How to Help Adolescents Quit Smoking
PHS GUIDELINE RECOMMENDATIONS How to Help Adolescents Quit Smoking
The 2008 Update to the PHS Clinical Practice Guideline on º cognitive-behavioral strategies (self-monitoring Treating Tobacco Use and Dependence recommends for the and coping skills), first time that adolescent smokers be provided with º social influence strategies (addressing social counseling interventions to aid them in quitting smoking.1 influences that serve to promote or maintain smoking) Although the use of counseling approximately doubled quit º motivational strategies (techniques to clarify rates in the seven studies on youth cessation reviewed by desire for change and reduce ambivalence the Guideline Panel, the Panel noted that absolute toward change). abstinence rates of those who received counseling remained • Special considerations for adolescents: quite low (11.6% quit rate at 6 months) attesting to the Interventions should be developmentally continued need for research to identify the most effective appropriate across the adolescent age span (e.g., counseling strategies for adolescents. appropriate for a 12-year-old vs. an 18-year-old).
MORE INFORMATION ON THE 2008 Recommendation: Intervening During the Adolescent’s Health Care Provider Visit UPDATE TO THE PHS GUIDELINE Health care providers should ask pediatric and Although there are limited studies on how adolescent patients about their tobacco use and to help adolescents quit smoking, the existing clearly communicate the importance of abstaining evidence supports the following recommendations. from using tobacco. • Asking adolescents about tobacco use and Recommendation: Counseling Adolescent Smokers advising them to quit are the first steps toward the use of effective treatments to quit. Counseling interventions should be provided to º In a sample of 11th graders , more than 79 adolescent smokers to aid them in quitting smoking. percent reported they would acknowledge
• Counseling for adolescent smokers has been their smoking if asked.3 shown to be effective, approximately doubling • Clinicians need to routinely assess adolescent long-term abstinence rates when compared to usual tobacco use, offer counseling, and follow up care (e.g., brief advice, self-help pamphlets, with these patients. referral) or no treatment. • For patients not ready to make a quit attempt,
• The counseling studies reviewed for the Guideline clinicians may adapt the motivational interventions varied in content and included strategies designed to: provided in the Guideline for use with adolescents. º enhance adolescent’s motivation to quit, • Special considerations for adolescents: º establish rapport with the adolescents, It is important for clinicians to intervene º set goals for quitting, with adolescents in a manner that respects º promote problem solving and skill training, and confidentiality and privacy (e.g., interviewing º prevent relapse. adolescents without parents present). • A meta-analysis of smoking cessation for teens found significant effects for studies that included the following treatment approaches:2
National Center for Chronic Disease Prevention and Health Promotion Office on Smoking and Health Recommendation: Counseling Parents During the to quit smoking.4 These interventions, in addition Pediatric Visit to those that prevent initiation, need to be fully implemented to lower the prevalence of smoking in Health care providers should ask parents about their the U.S. tobacco use, and offer cessation advice and assistance. Providing advice and assistance to parents who use tobacco has been shown to increase abstinence, protecting children FUTURE RESEARCH from secondhand smoke. • Research suggests that tobacco use interventions • The Guideline suggests the following topics require provided to parents can: additional research: effectiveness of using the 5 A’s in º increase parents’ interest in stopping smoking, pediatric settings to treat both adolescents and parents; º increase parents’ quit attempts, and safety and effectiveness of medications in adolescents; º increase parents’ quit rates. effectiveness of counseling interventions designed to motivate youth to quit; effectiveness of child-focused Not Recommended At This Time: Tobacco Use Medication for Adolescents versus family focused or peer-focused interventions as well as interventions accessed via the Internet, • Although nicotine replacement has been shown quitlines, and school-based programs; and strategies to be safe for adolescents to use, it is not currently for increasing the efficacy, appeal, and reach of recommended as a component of pediatric tobacco counseling treatments for adolescents. use interventions. • Although NRT and bupropion SR have been proven This document is adapted from a Learnings Resource Sheet devel useful in increasing cessation success in adults, they oped by the Youth Tobacco Cessation Collaborative.5 are not currently recommended as a component of pediatric tobacco use interventions. References: TAKE ACTION 1. Fiore MC, Jaén CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. • When working with health care systems (managed Clinical Practice Guideline. Rockville, MD: U.S. care organizations, etc.) to increase their use of Department of Health and Human Services. effective cessation treatments recommended in the Public Health Service. May 2008. 2008 PHS Clinical Practice Guideline on Treating 2. Sussman S, Sun P, Dent CW. A meta-analysis of Tobacco Use and Dependence; be sure to encourage teen cigarette smoking cessation. Health them to provide cessation counseling for both parents Psychol. 2006;25:549–57. and adolescents. 3. Alfano CM, Zbikowski SM, Robinson LA. et al. • Tobacco control policies and community-based Adolescent reports of physician counseling interventions (e.g., increasing prices, mass media for smoking. Pediatrics. 2002;109:e47. campaigns, smoke-free policies, etc.) that increase 4. The Guide to Community Preventive Services. cessation among adults also likely encourage youth Reducing tobacco use and secondhand smoke exposure. http://www.thecommunityguide.org/ tobacco/index.html 5. Youth Tobacco Cessation Collaborative (YTCC). YTCC Learnings Resource Sheet: PHS Guideline recommendations: How to help adolescents quit smoking.
National Center for Chronic Disease Prevention and Health Promotion Office on Smoking and Health
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