USPSTF: Intervene to Keep Youth From Starting Tobacco Use

As the COVID-19 pandemic continues to affect the lives of millions of Americans, concern is growing that tobacco use may increase the risk of severe complications from the disease. Given that concern, it is important to make children and teenagers aware of the risks of tobacco use to discourage them from starting to smoke or vape or help them quit if they already do.

On April 28, the U.S. Preventive Services Task Force posted a final recommendation statement and final evidence summary on primary care interventions for the prevention and cessation of tobacco use in children and adolescents.

The USPSTF recommended that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-age children and adolescents. This is a "B" recommendation. 

"All youth are at risk for tobacco use, and prevention is critical to keeping our young people healthy," said task force member Michael Silverstein, M.D., M.P.H., in a news release. "The good news is that clinicians can help children and teens from starting to use tobacco by providing education or brief counseling."

The task force also reviewed the evidence on interventions to help children and teens who are already using tobacco to quit. It concluded that the current evidence is insufficient to assess the balance of benefits and harms of primary care-feasible interventions for cessation of tobacco use in this population -- an "I" recommendation.

The recommendation statement applies to individuals younger than 18. The USPSTF issued a separate recommendation statement on interventions for tobacco use cessation in those 18 and older, including pregnant women, in 2015.

Update of Previous Recommendation

This final recommendation statement is consistent with the USPSTF's June 2019 draft recommendation statement on the topic, and is largely consistent with the task force's 2013 final recommendation which also garnered a "B" designation.

One difference between the current recommendation statement and the 2013 recommendation statement is that the current statement includes electronic nicotine delivery systems such as e-cigarettes and vape pens. Another is the task force's issuance of the "I" recommendation regarding tobacco cessation interventions. The 2013 recommendation statement applied only to interventions to prevent initiation of tobacco use.

The AAFP supported the 2013 recommendation.

Addressing Evidence Gaps

The task force found critical evidence gaps regarding how clinicians can help youth stop using tobacco and called for more research to identify effective interventions to help those who use tobacco products quit, including studies on the benefits and harms of tobacco cessation medications in youth and studies on interventions tailored specifically to prevent initiation of and promote cessation of e-cigarette use.

"Tobacco use in children and teens is now on the rise, driven largely by vaping, said task force member Chien-Wen Tseng, M.D., M.P.H., M.S.E.E. "The task force examined how clinicians can help youth quit tobacco products, including e-cigarettes, but unfortunately there is not enough evidence in this area, so we are calling for more research."

In the absence of available research, the press release advised clinicians to use their own judgment about how to best help each child or adolescent stop using tobacco.

Response to Public Comment

The agency posted its draft recommendation statement and draft evidence review on June 25, 2019, and accepted comments through July 22.

In response to numerous requests that the USPSTF recommend behavioral counseling interventions for tobacco cessation in youth given the known harms of tobacco use and the lack of proven harms from counseling, the task force stated that absence of harms from a service is not sufficient evidence for it to recommend a preventive service. The USPSTF also modified the Practice Considerations section to include more population-specific language.

Up Next

The AAFP's Commission on Health of the Public and Science plans to review the USPSTF's final recommendation statement and evidence summary and will then determine the Academy's stance on the recommendation.