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March 16, 2015

New paper in Pediatrics by UMMS professor helps pediatricians reduce youth tobacco use

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  • Medical School
Smoking cessation experts provide practical guidelines for pediatric practice

Pediatricians are in a unique position to counsel young patients about tobacco use but they often hesitate because they are not sure how best to prevent and treat tobacco dependence, according to a new, comprehensive paper by Lori Pbert, PhD, published March 16 in Pediatrics.

“The purpose of our new paper is to give pediatric providers practical strategies to integrate tobacco prevention and treatment into their clinical practice,” said Dr. Pbert, lead author of “State of the Art Office-Based Intervention to Eliminate Youth Tobacco Use: The Last Decade.” The paper reaffirms that questions about tobacco use for both patients and parents should be part of all child care visits.

“Our goal is to provide practical guidance for pediatric providers,” said Pbert, professor of medicine in the Division of Preventive and Behavioral Medicine and director of the Center for Tobacco Treatment Research and Training at UMass Medical School. “The Public Health Service Clinical Practice Guideline recommends providers deliver tobacco counseling interventions to adolescents, and evidence shows that they can have an impact.”

It is estimated that 1,100 adolescents becoming daily smokers each day. With more than 3 million U.S. youth currently smoking and 80 percent continuing to smoke into adulthood, early intervention and education is essential to reduce youth smoking rates. In addition, the majority of adolescent smokers want to quit and try to do so, but few seek help and most relapse.

“Pediatric providers are well-respected by teens and families. Their advice is highly valued,” Pbert noted. “They have an opportunity to make a difference, even within the constraints of a busy clinical practice.”

The current paper updates a similar review she and colleagues conducted 10 years ago, when there were very few studies about youth tobacco interventions, and no clinical practice guidelines. Much has been learned since then, and the new publication gives pediatricians a comprehensive review of what is now known about nicotine dependence in youth; which interventions studied to date have been most effective; and what knowledge gaps need to be filled with further research.

Most important, the paper provides practical guidelines for clinicians to proactively integrate tobacco interventions into their clinical practices.

Based on an intervention model proven successful with adult smokers and recommended by the Public Health Service Clinical Practice Guideline for adolescents, the authors advise pediatricians to ask patients and family members about tobacco use, and if tobacco use is identified, to offer tobacco-cessation strategies that include quit materials, referrals to quit-lines or cessation programs, and medications when appropriate.

Pbert and co-authors are members of the American Academy of Pediatrics Julius B. Richmond Center of Excellence Tobacco Consortium, a group of experts in the field of tobacco dependence in youth that supports research and policy development to protect children from tobacco and secondhand smoke. The state-of-the-art paper was produced on behalf of the consortium, which was established in 2006 and is part of the Center of Excellence named for former Surgeon General Julius B. Richmond.

Members of the consortium are now conducting a large randomized controlled trial in 152 pediatric practices across the nation to test the effectiveness of an office-based smoking cessation intervention for adolescents, based on the intervention recommended in the Pediatrics paper.

“Our aims for the Adolescent Health in Pediatric Practice study are to demonstrate pediatric providers’ ability to deliver tobacco cessation interventions, and to assess their impact on adolescent quit attempts and abstinence compared to those not receiving the cessation counseling,” Pbert explained.

Pbert is co-investigator for the study along with Jonathan Klein, MD, Richmond Center founding director and the study’s principal investigator. The study, which has enrolled close to 11,000 youth in 142 primary care practices nationwide, was launched by the American Academy of Pediatrics’ Pediatric Research in Office Settings practice-based research network and the AAP Julius B. Richmond Center of Excellence with funding from the National Cancer Institute.

“We hope that with evidence-based guidelines and tools we can help pediatricians increase their confidence and ability to intervene effectively, which are key barriers to addressing tobacco with their patients,” Pbert noted. “Our ultimate goal is to help pediatric providers feel more confident, comfortable and prepared to address tobacco within their clinical practice.”

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