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As more jurisdictions adopt these policies, continued monitoring will help determine how enforcement, policy design and community context shape their public health impact. Additional co-authors on the study include: David Strong, PhD, Dennis R

19 Tobacco Smoking in Children and Adolescents: Prevention Recommendation These guidelines provide recommendations for practitioners on preventive health screening in a primary care setting Weak recommendation, low quality evidence Applies to children and youth (5-18 years) who: Do not currently smoke tobacco (includes never or former smokers) Do not have cognitive deficits Do not have mental or physical health issues Do not have a history of alcohol or drug abuse 21 We recommend asking children and youth (5-18 years) or their parents about tobacco use by the child or youth and offering brief information and advice as appropriate during primary care visits to prevent initiation of tobacco smoking Tobacco Smoking in Children and Adolescents: Treatment Recommendation These guidelines provide recommendations for practitioners on preventive health screening in a primary care setting Weak recommendation, low quality evidence Applies to children and youth (5-18 years) who: Have smoked tobacco within the past 30 days Do not have cognitive deficits Do not have mental or physical health issues Do not have a history of alcohol or drug use 22 We recommend asking children and youth (5-18 years) or their parents about tobacco use by the child or youth and offering information and brief advice, as appropriate, during primary care visits to treat tobacco smoking among children and youth who have smoked in the last 30 days Rationale for Recommendations Recommendations are in favour of low-intensity, behavioural preventive and treatment interventions for children/youth, because of the: Potentially moderate reduction in smoking initiation Modest increase in the likelihood that youth will stop smoking Similar size effect of low and high intensity interventions High likelihood that harms of preventive or treatment interventions are minimal Fact that stakeholders find interventions important and acceptable The recommendations on both prevention and cessation are based on limited evidence, and, thus, are weak because of low certainty that the: - Evidence reflects the true effect of behavioural interventions, for either prevention or treatment of smoking - Lack of evidence that any benefit, if present, would be sustained or have longer-term health benefits 23 24 Comparison: CTFPHC guideline vs

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