Summary for Clinicians: Clinical Practice Guideline on Treatment of Nicotine Use in Adolescents Under 18 Years of Age

With the rising popularity of e-cigarettes, nicotine use in adolescents is increasing. Recommendations for treatment, however, are limited. A multidisciplinary panel of experts developed an evidence-based guideline for treatment of adolescents with nicotine use. The panel formulated 5 key questions on whether a therapeutic intervention results in nicotine abstinence in adolescence. The panel focused on treating adolescent nicotine use rather than dependence, since even brief use carries high addiction risk, and early cessation can prevent health complications and future substance use.

This summary is intended to provide clinicians with the key recommendations from the guideline. Community and institutional resources and medical comorbidities vary among patients, therefore clinicians should apply each recommendation according to each patient’s unique circumstances.

Target Audience

Pulmonologists, critical care specialists, translational researchers, and clinicians

Learning Objectives

  • Compare and contrast the recommendations for counsel based, technology based, and pharmacologic interventions for nicotine cessation with regards to strength of recommendation and quality of evidence.
  • Evaluate the benefits, limitations, and safety considerations of pharmacologic therapies for adolescent nicotine use, specifically, nicotine replacement therapy, varenicline, and bupropion.
  • Identify current evidence gaps and research priorities related to treatment of nicotine use in adolescents.
Course summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit(s)™

    The American Thoracic Society designates this Journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

  • 1.00 Participation
Publication Date: 
07/22/2026
Credit Expires: 
08/01/2028
Cost:
$25.00
Rating: 
0

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Accreditation Statement

The American Thoracic Society is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Disclosure Declaration

Article Authorship Disclosures (as submitted to the ATS prior to article publication date)

Emily H Skeen, M.D., (Department of Pediatric Pulmonary and Sleep Medicine, University of Colorado School of Medicine, Aurora, CO, USA) reported grants for Health Resources and Services Administration (HRSA). Grant #T72MC54787

Sarah E Bauer, M.D., (Indiana School of Medicine, Indianapolis, IN) reported no relevant financial relationships with ineligible companies.

Devika R Rao M.D., F.A.C.P. (Division of Pulmonology and Sleep Medicine, Department of Pediatrics, University of Texas at Southwestern Medical Center, Dallas, TX) reported membership of the Pediatric Advocacy Committee for the American Thoracic Society.

W. Graham Carlos M.D., M.S.C.R., A.T.S.F. (Division of Pulmonology and Sleep Medicine, Department of Pediatrics, University of Texas at Southwestern Medical Center, Dallas, TX) reported no relevant financial relationships with ineligible companies.

All other authors reported no relevant financial relationships with ineligible companies.

AnnalsATS CME Planners 

Margaret M. Hayes, M.D., (Harvard Medical School, Boston, MA, USA) reported receiving payments as an author for a chapter on heliox for UpToDate.

Caroline Okorie, M.D., M.P.H., (Stanford University School of Medicine, Stanford, CA, USA) reported no financial relationships with ineligible companies.

Off-Label Usage Disclosure

Nicotine replacement therapy (lozenges, patches and gum). FDA approved for smoking cessation in adults. Off-label use discussed in the paper is use in patients younger than 18 years of age.

Varenicline. FDA approved for smoking cessation in adults. Off-label use discussed in the paper is use in patients younger than 18 years of age.

Bupropion. FDA approved for smoking cessation in adults. Off-label user discussed in the paper is use in patients younger than 18 years of age.

All relevant financial relationships have been reviewed and mitigated.

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Available Credit

  • 1.00 AMA PRA Category 1 Credit(s)™

    The American Thoracic Society designates this Journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

  • 1.00 Participation

Price

Cost:
$25.00
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