10.1542/peds.2007-1029PubMedGoogle ScholarCrossref
30.
Lando  HA , Hennrikus  D , Boyle  R , Lazovich  D , Stafne  E , Rindal  B .  Promoting tobacco abstinence among older adolescents in dental clinics.   J Smok Cessat. 2007;2(1):23-30. doi:10.1375/jsc.2.1.23Google ScholarCrossref
31.
Redding  CA , Prochaska  JO , Armstrong  K ,  et al.  Randomized trial outcomes of a TTM-tailored condom use and smoking intervention in urban adolescent females.   Health Educ Res. 2015;30(1):162-178. doi:10.1093/her/cyu015PubMedGoogle ScholarCrossref
32.
Haggerty  KP , Skinner  ML , MacKenzie  EP , Catalano  RF .  A randomized trial of Parents Who Care: effects on key outcomes at 24-month follow-up.   Prev Sci. 2007;8(4):249-260. doi:10.1007/s11121-007-0077-2PubMedGoogle ScholarCrossref
33.
Cremers  HP , Mercken  L , Candel  M , de Vries  H , Oenema  A .  A Web-based, computer-tailored smoking prevention program to prevent children from starting to smoke after transferring to secondary school: randomized controlled trial.   J Med Internet Res. 2015;17(3):e59. doi:10.2196/jmir.3794PubMedGoogle Scholar
34.
Hoffmann  TC , Glasziou  PP , Boutron  I ,  et al.  Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide.   BMJ. 2014;348:g1687. doi:10.1136/bmj.g1687PubMedGoogle ScholarCrossref
35.
Moyer  VA ; US Preventive Services Task Force.  Primary care behavioral interventions to reduce illicit drug and nonmedical pharmaceutical use in children and adolescents: U.S. Preventive Services Task Force recommendation statement.   Ann Intern Med. 2014;160(9):634-639. doi:10.7326/M14-0334PubMedGoogle ScholarCrossref
36.
US Department of Health and Human Services.  Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Centers for Disease Control and Prevention; 2012.
37.
CHANTIX (varenicline tartrate) prescribing information. Pfizer. Published 2018. Accessed June 5, 2019. https://www.pfizermedicalinformation.com/en-us/chantix
38.
Scherphof  CS , van den Eijnden  RJ , Engels  RC , Vollebergh  WA .  Short-term efficacy of nicotine replacement therapy for smoking cessation in adolescents: a randomized controlled trial.   J Subst Abuse Treat. 2014;46(2):120-127. doi:10.1016/j.jsat.2013.08.008PubMedGoogle ScholarCrossref
39.
WELLBUTRIN (bupropion hydrochloride) prescribing information. US Food and Drug Administration. Published 2017. Accessed June 5, 2019. https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018644s053lbl.pdf
40.
Collins  L , Smiley  SL , Moore  RA , Graham  AL , Villanti  AC .  Physician tobacco screening and advice to quit among U.S. adolescents—National Survey on Drug Use and Health, 2013.   Tob Induc Dis. 2017;15:2. doi:10.1186/s12971-016-0107-6PubMedGoogle ScholarCrossref
41.
Dai  H , Clements  M .  Trends in healthcare provider advice on youth tobacco use, 2011-2015.   Am J Prev Med. 2018;55(2):222-230. doi:10.1016/j.amepre.2018.04.015PubMedGoogle ScholarCrossref
42.
Moyer  VA ; US Preventive Services Task Force.  Primary care interventions to prevent tobacco use in children and adolescents: U.S. Preventive Services Task Force recommendation statement.   Pediatrics. 2013;132(3):560-565. doi:10.1542/peds.2013-2079PubMedGoogle ScholarCrossref
43.
Colby  SM , Monti  PM , O’Leary Tevyaw  T ,  et al.  Brief motivational intervention for adolescent smokers in medical settings.   Addict Behav. 2005;30(5):865-874. doi:10.1016/j.addbeh.2004.10.001PubMedGoogle ScholarCrossref
44.
Killen  JD , Robinson  TN , Ammerman  S ,  et al.  Randomized clinical trial of the efficacy of bupropion combined with nicotine patch in the treatment of adolescent smokers.   J Consult Clin Psychol. 2004;72(4):729-735. doi:10.1037/0022-006X.72.4.729PubMedGoogle ScholarCrossref
45.
Muramoto  ML , Leischow  SJ , Sherrill  D , Matthews  E , Strayer  LJ .  Randomized, double-blind, placebo-controlled trial of 2 dosages of sustained-release bupropion for adolescent smoking cessation.   Arch Pediatr Adolesc Med. 2007;161(11):1068-1074. doi:10.1001/archpedi.161.11.1068PubMedGoogle ScholarCrossref
46.
Scherphof  CS , van den Eijnden  RJ , Engels  RC , Vollebergh  WA .  Long-term efficacy of nicotine replacement therapy for smoking cessation in adolescents: a randomized controlled trial.   Drug Alcohol Depend. 2014;140:217-220. doi:10.1016/j.drugalcdep.2014.04.007PubMedGoogle ScholarCrossref
47.
Gray  KM , Baker  NL , McClure  EA ,  et al.  Efficacy and safety of varenicline for adolescent smoking cessation: a randomized clinical trial.   JAMA Pediatr. Published online October 14, 2019 doi:10.1001/jamapediatrics.2019.3553Google Scholar
48.
Pfizer. Smoking cessation study in healthy adolescent smokers [NCT01312909]. ClinicalTrials.gov. Accessed March 20, 2020. https://clinicaltrials.gov/ct2/show/NCT01312909
49.
Pfizer reports top-line results from a study of Chantix®/Champix® (varenicline) in adolescent smokers [press release]. Pfizer. Published March 23, 2018. Accessed June 5, 2019. https://www.pfizer.com/news/press-release/press-release-detail/pfizer_reports_top_line_results_from_a_study_of_chantix_champix_varenicline_in_adolescent_smokers
50.
Gray  KM , Carpenter  MJ , Baker  NL ,  et al.  Bupropion SR and contingency management for adolescent smoking cessation.   J Subst Abuse Treat. 2011;40(1):77-86. doi:10.1016/j.jsat.2010.08.010PubMedGoogle ScholarCrossref
51.
Farber  HJ , Walley  SC , Groner  JA , Nelson  KE ; Section on Tobacco Control.  Clinical practice policy to protect children from tobacco, nicotine, and tobacco smoke.   Pediatrics. 2015;136(5):1008-1017. doi:10.1542/peds.2015-3110PubMedGoogle ScholarCrossref
52.
Walley  SC , Jenssen  BP ; Section on Tobacco Control.  Electronic nicotine delivery systems.   Pediatrics. 2015;136(5):1018-1026. doi:10.1542/peds.2015-3222PubMedGoogle ScholarCrossref
53.
US Department of Health and Human Services.  Smoking Cessation: A Report of the Surgeon General. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2020.
54.
Clinical preventive service recommendation: tobacco use in children and adolescents. American Academy of Family Physicians. Accessed June 5, 2019. https://www.aafp.org/patient-care/clinical-recommendations/all/tobacco-use-children.html
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