Clinician Summary

Tobacco Use in Children and Adolescents: Primary Care Interventions

April 28, 2020

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

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Panel 1
What does the USPSTF recommend? School-aged children and adolescents who have not started to use tobacco: Grade B
Provide interventions, including education or brief counseling, to prevent initiation of tobacco use.
School-aged children and adolescents who use tobacco: I statement
The evidence is insufficient to assess the balance of benefits and harms of primary care–feasible interventions for cessation of tobacco use.
To whom does this recommendation apply? School-aged children and adolescents younger than 18 years.
What’s new? This recommendation is consistent with the 2013 USPSTF recommendation, with some key updates:
  • Adds a new “I statement” on interventions for the cessation of tobacco use in school-aged children and adolescents.
  • Includes e-cigarettes as a tobacco product. 
How to implement this recommendation?   Definition of tobacco use: Tobacco use refers to any tobacco product, including cigarettes, cigars (including cigarillos and little cigars), as well as vaping e-cigarettes.
  1. Determine if youth are using tobacco.
  2. If youth are not using tobacco:
    • Provide behavioral counseling interventions to all youth to prevent tobacco use.
      • Effective behavioral counseling interventions to prevent initiation of tobacco use include face-to-face counseling, telephone counseling, and computer-based and print-based interventions.
  3. If youth are using tobacco:
    • The evidence is insufficient to recommend for or against providing interventions to youth for cessation of tobacco use.
      • Existing studies on behavioral interventions to help youth quit tobacco use have been too heterogeneous and too small to detect a benefit.
      • No medications are currently approved by the US Food and Drug Administration for tobacco cessation in children and adolescents.
    • Use clinical judgement to decide how to best help youth who use tobacco.
What are other relevant USPSTF recommendations? The USPSTF has made recommendations on behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women, and primary care behavioral interventions to reduce illicit drug and nonmedical pharmaceutical use in children and adolescents. These recommendations are available at www.uspreventiveservicestaskforce.org.
Where to read the full recommendation statement? Visit the USPSTF Web site (www.uspreventiveservicestaskforce.org) to read the full recommendation statement. This includes more details on the rationale of the recommendation, including benefits and harms; supporting evidence; and recommendations of others.