The Difference a Decade Makes: Smoking Cessation Counseling and Screening at Pediatric Visits

Nicotine Tob Res. 2016 Nov;18(11):2100-2105. doi: 10.1093/ntr/ntw146. Epub 2016 Jul 11.


Introduction: There has been a sharp decline in adolescents who smoke cigarettes but no national-level study evaluating the impact of smoking cessation counseling by pediatricians or other clinicians who care for children.

Methods: Combined data from ambulatory portions of the National Hospital Ambulatory Care Survey and National Ambulatory Medical Care Survey from 1997-1999 and 2009-2011 were analyzed to determine changes in the frequency of pediatric visits that included clinician-reported tobacco counseling and how such counseling varied by child, family, and clinician characteristics.

Results: In 1997-1999, 1.5% of all medical visits for children aged below 19 years included tobacco counseling; this increased to 3.8% in 2009-2011 (P < .001). A marked increase from 4.1% to 11.1% was noted at well-child visits (P < .001). There were significant increases in counseling by pediatricians but not mid-level providers or general/family physicians. Provision of counseling did not result in greater visit length during either time point. During 2009-2011, visits with a diagnosis of asthma were four times as likely (OR 4.2, 95% CI 2.8-6.2) and visits for otitis media two times as likely (OR 2.1, 95% CI 1.2-3.7) to include smoking cessation counseling than sick visits for all other diagnoses.

Conclusion: These results demonstrate a significant increase in tobacco counseling by pediatric providers within the last decade, especially at well-child visits. However, the American Academy of Pediatrics' recommendation that pediatricians counsel about the harms of tobacco use and secondhand smoke exposure has not yet been exhaustively implemented.

Implications: A significant increase in smoking cessation counseling at pediatric medical appointments, especially at well-child visits, occurred from 2009-2011 compared with 1997-1999, paralleling a large decrease in smoking prevalence. These improvements in counseling rates have been predominantly noted for pediatricians but not mid-level providers or general practitioners. Counseling was not associated with increased visit lengths. Although improved counseling practices by pediatricians have been demonstrated, there is still room for improvement.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Counseling / methods
  • Counseling / statistics & numerical data*
  • Female
  • Health Care Surveys
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Office Visits
  • Pediatrics*
  • Practice Patterns, Physicians'*
  • Prevalence
  • Program Evaluation
  • Smoking / epidemiology*
  • Smoking / trends
  • Smoking Cessation / methods
  • Smoking Cessation / statistics & numerical data*
  • Smoking Prevention
  • Tobacco Use Disorder / epidemiology
  • Tobacco Use Disorder / prevention & control
  • United States / epidemiology