How to Help Adolescents Quit Smoking 

PHS GUIDELINE RECOMMENDATIONS 

The 2008 Update to the PHS Clinical Practice Guideline on 

Treating Tobacco Use and Dependence recommends for the 

first time that adolescent smokers be provided with 

counseling interventions to aid them in quitting smoking.1 

Although the use of counseling approximately doubled quit 

rates in the seven studies on youth cessation reviewed by 

the Guideline Panel, the Panel noted that absolute 

abstinence rates of those who received counseling remained 

quite low (11.6% quit rate at 6 months) attesting to the 

continued need for research to identify the most effective 

counseling strategies for adolescents. 

MORE INFORMATION ON THE 2008
 

UPDATE TO THE PHS GUIDELINE
 

Although there are limited studies on how 

to help adolescents quit smoking, the existing 

evidence supports the following recommendations. 

Recommendation: Counseling Adolescent Smokers 

Counseling interventions should be provided to 

adolescent smokers to aid them in quitting smoking. 

•	Counseling for adolescent smokers has been 

shown to be effective, approximately doubling 

long-term abstinence rates when compared to usual 

care (e.g., brief advice, self-help pamphlets, 

referral) or no treatment. 

•	The counseling studies reviewed for the Guideline 

varied in content and included strategies designed to: 

o enhance adolescent’s motivation to quit, 

o establish rapport with the adolescents, 

o set goals for quitting, 

o promote problem solving and skill training, and 

o prevent relapse. 

•	A meta-analysis of smoking cessation for teens found 

significant effects for studies that included the 

following treatment approaches:2 

o	 cognitive-behavioral strategies (self-monitoring 

and coping skills), 

o	 social influence strategies (addressing social 

influences that serve to promote or 

maintain smoking) 

o	 motivational strategies (techniques to clarify 

desire for change and reduce ambivalence 

toward change). 

•	 Special considerations for adolescents: 

Interventions should be developmentally 

appropriate across the adolescent age span (e.g., 

appropriate for a 12-year-old vs. an 18-year-old). 

Recommendation: Intervening During the 

Adolescent’s Health Care Provider Visit 

Health care providers should ask pediatric and 

adolescent patients about their tobacco use and 

clearly communicate the importance of abstaining 

from using tobacco. 

•	Asking adolescents about tobacco use and 

advising them to quit are the first steps toward 

the use of effective treatments to quit. 

o In a sample of 11th graders , more than 79 

percent reported they would acknowledge 

their smoking if asked.3 

•	Clinicians need to routinely assess adolescent 

tobacco use, offer counseling, and follow up 

with these patients. 

•	 For patients not ready to make a quit attempt, 

clinicians may adapt the motivational interventions 

provided in the Guideline for use with adolescents. 

•	 Special considerations for adolescents: 

It is important for clinicians to intervene 

with adolescents in a manner that respects 

confidentiality and privacy (e.g., interviewing 

adolescents without parents present). 

National Center for Chronic Disease Prevention and Health Promotion 

Office on Smoking and Health 
provided to parents can: 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Recommendation: Counseling Parents During the 

Pediatric Visit 

Health care providers should ask parents about their 

tobacco use, and offer cessation advice and assistance. 

Providing advice and assistance to parents who use tobacco 

has been shown to increase abstinence, protecting children 

from secondhand smoke. 

•	 Research suggests that tobacco use interventions 

o increase parents’ interest in stopping smoking, 

o increase parents’ quit attempts, and 

o increase parents’ quit rates. 

Not Recommended At This Time: Tobacco Use 

Medication for Adolescents 

•	Although nicotine replacement has been shown 

to be safe for adolescents to use, it is not currently 

recommended as a component of pediatric tobacco 

use interventions. 

•	Although NRT and bupropion SR have been proven 

useful in increasing cessation success in adults, they 

are not currently recommended as a component of 

pediatric tobacco use interventions. 

TAKE ACTION 

•	 When working with health care systems (managed 

care organizations, etc.) to increase their use of 

effective cessation treatments recommended in the 

2008 PHS Clinical Practice Guideline on Treating 

Tobacco Use and Dependence; be sure to encourage 

them to provide cessation counseling for both parents 

and adolescents. 

•	 Tobacco control policies and community-based 

interventions (e.g., increasing prices, mass media 

campaigns, smoke-free policies, etc.) that increase 

cessation among adults also likely encourage youth 

to quit smoking.4

 These interventions, in addition 

to those that prevent initiation, need to be fully 

implemented to lower the prevalence of smoking in 

the U.S. 

FUTURE RESEARCH 

•	The Guideline suggests the following topics require 

additional research: effectiveness of using the 5 A’s in 

pediatric settings to treat both adolescents and parents; 

safety and effectiveness of medications in adolescents; 

effectiveness of counseling interventions designed to 

motivate youth to quit; effectiveness of child-focused 

versus family focused or peer-focused interventions 

as well as interventions accessed via the Internet, 

quitlines, and school-based programs; and strategies 

for increasing the efficacy, appeal, and reach of 

counseling treatments for adolescents. 

This document is adapted from a Learnings Resource Sheet developed by the Youth Tobacco Cessation Collaborative.5 

References: 

1.	 Fiore MC, Jaén CR, Baker TB, et al. Treating 

tobacco use and dependence: 2008 update. 

Clinical Practice Guideline. Rockville, MD: U.S. 

Department of Health and Human Services. 

Public Health Service. May 2008. 

2. 	 Sussman S, Sun P, Dent CW. A meta-analysis of 

teen cigarette smoking cessation. Health 

Psychol. 2006;25:549–57. 

3. 	 Alfano CM, Zbikowski SM, Robinson LA. et al. 

Adolescent reports of physician counseling 

for smoking. Pediatrics. 2002;109:e47. 

4. 	 The Guide to Community Preventive Services. 

Reducing tobacco use and secondhand smoke 

exposure. http://www.thecommunityguide.org/ 

tobacco/index.html 

5. 	 Youth Tobacco Cessation Collaborative 

(YTCC). YTCC Learnings Resource Sheet: PHS 

Guideline recommendations: How to help 

adolescents quit smoking. 

National Center for Chronic Disease Prevention and Health Promotion 

Office on Smoking and Health 

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