Primary prevention

Prevention of smoking in children and adolescents has the potential to substantially reduce smoking rates in adults, given that nearly 90% of adult daily smokers smoke their first cigarette by the age of 18 years, and approximately 80% of regular adolescent smokers will carry on smoking into adulthood.[14][59]​​​​​ Although older teens are more likely to smoke than younger teens, the earlier a person starts smoking or using any addictive substance, the more likely they are to develop an addiction. According to the American Academy of Pediatrics (AAP), tobacco prevention messaging should start no later than 11 or 12 years of age.[60]​ Boys are more likely to take up smoking in adolescence than girls.[56]

Overall, the evidence suggests that high-intensity, family-based interventions have a positive effect on preventing children and adolescents from starting to smoke.[61] [ Cochrane Clinical Answers logo ] ​​​​ According to the US Preventive Services Task Force (USPSTF), there is moderate certainty that behavioural interventions carried out in primary care to prevent tobacco use in school-aged children and adolescents have a moderate net benefit. Interventions listed by the USPSTF as being effective include behavioural support, face-to-face or telephone interaction with a healthcare clinician, print materials, and computer applications. No harms of behavioural support interventions were noted by the USPSTF.[62]​ The AAP echoes this approach and recommends that paediatricians include tobacco and nicotine use prevention as part of anticipatory guidance for children and adolescents.[60]

Experimentation or regular use of e-cigarettes by young people should be discouraged.[63]​ A number of studies have found a strong association between e-cigarette use and subsequent smoking initiation among adolescents and young adults, although it is unclear whether this relationship is causal.[37][38][39]​ Evidence on strategies for preventing e-cigarette use in children and adolescents is currently lacking.[64]

Prevention can also take place at the school or community level, including peer-led interventions.[63] In addition to education, successful evidence-based interventions aim to reduce smoking, alcohol use, and illicit drug use by reducing or mitigating modifiable risk factors and bolstering protective factors.[65] 

Population-level interventions are effective in reducing smoking.[66] Increased excise taxes on cigarettes, smoke-free legislation, and regional and national comprehensive tobacco control programmes decrease cigarette consumption and smoking prevalence. Restriction on advertising and mandatory health warnings on packages have also been shown to work.[67][68]

Media anti-smoking or counter-advertising campaigns can have significant impact. In the US, the 'Tips from Former Smokers (Tips)' campaign used impactful imaging of real-life smokers with dramatic physical changes from smoking-induced harm and surgeries. Following the campaign there was an immediate, sustained, and dramatic spike in calls to the smoking quitline and visits to the website.[69]​​ In a longitudinal survey of the US adults who smoke cigarettes, aged 18 years or older in 2012-2018, the US Centers for Disease Control and Prevention estimates 16.4 million quit attempts and over 1 million successful quits because of the Tips campaign.[70]

Secondary prevention

Providing free cessation resources to smokers significantly increases the proportion of smokers who attempt to stop, use drug treatments, and stop smoking.[221]

Measures like promoting smoke-free homes are also important in decreasing consumption and smoking cessation in adults. They also reduce exposure to second-hand smoke.[222]

Involving parents in school-based strategies for smoking cessation as part of the patient’s support system has also been effective.[223]

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