MEMORANDUM FOR: Science Writers and Editors on the Journal Press List

Few Physicians Counsel Adolescents About Smoking

October 28, 1999 (EMBARGOED FOR RELEASE 4 P.M. EST November 2)

Julianne Chappell, Executive Editor, Dan Eckstein, (301) 986-1891, ext. 112

A vast majority of American physicians do not counsel their young patients about smoking, even though numerous professional groups encourage them to do so.

This information is presented in the November 3 issue of the Journal of the National Cancer Institute by Anne Thorndike, M.D., M.P.H., and colleagues at Harvard Medical School.

The authors worked with data from the National Ambulatory Medical Care Survey (NAMCS), an ongoing annual survey of office-based physicians in the United States. In this survey, conducted by the National Center for Health Statistics, doctors selected by random sampling are asked to complete a one-page form after each ambulatory non-emergency visit. Smoking status and counseling are specific items on the form. Data for the study by Thorndike et al. were available on 16,648 adolescent visits to 5087 physicians from 1991 through 1996.

Because more than 70% of adolescents are seen by a physician yearly, and because this age group see physicians as credible health experts, many groups (American Medical Association, National Cancer Institute, American Academy of Pediatrics, etc.) have recommended that physicians screen and counsel adolescents about tobacco use. The physicians participating in the NAMCS identified whether or not an adolescent smoked at 72.4% of visits. However, they counseled adolescents (ages 11-21) about smoking at only 1.7% of all office visits in 1991-1996 and at just 16.9% of visits by known adolescent smokers.

Primary care physicians were more likely to identify smoking status and to discuss smoking than were specialists. Patients with asthma or lower respiratory tract infections, and those who were pregnant, were more likely to be counseled. Adolescents were five times more likely to be counseled at a general medical visit than at a problem visit, and physicians were more likely to discuss smoking with white than with nonwhite patients.

The authors note that physicians are doing less smoking counseling among adolescents than among adults. The rates of counseling did not improve from 1991 to 1996, despite clear consensus among professional organizations about the importance of addressing smoking with adolescents. It is especially important to address smoking with younger patients say the investigators, as smoking initiation rates increase rapidly after age 10 and peak at ages 13-14. An estimated 5 million premature smoking-related deaths will occur among youths who were 17 or younger in 1995.

Thorndike at al. conclude that physicians should take better advantage of their opportunity to discourage smoking among their adolescent patients.

Harry Lando, Ph.D., and Dorothy Hatsukami, Ph.D., note in an editorial that the paper by Thorndike et al. is an important wake-up call to physicians, teachers, and researchers. The NAMCS data are discouraging, given efforts in recent years to educate practicing physicians to identify and treat smokers, the editorial writers say. They note that intervention with adolescents is critical, as 70% of smokers become nicotine-dependent before the age of 18, and conclude that despite a number of initiatives underway, we still have a long way to go in addressing youth tobacco use.

Contact: Sue McGreevey (617) 724-2764; fax (617) 726-7475. Editorial: Coleen Southwell (612) 626-1107; fax (612) 626-3069.

Note: This memo to reporters is from the Journal staff and is not an official release of the National Cancer Institute (NCI) or Oxford University Press (OUP) nor does it reflect NCI or OUP policy. In addition, unless otherwise stated, all articles and items published in the Journal reflect the individual views of the authors and not necessarily the official points of view held by NCI, any other component of the U.S. government, OUP, or the organizations with which the authors are affiliated. Neither NCI nor any other component of the U.S. government nor OUP assumes any responsibility for the completeness of the articles or other items or the accuracy of the conclusions reached therein.



             
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