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JAMA Patient Page
April 28, 2020

Preventing Tobacco Use in Children and Adolescents

JAMA. 2020;323(16):1626. doi:10.1001/jama.2020.5349

The US Preventive Services Task Force (USPSTF) has recently updated recommendations for the prevention and cessation of tobacco use in children and adolescents.

What Is Tobacco Use?

Tobacco use is defined as consuming any product that contains tobacco. This includes but is not limited to cigarettes, cigars, hookah, nicotine gels, pipe tobacco, roll-your-own tobacco, smokeless tobacco products, vapes, electronic cigarettes (e-cigarettes), hookah pens, and other electronic nicotine delivery systems. The current recommendation is updated from 2013 to include e-cigarettes as a tobacco product.

What Is the Patient Population Under Consideration for Providing Interventions to Prevent and Cease Tobacco Use?

The USPSTF recommendation applies to school-aged children and adolescents younger than 18 years. Minimizing the use of tobacco products that contain nicotine is important because exposure to nicotine at a young age may affect attention, mood, and brain function.

How Can Tobacco Use Be Prevented?

Recent studies have demonstrated the increasing popularity of e-cigarettes and suggested an association between e-cigarette use in adolescents and subsequent cigarette smoking in young adults. Behavioral counseling interventions used by primary care clinicians are sometimes used to prevent or stop tobacco use. These interventions include digital or print-based education and face-to-face or telephone counseling, among others.

What Are the Potential Benefits and Harms of Providing Primary Care Interventions for Preventing and Ceasing Tobacco Use in Children and Adolescents?

The USPSTF found some evidence that behavioral counseling interventions can have a moderate benefit in preventing tobacco use in school-aged children and adolescents, and no evidence on the harms of counseling. However, there was insufficient evidence on the benefits or harms of behavioral counseling interventions or on the use of medications for stopping tobacco use in school-aged children and adolescents.

How Strong Is the Recommendation for Primary Care Interventions to Prevent and Cease Tobacco Use in Children and Adolescents?

The USPSTF concluded that current evidence for providing education or counseling in the primary care setting to prevent tobacco use in children and adolescents has a moderate benefit. However, the USPSTF also concluded that there is insufficient evidence to recommend for or against primary care interventions, behavioral counseling, or medications among school-aged children and adolescents who already smoke, because not enough large studies that could answer this question have been conducted.

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Financial Disclosures: None reported.

Source: 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. Published April 28, 2020. doi:10.1001/jama.2020.4679

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