To help curb the use of cigarettes, and especially e-cigarettes, the United States Preventive Services Task Force (USPSTF) now recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents. The updated evidence report and recommendation statement were both published in JAMA.1,2

The new recommendation report “found adequate evidence that behavioral counseling interventions with a health care clinician can have a moderate effect in preventing initiation of tobacco use in school-aged children and adolescents” and found no harms related to counseling. Therefore, the task force concludes “that primary care-feasible behavioral interventions to prevent tobacco use in the pediatric population have a moderate net benefit.” These recommendations will replace the 2013 USPSTF report and includes the use of e-cigarettes as a tobacco source.

The taskforce did not find sufficient evidence to show that tobacco cessation interventions helped improve health outcomes in school-aged children and adolescents who already use tobacco products. Tobacco products as defined in the 2020 review include any product made or derived from tobacco intended for human consumption by the US Food and Drug Administration (FDA).

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The USPSTF evidence report supported these recommendations. Researchers assessed 24 randomized clinical trials that compared behavioral or pharmacological interventions with no or a minimal tobacco use intervention control group. The assessment found that behavioral interventions were associated with a decreased likelihood of cigarette smoking initiation compared with control interventions at 7 to 36 months’ follow-up. No statistically difference was found between behavioral interventions and controls in smoking cessation when trials were restricted to those who already smoked. Few trials addressed prevention or cessation of tobacco products other than cigarettes; no trials evaluated effects of interventions on e-cigarette use.

According to the report, behavioral counseling interventions that are effective in preventing tobacco initiation in children include face-to-face counseling, telephone counseling, and computer-based and print-based interventions.

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The USPSTF is calling for more research to be conducted to identify effective interventions to help children and adolescents who already use tobacco products to quit. These studies should include pharmacologic therapies that may help these patients quit smoking. More research is also needed on interventions tailored specifically to prevent initiation of use and promote cessation of e-cigarette use.


1.Selph S, Patnode C, Bailey SR, Pappas M, Stoner R, Chou R. 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;323(16):1599–1608.

2. Owens DK; US Preventive Services Task Force. Primary care interventions for prevention and cessation of tobacco use in children and adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. 2020;323(16):1590-1598.