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Doctors may be missing chances to talk to teens about smoking

By Kathryn Doyle

NEW YORK (Reuters Health) - Less than a third of teens say their doctors have spoken to them about tobacco use, according to a new study.

“Given that tobacco is still the number one preventable cause of death and disease in the U.S., it is surprising that more clinicians are not intervening with adolescent patients to help them avoid or quit tobacco,” lead author Gillian L. Schauer, of Carter Consulting, Inc., told Reuters Health.

Schauer worked on the study as a contractor to the Office on Smoking and Health of the Centers for Disease Control and Prevention in Atlanta, Georgia. She and her colleagues write in the journal Pediatrics that most current smokers started as teenagers or young adults.

Every year, 400,000 U.S. youth under age 18 smoke their first cigarette, they add, with about a quarter of those becoming new daily smokers.

To see whether healthcare providers are taking every opportunity to steer kids away from smoking, the researchers analyzed data from a 2011 nationally representative survey of adolescents in middle school and high school.

The survey included questions about tobacco use and about conversations with doctors, dentists or nurses regarding tobacco use over the past 12 months.

Among the more than 18,000 kids included in the survey, 11 percent currently smoked cigarettes, 17 percent were former smokers and 72 percent had never smoked. More than 90 percent said they had been to the doctor in the past year.

Of the whole group, 32 percent said a healthcare provider had asked them about smoking and 31 percent had been advised to avoid tobacco or quit.

“Young people often underestimate the addictive potential of nicotine, and 9 out of 10 adults who smoke started before age 18, making anti-smoking and anti-tobacco messages delivered by a health care provider an important intervention for youth,” Schauer told Reuters Health by email.

“Our results suggest that more than 6.6 million youth and adolescents who currently use tobacco or are at high risk for future smoking did not receive advice from their health care provider to quit or avoid tobacco,” she said.

Kids who reported smoking on at least 20 of the past 30 days, considered “established smokers,” were more likely to have had these discussions with healthcare providers.

Those who had received advice from a provider were almost 50 percent more likely to have tried to quit in the past year.

Even so, less than half of kids who used any kind of tobacco reported being asked about tobacco use or advised to quit.

A number of guidelines urge primary care clinicians to ask youth and adolescent patients, at every visit, if they use tobacco and to provide a strong message to quit or avoid it, Schauer said.

Earlier this month, other research indicated that dentists in particular are missing chances to urge patients to stop smoking (see Reuters story of August 8, 2014, here: http://reut.rs/1BkD6G9).

At the doctors office, someone on the clinical team will typically ask about tobacco use while collecting vital signs, and if the answer is yes, the same person may provide strong messaging about quitting or avoiding tobacco, Schauer said.

Doctors may tie the messaging to health effects that might be most concerning to adolescents, including more immediate effects like acne, bad breath or yellow teeth, she said.

Another way to broach the conversation is by talking about one of the recent high-profile tobacco education media campaigns, including the CDC’s Tips from Former Smokers, she said.

“We know that brief counseling interventions by clinicians are effective at both prevention and cessation and are recommended,” said Dr. Jonathan D. Klein, who wrote an accompanying editorial in the journal.

“There’s the opportunity to actually impact smoking but if you don’t ask the right question you can’t begin to have an impact,” he told Reuters Health.

Even if the patient does not smoke, bringing up the subject can be important for prevention, said Klein, who directs the Julius B. Richmond Center at the American Academy of Pediatrics in Grove Village, Illinois.

Some clinicians ask and counsel almost all the time, while others almost never do, he said.

“The good news is that most young people do see a physician or a healthcare provider at least once a year,” Klein said. “To add effective brief counseling to that encounter is a relatively low cost improvement, it’s only a 30 to 60 second intervention and even less for nonsmokers.”

“This really is an opportunity to use those visits more effectively,” he said.

SOURCE: http://bit.ly/1n5D4Zl and http://bit.ly/1o9zzQY Pediatrics, online August 18, 2014.

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