Counseling smoking parents of young children - Comparison of pediatriciansand family physicians

Background: Secondhand smoke is a major cause of morbidity in young childre n, and exposure to smoking parents is the principal source. Physician visit s for young children present an opportunity to effect behavioral change amo ng smoking parents. Objective: To survey pediatricians and family physicians in their knowledge and practice of smoking cessation counseling with parents. Design: Cross-sectional mail survey. Setting: Urban California. Participants: Pediatricians and family physicians in urban areas of Califor nia, younger than 65 years, practicing in an ambulatory setting, and random ly selected from the American Medical Association Physician Masterfile. Main Outcome Measures: Reported frequency of asking about tobacco use, usin g cessation counseling techniques with smokers, and perceived barriers to p roviding cessation services. Results: Of the 1000 mailed surveys, 899 were eligible and 499 (56% respons e rate) were returned and completed. A higher proportion of pediatricians c ompared with family physicians were women (44% vs 29%; P<.01) and nonwhite (44% vs 32%, P=.01). Family physicians compared with pediatricians were mor e likely to report referring a parent to a smoking cessation program (41% v s 30%), giving pamphlets on smoking cessation (40% vs 28%), asking for a qu it date (41% vs 18%), scheduling a follow-up visit to discuss quitting (27% vs 5%), and recommending nicotine replacement therapy (41% vs 13%) (for ea ch comparison, P<.001). Pediatricians were more likely to report recording in the medical record smoking by a parent as a problem for the child (65% v s 48%; P<.001), but a higher proportion of pediatricians perceived that par ents would ignore the advice (39% vs 24%; P<.001) and lacked interest in qu itting smoking (45% vs 27%; P<.001). Pediatricians were more likely to agre e that they lacked smoking cessation counseling skills (26% vs 7%; P<.001). Multivariate models showed that pediatricians were less likely to report p erforming 5 of 14 smoking cessation techniques in at least. 50% of smoking parents. Conclusions: Pediatricians appear to lack training to implement smoking ces sation counseling with smoking parents. Physicians in private practice are less likely to counsel smoking parents. Educational interventions for pedia tricians are needed to decrease secondhand smoke exposure for young childre n.