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​​​​​​​Youth (Children and Adolescents)  Overview of Evidence


The following recommendations, and supporting evidence, have been extracted from existing clinical practice guidelines to inform the development of the CAN-ADAPTT Summary Statements. 
CAN-ADAPTT worked with the Guidelines Advisory Committee (GAC) to conduct a literature search (years: 2002-2009) to identify existing clinical practice guidelines (CPGs). Five existing clinical practice guidelines were identified as meeting the high quality criteria set out in the AGREE Instrument. The recommendations contained in these high-quality CPGs have been used as the evidence base for the CAN-ADAPTT guideline development process. Click here to view CAN-ADAPTT’s guideline development process flowchart.

U.S. Department of Health and Human Services Public Health Service (2008)1

Clinicians should ask pediatric and adolescent patients about tobacco use and provide a strong message regarding the importance of totally abstaining from tobacco use. (Strength of Evidence = C)
Counselling has been shown to be effective in treatment of adolescent smokers. Therefore, adolescent smokers should be provided with counselling interventions to aid them in quitting smoking. (Strength of Evidence = B)
Secondhand smoke is harmful to children. Cessation counselling delivered in pediatric settings has been shown to be effective in increasing abstinence among parents who smoke. Therefore, to protect children from secondhand smoke, clinicians should ask parents about tobacco use and offer them cessation advice and assistance. (Strength of Evidence = B)

Institute for Clinical Systems Improvement (2004)2

(Birth to 10 years): Smoke exposure (in home, at day care, etc.) should be established at nearly every visit.  Tobacco use status of all patients (and in the case of infants and children, the use status of everyone in the home) should be established.  (Class of Evidence = D, M, R, X)
(10 years and above): Patient’s tobacco use and second hand smoke exposure should be established at nearly every visit. (Class of Evidence = D, M, R, X)

Adolescents should have usage re-assessed at nearly every visit, regardless of whether there is a chart notation of non-use. (Class of Evidence = A, C, D, M, R)
(10 years and above): “Pre-contemplators” benefit from non-confrontational messages about the importance of quitting and the awareness that provider help is available when ready. (Class of Evidence = R)
(10 years and above):  “Contemplators” should receive support and respectful urging to quit.  A patient in “preparation” should set a quit date, receive self-help information and be encouraged to accept follow-up after the quit date. (Class of Evidence = A, M, R) 
(10 years and above): If a patient’s parent, sibling or friend uses tobacco, patients should be assisted in developing refusal skills and given educational materials. (Class of Evidence = A) 

New Zealand Ministry of Health (2007)3

Offer smoking cessation interventions that incorporate known effective components (such as those identified in the previous sections) to young people who smoke. (Grade = √)
NRT can be used by young people (12-18 year olds) who are dependent on nicotine (that is, NRT is not recommended for use by occasional smokers) if it is believed that NRT may aid the quit attempt.  (Grade = C)

  1. U.S. Department of Health and Human Services Public Health Service. (2008, May). Clinical practice guideline: Treating tobacco use and dependence: 2008 update.
2. Institute for Clinical Systems Improvement (ICSI). (2004, June). Health care guideline: Tobacco use prevention and cessation for adults and mature adolescents. Retrieved October 24, 2007 from:
3. Ministry of Health. (2007, August). New Zealand smoking cessation guidelines. Wellington: Ministry of Health.

  Y​outh (Children and Adolescents)