Preventative Medicine

Physicians Fail to Counsel Adolescents About Smoking

Physicians are not taking an active role in discouraging smoking among their young patients, reported a study released in the Nov. 3 issue of the Journal of the National Cancer Institute. The study, led by researchers from Massachusetts General Hospital, found that doctors rarely offered their young patients advice about the hazards of smoking, even when they knew that they smoked.

Researchers analyzed data from a 1991-1996 survey of approximately 5,000 doctors. Information was gathered from more than 16,000 visits with patients aged 11 to 21. While doctors inquired about cigarette use in approximately 70 percent of these visits, they neglected to counsel the majority of their young patients about the dangerous habit. Indeed, physicians were found to counsel patients about smoking in less than 2 percent of their visits with adolescents. Among patients who were known smokers, doctors discussed tobacco use in only 17 percent of their visits.

“The report … is an important wake-up call to physicians, academic teachers, and researchers,” wrote University of Minnesota Drs.Dorothy K. Hatsukami and Harry A. Lando.

Experts estimate that more than 3,000 American teenagers begin smoking every day. Those who pick up the habit as youngsters are more likely to become lifetime smokers, and as a consequence suffer from smoking-related diseases such as lung cancer and heart disease. Targeting adolescents has been identified as a crucial step in reducing the prevalence of smoking, and doctors can play an important role in these efforts.

“The responsibility of a physician is to prevent disease as much as it is to cure it,” remarked Dr. William G. Cahan, a chest surgeon with Memorial Sloan-Kettering Cancer Center in New York. “Advising adolescents about not smoking is just as important as vaccinating them against polio and other adolescent diseases. There’s no difference.”

The study found that non-white patients were less likely to be questioned about their smoking habits and to receive tobacco counseling than white patients. Doctors were more inclined to discuss tobacco use with older patients, and with those who had asthma, lower respiratory infections or who were pregnant. Researchers also reported that compared to specialists, primary care physicians more often discussed the harms of smoking with their patients.

Guidelines for counseling adolescents and young adults have been provided by the National Cancer Institute and the American Academy of Pediatrics. These guidelines recommend that physicians inquire about the use of tobacco by their young patients, commend non-users and advise patients to quit or abstain from tobacco.

Study authors expressed concern that despite these guidelines and the highly publicized efforts of the public health community to reduce teen smoking, physicians have not assumed their responsibility in discouraging adolescent tobacco use.

“I think a lot of physicians are defeatist about the impact they can have on adolescents,” said Cahan. “Talking to young patients about not smoking can be difficult, but it’s very important,” he added.

Cahan recommended that supplementary materials and a list of referrals be made available to physicians to help them in their efforts to counsel patients about the risks of tobacco use.

“The overwhelming majority of smokers take up smoking as teenagers,” commented Dr. Gilbert Ross, medical director of the American Council on Science and Health. “If we are ever to have an impact on reducing the rate of smoking in this country, we have to educate our young people to its real dangers. Physicians must take a leadership role in this endeavor.”

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