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USPSTF: Youth should be counseled against tobacco use
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The US Preventative Services Task Force today recommended that primary care physicians counsel school-aged children and adolescents against tobacco use.
The recommendation statement, jointly published in Annals of Internal Medicine and Pediatrics, serves as an update to a 2003 recommendation in which the task force suggested there was insufficient evidence to recommend such interventions by primary care physicians.
Tobacco use remains the most common cause of preventable death in the United States. About 443,000 deaths each year are attributable to smoking, including an estimated 161,000 deaths from cancer, according to USPSTF.
Young people can become addicted to tobacco within 2 years of first use, with some youth developing dependency faster, according to the task force’s recommendation.
Virginia A. Moyer
In making its recommendation, Virginia A. Moyer, MD, MPH — chair of the USPSTF — and colleagues reviewed data from a 2009 survey in which 8.2% of middle school students and 23.9% of high school students reported current use of tobacco products. Ninety percent of adult smokers report having smoked their first cigarette before age 18.
Moyer and colleagues also evaluated data from a pooled meta-analysis of nine trials that included 26,624 children and adolescents. They examined smoking initiation in participants who were nonsmokers at baseline. Follow-up ranged from 6 to 36 months.
The results suggested a statistically significant 19% reduction in risk for smoking initiation among participants who received the interventions (RR=0.81; 95% CI, 0.70-0.93).
Researchers found less-intensive interventions, such as mailing educational materials, were still effective at preventing youth from smoking. Other interventions included mailing videos to youths’ homes, computer programs, and individual and group sessions with health care providers.
Moyer and colleagues also reviewed results of a pooled meta-analysis of seven trials that included 2,328 children and adolescents who reported prior smoking. The findings showed interventions intended to promote smoking cessation were associated with a small benefit after 6 to 12 months of follow-up (RR=0.96; 95% CI, 0.90-1.02).
The USPSTF recommendations are in alignment with the 2008 Public Health Service clinical practice guidelines — which advise pediatricians to inquire about tobacco use and offer counseling to patients and their parents — and the 2009 American Academy of Pediatrics recommendation that calls for counseling all youth aged 5 years and older against tobacco use.
“Children are susceptible to smoking experimentation and initiation,” the recommendation states. “Adequate evidence shows that individual and combination behavior-based interventions in primary care settings can reduce the risk for initiation of tobacco use in school-aged children and adolescents.”
In an accompanying opinion article, Michael B. Steinberg, MD, MPH, FACP, of Robert Wood Johnson Medical School and Cristine D. Delnevo, PhD, MPH, of the University of Medicine and Dentistry of New Jersey School of Public Health, expressed support for a proposal under consideration in New York City that would increase the age for the legal purchase of tobacco products from 18 to 21 years.
The authors pointed to “ample evidence” suggesting that increasing the legal age to purchase tobacco products is associated with reduced smoking rates among teenagers and young adults.
“Making it more difficult for young adults to purchase cigarettes has the potential to interrupt the trajectory from experimentation to regular use,” they wrote. “With most current smokers wanting to stop but having difficulty doing so, it seems ill-advised to defend the right for people to start smoking, especially at a young age. preventing persons aged 18 to 20 years from slipping down the undesirable path of lifelong tobacco addiction will certainly not be accomplished by this one piece of legislation alone, but it is a start and is the right thing to do.”
Perspective
Back to TopMichael B. Steinberg, MD, MPH, FACP
The US Preventive Services Task Force’s latest recommendations call for clinicians to provide interventions to prevent initiation of tobacco use in children and adolescents. Although seemingly a “no-brainer,” it is an important statement as to both the public health importance of the issue as well as recognition of the level of evidence that supports the effectiveness of such interventions. These interventions do not need to be a burden on an already-overwhelmed primary care provider; they can take the form of a system-based approach, ancillary-staff responsibility, computer or mobile-based application, or educational material.
Considering that 1 in 3 people who ever use tobacco become addicted, reducing initiation and the subsequent link to experimentation and addiction can have one of the most dramatic impacts on the future health of these young people. If an intervention that has no apparent adverse effects can prevent a lifetime of addiction to the most deadly product in our society, it is well worth the effort. These interventions are not a solution alone; instead, they represent one important piece in a larger effort to make tobacco use less appealing, less accessible and socially unacceptable — and through this, substantially reduce the harm of its continued addiction to both young and old.
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