ADDRESSING PARENTAL SMOKING IN PEDIATRICS AND FAMILY PRACTICE: A NATIONAL SURVEY OF PARENTS Jonathan P Winickoff ^1,2, Robert C McMillen ³, Jonathan D Klein ⁴ and Michael Weitzman ⁴. ¹MGH Center for Child and Adolescent Health Policy, Harvard Pediatric Health Services Research Program, Boston, MA; ²MGH Tobacco Research and Treatment Center, Boston, MA; ³Social Science Research Center, Mississippi State University, MS; and ⁴AAP Center for Child Health Research and Strong Children's Research Center, U of Rochester, Rochester, NY.

BACKGROUND: Parental smoking has been associated with increased rates of sudden infant death syndrome, low birth weight, otitis media, asthma, decreased lung growth, and burns due to house fires. No prior studies assess national rates of screening and counseling parents for tobacco use by their child's primary care doctor.

OBJECTIVE: To assess and compare rates of pediatrician and family practitioner screening and counseling for parental smoking.

DESIGN/METHODS: Data were collected by telephone survey of households from July to September 2001. The sample is weighted by race and gender based upon 1999 U.S. Census estimates to be representative of the U.S. population.

RESULTS: Of 3,566 eligible respondents contacted, 3,002 (84.2%) completed surveys; 903 of those were parents who had a child seen by a pediatrician (62%) or family practitioner (38%) in the past year. About half of all parents who visited a pediatrician or family practitioner were asked about household member smoking status (52% vs. 48%, P=.24). More parents who visited pediatricians were asked if they had rules prohibiting smoking in the home than those who visited family practitioners (38% vs. 29%, P=.006). Of 180 (20%) parents who were smokers, a similar proportion were asked about household member smoking status (52% Peds vs 45% FPs, P=.30). Parental smokers visiting a pediatrician were more likely than those seeing family practitioners to have been asked if they had rules prohibiting smoking in the home (49% vs. 33%, P=.04) and if they had rules prohibiting smoking in the family vehicle (28% vs. 14%, P=.03). Fewer than half of parental smokers reported being counseled by either specialty about dangers of second-hand smoke (41% vs. 33%, P=.28) or about risks of modeling smoking behavior (31% vs. 28%, P=.74). Similarly, fewer than half of parental smokers received advice to quit (36% vs. 45%, P=.28).

CONCLUSIONS: Overall rates of screening and counseling for parental smoking in pediatric and family practice are low. Despite some differences between specialties, significant opportunities exist to improve tobacco control activities in both primary care settings.