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Docs should counsel youth about not smoking: panel

By Genevra Pittman

NEW YORK (Reuters Health) - Doctors should talk to school-aged kids and teens about the consequences of smoking and how to avoid pressure to start using cigarettes, a government-backed panel said today.

The draft guidelines from the U.S. Preventive Services Task Force are based on a review of studies that found 19 percent fewer youths started smoking after a range of prevention programs.

Out of more than 26,000 kids and teens in those trials, researchers found 50 would have to be counseled to prevent one from trying cigarettes over the next seven months to three years.

However, the same review showed no benefits from smoking cessation counseling or drug treatment with Zyban (bupropion) for youth who had already taken up the habit.

"Ninety percent or so of smokers initiate smoking prior to (age) 18, so to really prevent smoking you have to address the teenage and older child population," said Dr. David Grossman, a member of the task force from Group Health Research Institute and the University of Washington in Seattle.

"This is really good news that primary care clinicians can play a role in this," he told Reuters Health.

The draft guidelines are an update to the task force's 2003 guidelines, which found there wasn't enough evidence to determine whether counseling could help prevent kids from starting to smoke or help youth smokers quit. The newest version will be posted on the USPSTF website for public comment (http://bit.ly/cy0SzP) from December 11 until January 7.

The studies analyzed in the new review looked at everything from home mailings and phone calls to group counseling sessions with kids and their parents.

"A variety of approaches appear to work. The most important thing is that clinicians do raise the issue as part of well-child care," Grossman said, noting that counseling can be quick and inexpensive.

The task force said there's still a need for more research, including studies looking at what types of prevention programs are most feasible in the real world.

It also recommends referring kids who already smoke to counseling programs designed for smoking cessation. There's some evidence that school-based programs may help kids quit, for example.

Researchers at the Kaiser Permanente Center for Health Research in Portland, Oregon, led by Carrie Patnode conducted the review supporting the new guidelines, which is published in the Annals of Internal Medicine.

"If you're parents, you certainly want the family doctor to speak to your child on every occasion about not smoking," said Dr. Roger Thomas from the University of Calgary in Canada, who studies interventions to prevent adolescent smoking.

And for doctors, "the more politely you do it, the less lecturing you do, the better," Thomas, who isn't part of the task force or the evidence review team, told Reuters Health.

He said implementing non-smoking policies around schools and making sure shopkeepers don't sell cigarettes to teens can dissuade some young people from taking up the habit as well.

"These interventions are working, and states should be putting money into these programs… because in the long term they save lives," agreed Dr. Joseph DiFranza, a tobacco researcher from the University of Massachusetts Medical School in Worcester, who also wasn't involved in the new guidelines.

"Smoking or nicotine addiction really is a pediatric disease that carries over into adulthood," DiFranza told Reuters Health.

A combination of community and school initiatives, as well as counseling during primary care visits, Grossman said, "really give us a chance at being able to prevent youth smoking."

SOURCE: http://bit.ly/bN9DEh Annals of Internal Medicine, online December 10, 2012.

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