Based on an independent systemic review, a Canadian task force recently suggested behavioral interventions to discourage smoking among Canadian youth.
The use of tobacco by young people is becoming a global epidemic that poses a serious health threat to children, youth, and adults. Most of the young smokers become adult smokers and are less likely to quit if they start smoking as a child or youth. The impact of cigarette smoking on health and chronic diseases is well-documented. In fact, one-half of adult smokers die prematurely due to tobacco-related diseases.
In Canada, 85% of incident cases of lung cancer are caused by tobacco use. Additionally, many other types of cancers including those found in the respiratory system, digestive tract, stomach, kidney, pancreas, and cervix are associated with the use of tobacco. Smoking among Canadian youth is a pressing health care issue. In fact, among Canadian youth, 36% have tried smoking by the time they are in grade 12. Families and health providers play an important role in the prevention and treatment of cigarette smoking among youth by providing information on the risk of tobacco use and strategies for dealing with the urge to smoke.
A recent edition of the Canadian Medical Association Journal published a guideline document that suggests recommendations made by the Canadian Task Force on Preventive Health Care. The task force, an independent panel of clinicians and prevention experts, conducted a systemic review of clinical trials that studied the effectiveness of behavioral interventions in the prevention and treatment of smoking among children and youth. The database used for the research was the same as that used by the US Preventive Services Task Force review on the same subject. A total of nine randomized controlled trials (RCTs) were included in the review.
Categories of Interventions and Recommendations
Behavioral interventions used for the prevention and treatment of smoking were categorized as low intensity or high intensity. Low-intensity interventions included a brief interaction with a health professional or provision of written material. High-intensity interventions included two or more interactions of any length with a health professional or one long session such as a workshop.
Recommendations were graded as strong or weak based on the quality of supporting evidence. Strong recommendations are those for which desirable effects of an intervention outweigh its undesirable effects while weak recommendation are those for which the desirable effects probably outweigh the undesirable effects. Strong recommendations are used to make the recommended course of action for serving most individuals.
Recommendations for Prevention
For prevention, the task force recommends that the health care providers should first find out if the children and youth are smokers. They should then provide brief information and advice to both the parents and children about the risks associated with tobacco use and strategies to deal with peer influence. The RCT review results showed that such interventions resulted in 18% reduction in the likelihood that a child or youth will start smoking immediately after the intervention period.
Recommendations for Treatment
Recommendations for treatment were very similar to those for prevention. Smokers, defined as the ones smoking regularly, occasionally, or having smoked a cigarette in the past 30 days, were subjected to treatment interventions that included a brief information and advice on ways to stop tobacco smoking. The results of the RCT review showed that youth who took part in treatment interventions were 34% more likely to quit smoking immediately after the intervention compared to the youth that did not participate in interventions.
Application of Recommendations
The primary care practitioner plays a vital role in the application of the recommendations made by the task force. If the primary care providers ascertain the need for preventive or treatment intervention, they can have a brief conversation with the youth and parents to help prevent initiation of smoking or cause cessation of smoking. Behavioral intervention may be implemented in the form of a 5-minute verbal communication to discuss the attitude and beliefs of the patient, advice on risks of smoking, and strategies for dealing with peer influence. Printed or electronic material can also be used for these interventions. Primary care visits for annual examinations or vaccinations may be the appropriate time for implementation of the preventive interventions for children and youth.
Although the rate of smoking among Canadian youth has decreased over the last few years it is still very high. The application of these recommended guidelines may bring in short- and long-term benefits of behavioral interventions for children and youth using tobacco. Furthermore, similar recommendations and guidelines exist internationally and the benefits associated with the interventions are applicable globally.
Based on the evidence from literature research, the task force recommended that prevention and treatment interventions in the form of brief information and advice may help to prevent and treat smoking among Canadian youth. Low-intensity behavioral interventions by primary care providers may help reverse the damaging effects of smoking in children and youth that could lead to diseases in adults. Further research is needed to understand the type of advice, duration of interventions, and type of providers for most effective interventions.
Written by Preeti Paul, MS Biochemistry
Reference: Canadian Task Force on Preventive Health Care. Recommendations on behavioral interventions for the prevention and treatment of cigarette smoking among school-aged children and youth. CMAJ 2017 February 2017;189:E310-6