Most pediatric clinicians do not provide smoking cessation counseling to parents
Click Here to Manage Email Alerts
Pediatric primary care clinicians “frequently” screened parents to obtain their smoking behaviors but “rarely” provided smoking cessation counseling, researchers wrote in PLoS One.
“Our [pediatric] patients are often affected by the decisions and choices of their parents, making it important that we provide education, resources and support to the parents,” Tregony Simoneau, MD, a pediatric pulmonologist at Boston Children’s Hospital, told Healio Primary Care. “In order to do this well, we need to understand the needs of the parents.”
In addition, although pediatric primary care clinicians acknowledged the dangers of e-cigarettes, Simoneau and colleagues reported that they “infrequently” provided youth with information about these dangers.
The researchers surveyed a convenience sample of 1,549 families and 95 clinicians throughout Connecticut to learn more about smoking habits, trends in screening, cessation counseling practices and efforts to educate parents and youth about the health risks tied to smoking. Thirty-four clinicians who responded to the survey also participated in one of three focus groups that explored smoking and vaping counseling practices.
After tabulating responses, Simoneau and colleagues reported that 21% of parents said there was at least one smoker in their household. Most parents (71%), regardless of smoking amount, smoking duration or whether they resided in an urban or rural area, expressed interest in the smoker quitting.
Among the clinicians:
- 90% asked parents about their smoking behaviors at least once a year, but 36% did not offer smoking cessation counseling services or referrals;
- 99% advised youth about the risks associated with nicotine and tobacco use, but most clinicians “reported low self-efficacy” regarding smoking cessation and prevention counseling in parents and youth; and
- 93% said e-cigarettes were “equally or more dangerous than cigarettes,” yet 34% never discussed the dangers of e-cigarette use with minors.
“At the time that this survey was done, vaping was really quite new, and we didn’t know as much about its dangers and risks,” Simoneau said. “It has really only been in the last year or 2 that we have learned more about [e-cigarette or] vaping‐related lung injury, or EVALI, and now we are more prepared to speak to the risks.”
According to the researchers, the clinicians who were part of the focus groups said a lack of time kept them from making smoking cessation discussions a “priority” during well-child visits and that discussions about drugs, gun violence and sex were more important.
Simoneau noted that family practices where parents are also patients might see different results from a duplicate study. She stressed the need for primary care providers to “have easily accessible resources to learn about the dangers of electronic cigarettes.”
“The AAP is an excellent resource for finding key talking points to use with patients,” Simoneau said.
Perspective
Back to Top
Susan C. Walley, MD, NCTTS, FAAP
It is unfortunate that if replicated elsewhere in the United States, the study from Simoneau and colleagues would likely have similar findings.
The lack of time a pediatrician or primary care physician has with patients is a significant barrier to conversations between health care professionals and their teenaged patients regarding the dangers of vaping. However, it is still important to convey the message that tobacco companies are still aggressively marketing and advertising their products and doing so in ways we never thought of when some of us were in residency, such as paying teenagers to vape on social media and designing the products to look like flash drives or small flashlights.
The most important things health care professionals can do is stop vaping and other tobacco use before it starts. We need to ask patients, point blank, if they are engaging in these activities and ask before they start. The most recent study from the National Youth Tobacco Survey shows that one in four children in middle school have already tried tobacco, so if you wait until they’re in high school, it may be too late.
If the patient indicates that they are smoking, refer them to the 1-800-QUIT-NOW hotline or other evidence-based tools like the Truth Initiative’s “This is Quitting” program and the quitSMART app to get them to quit.
Telling a young smoker that they are likely to get lung cancer in 30 years is not likely going to make an impact. However, talking to teenagers about short-term health effects has a better chance of making an impact. EVALI was first reported in the summer of 2019 and has resulted in hundreds of people needing hospitalization. Nicotine addiction is a serious health risk, as one small pod in an e-cigarette has as much nicotine as one pack of cigarettes. During this COVID-19 pandemic, teenagers who use e-cigarettes are almost five times more likely to get COVID-19 and teenagers who vape and use combustible cigarettes are seven times more likely to develop COVID-19.
Chair, AAP section on tobacco control
Professor of pediatrics, University of Alabama at Birmingham
Collapse
Click Here to Manage Email Alerts