Adolescent smokers seen in general practice: health, lifestyle, physical measurements, and response to antismoking advice

BMJ. 1991 Oct 19;303(6808):947-50. doi: 10.1136/bmj.303.6808.947.


Objective: To compare physical, lifestyle, and health characteristics of adolescent smokers and non-smokers and their initial response to anti-smoking counselling.

Design: Adolescents aged 13, 15, and 17 years were identified from age-sex registers and invited by letter for a general practice health check.

Setting: Three general practices in the MRC general practice research framework.

Main outcome measures: Blood pressure, body mass index, saliva cotinine concentration, peak flow rate, alcohol consumption, exercise, duration of sleep, and stated persistent health problems.

Results: 73% of the adolescents (491) attended for the health check. A total of 68 (14%) were regular smokers. By age 17 those who smoked regularly had a significantly lower systolic blood pressure than those who had never smoked regularly (by 6 mm Hg; p = 0.025) despite a significantly higher body mass index (by 1.5; p <0.001) [corrected]. Cotinine concentrations increased with smoking exposure, from 0.7 ng/ml when no family member smoked to 155 ng/ml in active smokers of six or more cigarettes a week. Significantly more regular smokers than never regular smokers drank greater than or equal to 8 g alcohol a day (chi 2 = 15.2 adjusted for age and sex p less than 0.001); regular smokers exercised less (1.0 hrs/week in boys and 0.8 hrs/week in girls v 3.4 hrs/week in boys and 2.2 hrs/week in girls; p less than 0.001) and slept less (8.0 hrs/night v 8.5 hrs/night at age 17; p less than 0.005). Persistent health problems, mostly asthma or allergic symptoms, were reported by 25% (17/68) of the smokers and 16% (60/381) of the non-smokers. Of the smokers given counselling, 60% (26/43) made an agreement with the practice doctor or nurse to give up smoking.

Conclusion: General practice is an appropriate setting for adolescents to receive advice on healthy lifestyle, which should not focus solely on smoking.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Alcohol Drinking
  • Asthma / etiology
  • Blood Pressure
  • Body Weight
  • Cotinine / analysis
  • Counseling*
  • Exercise
  • Family Practice
  • Female
  • Health Status*
  • Humans
  • Life Style*
  • Male
  • Saliva / chemistry
  • Sleep
  • Smoking Prevention*
  • United Kingdom


  • Cotinine