USPSTF recommends clinicians provide interventions to prevent tobacco use in children

The United States Preventive Services Task Force (USPSTF) recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents. This recommendation statement is being jointly published in the peer-reviewed medical journals Annals of Internal Medicine and Pediatrics.

This recommendation is an update. In 2003, the Task Force found insufficient evidence to recommend for or against primary care relevant interventions for youth tobacco prevention.

Smoking is the leading cause of preventable death in the United States, causing approximately 443,000 deaths each year. Each day, more than 3,800 children and adolescents aged 12 to 17 years smoke their first cigarette, and an estimated 1,000 children and adolescents younger than 18 years begin smoking on a daily basis. Prevention strategies are needed to reduce deaths directly related to tobacco use.

A systematic evidence review of trials designed to prevent tobacco use initiation, promote cessation, or both showed that primary care-relevant behavior-based prevention interventions helped to reduce the risk of smoking initiation by 19 percent compared to control participants at 6 to 36 months follow-up. Primary care-relevant interventions were defined as those targeted at children, their parents, or both and were conducted in or were potentially feasible for health care settings.

"We are pleased to be publishing these recommendations simultaneously with Pediatrics," said Christine Laine, MD, MPH, FACP, editor-in-chief of Annals of Internal Medicine. "Youth tobacco prevention is an important public health issue that requires layered intervention. Internal medicine physicians who treat both adolescents and adults are uniquely positioned to provide education and counseling to children and their parents."

The authors of a related opinion piece write that increasing the legal age of sale for tobacco products to 21 years is "the right thing to do." They argue that 90 percent of daily adult smokers experienced their first cigarette by age 18.

"Making it more difficult for young adults to purchase cigarettes has the potential to interrupt the trajectory from experimentation to regular use," wrote Michael Steinberg, MD, MPH of UMDNJ-Robert Wood Johnson Medical School, Division of General Medicine.