Doctors are not using tools to help youths quit smoking

September 23, 2019

BOSTON (September 23, 2019) --At a time when the rapid growth in electronic cigarette "vaping" among young people threatens to reverse decades of progress in reducing tobacco use, a large study published today in JAMA Pediatrics finds that medical professionals are largely failing to use existing tools to help young people quit smoking.

Medicaid data from more than 80,000 adolescents and young adults diagnosed with nicotine use disorder indicated that only four percent had received counseling to encourage them to stop using tobacco products, only 1.2 percent were prescribed medications to help them quit, and only one in 1,000 got both counseling and treatment, a combination that could double or triple their chances of quitting.

"We have treatments that are proven to work for older people and are very likely to work for young people as well. Not using these treatments is a missed opportunity," says Nicholas Chadi, MD, MPH, a pediatrician at Boston Children's Hospital and first author on the paper.

Nicotine, the main active ingredient in most tobacco products, is highly addictive. An estimated 20-30 percent of all smokers develop nicotine use disorder, unable to give it up and suffering withdrawal symptoms if they try. Its potential health effects are well known, and youth have an additional risk because their brains are still developing.

For 15 years or more, the American Academy of Pediatrics has issued periodic guidelines concerning the use of tobacco products in children. They urge pediatricians to ask their patients whether they or family members smoke or use electronic cigarettes, advise them on the dangers of tobacco products, encourage them to stop and, for those who are addicted, offer medication to help them quit. Among the medical options are nicotine replacement therapy (tapering doses of nicotine delivered via skin patch, gum, or lozenge) and two other drugs: bupropion and varenicline.

But are these things being done? To find out, Chadi and colleagues tapped a database of some 3.5 million Medicaid patients, between the ages of 10 and 22, across 11 states. Over an 18-month period in 2014 and 2015, 3.8 percent of patients had been diagnosed with nicotine use disorder. Among a smaller group of patients that had six months of follow-up after diagnosis, 95 percent had received no treatment or counseling related to their nicotine use disorder.

Nicotine use on the rise

The team hopes the paper will help persuade health care professionals -- including pediatricians, nurse practitioners, and school health providers -- to take advantage of interventions at their disposal, especially in light of the recent resurgence in nicotine use through electronic cigarettes.

"As providers, we have a tremendous opportunity here to intervene and help prevent future generations of people dealing with the long-term health consequences of nicotine use disorder," said Scott Hadland, MD, MPH, MS, senior author on the report, and a pediatrician and addiction specialist at Boston Medical Center's Grayken Center for Addiction. "We have tools that we know are effective in helping curb nicotine addiction, and we need to get these tools into the appropriate hands."

Adolescent smoking had dropped nearly five-fold since the Surgeon General's 1964 report warning of the health risks. But in the last decade, the soaring popularity of e-cigarettes has driven up youth tobacco use. E-cigarette use among high school students rose nearly 80 percent in a single year, from 2017 to 2018, as new vaping devices, candy-like flavors, and youth-oriented marketing campaigns enticed one out of every five students to try them.

Even more worrisome, in Canada a similar rise in e-cigarette use was accompanied by a 50 percent increase in the use of traditional cigarettes in a single year. The team's fear is that we'll soon see the same trend in the U.S., as students start out on e-cigarettes because they're cheap, fun and readily available, and then switch to regular cigarettes when the nicotine cartridge runs out. That could lead to a "new nicotine epidemic" among America's youth, Chadi says, erasing recent progress.
For a complete list of authors see JAMA Pediatrics. This study was funded in part by the National Institute on Drug Abuse and the Thrasher Research Foundation.

About Boston Children's Hospital

Boston Children's Hospital is ranked the #1 children's hospital in the nation by U.S. News & World Report and is the primary pediatric teaching affiliate of Harvard Medical School. Home to the world's largest research enterprise based at a pediatric medical center, its discoveries have benefited both children and adults since 1869. Today, more than 3,000 scientists, including 8 members of the National Academy of Sciences, 18 members of the National Academy of Medicine and 12 Howard Hughes Medical Investigators comprise Boston Children's research community. Founded as a 20-bed hospital for children, Boston Children's is now a 415-bed comprehensive center for pediatric and adolescent health care. For more, visit our Discoveries blog and follow us on social media @BostonChildrens,

@BCH_Innovation, Facebook and YouTube.

About Boston Medical Center

Boston Medical Center is a private, not-for-profit, 514-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. Committed to providing high-quality health care to all, the hospital offers a full spectrum of pediatric and adult care services including primary and family medicine and advanced specialty care with an emphasis on community-based care. Boston Medical Center offers specialized care for complex health problems and is a leading research institution, receiving more than $117 million in sponsored research funding in fiscal year 2016. It is the 13th largest recipient of funding in the U.S. from the National Institutes of Health among independent hospitals. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. It does business in Massachusetts as BMC HealthNet Plan and as Well Sense Health Plan in New Hampshire, serving 290,000 people, collectively. Boston Medical Center and Boston University School of Medicine are partners in the Boston HealthNet - 14 community health centers focused on providing exceptional health care to residents of Boston. For more information, please visit

Boston Children's Hospital

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