Behavior-based interventions in the primary care setting reduce the risk for children and adolescents taking up smoking, conclude US investigators who also found that neither behavior- nor drug-based interventions improve cessation rates.
The team, led by Carrie Patnode (Kaiser Permanente Center for Health Research, Portland, Oregon), notes: "Despite the substantial resources committed to reducing childhood and adolescent tobacco use over recent decades, approximately 10% of middle school students and nearly a quarter of high school students currently use tobacco in the United States."
They add in the Annals of Internal Medicine: "Our findings suggest that primary care-relevant interventions designed to reduce cigarette smoking among children and adolescents can have small, positive effects on smoking initiation among those who have not yet become regular smokers."
To find studies that examined interventions to prevent smoking uptake or encourage cessation in young people, the researchers searched the MEDLINE, PsycINFO, and Cochrane Central Register of Controlled Trials, as well as the Database of Abstracts of Reviews of Effects, reference lists and gray literature. They identified 18 trials, of which four were deemed to be good quality and 14 of fair quality.
Seven trials reported the combined effect of interventions, including brief advice to quit smoking or remain abstinent or a single counselling session, on smoking prevalence. These reported a nonsignificant reduced relative risk (RR) of 0.91 for smoking prevalence at 7-12 months of follow up in young people assigned to the intervention, compared with control individuals. The pooled absolute risk difference (RD) was 2%.
In 10 trials that examined prevention of smoking initiation among non-smoking young persons, there was a statistically significant reduced risk for smoking initiation among those receiving prevention interventions at 7-36 months of follow up, at an RR of 0.81, and a pooled absolute RD of 2%, indicating that 50 individuals would need to be treated for one person to avoid taking up smoking. There was evidence to suggest that the effectiveness of the interventions waned at approximately 2 years.
Behavior-based cessation interventions did not yield a difference in cessation rates, compared with no intervention, at an RR of 0.96, and a pooled absolute RD of 0.96. Neither of the two bupropion trials included in the analysis showed a benefit with the treatment compared with placebo.
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