Risk Management Strategy: Reduction of Tobacco Smoking in the Adolescent Population

Risk Management Strategy: Reduction of Tobacco Smoking in the Adolescent Population

Adolescence is a vulnerable stage of growth and development due to the significant physical, emotional, physiological, and sexual changes that occur. This stage represents a unique phase of development in which adolescents are confronted with new realities about their bodies and are curious about much in their surroundings, including trying new things.

Adolescents may begin smoking cigarettes and other tobacco products depending on the influence they have in their lives and surroundings. According to the CDC (2022), approximately 5.6 million Americans under the age of 18 will die as a result of a smoking-related illness in the United States, equaling one in every 13 Americans aged 17 or younger.

Furthermore, initiation of tobacco use is primarily established during adolescence, with statistics indicating that 9 out of 10 adults who smoke cigarettes daily first try smoking by the age of 18 (CDC, 2022). To compound the issue, 1600 new youth in the United States smoke their first cigarette every day, and approximately 200 youth start smoking every day (CDC, 2022).

In addition to the health risks associated with smoking, such as lung cancer, cardiovascular disease, and the effects on adolescent neurocognitive development, a risk management strategy must be developed to reduce smoking in this population. The chosen strategy, which will be revealed in greater detail in the following discussion, is a primary care-feasible behavioral intervention aimed at school-aged children and adolescents under the age of 18.


            This discussion will make reference to a hospital with which I am affiliated, which I will refer to as the ZN facility, for the sake of anonymity. Even though the hospital has a preventative health division, the emphasis is on the elderly population, who are predisposed to chronic illnesses. As a result, the hospital places little emphasis on the adolescent population’s health risks; thus, there is a greater need to emphasize adolescent health and develop risk management strategies, such as the proposed primary care-feasible behavioral interventions.

Implementing the risk management strategy will aid in lowering the number of adolescent populations who begin smoking and those who already smoke. Furthermore, it would reduce the health complications associated with cigarette smoking at all levels, including the local community and state, and the impact would be felt nationally if several other facilities in many states implement the intervention.

Support: Data that indicate the Need for the Proposed Risk Management Initiative

            To justify the need for the proposed risk management strategy, it is critical to review the statistics on the harm caused by smoking in the target population, as well as to support the initiative’s effectiveness with evidence-based research studies. The CDC (2022) statistics indicating that 5.6 million Americans under the age of 18 will die from a smoking-related illness are already a visible indicator of the severity of the problem.

Current tobacco product use among high school-aged children and adolescents was 13.4% overall in 2021, with girls at 13.8% and boys at 13.0%, and e-cigarettes accounting for the highest percentage of tobacco product use at 11.3% (CDC, 2022). Among middle school-aged students, the overall tobacco product use rate was 4.0%, girls (4.4%) and boys (3.6%), with e-cigarettes accounting for the highest tobacco product use rate at 2.8% (CDC, 2022). The statistics provide sufficient impetus for the quest for a risk management strategy that reduces smoking in this population to protect the health, education, and future of these school-aged children.

Furthermore, the US Preventative Services Task Force et al. (2020) conclude with a moderate degree of certainty that primary care-accessible behavioral interventions such as brief counseling and education sessions have a moderate net benefit in preventing tobacco use among school-aged children and adolescents. With this certainty, the ZN facility is eager to implement the strategy.


            Before delving into the implementation phases, it is critical to understand what tobacco use entails. Tobacco use refers to the habitual consumption of a tobacco plant and its products.  The US Food and Drug Administration (2020) defines tobacco products as any product made from tobacco intended for human consumption, including but not limited to cigarettes, cigars, Hookahs, nicotine gels, smokeless tobacco, e-cigarettes, vapes, and so on. In this context, smoking refers to the act of inhaling and exhaling smoke produced by combustible tobacco products (US PSTS et al., 2020).

The first step in implementation is determining whether or not youth use tobacco. This data is available at the county, state, and federal levels, but it can also be reported by parents or teachers who care for the adolescents. The second step entails strategies aimed at youth who do not use tobacco. Face-to-face counseling, telephone counseling, and computer-based and print-based interventions delivered by healthcare providers are all effective behavioral interventions for preventing tobacco smoking initiation in this population (Villanti et al., 2019). In the case of youths who are already using tobacco, a healthcare provider will use clinical judgment to determine which of the aforementioned interventions will be most beneficial to the individuals.

The hospital’s preventative health division will create variable prints such as stickers, activity books or guides, and newsletters with information about tobacco addiction, smokeless tobacco, and adverse health consequences. The face-to-face strategy will be the primary or component of the multimodal interventions employed. The healthcare providers can also organize a community talk attended by adolescents to educate them on the dangers of tobacco use and assign each to a peer counselor (Choi et al., 2021).

The telephone call is most effective when combined with other interventions such as face-to-face and material print counseling (Karekla & Savvides, 2021). The phone calls are made weekly, say three times a week, and contact with either the parent or the youth suffices. Most studies recommend computers for intervention recipients aged 10 to 17, who can learn through interactive or web-based programs and computer screenshots.


            ZN facility may face a few challenges in implementing the risk management strategy. To begin, financial and human resources are required to facilitate the process. This may necessitate the facility to write a proposal to interested stakeholders to finance the project, which could take a long time or fail.

Second, the facility’s staff is insufficient for the fieldwork, so more staff, particularly nurses, will need to be recruited to perform the behavioral counseling; this necessitates adequate funding, which is a challenge for the facility. Third, school-aged children have a busy schedule during the week and are only free on weekends. This may necessitate staff working on weekends when they are supposed to be resting.

Evaluation and Opportunities

To assess the success of the risk management initiative, a smoking health indicator report has proven to be useful. Quantitative measurements are required, for example, if the intervention lasts six months, the total number of students at the start of the intervention and the end is obtained.  Any discrepancy is noted, and the reasons for the discrepancy are discovered.

Every month, the number of students who smoked cigarettes in one or more of the previous 30 days is recorded. This serves as the numerator, while the total number of students surveyed serves as the denominator. The value obtained equals the percentage of students who smoked cigarettes on one or more occasions in the previous 30 days. This can be used to determine whether the intervention’s progress is positive or negative.

Other recommended risk management improvement strategies, according to USPSTF et al. (2020), include behavioral and pharmacology. In addition, the facility may consider behavioral interventions to reduce the use of illicit drugs and non-medical pharmaceuticals in children and adolescents.


            Adolescence is a critical stage of development, and this population requires close guidance from parents, teachers, or anyone else in their immediate environment. Teenagers are curious to try new things at this age, and statistics show that is when the majority of future cigarette smokers begin smoking.

It is therefore critical to provide risk management strategies to prevent smoking initiation or help those who have begun to smoke quit. The primary care-feasible behavioral intervention proposed in this paper provides a strategy with a broad scope to help teens avoid initiating and those who have begun to stop.


Centers for Disease Control and Prevention. (2022, April 14). Youth and tobacco use. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm

Choi, Y., Lee, C. M., Cho, B., Lee, E. S., Oh, S.-W., Lee, N., & Yun, J. M. (2021). Behavioral interventions for smoking cessation among adolescents: a rapid review and meta-analysis for the Korea Preventive Services Task Force. Osong Public Health and Research Perspectives12(3), 177–186. https://doi.org/10.24171/j.phrp.2021.0018

Karekla, M., & Savvides, S. N. (2021). Smoking cessation avatar-led Acceptance and Commitment Therapy digital intervention: feasibility and acceptability in young adults. Translational Behavioral Medicine11(1), 198–205. https://doi.org/10.1093/tbm/ibz128

US Food and Drug Administration. (2020). Tobacco products, ingredients, and components. U.S. Food and Drug Administration; FDA. Retrieved from https://www.fda.gov/tobacco-products/products-guidance-regulations/products-ingredients-components

US Preventive Services Task Force, Owens, D. K., Davidson, K. W., Krist, A. H., Barry, M. J., Cabana, M., Caughey, A. B., Curry, S. J., Donahue, K., Doubeni, C. A., Epling, J. W., Jr, Kubik, M., Ogedegbe, G., Pbert, L., Silverstein, M., Simon, M. A., Tseng, C.-W., & Wong, J. B. (2020). Primary care interventions for prevention and cessation of tobacco use in children and adolescents: US preventive services task force recommendation statement: US preventive services task force recommendation statement. JAMA: The Journal of the American Medical Association323(16), 1590–1598. https://doi.org/10.1001/jama.2020.4679

Villanti, A. C., Niaura, R. S., Abrams, D. B., & Mermelstein, R. (2019). Preventing smoking progression in young adults: The concept of prevescalation. Prevention Science: The Official Journal of the Society for Prevention Research20(3), 377–384. https://doi.org/10.1007/s11121-018-0880-y