Primary care physicians should provide school-aged children and adolescents with education, brief counseling, or other interventions to prevent them from starting to use tobacco products, according to guidelines issued by the 2013 U.S. Preventive Services Task Force.
This recommendation is a change from the last USPSTF guidelines on tobacco use in children and adolescents, which in 2003 did not make a recommendation for or against such counseling for these age groups because of insufficient evidence to support either recommendation.
But the 2013 recommendation says that the task force "found adequate evidence that behavioral counseling interventions, such as face-to-face or phone interaction with a health care provider, print materials, and computer applications, can reduce the risk for smoking initiation in school-aged children and adolescents." There is "moderate certainty" that behavioral interventions aimed at preventing tobacco use in these two pediatric populations that are relevant to primary care settings will have a "moderate net benefit," the task force concluded.
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The 2013 U.S. Preventive Services Task Force concluded that face-to-face or phone interaction with a health care provider, print materials, and computer applications can reduce the risk for smoking initiation children and teenagers.
The task force statement, which includes resources for primary care clinicians, is being published simultaneously in Annals of Internal Medicine and Pediatrics (2013;132:560-5) on Aug. 26.
Interventions relevant to primary care were defined as those targeted at children, parents, or both, and either were practiced in health care settings or were considered feasible for such settings.
Interventions aimed at preventing tobacco use ranged from those that did not involve any direct interaction with the health care professional to those that entailed seven group sessions of more than 15 hours in total. "Even very minimal interventions, such as mailing materials to a youth's home, had substantial effects on reducing smoking initiation," the report said.
The evidence in the report includes a meta-analysis of nine studies of more than 26,000 children and adolescents, nonsmokers at baseline, which found that the risk of starting smoking at 6- to 36-month follow-up was reduced by 19% among those who received behavioral interventions, compared with controls - a statistically significant reduction.
Among the task force's other recommendations were mobile phone-based interventions for tobacco cessation, telephone follow-up combined with patient education materials, increasing the cost of tobacco products, mass media campaigns, and school-based education programs.
In 2009, about 8% of middle school students and almost 24% of high school students reported currently using a tobacco product, according to the report. Almost 30% of male high school students smoke, vs. approximately 22% of female high school students. In addition, every day in the United States, more than 3,800 children and adolescents aged 12-17 years smoke a cigarette for the first time, and about 1,000 children and adolescents under aged 18 start smoking daily, according to 2012 data.
Resources for primary care physicians in the report include:
• http://betobaccofree.hhs.gov/index.html
• http://www2.aap.org/richmondcenter/TobaccoPreventionPolicyTool/TPPT_PracticeCessation.html