National Health Crisis: Treating Tobacco Dependence in Adolescents

Partners For Kids® offers a free tool to support primary care providers use nicotine replacement therapy to increase smoking cessation success.

In 2023, the Centers for Disease Control and Prevention (CDC) reported that more than 6.6% of middle school students and about 12.6% of high school students regularly use a tobacco product. Almost 2% of high school students said they had smoked cigarettes, and 10% reported that they had used electronic cigarettes or vapes in the past 30 days. Most students who smoke e-cigarettes or vapes use flavored tobacco. This is a problem for parents and health professionals because many kids using these products do not consider it to be the same thing as smoking.

Yet, vaping can be even more harmful than cigarettes because the flavors mask the smell and causticness of nicotine.

“Nicotine is still one of the most addictive and dangerous substances that kids can use,” says Erin McKnight, MD, adolescent medicine physician and medical director of the Substance Use Treatment and Recovery Program at Nationwide Children’s Hospital. “It’s easier to become addicted to nicotine faster when smoking vapes instead of cigarettes. Studies have shown that ten puffs of an e-cigarette is about equal to one cigarette.”

Primary care providers must help their young patients understand how harmful tobacco (including e-cigarettes) is to their health. This starts with regular screening as early as nine years of age and providing appropriate education and behavioral support as needed. It’s critical that doctors ask patients about vaping, as well as cigarettes. When dependence is diagnosed, providers should provide medical support to permanently stop tobacco product usage.

NIH’s National Institute on Drug Abuse (NIDA) funded a study in 2022 that reported that approximately 5.74% of teen smokers attempted to quit smoking that year but failed. It’s estimated that fewer than 10% of people succeed in quitting tobacco. However, many succeed when using a product or medication that supports smoking cessation. When patients combine counseling with a cessation product, the odds of success are higher.

Researchers at UCSF have researched and published the general success rates for several cessation tools. They include:

• Counseling: 13 to17%
• Bupropion SR (Zyban): 24%
• Nicotine Replacement Therapy: 19 to 26%
• Varenicline (Chantix): 33%
• Medication Combinations: 26 to 36%
• Counseling and Medication Combinations: 26 to 32%

Currently, the FDA has not approved any medications for smoking cessation in patients under 18. However, pediatric substance use experts say pediatricians should consider off-label nicotine replacement therapy (NRT), Bupropion, or Varenicline in combination with cognitive behavioral therapy for young patients who are moderately to severely dependent on nicotine.

Partners For Kids® and Nationwide Children’s have developed a resource for pediatric primary care providers with information on NRT and other smoking cessation strategies for adolescents and youth. The resource also includes several assessment tools to help clinicians determine the level of nicotine dependence in their young patients.

“These evidence-informed clinical guidelines offer primary care providers expert opinions on this critical youth health issue. We designed them to provide timely and effective treatment specifically for children with nicotine use disorders,” Timothy Crabtree, PharmD, a clinical pharmacist with Partners For Kids says.