The United States Preventive Services Task Force (USPSTF) is now recommending a number of validated smoking prevention and cessation interventions to help primary care clinicians prevent tobacco use in children and adolescents — a shift away from it’s 2003 position, when it deemed evidence was insufficient to recommend for or against such practices.

Interventions range from simple, such as mailing an information packet to patients and their families, to more complex strategies, like in-person group counseling, Virginia Moyer, MD, of Baylor College of Medicine in Houston and colleagues reported in Pediatrics.

“[P]rimary care providers can provide simple, economical and effective interventions to help prevent tobacco use among children and teens,” the researchers wrote. “Although most serious and life-threatening effects from smoking show up in adults, it is important for children and adolescents to understand that young smokers can suffer from impaired lung growth, early onset of lung deterioration, and respiratory and asthma-related symptoms.”

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For the current recommendations, USPSTF reviewed evidence on the effectiveness of primary care interventions on tobacco initiation and cessation among children and adolescents, as well as health outcomes on respiratory, dental, and oral health measures and adult smoking rates.

They found that even very minimal interventions can have substantial effects on reducing smoking initiation. Overall messages were similar among tobacco-cessation strategies, and focused on participants’ attitudes and knowledge about smoking and it’s consequences, tobacco marketing awareness, parental attitudes and beliefs, as well how to decline cigarettes and improve parent-child communication.

For example, one recommended tobacco prevention intervention consisted of mailing an information document  to children and their families, along with a 28-minute video and two follow-up phone calls to offer counseling on the mailed item.

Another more intense intervention required youth and at least one parent to participate in group and family counseling sessions for seven weeks, with each session lasting 2 to 2.5 hours. The workshops involved take-home workbooks and activities and were aimed at preventing universal substance abuse and behavioral problems.

Other recommended interventions include mobile phone-based cessation programs, raising the cost of tobacco products, mass media public health campaigns against smoking and encouraging advocacy for stronger laws against tobacco products and sales to minors.

Tobacco use is currently the leading preventable cause of death in the United States, according to USPSTF. More than 3,800 children aged 12 to 17 years smoke their first cigarette and 1,000 younger than 18 become daily smokers.

“As a pediatrician, I believe that preventing tobacco use is critical in helping young people live long, healthy lives,” USPSTF member David Grossman, MD, MPH, said in a press release. “An ounce of prevention is worth a pound of cure.”


  1. Moyer VA et al. Pediatrics 2013; 132: 560-565; DOI: 10.1542/peds.2013-2079.