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Trends in Tobacco Counseling: Results from the AAP Periodic Survey of Fellows

Robert McMillen, PhD1,2 , Karen O'Connor3, Judith Groner, MD 4,1 and Jonathan Klein, MD1.

1AAP Julius B. Richmond Center of Excellence, Elk Grove Village, IL, United States; 2SSRC, Mississippi State University, Starkville, MS, United States; 3AAP Dept of Research, Elk Grove Village, IL, United States and 4Nationwide Children’s Hospital, Columbus, OH, United States.

Background: Provision of smoking cessation advice, medications and enrollment in cessation programs can increase the chances of quitting smoking. The 2009 AAP Policy Statement -Tobacco Use: A Pediatric Disease advises pediatricians to advise parents and patients who use tobacco to quit.

Objective: To assess trends in tobacco cessation counseling between 2004 and 2010.

Design/Methods: A national, random sample of nonretired US AAP members were mailed Periodic Surveys in 2010 (N=887,RR=55%) and 2004 (N=879,RR=54%). Χ 2 analyses were used to examine responses of post residency pediatricians who provide health supervision across survey years.

Results: Similar proportions of pediatricians in both survey years advise most adolescents who smoke to quit (85% v 81%), talk about quitting techniques (34% v 32%), and recommend nicotine replacement medications (17% v 18%). However, more pediatricians in 2010 say they help patients to assess reasons for and against continuing to smoke (56% v 48%), provide quitting materials (20% v 15%) and refer patients to a 'quit line' or enroll them in a smoking cessation program (18% v 13%) (all p <.05).

Slightly more pediatricians in 2010 compared to 2004 say they provide quitting materials to most parents who smoke (14% v10%) and refer to a 'quit line' or enroll them in a smoking cessation program (16% v 11%)(all p<.05). There was no change in the proportion of pediatricians who report counseling parents on other smoking cessation topics: advise to quit, 71% v 70%; assess reasons for quitting, 39% v 37%; discuss quit techniques, 22% v 21%; recommend medications, 16% v 18%; and prescribe medications, 3% v 4%.

Conclusions: Most pediatricians advise adolescents patients and parents who smoke to quit, and the rates did not change from 2004 to 2010. Although rates for providing more detailed cessation guidance did increase for several activities, most pediatricians do not provide quitting materials, discuss quitting techniques, recommend medications, or refer smokers to a ‘quit line’. The opportunity exists for more pediatricians to protect children from the harms of tobacco and tobacco smoke by offering more counseling regarding why and how to quit tobacco.