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| 2002 Pediatric Academic Societies Abstract TOBACCO COUNSELING AT WELL-CHILD AND TOBACCO INFLUENCED ILLNESS VISITS: OPPORTUNITIES FOR IMPROVEMENT Susanne E Tanski MD 1, Jonathan D Klein MD 1,2, Jonathan P Winickoff MD, MPH 3, Peggy Auinger MS 1,2, Michael Weitzman MD 1,2. 1Strong Children's Research Center, University of Rochester, Rochester, NY, 2AAP Center for Child Health Research, Rochester, NY and 3MGH Center for Child and Adolescent Health Policy, Harvard Pediatric Health Services Research Program, Boston, MA.BACKGROUND: Environmental tobacco smoke (ETS) exposure is one of the greatest environmental health problems in the U.S. with 42% of children living in households with smokers. ETS exposure and tobacco use should be addressed during well-child visits and during illness visits for ETS-associated conditions such as asthma and otitis media (OM). OBJECTIVE: To assess frequency of physician-reported delivery of counseling for child ETS exposure avoidance and tobacco use at periodic well-child visits, and at ill visits for asthma or OM. DESIGN/METHODS: Combined data from the National Ambulatory Medical Care Survey and the outpatient portion of the National Hospital Ambulatory Medical Care Survey from years 1997-1999 were analyzed. Pediatric visits (£ 18 years) that included any physician-reported counseling for tobacco use/exposure prevention were assessed. Diagnosis-specific visits were determined by using ICD-9 codes for asthma (493-), OM (381-, 382-), and well-child visits. Bivariate and regression analyses were performed. Results were weighted to provide national estimates and standard errors were adjusted for the complex sample design of the surveys. RESULTS: Of 36,141 ambulatory care visits by children, 544 (1.5%) visits were reported to include tobacco counseling. Of 5421 well-child visits, 4% included tobacco counseling. Tobacco counseling was reported in 4.4% of 1244 visits with a diagnosis of asthma and 0.25% of 3087 visits with a diagnosis of OM. Using logistic regression models, adolescent patients (13-18 years) were more likely to receive tobacco counseling than younger children [OR= 5.1, 95% CI (2.9-9.2), p<0.0001]. There were no statistically significant differences in counseling delivery by race, ethnicity, insurance, type of provider (pediatrician vs. family physician, physician vs. nurse practitioner or physician's assistant), or diagnosis. CONCLUSIONS: Overall rates of tobacco counseling in this survey are extremely low. Rates of tobacco counseling at illness visits for diagnoses directly impacted by tobacco use and ETS exposure are equally low. Low rates in this survey may reflect actual rates of tobacco counseling, poor documentation, or both. These results suggest that significant opportunities exist to improve counseling rates for child ETS exposure and adolescent tobacco use in primary care. |
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