Smoking cessation in adolescents and effective strategies: a position paper

Adolescent nicotine dependence represents a public health challenge, driven by the rapid evolution of tobacco products and by the unique neurobiological vulnerability of the developing brain to nicotine exposure. Clinically significant dependence may emerge after brief and intermittent use, often before adolescents self-identify as users, underscoring the need for proactive and systematic screening across all nicotine and tobacco product modalities. This position paper reviews the evidence on effective cessation strategies for adolescents and provides practical recommendations for clinicians and health systems. Psychological interventions, including cognitive-behavioral therapy and shared decision-making, remain the cornerstone of treatment, given their alignment with the motivational and developmental characteristics of this age group. Educational approaches, particularly school-based and digital interventions, show promise in reducing initiation and supporting cessation among current users. Family engagement and school environment play a critical supporting role, provided that adolescent confidentiality is consistently respected. Pharmacological options are limited by the absence of approved medications for individuals under 18 years of age. However, off-label use of nicotine replacement therapy may be considered in cases of moderate-to-severe dependence under specialist oversight. Effective strategies require integrated care pathways linking primary pediatric care, school health services, and community resources, supported by policy measures that reduce product accessibility and appeal. This joint position paper, endorsed by the Italian Society of Pediatrics (SIP) and the Italian Pediatric Respiratory Society (SIMRI), provides evidence-based recommendations for adolescent smoking cessation, encompassing educational and clinical interventions.