Established in 1927 by the American College of Physicians


11 Decemeber 2012 Annals of Internal Medicine Tip Sheet

Annals of Internal Medicine is published by the American College of Physicians on the first and third Tuesday of every month. These highlights are not intended to substitute for articles as sources of information. For a copy of an article, call 215-351-2653 or e-mail Angela Collom at

1. Task Force Reviews Evidence to Inform Recommendations on Reducing Youth Tobacco Use

Evidence suggests that behavior-based interventions in or around the health care setting can have a small, positive effect on preventing smoking initiation among young people who have not yet become regular smokers. While the legal age for purchasing tobacco products in the United States is 18, more than 3,800 children and adolescents aged 12 to 17 years smoke their first cigarette every day, and an estimated 1,000 young people begin smoking on a daily basis. Interventions that discourage young people from ever initiating smoking or those that help current smokers quit can prevent tobacco-related illness. Researchers conducted a systematic evidence review of trials designed to prevent tobacco use initiation, promote cessation, or both to determine the efficacy and harms of primary care-relevant interventions. Primary care-relevant interventions were defined as those targeted at children, their parents, or both and were conducted in or were potentially feasible for health care settings. All studies included self-reported smoking status or harms and had control groups that offered minimal or no treatment and had to report tobacco use prevalence or similar outcome at least six months after baseline. The evidence showed that primary care-relevant behavior-based prevention interventions helped to reduce the risk of smoking initiation by 19 percent compared to control participants at seven to 36 months follow-up. However, neither behavior-based or medication (bupropion) cessation interventions improved cessation rates. In some studies, patients reported greater adverse events associated with bupropion use compared to placebo. There were no harms reported with behavior-based interventions. Draft recommendations on primary care interventions to reduce youth tobacco use will be posted to on December 10 at 5:00 p.m.