Supporting Youth who are Addicted to Nicotine: Advice for Pediatricians
Ask the Right Questions:
•Ask about tobacco and nicotine use in the context of routine screening, using language that youth
will understand. Sample screening questions include:
o “Do you use any tobacco products, like cigarettes, chewing tobacco, or hookah? Have you used them
in the last year?”
o “Do you use any vaping products, like e-cigarettes or JUUL? Have you used them in the last year?”
Talk with Youth About Quitting:
• Provide clear, personalized guidance about the negative health impacts of tobacco use and vaping.
• Consider using motivational interviewing to guide a conversation about quitting.
• Messages that may resonate with youth include the impact of tobacco and vaping on breathing,
athletic performance, health, or appearance. Other relevant messages may include the outbreak of
vaping-related lung injuries, the expense of tobacco products, or the Tobacco Industry’s deceitful
marketing practices that recruit youth to become life-long tobacco users.
• Consider using a practice tool to assess level of addiction to nicotine. Some options are the
Hooked On Nicotine Checklist (tailored for cigarettes or vaping), the E-Cigarette Dependence Scale,
or the Modified Fagerstrom Tolerance Questionnaire.
Help Youth make a Successful Quit Plan:
• Assess youth’s desire to quit and help them set a quit date within 2 weeks. Try to avoid
stressful times, such as final exams.
• Develop a plan for success and anticipate challenges:
o Quit completely: on the quit date, stop use of all tobacco and vaping products.
o Triggers: identify people or situations that may cause youth to want to use tobacco or vape.
o Withdrawal Symptoms: discuss the symptoms of nicotine withdrawal and develop strategies to manage
o Social Support: identify friends and family who can encourage success. When appropriate, speak
with youth and parent(s) together about the importance of a supportive social network.
o Self-Care: consider support strategies such as healthy eating, exercise, mindfulness, or
• Utilize cessation support services:
o SmokefreeTeen.gov (tobacco and vaping cessation support from the National Institutes of Health)
o This Is Quitting (text-based tobacco and vaping cessation support service from Truth Initiative®)
o 1-800-QUIT-NOW (national tobacco quitline)
o Behavioral counseling or cognitive-behavioral therapy
• Consider pharmacotherapy for youth who are moderately or severely addicted:
o FDA-approved tobacco dependence medications for adults include nicotine replacement therapy (eg,
nicotine gum or patch), bupropion, and varenicline. At present, these medications have not been
approved for youth under 18.
o Limited research studies on pharmacotherapy for youth tobacco cessation have not demonstrated
efficacy. However, there is no evidence of harm related to using nicotine replacement therapy in
youth under 18.
o Given the effectiveness of pharmacotherapy for adults and the severe harms of tobacco dependence,
AAP policy recommends that pediatricians consider off-label pharmacotherapy for youth who are
moderately or severely addicted.
o In order for youth under 18 to access pharmacotherapy (including over-the-counter options), they
need a prescription.
• Offer encouragement and assure youth that you are here to help them succeed.
• If the youth is not ready to quit completely, discuss strategies for cutting back and revisit the
topic at their next visit.
• Check in with the patient electronically or in-person to find out how the quit attempt is going.
• If the patient reports a relapse, talk with them about the circumstances surrounding the relapse,
and help them learn from the experience. Encourage youth to use the cessation-support strategies
above until they quit successfully.
• Tobacco cessation is a difficult process, and relapse is common. Additional support from a
pediatrician or other healthcare provider can help the teen learn from their experiences and quit
Coding and Payment:
• Ensure that you and your office staff are compensated for the time you spend discussing tobacco
and nicotine addiction
during patient visits. For up-to-date information on coding, see the AAP Tobacco Coding Fact Sheet.