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Identification of Adolescent Tobacco Users in a Pediatric Practice
Irwin Benuck, MD;
Samuel S. Gidding, MD;
Helen J. Binns, MD, MPH
Arch Pediatr Adolesc Med. 2001;155:32-35.
Context Though prevention of adolescent tobacco use is a major public health
goal, there is little information on the ability of pediatricians to identify
adolescents experimenting with tobacco and regular tobacco users.
Objectives To pilot use of a short questionnaire and analysis of urinary cotinine
level to identify adolescent smokers in a pediatric practice, and to determine
characteristics of tobacco users.
Setting Suburban pediatric practice.
Method Consecutive high school students completed a short questionnaire and
urine cotinine assessment. Three groups were defined: smokers (urine cotinine
level >100 ng/mL), experimenters (smoked within the last year; urine continine
level  100 ng/mL), and nonsmokers. Logistic regression was used to examine
characteristics of experimenters.
Results One hundred twenty-four adolescents were enrolled throughout 3 months:
83 nonsmokers (67%), 28 experimenters (23%), and 13 smokers (10%). The questionnaire
alone identified 92% of regular smokers. Smoking frequency increased by grade
level. Smoking initiation occurred with peers. Compared with nonsmokers, smokers
and experimenters were more likely to be older and have a majority of friends
who smoked. Smokers were more likely to have a family member who smoked. A
majority of smokers and experimenters had tried to quit and understood the
adverse health effects of tobacco use.
Conclusions Adolescent smokers and experimenters were identified using a brief questionnaire.
This method will allow pediatricians the opportunity to identify at-risk adolescents
before they become regular smokers. Further studies at primary care offices
are needed to examine identification of adolescents at highest risk and examine
methods to initiate smoking cessation before addiction is established.
From the Departments of Pediatrics (Drs Benuck, Gidding, and Binns)
and Preventive Medicine (Dr Gidding), Northwestern University Medical School,
and the Willis J. Potts Children's Heart Center, Children's Memorial Hospital
(Dr Gidding), Chicago, Ill.
Corresponding author: Helen J. Binns, MD, MPH, 2300 Children's Plaza,
Box 208, Chicago, IL 60614 (e-mail: hbinns{at}northwestern.edu).
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