Primary Care Relevant Interventions for Tobacco and Nicotine Use Prevention and Cessation in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force

Project Summary Title and Description

Title
Primary Care Relevant Interventions for Tobacco and Nicotine Use Prevention and Cessation in Children and Adolescents: A Systematic Review for the U.S. Preventive Services Task Force
Description
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.
Attribution
N/A
Authors of Report
N/A
Methodology description
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.
PROSPERO
N/A
DOI
N/A
Notes
DOI: PubMed: The data of this project were entered retrospectively. Tables uploaded to this project: Appendix B. Quality Assessment Table, Appendix B2. Behavioral Intervention Details
Funding Source
Agency for Healthcare Research and Quality

Key Questions

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 or nicotine use in adulthood?
2. Do primary care interventions prevent tobacco and nicotine use or improve tobacco and nicotine cessation rates in children and adolescents?
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?

Associated Extraction Forms

Associated Studies (each link opens a new tab)

TitleAuthorsYear
Can brief intervention through community dental care have an effect on adolescent smoking?1999
Effectiveness of a nurse-led intensive home-visitation programme for first-time teenage mothers (Building Blocks): a pragmatic randomised controlled trial.2016
A Web-based, computer-tailored smoking prevention program to prevent children from starting to smoke after transferring to secondary school: randomized controlled trial.2015
Efficacy of a text message-based smoking cessation intervention for young people: a cluster randomized controlled trial.2013
Long-term effects of a home-based smoking prevention program on smoking initiation: a cluster randomized controlled trial.2014
Randomized trial outcomes of a TTM-tailored condom use and smoking intervention in urban adolescent females.2015
Long-term efficacy of nicotine replacement therapy for smoking cessation in adolescents: a randomized controlled trial.2014
Promoting smoking cessation among parents: effects on smoking-related cognitions and smoking initiation in children.2015
Short-term effects of a randomized computer-based out-of-school smoking prevention trial aimed at elementary schoolchildren.2002
Influence of a family program on adolescent smoking and drinking prevalence.2002
Brief motivational intervention for adolescent smokers in medical settings.2005
Enhanced motivational interviewing versus brief advice for adolescent smoking cessation: results from a randomized clinical trial.2012
A randomized trial of a family-based smoking prevention intervention in managed care.2003
A prescription for health: a primary care based intervention to maintain the non-smoking status of young people.2001
A randomized trial of Parents Who Care: effects on key outcomes at 24-month follow-up.2007
Teen reach: outcomes from a randomized, controlled trial of a tobacco reduction program for teens seen in primary medical care.2005
An adolescent tobacco-use prevention trial in orthodontic offices.1996
Enabling parents who smoke to prevent their children from initiating smoking: results from a 3-year intervention evaluation.2006
Randomized clinical trial of the efficacy of bupropion combined with nicotine patch in the treatment of adolescent smokers.2004
Randomized, double-blind, placebo-controlled trial of 2 dosages of sustained-release bupropion for adolescent smoking cessation.2007
Effectiveness of a school nurse-delivered smoking-cessation intervention for adolescents.2011
Effect of a pediatric practice-based smoking prevention and cessation intervention for adolescents: a randomized, controlled trial.2008
A randomized controlled trial of a parent-centered intervention in preventing substance use and HIV risk behaviors in Hispanic adolescents.2007
A pediatric, practice-based, randomized trial of drinking and smoking prevention and bicycle helmet, gun, and seatbelt safety promotion.2002
Bupropion SR and contingency management for adolescent smoking cessation.2011
Promoting tobacco abstinence among older adolescents in dental clinics2007

Downloadable Data Content

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