USPSTF Recommends Interventions to Prevent Tobacco Use in Children and Adolescents

By Will Boggs MD

April 29, 2020

NEW YORK (Reuters Health) - Primary care providers should provide education or brief counseling to school-aged children and adolescents in an effort to keep them from starting to use tobacco, according to updated recommendations from the U.S. Preventive Services Task Force (USPSTF).

"Tobacco use is the leading cause of preventable death in the U.S., and nearly 90% of smokers try their first tobacco product before they turn 18," Task Force member Dr. Michael Silverstein from Boston University School of Medicine told Reuters Health by email. "Evidence shows that behavioral interventions are effective in helping prevent tobacco use among children and teens, which is why the Task Force strongly recommends that clinicians provide these services for their patients."

The USPSTF commissioned an evidence report on primary care-relevant interventions for tobacco use prevention and cessation in children and adolescents as part of its update of its 2013 recommendation.

The update, prepared by Dr. Shelley Selph from Oregon Health and Science University's Pacific Northwest Evidence-based Practice Center in Portland and colleagues, included 24 randomized clinical trials enrolling 44,521 participants.

In 13 trials, behavioral interventions, including brief counseling and education, were associated with an 18% lower risk of smoking initiation at 7 to 36 months' follow-up (7.4% versus 9.2% among controls).

In contrast, there was no significant difference between behavioral interventions versus controls in nine trials in which endpoints were smoking cessation at 6 to 12 months' follow-up.

Similarly, nicotine replacement therapy and bupropion had no significant effect on smoking cessation in adolescents.

Based on this evidence, the USPSTF reiterated their earlier recommendation for primary care clinicians to provide behavioral interventions to prevent initiation of tobacco use among children and adolescents.

New to the current recommendation is the inclusion of e-cigarettes as a tobacco product, as is the conclusion that there is insufficient evidence on interventions for cessation of tobacco use among this population.

"The Task Force recognizes the importance of helping children and teens who already use tobacco products quit, but there is unfortunately not enough evidence to make a recommendation on whether and how clinicians can achieve that goal, so we are calling for more research in this vital area," Dr. Silverstein said.

"Although there is insufficient evidence to recommend a behavioral intervention or any specific medication for tobacco/nicotine cessation, because the potential harms of smoking and vaping are so great, it is worth trying something in motivated children and adolescents," Dr. Selph told Reuters Health by email. "I would offer counseling to all and would consider pharmacotherapy in older adolescents if counseling has not been successful. Future studies may provide additional evidence for these or other strategies."

"Although studies for the prevention and cessation of e-cigarettes/vaping in children and adolescents are greatly needed, clinicians cannot ignore any form of tobacco product use in this age group," she said.

Dr. Silverstein concluded, "With more than 1 million high school and middle school students reporting that they were smokers in 2019 and more than 5 million using e-cigarettes, it is essential that we take action to prevent tobacco use from growing and conduct more research to identify how we can help children and teens already using tobacco products to quit."

"Along with primary care interventions, regulation of tobacco products may help reverse recent trends in youth use of e-cigarettes, similar to how past regulation of combustible cigarettes successfully contributed to reversing high youth cigarette smoking rates in the 1990s," write Dr. Adam M. Leventhal from University of Southern California Keck School of Medicine, Los Angeles, and colleagues in a related editorial.

"Needed are regulations that restrict availability of e-cigarette products that appeal to youth by limiting nontobacco flavors, permitting only product designs meant for adult smokers that mimic the cigarette (and do not resemble computer USB drives), and setting limits on e-cigarette nicotine concentration or prohibiting e-cigarettes containing nicotine salt formulations that may be easy for youth to inhale and become addicted to," they conclude.

The complete recommendations, along with the evidence underlying them and the editorial, appear in JAMA.

SOURCE:, and JAMA, April 28, 2020.