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Knowledge Gaps Lack of high-quality RCTs that examine the short and long-term benefits of behavioural prevention and treatment interventions More research is needed to identify the characteristics of the most effective interventions, including factors such as the: Type of advice provided Duration of the intervention Type of provider Contact time needed No conclusive evidence in either adults or youth on the potential harmful effects of e-cigarettes or whether they can be used in smoking cessation Further research is needed to assess the benefits and harms of interventions in at risk populations 26 Considerations for Implementation Primary care practitioners implement procedures to assess smoking risk and/or status in a child or youth Most children and youth and their parents/caregivers would want the child or youth to receive the recommended course of action - Many would not (implication of a weak recommendation) - For those who consent, primary care practitioners should offer them brief information and advice at appropriate primary care visits 28 If practitioner determines likely need for a prevention or cessation intervention Primary care practitioner should ask if the child/youth and/or parent would consider having a brief conversation that may help the child/youth: - Prevent the uptake of smoking - Stop smoking Considerations for Implementation Primary care practitioners who may deliver the intervention include: - Family physicians, nurses, or other appropriate members of the health care team Brief information and advice may include verbal communication of up to five minutes to discuss patient attitudes and beliefs, risks of smoking, and/or strategies for dealing with the influence of peers Sharing of printed or electronic material (brochures, newsletters and interactive computer programs) could be considered Appropriate primary care visits include scheduled health supervision visits, visits for immunizations or medication renewal, episodic care or acute illness, and other visits 29 Values and Preferences CTFPHC did not conduct a full systematic review of the evidence on parental preferences or values Neither youth nor clinician preferences were examined due to resource limitations The CTFPHC recruited parents of school-aged children and youth (smokers and non-smokers) for a focus group (n=10) and subsequent survey (n=13) Parents agreed it is important to offer prevention and treatment interventions, but would want to be informed about the components of offered interventions Some parents questioned primary care settings as the best place for behavioural interventions Better data is needed on the values and preferences of children and youth 30 Conclusions: Key Points 33 The evidence suggests that low-intensity behavioural interventions based on providing information and advice aimed at prevention and treatment of smoking among children and youth may be effective The CTFPHC therefore recommends that primary care practitioners consider offering them to children and youth aged 5 to 18 years Questions & Answers Thank you 35

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The move to remove tobacco products effective this morning coincides with a company decision to also change its corporate name to CVS Health (CVS), from CVS/Caremark Corp

We log-transformed both cigarette consumption and smoking prevalence to enforce positivity of the fitted ppc values and to account for heteroscedasticity in the residual errors