Doctors urged to intervene, prevent youth smoking

Primary care physicians should offer children and teens counseling and guidance to prevent them from starting smoking, according to draft guidelines  issued by the U.S. Preventive Services Task Force (USPSTF).

That’s a change from the group's 2003 guidelines, which found insufficient evidence to recommend for or against doctors taking actions to thwart tobacco use among younger patients.

Since then, “there were a bunch of new studies that were published throughout the last nine years that do point to a positive effect by primary physicians in their efforts to prevent tobacco initiation by kids,” explained USPSTF member Dr. David C. Grossman, a practicing pediatrician at the Group Health Cooperative in Seattle, Washington.

Why the focus on children and teens?  “Over 90% of adults started smoking before they were 19,  so that means this is a problem that starts in late childhood and early adolescence,” Grossman explained.

Tobacco use is the leading cause of preventable death in the United States, so stopping people from ever starting to smoke could work toward eliminating the estimated 443,000 deaths each year nationwide that are attributed to smoking, and the $96 billion spent in the United States for medical care directly related to smoking.

The USPSTF is an independent group of experts that make "evidence-based" recommendations on preventive services like screenings, preventive medications and counseling services.

The group found that behavior-based treatments, which include methods like counseling alone or with educational material such as booklets, e-mails or online materials, phone counseling, and counseling plus a booster message by physicians, were effective in preventing young people from ever beginning to use tobacco products.

The draft guidelines note the influence of parents when it comes to their children picking up the habit, saying that parents who smoke and who are dependent upon nicotine are “one of the strongest factors associated with smoking initiation among children and adolescents.” Grossman said that asking about household smoking habits is a regular part of patient screening, and he offers guidance on quitting to parents who smoke.

“I think the key here is that, although we’ve known that community-based interventions have been effective, which is why we’ve seen reduced rates of smoking in the United States compared to two decades ago, behavioral interventions work best when kids and teens are receiving the same message everywhere," Grossman said. "And if they’re receiving it in the community through school and through media and they’re receiving it through their doctor’s office and it's being reinforced in the home, then we really have a chance at preventing smoking from ever beginning.”