Youth tobacco use: who has a say?

Abstract

www.thelancet.com Vol 381 February 2, 2013 357 Tobacco use is a major cause of morbidity and mortality worldwide, and has wide-ranging socioeconomic consequences. The Global Burden of Disease Study 2010 ranks tobacco smoking, including second-hand smoke, as the second leading risk factor for global disease burden, accounting for an estimated 6·3 million deaths and 6·3% of disability-adjusted life-years in 2010. US data indicate that almost 90% of adult daily smokers smoked their fi rst cigarette by age 18 years. Hence, targeting young people seems to be a good idea. However, interventions that work in adults do not necessarily apply to children and adolescents. According to the 2012 US Surgeon General’s report “coordinated, multicomponent interventions that com bine mass media campaigns, price increases including those that result from tax increases, school-based policies and programmes, and statewide or community-wide changes in smokefree policies and norms are eff ective in reducing the initiation, preva lence, and intensity of smoking among youth and young adults”. The report also highlighted the insuffi cient evidence for health-care prevention strategies to reduce smoking initiation in young people. On behalf of the US Preventive Services Task Force, Carrie Patnode and colleagues recently presented a systematic review and meta-analysis on the effi cacy and harms of primary care interventions to prevent tobacco use or improve tobacco cessation rates among children and adolescents. These interventions varied widely in terms of content, ranging from brief advice, print material, and tailored computer programming to phone calls or in-person counselling and motivational interviewing. Fair and good quality trials were included. Pooled analyses indicated a statistically signifi cant preven tive eff ect of behaviour-based interventions on smoking initiation, with a 19% relative risk reduction (risk ratio 0·81, 95% CI 0·70-0·93) in intervention groups compared with controls within 7–36 months of follow up. The absolute risk reduction was 2 percentage points, corresponding to a number needed to treat of 50. Qualitative exploration of studies did not reveal any clear pattern of associations between intervention or study characteristics and eff ect size. Pooled analysis showed no statistically signifi cant eff ects of the interventions on tobacco cessation. However, potential eff ects could have been masked by factors such as the limited number of studies included, variability in interventions and measures across studies, and lack of stratifi ed data. The limitations of this study include the short follow-up time and the question of generalisability, since only three studies were undertaken outside the USA. Nonetheless, Patnode and colleagues’ study indicates that primary care health workers might have a say in the prevention of cigarette smoking among children and adolescents.