Monday, November 24, 2014

USPSTF: strategies to stop smoking initiation of moderate benefit

- Jennifer Middleton, MD, MPH

We have an impressive array of medical technology to diagnose and treat tobacco-related illness, but we should not let that technology keep us from the vital task of stopping people from smoking before they start. Last week on the AFP Community Blog, Dr. Lin wrote about shared decision making regarding low-dose CT screening for lung cancer in current and former smokers. He quoted Dr. Gates from his November 1st AFP article:

"[C]onvincing persons to quit smoking (or to not start) is far more effective in preventing lung cancer deaths than low-dose CT screening."

Cigarette smoking is linked to hundreds of thousands of deaths in the United States every year, with thousands more afflicted with COPD, cardiovascular disease, or one of the many cancers that smoking can cause. One of the great triumphs of public health in the U.S. has been the dramatic reduction in smoking over the last several decades; in 1965, 42% of US adults smoked tobacco, compared with 19% in 2011 (latest year for which data is available).

19%, however, still leaves still plenty of room for improvement. The benefits to the individuals who never start smoking, as well as the resources saved from not treating the many serious sequelae that can arise from smoking, are innumerable. Most individuals who smoke begin before age 18, making our offices an ideal place to provide counseling to children and teens to keep them from picking up the habit. The USPSTF recently weighed in on the usefulness of office strategies to prevent tobacco initiation among children and adolescents, and the November 15 AFP issue reviews this new "B" recommendation:

"The USPSTF found adequate evidence that behavioral counseling interventions, such as face-to-face or phone interaction with a health care professional, print materials, and computer applications, can reduce the risk of smoking initiation in school-aged children and adolescents."

The first step for clinicians is to assess the adolescent's risk of initiating smoking, the most powerful being parental tobacco use. Other important risk factors include peer smoking, low parental involvement, and exposure to tobacco ads. Medical offices don't have to go to great lengths to provide a meaningful intervention for these at-risk teens; although some of the interventions the USPSTF studied were quite intensive, even pre-printed anti-tobacco messages decreased tobacco initiation in one study. 

We can all have a role to play in stopping the initiation of tobacco use in children and adolescents. You can get more ideas, along with patient education materials, at the AFP By Topic for Tobacco Abuse and Dependence. If every family physician's office in the U.S. adopted one or more of these interventions, how many cases of COPD, cardiovascular disease, and cancer might we prevent?

How does your office discourage smoking among the kids and teens that you care for?

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