Primary care providers key to tobacco prevention in teens

Primary care doctors are the front line when it comes to the fight against tobacco use. Frequent interactions throughout childhood and adolescence make these providers the ideal resource for education and counseling on tobacco avoidance, according to an updated recommendation from the US Preventive Services Task Force (USPSTF).

The USPSTF outlined its updated recommendations in a series of reports published in April in JAMA. These reports include an updated recommendation statement, an evidence report, and an editorial on the recommendations.^1-3

The evidence report, penned by Shelley Selph, MD, MPH, of the Oregon Health and Science University's Pacific Northwest Evidence-based Practice Center in Portland examined 24 randomized clinical trials with more than 44,000 participants. In 13 of the trials, an 18% drop in the risk of smoking initiation was attributed to behavioral interventions by clinicians. On the other hand, the study found no significant change in smoking cessation efforts after behavioral interventions—but also no improvement after pharmacologic interventions using nicotine replacement or bupropion.

This evidence led the task force to confirm earlier recommendations that primary care physicians should focus on behavioral interventions as a prevention tool to keep children and teenagers from using tobacco in the first place rather than trying to get them to stop.

Tobacco is the top cause of preventable death in the United States, with about 480,000 deaths each year are attributed to tobacco use among adults, according to the evidence report. In children and adolescents, an estimated 1600 adolescents aged 12 to 17 smoke their first cigarette each day, and 5.6 million teenagers will eventually die from an illness related to smoking. Increasingly, tobacco use in teenagers is moving from conventional cigarettes to electronic cigarettes (e-cigarettes).

“Pediatricians cannot ignore the use or potential use of any tobacco product in their patients, due to the risk of significant harms associated with such use,” says Selph.

The evidence report was used to update the task force’s recommendation, which was last reviewed in 2013. Changes to the task force’s recommendations include the addition of e-cigarettes to the tobacco products addressed in the recommendation. The USPSTF also concluded that there isn’t enough evidence to make a clear recommendation on tobacco cessation methods in children and adolescents. More research is needed to identify the best methods to help children and teens stop using tobacco products.

References

1. Sargent JD, Unger JB, Leventhal AM. Recommendations from the USPSTF for prevention and cessation of tobacco use in children and adolescents. JAMA. 2020:323(16):1563–1564. doi:10.1001/jama.2019.22312.

2. 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. 2020:323(16):1599–1608. doi:10.1001/jama.2020.3332.

3. US Preventive Services Task Force. Primary care interventions for prevention and cessation of tobacco use in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2020:323(16):1590–1598. doi:10.1001/jama.2020.4679.