Two-thirds of adolescents say their doctors don’t ask about tobacco use

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Time for action in adolescent tobacco intervention

These findings are critically important for child and adolescent health care delivery and should challenge both researchers and clinicians. The 4As (ask, advise, assess, arrange) tobacco cessation counseling guidelines have existed for decades, and specific pediatric and adolescent guidelines, adding the fifth A (anticipate) for anticipatory guidance, date to 1991.

The majority of adolescents’ health care encounters and clinical visits did not include discussion or interventions into the leading preventable cause of disease and death. Although the prevalence of being asked and advised about smoking was highest among youth who were smokers, these numbers, too, were low, reaching barely half of smokers with counseling interventions.

Dr. Jonathan D. Klein is with the American Academy of Pediatrics Julius B Richmond Center in Grove Village, Ill. The center offers clinicians advice and materials for counseling on smoking cessation. Dr. Klein made his remarks in an editorial that accompanied Dr. Schauer’s report (Pediatrics 2014; 134:600-1 [doi:10.1542/peds.2014-1925]).




Less than a third of all adolescents surveyed were asked about tobacco use by their doctors, a study published in Pediatrics reported.

The study used data from 18,094 participants in the 2011 National Youth Tobacco Survey. All participants were in grades 6-12, and had visited a health care provider in the previous year.

Fewer adolescents are being asked about tobacco habits by their doctors, says a new study.

Among all of those interviewed, 32.2% reported being asked by their doctors in the past year about tobacco use; 31.4% were advised to quit or avoid tobacco.

Established tobacco users were more likely to be asked about tobacco use, with 65% reporting their doctors asked about smoking and 53% reporting their doctor recommended that they quit, according to Gillian L. Schauer and associates (Pediatrics 2014;134:446-55).

Fewer nonsmokers said they were advised about tobacco use, with 38% of nonsmokers at high risk and 29% of adolescents at low risk reporting their doctors had talked to them about tobacco. Nonsmoking adolescents who indicated any interest in tobacco were labeled as high risk, whereas those who had no interest were labeled as low risk.

High school–aged teens, with the exception of nonestablished smokers, were more likely to be asked about tobacco use in general. Of females who were established smokers, 75% were asked about tobacco use; of males who were established smokers, 59% reported their doctors asked about smoking.

Though improvements are needed, the results indicate that more doctors are asking teens about their tobacco use. A previous version of the survey conducted in 2000 found that 30% of established smokers and 13% of nonestablished smokers were advised to quit, compared with 53% and 33%, respectively, in the more recent survey, the researchers reported.

Among all interviewed adolescents, 17% reported being a current tobacco user, with 11% smoking cigarettes. Participants reported that 17% were former smokers, and 72% had never smoked.

The authors of the study reported no disclosures.

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