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Children's Health

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Doctors can do much more to encourage adolescents to not smoke or stop smoking

More than one-third of adolescents smoke, and as many as 20 percent of high school boys use smokeless tobacco. It appears that doctors can do much more to encourage adolescents to not smoke or stop smoking, according to a study supported in part by the Agency for Healthcare Research and Quality (HS08192).

Many physicians ask their adolescent patients about their use of tobacco products, but far fewer physicians pursue the subject with these youngsters, despite guidelines that recommend specific steps that have been effective in helping many adults to quit smoking. Among these are smoking prevention guidelines sponsored by the U.S. Public Health Service (PHS).

Researchers at the University of Rochester Medical Center, led by Jonathan D. Klein, M.D., M.P.H., analyzed survey responses from a random sample of New York pediatricians and family physicians who had seen one or more adolescents for well care within the past 6 months. Physicians reported asking 91 percent of adolescents about their smoking habits, and they discussed the health risks of tobacco with 77 percent. However, the physicians only asked 41 percent of adolescents about smoking among their friends (which increases the likelihood they will smoke), and only 32 percent were asked if they used smokeless tobacco. Doctors assessed the motivation of 81 percent of smokers to quit, but they only set quit dates for 34 percent and scheduled followup visits for 28 percent of smokers.

Pediatricians asked more patients about peer influences than did family physicians. However, family physicians more often asked about smokeless tobacco use, assessed motivation to quit, provided smoking cessation handouts, helped set quit dates, and scheduled followup visits for smokers, perhaps because of their experience with adult smokers. Overall, doctors used more tobacco interventions when they were familiar with the PHS guidelines (family doctors were more familiar than pediatricians at 48 percent vs. 27 percent), spent more time with adolescent patients (female doctors spent more time at 26 vs. 21 minutes), and spent more time alone with patients (enhancing rapport and confidentiality).

See "Delivery of smoking prevention and cessation services to adolescents," by Dr. Klein, Leonard J. Levine, M.D., and Marjorie J. Allan, B.S. in the May 2001 Archives of Pediatric and Adolescent Medicine 155, pp. 597-602.

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