PEDIATRICIANS' TOBACCO CESSATION ATTITUDES AND PRACTICES: TRENDS FROM 1994-2004
Susanne E. Tanski, Jonathan P. Winickoff, Karen G. O'Connor, Michael Weitzman.. Pediatrics, Dartmouth Medical School, Lebanon, NH; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Pediatrics, Massachusetts General Hospital, Boston, MA; Survey Division, American Academy of Pediatrics, Elk Grove Village, IL; Pediatrics and AAP Center for Child Health Research, University of Rochester, Rochester, NY; Pediatrics, New York University, New York, NY.

BACKGROUND: A 1994 AAP Periodic Survey included questions regarding attitudes about counseling for tobacco cessation and effects of smoking on children, which were repeated in a 2004 Periodic Survey.

OBJECTIVE: To compare pediatricians' current attitudes regarding tobacco cessation for patients and their parents across survey years.

DESIGN/METHODS: Surveys were mailed to random samples of US AAP members: 1627 in 2004 (response rate 54%) and 1610 in 1994 (72%). Analyses were limited to post-residency pediatricians providing health supervision for children (n=680 in 2004 and n=605 in 1994). Responses were scaled from 1 to 7-not important to very important; not confident to very confident; or a little to a lot. Means were compared across years using ANOVA.

RESULTS: In 2004, more pediatricians reported it is very important to advise parents to stop smoking (6.6 vs 5.8, p<0.001); and to counsel on the harmful effects of smoking (6.5 vs 6.0, p<0.001) than in 1994. However, they expressed less confidence in providing guidance on the effects of smoking in 2004 vs. 1994 (5.8 vs 6.2, p<0.001), and were unchanged regarding their confidence in advising parents to stop smoking (5.8 vs 5.7, p=NS). Pediatricians were also less optimistic in 2004 vs. 1994 about clinician impact on parental behavior, reporting only some effect in getting parents to stop smoking, (3.9 vs 4.2, p=0.01); and preventing the harmful effects of smoking (4.4 vs 4.7, p=0.006).

CONCLUSIONS: At the same time that pediatricians report parental smoking cessation and harm reduction from tobacco smoke are more important than in prior years, they report less confidence in their abilities to provide guidance regarding the harms of smoking, and perceive less effectiveness in changing parents' behavior. Overall, these trends over time are disappointing, and suggest tobacco control efforts in the pediatric office setting may be an area in need of systems-level changes to enhance screening, support clinician efforts, and improve quality.