Getting adolescents to stop smoking, or better yet, not start is easier said than done, which is why so many studies try to find the “secret sauce” that can prevent teens from starting to smoke or have them stop if they do begin this addictive habit. In adults, counseling, using methods such as motivational interviewing, has been found helpful in encouraging smoking cessation, but the adolescent literature has yet to show that counseling can be successful in teenagers. It is for that reason that Klein et al (10.1542/peds.2020-0644) evaluated a counseling intervention in the Pediatric Research in Office Settings (PROS) Network.
In this particular study, 120 primary care practices enrolled in the PROS Network participated, with randomization resulting in half the practices being taught motivational interviewing for smoking cessation using the Public Health Services “5As” approach. This approach involves training providers to “Ask-Advise-Assess-Assist-Arrange,” a set of steps and processes to facilitate smoking cessation, and control practices to simply teach social media counseling. All self-reported smokers in the intervention practices and a random sample of non-smokers were invited to learn about cessation using the 5As approach and were then followed at 4-6 weeks, 6 months, and 12 months after these 5As visits had ended. The good news is that those clinicians in the intervention arm delivered more screening and counseling about smoking cessation to their patients, with current smokers outnumbering non-smokers who received the counseling. The less-than-good news is that 6 months after the intervention, there was no difference in successful cessation in those who did and did not receive the counseling.
Does this mean we should just stop trying to get teens to stop smoking based on this well conducted randomized clinical trial? Not necessarily, according to an accompanying commentary by Drs. Groner (Nationwide Children’s Hospital) and Balk (Children’s Hospital at Montefiore) (10.1542/peds.2020-010595) who point out the strengths but also some key limitations of this study. For example, nicotine replacement therapy was not part of the counseling process, nor was e-cigarette use included in the data collection. Social media apps and websites were not used to reinforce the counseling, and new health issues such as e-cigarette or vaping use associated lung injury (EVALI) and COVID-19 might both enhance cessation efforts in combination with counseling strategies such as the 5As—but these suggestions were not used in this particular study. We congratulate PROS practices who participated in this study and thank them for setting the table for the subsequent studies that will now ensue thanks to this study to further determine the best way to screen, counsel, and treat adolescent tobacco users.