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Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force
Evidence Synthesis, No. 185
Investigators: Shelley Selph, MD, MPH, Carrie D. Patnode, PhD, MPH, Steffani R. Bailey, PhD, Miranda Pappas, MA, Ryan Stoner, PhD, Erica Hart, MST, and Roger Chou, MD.
Structured Abstract
Background:
Interventions to discourage use of tobacco products among children and adolescents may help decrease tobacco-related illness. Tobacco products for this review include electronic nicotine delivery systems, often referred to as e-cigarettes.
Purpose:
To systematically update the 2013 U.S. Preventive Services Task Force (USPSTF) review on primary care relevant interventions for tobacco use prevention and cessation in children and adolescents.
Data Sources:
We searched the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, MEDLINE, PsycINFO, and EMBASE (September 1, 2012 to June 25, 2019) with surveillance through February 7, 2020.
Study Selection:
We selected primary care relevant studies based on inclusion and exclusion criteria developed for each key question. We included randomized and nonrandomized controlled trials of children and adolescents up to 18 years of age for cessation and 25 years of age for prevention. Trials that compared behavioral or pharmacological interventions with a no or minimal smoking intervention control group (e.g., usual care, attention control, wait list) were included.
Data Extraction:
One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF.
Data Synthesis (Results):
Twenty-six trials met inclusion criteria. Behavioral interventions were associated with decreased likelihood of smoking initiation compared with control interventions (k=13, n=21,700; 7.4% vs. 9.2%; relative risk [RR] 0.82, 95% confidence interval [CI] 0.73 to 0.92). In trials restricted to smokers, behavioral interventions had no effect on smoking prevalence (k=9, n=2,516, 80.7% vs. 84.1% continued smoking, RR 0.97, 95% CI, 0.93 to 1.01). Behavioral interventions were more effective than control interventions at decreasing smoking prevalence in trials of smokers and nonsmokers (k=7, n=10,533; 16.8% vs. 20.1%; RR 0.91, 95% CI, 0.83 to 0.995). However, these results were sensitive to inclusion of two trials of very intensive interventions. Two trials of bupropion and one trial of nicotine replacement therapy found no significant benefits of medication on likelihood of smoking cessation. One trial each found no evidence for a beneficial intervention effect on health outcomes or on adult smoking.
Limitations:
Few trials addressed the prevention or cessation of tobacco products other than cigarettes; no trials evaluated effects of interventions on e-cigarette use. Trials of pharmacotherapy were few and had small sample sizes.
Conclusions:
Behavioral interventions can reduce the likelihood of smoking initiation in nonsmoking youth and young adults. Research is needed to identify effective behavioral interventions for youth who smoke or who use other tobacco products and to understand the effectiveness of pharmacotherapy on cessation. Due to the rapid escalation of e-cigarette use among youth, both prevention and cessation trials that target and/or include e-cigarettes are imminently needed.
Contents
- Acknowledgments
- Chapter 1. Introduction and Background
- Chapter 2. Methods
- Chapter 3. Results
- Key Question 1. Do Primary Care Interventions to Prevent Tobacco and Nicotine Use or Improve Tobacco and Nicotine Cessation Rates in Children and Adolescents Improve Health Outcomes (i.e., Respiratory, Dental, Cardiovascular, and Oral Health) and Reduce the Likelihood of Tobacco and Nicotine Use in Adulthood?
- Key Question 2. Do Primary Care Interventions Prevent Tobacco and Nicotine Use or Improve Tobacco and Nicotine Cessation Rates in Children and Adolescents?
- Key Question 3. What Adverse Effects Are Associated With Primary Care Interventions to Prevent Tobacco and Nicotine Use or Improve Tobacco and Nicotine Cessation Rates in Children and Adolescents?
- Contextual Question 1. What Is the Relationship Between Use of E-Cigarettes and Use of Other Tobacco Products?
- Chapter 4. Discussion
- References
- Appendixes
Suggested citation:
Selph S, Patnode CD, Bailey SR, Pappas M, Stoner R, Hart E, Chou R. Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 185. AHRQ Publication No. 19-05254-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2020.
This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (HHSA-290-2015-00009-I, Task Order No. 7). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information (i.e., in the context of available resources and circumstances presented by individual patients).
The final report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
- NLM CatalogRelated NLM Catalog Entries
- Primary Care-Relevant Interventions for Tobacco and Nicotine Use Prevention and Cessation in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.[JAMA. 2020]Primary Care-Relevant Interventions for Tobacco and Nicotine Use Prevention and Cessation in Children and Adolescents: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.Selph S, Patnode C, Bailey SR, Pappas M, Stoner R, Chou R. JAMA. 2020 Apr 28; 323(16):1599-1608.
- Review Interventions for Tobacco Cessation in Adults, Including Pregnant Women: An Evidence Update for the U.S. Preventive Services Task Force[ 2021]Review Interventions for Tobacco Cessation in Adults, Including Pregnant Women: An Evidence Update for the U.S. Preventive Services Task ForcePatnode CD, Henderson JT, Melnikow J, Coppola EL, Durbin S, Thomas R. 2021 Jan
- Review Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task Force[ 2015]Review Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Review of Reviews for the U.S. Preventive Services Task ForcePatnode CD, Henderson JT, Thompson JH, Senger CA, Fortmann SP, Whitlock EP. 2015 Sep
- Review Primary Care Relevant Interventions for Tobacco Use Prevention and Cessation in Children and Adolescents: A Systematic Evidence Review for the U.S. Preventive Services Task Force[ 2012]Review Primary Care Relevant Interventions for Tobacco Use Prevention and Cessation in Children and Adolescents: A Systematic Evidence Review for the U.S. Preventive Services Task ForcePatnode CD, O'Connor E, Whitlock EP, Perdue LA, Soh C. 2012 Dec
- Interventions for Tobacco Cessation in Adults, Including Pregnant Persons: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.[JAMA. 2021]Interventions for Tobacco Cessation in Adults, Including Pregnant Persons: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.Patnode CD, Henderson JT, Coppola EL, Melnikow J, Durbin S, Thomas RG. JAMA. 2021 Jan 19; 325(3):280-298.
- Primary Care Interventions for Prevention and Cessation of Tobacco Use in Childr...Primary Care Interventions for Prevention and Cessation of Tobacco Use in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force
- LIPT1 [Ovis aries]LIPT1 [Ovis aries]Gene ID:101107774Gene
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