Pediatric Nicotine Abuse Treatment & Management

Updated: Oct 14, 2021
  • Author: Donna G Grigsby, MD; Chief Editor: Caroly Pataki, MD  more...
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Medical Care

According to the US Preventive Services Task Force (USPSTF) guidelines, clinicians should ask adolescents about use of tobacco products and provide cessation interventions to current users. The guideline engages a “5-A” approach to counseling that includes the following: [17]

  • Ask about tobacco use.

  • Advise to quit through personalized messages.

  • Assess willingness to quit.

  • Assist with quitting.

  • Arrange follow-up care and support.

Brief (< 10 min) behavioral counseling and pharmacotherapy are each effective alone, although they are most effective when used together. The task force also advises clinicians to ask all pregnant women, regardless of age, about tobacco use. Those who currently smoke should receive pregnancy-tailored counseling supplemented with self-help materials.

Because of the widespread use of tobacco, the WHO encourages multiple approaches to decrease tobacco use worldwide and suggests the following: [7]

  • Make treatment a priority.

  • Make treatment available.

  • Assess tobacco use at every opportunity and offer treatment.

  • Set an example, as health care workers, by avoiding tobacco use.

  • Motivate users to stop using tobacco.

  • Fund effective treatments and make them as accessible as tobacco products.

  • Governments should be responsible for monitoring and regulating tobacco.

Despite these recommendations, studies suggest that the rates of tobacco counseling at well child visits and illness visits for conditions affected by tobacco use remain low. [18]

While prevention of smoking initiation should be the focus of treating nicotine dependence, behavioral and pharmacological treatments developed in recent years have proven to be effective.

In 2000, clinical practice guidelines recommended offering nicotine replacement therapy (NRT) to adolescents addicted to nicotine. However, after studies failed to show significant efficacy of these medications in adolescents, the 2008 update no longer recommends their use. [19]

In 2001, The American Academy of Pediatrics (AAP) Subcommittee on Substance Abuse statement on tobacco use suggested that those who smoke more than 10 cigarettes per day may benefit from NRT. Nicotine substitutes, in the form of nicotine gum, patches, nasal sprays, and inhalers, are used to gradually reduce nicotine exposure, avoiding the symptoms of withdrawal while eliminating exposure to other toxic substances found in cigarette smoke. [20]

Studies in adults have shown that medications previously used for the treatment of depression have also shown good results when used for smoking cessation. The AAP Subcommittee on Substance Use report recognized bupropion, clonidine, and nortriptyline as additional therapeutic modalities. Combination therapy with nicotine replacements and bupropion or other oral agents increase 1-year abstinence rates in adults, and early research suggests that these therapies may also be safe and effective in adolescents. [20] However, the US Public Health Service withdrew support for use of these medications in adolescents in their 2008 report. [19]



Preventing initiation of smoking is crucial to decrease tobacco use and its health-related complications in adolescents and children for the following reasons:

  • Because of the highly addictive nature of nicotine, smoking cessation is not a matter of choice for most users.

  • Tobacco is addictive physiologically and psychologically and use is socially reinforced.

  • No amount of tobacco use has been proven to be safe.

The US Public Health Service made 3 specific recommendations regarding children and adolescents in their 2008 clinical practice update on treating tobacco use and dependence, as follows: [19]

  • Clinicians caring for children and adolescents should ask about tobacco use and should strongly discourage tobacco use in this population.

  • Because of the effectiveness of counseling programs, adolescent smokers should be provided with counseling interventions to help in smoking cessation.

  • Because of the harmful affects of secondhand smoke and the effectiveness of cessation counseling in increasing abstinence in parents who smoke, clinicians should ask parents about smoking and offer cessation advice and assistance.

In August 2013, the US Preventive Services Task Force (USPSTF) issued updated guidelines on prevention of tobacco use in children and adolescents. [21, 22] A systematic review by the USPSTF indicates that primary care clinicians can make a difference in helping youth choose not to use tobacco, thereby improving their health and lifespan. Accordingly, the USPSTF recommends that healthcare professionals deliver behavioral counseling against tobacco use in person, by telephone, or via reading materials, computer applications, and videos. [22]