The AAFP and the U.S. Preventive Services Task Force(www.uspreventiveservicestaskforce.org) (USPSTF) have updated their 2003 positions on tobacco use among children and teens, issuing final recommendations encouraging primary care physicians to counsel youth against using tobacco.
Previously, both the AAFP and the task force had cited a lack of evidence to recommend for or against such counseling, with the Academy's recommendation stating that although the AAFP recognizes that avoidance of tobacco products by children and adolescents is desirable, "the effectiveness of physician advice and counseling in this area is uncertain."
- The AAFP and U.S. Preventive Services Task Force (USPSTF) have issued final recommendations that physicians provide interventions, including education or brief counseling, to prevent the initiation of tobacco use by school-aged children and adolescents.
- A systematic review of trials designed to prevent tobacco use initiation, promote cessation, or both, showed that primary care-relevant behavior-based prevention interventions that target children, parents, or both, in health care settings helped reduce the risk of smoking initiation by 19 percent compared with control participants at six to 36 months follow-up.
- According to family physician and USPSTF Co-vice Chair Michael LeFevre, M.D., M.S.P.H., evidence shows there are intervention programs, such as the AAFP's Tar Wars program, that family physicians can implement to reduce the number of adolescents who become regular smokers.
According to family physician and USPSTF Co-vice Chair Michael LeFevre, M.D., M.S.P.H., of Columbia, Mo., the task force now has enough evidence to recommend that physicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents. A systematic review of trials designed to prevent tobacco use initiation, promote cessation, or both, showed that primary care-relevant behavior-based prevention interventions that target children, parents, or both, in health care settings helped reduce the risk of smoking initiation by 19 percent compared with control participants at six to 36 months follow-up.
LeFevre said that because most of the strategies to prevent tobacco use in this age group involve, for example, mass media campaigns, higher tobacco prices, community-wide efforts and school-based tobacco-free education programs such as the AAFP's Tar Wars program, family physicians can fill a gap by addressing this issue in the office with their patient population to try and prevent smoking.
"The pooled results across the studies that the task force looked at concerning what can be done in a physician's office suggest that reaching out to about 50 children and adolescents can prevent one of them from starting smoking," said LeFevre. "That's a pretty big impact if you can look across all of the children and adolescents that family physicians treat across this nation."
According to the USPSTF, tobacco use is the leading cause of preventable death in the United States, accounting for an estimated 443,000 deaths each year, including nearly 161,000 deaths from cancer, 128,000 from cardiovascular diseases and 103,000 from respiratory diseases. Smoking costs the United States about $96 billion per year in direct medical costs.
LeFevre also said he finds it a bit ironic that the task force just released a draft recommendation on screening certain patients for lung cancer using low-dose CT scans.
"Of course, looking at the data, we know that about 90 percent of those people that will qualify for lung cancer screening had their first cigarette before they were 18," he said. "So if there is something that we can do upstream to prevent all of these negative events downstream, then perhaps that's a better approach.
"They say an ounce of prevention is worth a pound of cure, but in this case, it may be worth several pounds if you think of the cost of caring for the health problems associated with tobacco use."
Related ANN Coverage
USPSTF Recommends Interventions, Education to Prevent Youth Tobacco Use