Carrie D. Patnode, PhD, MPH; Elizabeth O'Connor, PhD; Evelyn P. Whitlock, MD, MPH; Leslie A. Perdue, MPH; Clara Soh, MPA; Jack Hollis, PhD
Note: This review was conducted by the Oregon Evidence-based Practice Center under contract to the AHRQ. Staff from the AHRQ provided oversight for the project and assisted in external review of the companion draft evidence synthesis.
Disclaimer: Ms. Soh accepted a position at the Pharmaceutical Research and Manufacturers of America during the finalization of the full report and drafting and final submission of this manuscript; she contributed the majority of her intellectual content to this review while she was employed with the Oregon Evidence-based Practice Center at Kaiser Permanente Center for Health Research. The views and opinions expressed in this article are those of the authors and do not necessarily reflect the views of the Pharmaceutical Research and Manufacturers of America.
Acknowledgment: The authors thank the AHRQ staff; the USPSTF; Raymond S. Niaura, PhD, Steven Sussman, PhD, MA, Andrea C. Villanti, PhD, MPH, and Jonathan Winickoff, MD, MPH, for providing expert review of the report; and Kevin Lutz, MFA, Daphne Plaut, MLS, and Heather Baird of the Kaiser Permanente Center for Health Research.
Financial Support: By contract HHS-290-2007-10057-I from the Agency for Healthcare Research and Quality.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M12-1962.
Requests for Single Reprints: Reprints are available from the AHRQ Web site (www.ahrq.gov).
Current Author Addresses: Drs. Patnode, O'Connor, Whitlock, and Hollis and Ms. Perdue: Kaiser Permanente Center for Health Research, 3800 North Interstate Avenue, Portland, OR 97227.
Ms. Soh: The Pharmaceutical Research and Manufacturers of America, 950 F Street, NW, Suite 300, Washington, DC 20004.
Author Contributions: Conception and design: C.D. Patnode, E. O'Connor, E.P. Whitlock, J. Hollis.
Analysis and interpretation of the data: C.D. Patnode, E. O'Connor, L.A. Perdue, C. Soh.
Drafting of the article: C.D. Patnode.
Critical revision of the article for important intellectual content: C.D. Patnode, E. O'Connor, L.A. Perdue, C. Soh.
Final approval of the article: C.D. Patnode, E. O'Connor, E.P. Whitlock, L.A. Perdue, C. Soh, J. Hollis.
Statistical expertise: C.D. Patnode, E. O'Connor.
Obtaining of funding: E.P. Whitlock.
Administrative, technical, or logistic support: C.D. Patnode, E. O'Connor, E.P. Whitlock, L.A. Perdue.
Collection and assembly of data: C.D. Patnode, L.A. Perdue, C. Soh.
Interventions to prevent smoking uptake or encourage cessation among young persons might help prevent tobacco-related illness.
To review the evidence for the efficacy and harms of primary care–relevant interventions that aim to reduce tobacco use among children and adolescents.
Three systematic reviews that collectively covered the relevant literature; MEDLINE, PsycINFO, the Cochrane Central Register of Controlled Trials, and the Database of Abstracts of Reviews of Effects through 14 September 2012; and manual searches of reference lists and gray literature.
Two investigators independently reviewed 2453 abstracts and 111 full-text articles. English-language trials of behavior-based or medication interventions that were relevant to primary care and reported tobacco use, health outcomes, or harms were included.
One investigator abstracted data from good- and fair-quality trials into an evidence table, and a second checked these data.
19 trials (4 good-quality and 15 fair-quality) that were designed to prevent tobacco use initiation or promote cessation (or both) and reported self-reported smoking status or harms were included. Pooled analyses from a random-effects meta-analysis suggested a 19% relative reduction (risk ratio, 0.81 [95% CI, 0.70 to 0.93]; absolute risk difference, −0.02 [CI, −0.03 to 0.00]) in smoking initiation among participants in behavior-based prevention interventions compared with control participants. Neither behavior-based nor bupropion cessation interventions improved cessation rates. Findings about the harms related to bupropion use were mixed.
No studies reported health outcomes. Interventions and measures were heterogeneous. Most trials examined only cigarette smoking. The body of evidence was largely published 5 to 15 years ago.
Primary care–relevant interventions may prevent smoking initiation over 12 months in children and adolescents.
Agency for Healthcare Research and Quality.
Analytic framework and key questions.
Summary of evidence search and selection.
Appendix Table 1. Characteristics of Included Trials
Table. Summary of Evidence for Benefits and Harms of Tobacco Use Interventions
Appendix Table 2. Included Studies, by Group and Primary Outcome
Appendix Table 3. Results of Interventions: Combined Prevention and Cessation
Smoking outcomes for intervention groups compared with control groups from all behavioral trials.
Combined prevention and cessation, prevention, and cessation are shown. Because of the clustering adjustment, the denominators for references 15 through 17 and the subtotal denominators do not match what is reported in the text and tables.
Appendix Table 4. Results of Interventions: Prevention
Appendix Table 5. Results of Interventions: Cessation
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Patnode CD, O'Connor E, Whitlock EP, et al. Primary Care–Relevant Interventions for Tobacco Use Prevention and Cessation in Children and Adolescents: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013;158:253–260. doi: 10.7326/0003-4819-158-4-201302190-00580
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Published: Ann Intern Med. 2013;158(4):253-260.
Prevention/Screening, Tobacco, Alcohol, and Other Substance Abuse.
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