Few physicians counsel adolescents about smoking

Despite the fact that most smokers take up the habit as adolescents, few U.S. physicians counsel their young patients about the health risks of smoking, according to a study appearing in the Nov. 3 issue of the Journal of the National Cancer Institute. The report from physicians in the General Medicine Division of the Massachusetts General Hospital (MGH) found that, even when they knew their patients were smokers, physicians reported discussing smoking at office visits less than 20 percent of the time.

"We were surprised that counseling of all adolescents was so low and that it did not improve during the 1990s, despite the fact that numerous physician and government organizations recommend that all adolescents receive counseling, whether they currently smoked or not," says Anne Thorndike, MD, the study's lead author.

During the years 1991 through 1996, physicians responding to a national survey reported asking young patients ages 11 to 21 about their smoking habits at 71 percent of office visits. But they provided counseling and advice about smoking at less than 2 percent of overall office visits. In the 8.5 percent of office visits when patients identified themselves as smokers, physicians counseled patients on the risks of smoking and benefits of quitting 17 percent of the time.

The frequency at which physicians asked about smoking did not improve during the years studied; in fact, there was a small decrease from 72.5 percent in 1991 to 66.5 percent in 1996. The percentage of patients identifying themselves as smokers and the percentage of visits that included smoking-related counseling remained unchanged during the study period.

"We know that the peak years for young people to begin smoking are ages 13 and 14," Thorndike explained. "Even when youngsters tell their doctors they don't smoke, they may be experimenting with cigarettes or other tobacco products. It's important to get these prevention messages across before they become regular smokers."

The study also found that younger and nonwhite adolescents were even less likely to receive smoking-related counseling that older and white teenagers. Physicians were most likely to counsel patients about smoking if the office visit was for a respiratory problem like asthma or for pregnancy.

The study examined data from the National Ambulatory Medical Care Surveys of 1991 through 1996. In the annual survey conducted by the National Center for Health Statistics, physicians complete a form after outpatient visits, answering questions about patients' diagnoses and the treatments provided.

Co-authors of the study were Timothy Ferris, MD, Randall Stafford, MD, and Nancy Rigotti, MD, all of the MGH General Medicine Unit. Rigotti also is director of Tobacco Research and Treatment at the MGH. The study was supported by grants from the U.S. Public Health Service, the National Institute of Child Health and Human Development, and the National Heart, Lung and Blood Institute.