Doctors urged to counsel tweens on tobacco dangers

In light of recent data, a federal panel is recommending that primary care physicians take a more aggressive approach to preventing smoking among their young patients.

The U.S. Preventive Service Task Force issued a draft recommendation statement on Dec. 11 that encourages primary care doctors to provide tobacco-prevention interventions to patients ages 10 to 17. Interventions can include brief counseling and education, during office visits, on the negative health effects of tobacco. Such ill effects include cancer, emphysema and heart disease.

The task force is accepting public comments on the proposed guidelines through Jan. 7, 2013.

The draft updates the expert panel's 2003 guidance that says there is insufficient evidence to recommend for or against routine screening for tobacco use or for interventions aimed at preventing and treating tobacco use and dependence in youths.

“As a pediatrician, I believe preventing tobacco use is critical in helping young people to live long, healthy lives,” said task force member David C. Grossman, MD, MPH. “The good news is that primary care clinicians can play an important role in preventing tobacco use among their young patients.”

Tobacco use is the leading cause of preventable death in the United States, according to the Centers for Disease Control and Prevention. Each day, more than 3,800 youths ages 12 to 17 smoke their first cigarette, and 1,000 people in that age group become daily smokers, the task force said.

Although most of the serious health effects from smoking occur in adulthood, children and adolescents who partake can experience respiratory problems, including coughing, early onset of lung function decline, impaired lung growth and wheezing, according to the task force.

There also is a substantial economic toll that accompanies smoking. Each year, cigarette smoking costs the U.S. more than $193 billion in lost productivity and health care expenditures, the CDC said.

Effective interventions for primary care

In making its recommendation, the task force reviewed 19 studies published between 1980 and September 2012. The studies, which examined the efficacy of interventions relevant to primary care, are aimed at preventing young people from starting smoking or helping tobacco users quit the habit.

They found that behavior-based prevention interventions led to a 19% reduction in the risk of youth starting smoking at seven to 36 months of follow-up compared with participants in a control group.

The task force said there are a variety of ways primary care doctors can educate and counsel young patients to prevent them from starting smoking. Some effective methods include:

• Face-to-face interactions with the patient or the patient and his or her family.
• Telephone counseling.


• Providing patients with print materials, such as newsletters, tip sheets and preprinted prescription forms with anti-tobacco messages.
• Showing patients educational videos about the harms of tobacco use.

None of the interventions that were assessed improved cessation rates among young smokers, according to the evidence review that the task force used in making its recommendation. The review was published online Dec. 11 in Annals of Internal Medicine.

The lack of effect of cessation interventions could be due to the limited number of studies that target young established smokers, said Carrie D. Patnode, PhD, MPH, lead author of the review. While she worked on the review, she was a researcher at Kaiser Permanente Center for Health Research in Portland, Ore.

There were no harms reported with behavior-based interventions, the review said. The Food and Drug Administration does not approve any medication for tobacco cessation in children and adolescents, the task force said.

A limitation of the Annals review is that there were inconsistent measures of baseline smoking status and outcome measures. Such variation makes it difficult to compare study findings and generalize results, the review authors said.

There is uncertainty in the medical community about whether physicians will be reimbursed for smoking prevention and cessation interventions. Although the Affordable Care Act mandates coverage for a list of preventive services, including smoking cessation attempts, not all insurers reimburse doctors for that tobacco intervention. Researchers and insurers are calling for more guidance on tobacco cessation from the Dept. of Health and Human Services.

What is clear is that many of the interventions the task force recommended “are brief, low-cost and easy to implement in primary care,” said Dr. Grossman, professor of health services and adjunct professor of pediatrics at the University of Washington.

These interventions could have “potentially lifesaving results for teens,” he said.