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The Practices of Family Physicians and Pediatricians

Celia Patricia Kaplan, DrPH, MA; Eliseo J. Pérez-Stable, MD; Elena Fuentes-Afflick, MD, MPH; Virginia Gildengorin, PhD; Susan Millstein, PhD; Maria Juarez-Reyes, PhD, MD

Arch Pediatr Adolesc Med. 2004;158:83-90.

Objective  To investigate family physicians' and pediatricians' practice of and perceived barriers to smoking cessation counseling among patients 18 years and younger.

Design  Cross-sectional mail survey conducted between November 1, 1997, and January 31, 1998.

Participants  A stratified random sample selected from the 1997 American Medical Association Physician Masterfile of 1000 family physicians and pediatricians who practice in urban California, work at least 10% of the time in ambulatory care, and have at least 10% of patients 18 years and younger.

Main Outcome Measures  Physicians' adherence to 5 components of the National Cancer Institute's smoking cessation counseling recommendations (anticipate, ask, advise, assist, and arrange) and their perceived barriers to smoking cessation counseling.

Results  A total of 429 physicians participated in the study. Physicians of both specialties were more likely to anticipate, ask, and advise patients about smoking than to assist with and arrange cessation activities. Family physicians were more likely than pediatricians to assist and arrange, including scheduling follow-up visits to discuss quitting (25.1% vs 11.7%; odds ratio [OR], 3.07; 95% confidence interval [CI], 1.22-7.73) and directing nursing staff to counsel patients (17.1% vs 10.9%; OR, 3.70; 95% CI, 1.30-10.60). The most common perceived barrier to counseling was the belief that children would provide inaccurate responses due to either the presence of parents (86.4%) or the fear that parents would be notified of their answers (74.0%). Pediatricians reported lack of counseling skills as a barrier to providing smoking interventions in greater proportion than did family physicians (24.9% vs 54.8%; OR, 0.29; 95% CI, 0.14-0.63; P<.001).

Conclusion  Improvement in smoking cessation counseling skills and practices is needed among physicians treating children and adolescents.

From the Department of Medicine, Division of General Internal Medicine, Medical Effectiveness Research Center for Diverse Populations (Drs Kaplan, Pérez-Stable, Fuentes-Afflick, and Gildengorin), Department of Pediatrics (Drs Fuentes-Afflick and Millstein), and Comprehensive Cancer Center (Drs Kaplan and Pérez-Stable), University of California, San Francisco; and Santa Clara Valley Medical Center, San Jose, Calif (Dr Juarez-Reyes).

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