Treatment of Nicotine Use in Adolescents Under 18 Years of Age: An Official American Thoracic Society Clinical Practice Guideline.

Background: The rising popularity of electronic cigarettes (e-cigarettes), the nicotine product that is most used by adolescents since 2014, has reversed decades of progress in declining youth tobacco use. E-cigarette use in adolescents is associated with future smoking, and evidence is mounting of an increased association with nicotine dependence. Therapies used to treat nicotine dependence in adults include pharmacotherapy and behavioral interventions. Pediatric guidelines recommend routine screening for any tobacco product use beginning at age 10 years. The goal of this guideline was to develop an evidence-based clinical practice guideline for the treatment of nicotine use in adolescents. Methods: We summarized evidence addressing five PICO (patients, intervention, comparator, and outcome) questions, which were formulated by a multidisciplinary panel of experts and methodologists using the evidence-to-decision framework. The Grading of Recommendations, Assessment, Development, and Evaluation (or, GRADE) approach was used to evaluate the certainty in evidence and generate actionable recommendations, which were voted on by the panel. Results: The panel members considered the strength of the evidence as well as the potential benefits of the treatment modality from a clinical standpoint. The overall quality of the evidence was weak. Recommendations for or against the treatment modality for nicotine use were developed. Conclusions: This expert panel provides evidence-based recommendations for treating nicotine use in adolescents 10 to 18 years of age.