The difference a decade makes

Smoking cessation counseling and screening at pediatric visits

Philip B. Cawkwell, Lily Lee, Jenni Shearston, Scott Sherman, Michael Weitzman

    Research output: Contribution to journalArticle

    Abstract

    Introduction: There has been a sharp decline in adolescents who smoke cigarettes but no national-level study evaluating the impact of smoking cessation counseling by pediatricians or other clinicians who care for children. Methods: Combined data from ambulatory portions of the National Hospital Ambulatory Care Survey and National Ambulatory Medical Care Survey from 1997-1999 and 2009-2011 were analyzed to determine changes in the frequency of pediatric visits that included clinician-reported tobacco counseling and how such counseling varied by child, family, and clinician characteristics. Results: In 1997-1999, 1.5% of all medical visits for children aged below 19 years included tobacco counseling; this increased to 3.8% in 2009-2011 (P < .001). A marked increase from 4.1% to 11.1% was noted at well-child visits (P < .001). There were significant increases in counseling by pediatricians but not mid-level providers or general/family physicians. Provision of counseling did not result in greater visit length during either time point. During 2009-2011, visits with a diagnosis of asthma were four times as likely (OR 4.2, 95% CI 2.8-6.2) and visits for otitis media two times as likely (OR 2.1, 95% CI 1.2-3.7) to include smoking cessation counseling than sick visits for all other diagnoses. Conclusion: These results demonstrate a significant increase in tobacco counseling by pediatric providers within the last decade, especially at well-child visits. However, the American Academy of Pediatrics' recommendation that pediatricians counsel about the harms of tobacco use and secondhand smoke exposure has not yet been exhaustively implemented. Implications: A significant increase in smoking cessation counseling at pediatric medical appointments, especially at well-child visits, occurred from 2009-2011 compared with 1997-1999, paralleling a large decrease in smoking prevalence. These improvements in counseling rates have been predominantly noted for pediatricians but not mid-level providers or general practitioners. Counseling was not associated with increased visit lengths. Although improved counseling practices by pediatricians have been demonstrated, there is still room for improvement.

    Original languageEnglish (US)
    Pages (from-to)2100-2105
    Number of pages6
    JournalNicotine and Tobacco Research
    Volume18
    Issue number11
    DOIs
    StatePublished - Nov 1 2016

    Fingerprint

    Smoking Cessation
    Counseling
    Pediatrics
    Tobacco
    Health Care Surveys
    Tobacco Smoke Pollution
    Family Physicians
    Otitis Media
    Tobacco Use
    Ambulatory Care
    Child Care
    Smoke
    Tobacco Products
    General Practitioners
    Appointments and Schedules
    Asthma
    Smoking
    Pediatricians

    ASJC Scopus subject areas

    • Public Health, Environmental and Occupational Health

    Cite this

    The difference a decade makes : Smoking cessation counseling and screening at pediatric visits. / Cawkwell, Philip B.; Lee, Lily; Shearston, Jenni; Sherman, Scott; Weitzman, Michael.

    In: Nicotine and Tobacco Research, Vol. 18, No. 11, 01.11.2016, p. 2100-2105.

    Research output: Contribution to journalArticle

    Cawkwell, PB, Lee, L, Shearston, J, Sherman, S & Weitzman, M 2016, 'The difference a decade makes: Smoking cessation counseling and screening at pediatric visits', Nicotine and Tobacco Research, vol. 18, no. 11, pp. 2100-2105. https://doi.org/10.1093/ntr/ntw146
    Cawkwell, Philip B. ; Lee, Lily ; Shearston, Jenni ; Sherman, Scott ; Weitzman, Michael. / The difference a decade makes : Smoking cessation counseling and screening at pediatric visits. In: Nicotine and Tobacco Research. 2016 ; Vol. 18, No. 11. pp. 2100-2105.
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    abstract = "Introduction: There has been a sharp decline in adolescents who smoke cigarettes but no national-level study evaluating the impact of smoking cessation counseling by pediatricians or other clinicians who care for children. Methods: Combined data from ambulatory portions of the National Hospital Ambulatory Care Survey and National Ambulatory Medical Care Survey from 1997-1999 and 2009-2011 were analyzed to determine changes in the frequency of pediatric visits that included clinician-reported tobacco counseling and how such counseling varied by child, family, and clinician characteristics. Results: In 1997-1999, 1.5{\%} of all medical visits for children aged below 19 years included tobacco counseling; this increased to 3.8{\%} in 2009-2011 (P < .001). A marked increase from 4.1{\%} to 11.1{\%} was noted at well-child visits (P < .001). There were significant increases in counseling by pediatricians but not mid-level providers or general/family physicians. Provision of counseling did not result in greater visit length during either time point. During 2009-2011, visits with a diagnosis of asthma were four times as likely (OR 4.2, 95{\%} CI 2.8-6.2) and visits for otitis media two times as likely (OR 2.1, 95{\%} CI 1.2-3.7) to include smoking cessation counseling than sick visits for all other diagnoses. Conclusion: These results demonstrate a significant increase in tobacco counseling by pediatric providers within the last decade, especially at well-child visits. However, the American Academy of Pediatrics' recommendation that pediatricians counsel about the harms of tobacco use and secondhand smoke exposure has not yet been exhaustively implemented. Implications: A significant increase in smoking cessation counseling at pediatric medical appointments, especially at well-child visits, occurred from 2009-2011 compared with 1997-1999, paralleling a large decrease in smoking prevalence. These improvements in counseling rates have been predominantly noted for pediatricians but not mid-level providers or general practitioners. Counseling was not associated with increased visit lengths. Although improved counseling practices by pediatricians have been demonstrated, there is still room for improvement.",
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