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Counseling Smoking Parents of Young Children
Comparison of Pediatricians and Family Physicians
Eliseo J. Pérez-Stable, MD;
Maria Juarez-Reyes, MD, PhD;
Celia P. Kaplan, DrPH, MA;
Elena Fuentes-Afflick, MD, MPH;
Virginia Gildengorin, PhD;
Susan G. Millstein, PhD
Arch Pediatr Adolesc Med. 2001;155:25-31.
Background Secondhand smoke is a major cause of morbidity in young children, and
exposure to smoking parents is the principal source. Physician visits for
young children present an opportunity to effect behavioral change among smoking
parents.
Objective To survey pediatricians and family physicians in their knowledge and
practice of smoking cessation counseling with parents.
Design Cross-sectional mail survey.
Setting Urban California.
Participants Pediatricians and family physicians in urban areas of California, younger
than 65 years, practicing in an ambulatory setting, and randomly selected
from the American Medical Association Physician Masterfile.
Main Outcome Measures Reported frequency of asking about tobacco use, using cessation counseling
techniques with smokers, and perceived barriers to providing cessation services.
Results Of the 1000 mailed surveys, 899 were eligible and 499 (56% response
rate) were returned and completed. A higher proportion of pediatricians compared
with family physicians were women (44% vs 29%; P<.01)
and nonwhite (44% vs 32%; P = .01). Family physicians
compared with pediatricians were more likely to report referring a parent
to a smoking cessation program (41% vs 30%), giving pamphlets on smoking cessation
(40% vs 28%), asking for a quit date (41% vs 18%), scheduling a follow-up
visit to discuss quitting (27% vs 5%), and recommending nicotine replacement
therapy (41% vs 13%) (for each comparison, P<.001).
Pediatricians were more likely to report recording in the medical record smoking
by a parent as a problem for the child (65% vs 48%; P<.001),
but a higher proportion of pediatricians perceived that parents would ignore
the advice (39% vs 24%; P<.001) and lacked interest
in quitting smoking (45% vs 27%; P<.001). Pediatricians
were more likely to agree that they lacked smoking cessation counseling skills
(26% vs 7%; P<.001). Multivariate models showed
that pediatricians were less likely to report performing 5 of 14 smoking cessation
techniques in at least 50% of smoking parents.
Conclusions Pediatricians appear to lack training to implement smoking cessation
counseling with smoking parents. Physicians in private practice are less likely
to counsel smoking parents. Educational interventions for pediatricians are
needed to decrease secondhand smoke exposure for young children.
From the Division of General Internal Medicine, Department of Medicine
(Drs Pérez-Stable, Juarez-Reyes, and Kaplan), the Medical Effectiveness
Research Center for Diverse Populations (Drs Pérez-Stable, Juarez-Reyes,
Kaplan, Fuentes-Afflick, and Gildengorin), the Comprehensive Cancer Center
(Drs Pérez-Stable and Kaplan), the Department of Pediatrics (Drs Fuentes-Afflick
and Millstein), the Department of Epidemiology and Biostatistics (Dr Fuentes-Afflick),
and the Division of Adolescent Medicine (Dr Millstein), University of California,
San Francisco.
Corresponding author: Eliseo J. Pérez-Stable, MD, Division
of General Internal Medicine, University of California, San Francisco, 400
Parnassus Ave, Room A-405, Box 0320, San Francisco, CA 94143-0320 (e-mail: eliseops{at}medicine.ucsf.edu).
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