Ask, advise, assist: Pediatricians and passive smoke exposure

The objectives of this study were to determine: (1) how frequently pediatri cians obtain a history of passive smoke exposure (PSE), (2) what type of ad vice regarding PSE they offer and how frequently they offer it, and (3) wha t methods and what assistance the). believe would be useful to reduce PSE, A random sample of 1,000 US members (GEN) of the American Academy of Pediat rics (AAP) and all 724 members of the AAP sections of pulmonology, otolaryn gology, and allergy (SPECS) were sent a questionnaire. Seven hundred fifty- five usable questionnaires were returned. Ninety-six percent of,321 general pediatricians obtained a PSE history at least "sometimes" but were much mo re likely to "always" do so when seeing a patient with asthma (87%) or recu rrent otilis media (56%) than during well-child visits (41%) (p<0.0001). Ni nety-eight percent of pulmonologists and 95% of allergists "always" obtaine d a PSE. history from parents of their asthmatic patients as compared with generalists who reported doing so 87% of the time (p=0.0004). Fifteen perce nt of GEN gave specific assistance to parents with smoking cessation such a s referral to an internist or family practitioner or a community agency or initiating a smoking cessation program themselves, whereas 85% gave only no nspecific advice such as, "don't smoke around the child," or "quit smoking. " Reasons for not initialing a cessation program included lack: of skills ( 38%) or Lime (36%) or a belief that it was "not their responsibility" (13%) . Pediatricians indicated that brochures for parents that describe the haza rds of PSE and contain specific information regarding how to refer to commu nity smoking cessation programs would be of most use to them in helping par ents reduce PSE to their children. Pediatricians frequently ask about PSE a nd advise reducing it but seldom assist parents with specific advice regard ing effective methods to quit smoking.