Tobacco product use among youth and young adults is an urgent clinical concern. Despite declines in youth cigarette usage, youth continue to use tobacco products – including e-cigarettes—at alarming rates. Adolescents are uniquely vulnerable to nicotine dependence, and clinical visits are an important opportunity for intervention.

The American Academy of Pediatrics (AAP) developed the “Ask-Counsel-Treat” (A.C.T.) model to address tobacco cessation in adolescents. The A.C.T. model provides practical and efficient strategies to screen youth for tobacco use, counsel about cessation, connect patients to behavioral cessation supports, and learn strategies for using nicotine replacement therapy (NRT) to help youth quit.

This Progressive Web Application (PWA), designed for A.C.T. model utilization, provides support with clinical decisions and educational content on screening, counseling, and treatment for youth tobacco use.

Screen all youth age 11+ for tobacco use at each clinical encounter.

• Counsel all patients who use tobacco about quitting, regardless of amount used.
• Use a strengths-based perspective and non-judgmental language.
• Use personal examples of the benefits of quitting (e.g., better athletic performance).

If the patient is uncertain about quitting, or only wants to cut down, consider discussing the “5Rs:”  

• Relevance of quitting 
• Risks of not quitting 
• Rewards related to quitting 
• Roadblocks that may arise 
• Repetition: it may take several attempts to succeed.  

The 2-Week Challenge: A Strategy for Youth who Aren’t Ready to Quit

• If the patient isn’t ready to quit or tells you they can “quit anytime they want,” challenge them to completely stop their tobacco use for 2 weeks.
• At the end of the 2 weeks, check in to hear how it went and revisit the conversation about cessation support.
• TIP: If the patient isn’t ready to stop for 2 weeks, ask them to try for 1-3 days, and check in to see how it went.

Appropriate behavioral and pharmacologic supports may increase the odds of quitting successfully.

Dependency scales for cigarette use can be found under Resources.

NRT works best when paired with behavioral cessation support.

Pharmacologic Treatment for Moderate Dependency

For best results, pair a long-acting NRT (patch) with a shorter-acting form (e.g., gum, lozenge).

NRT works best when paired with behavioral cessation support.

Pharmacologic Treatment for Severe Dependency

For best results, pair a long-acting NRT (patch) with a shorter-acting form (e.g., gum, lozenge).

Link all youth who use tobacco to behavioral cessation support.

Behavioral Support Options:

• Text: Text "QUIT" to 47848
• Online: teen.smokefree.gov
• Phone: 1-800-QUIT-NOW
• Text DITCHVAPE to 88709
• Full List of Program Options: www.aap.org/help2quit

• Let them know that quitting is hard and relapse is common.
  Remind them that you’re here to help.
• Follow up about 2 weeks after their quit date to:
  • Assess progress.
  • Offer additional support.
  • Adjust treatment as needed.
  • Provide additional intervention in the event of relapse.
• Follow up can occur in person, by phone, or via telehealth.
• If patient was unwilling to make a quit attempt, follow up at next visit or clinical encounter.

Congratulate them and encourage them to keep going. Remind them that you’re here to help.